Oakbridge Care Home Care Home Service 2032 Great Western Road Knightswood Glasgow G13 2HA Telephone: 0141 950 1793 Type of inspection: Unannounced Inspection completed on: 1 July 2016 Service provided by: Oakbridge Care Ltd Service provider number: SP2003002479 Care service number: CS2003010470
About the service This inspection focused on standards of care for people living with dementia. We are using a sample of 150 care home services to look in detail at the standards of care for people living with dementia and this service is one those selected as part of the sample. The areas looked at were informed by the Scottish Government's Promoting Excellence: A framework for health and social care staff working with people with dementia and their carers, and the associated dementia standards. It is our intention to publish a national report on some of these standards during 2017. We also looked at the progress made in relation to requirements and recommendations since the last inspection. The progress made is recorded under 'what the service has done to meet any requirements or recommendations we made our last inspection' and any which have not been met are recorded under each quality theme. Oakbridge Care Home is registered to provide nursing care and support for a maximum of 85 Older People, six of which may be people who are under 65 years old and have a physical disability. The service also provides intermediate care for up to 15 older people who have been discharged from hospital. Accommodation is provided over two floors with lift access between them. All bedrooms are single with en suite facilities. The home is a converted school situated in a residential area within Knightswood and has a car park area to the rear. The home aims "to serve you to the best of our ability, to give you the highest standard of care and to do everything we can to make your stay with us as pleasant and as comfortable as possible." What people told us We sent 40 questionnaires to the manager to distribute to residents and relatives. Eleven residents and three relatives returned completed questionnaires. They were all overall happy with the quality of care received. Comments were: 'all good' 'I feel I get cared for properly and always feel respected' 'no complaints'. An inspection volunteer, who is a person who has experience of using care services, spoke with seven residents and six relatives. Feedback was overall positive and any individual issues were highlighted with the manager to address. This has been reflected under each Quality Theme. We also used the Short Observation Framework for Inspection (SOFI 2) to directly observe the experience and outcomes for people who were unable to tell us their views. We saw staff enable one resident to join other residents sitting in the lounge just before morning tea was served. Staff showed warmth and genuine interest by wanting the resident to feel included with the other residents. Staff discussed with them privately about what they wanted to do while in the lounge. They were given a mixture of scarves to sort through and the contentment and enjoyment this gave was obvious. They took a short break to drink their tea and eat their favourite snack which was given to them by staff. page 2 of 18
Self assessment There had been a change of manager and the submission of the self-assessment had been omitted in error. From this inspection we graded this service as: Quality of care and support Quality of environment Quality of staffing Quality of management and leadership 2 - Weak Quality of care and support Findings from the inspection We found that the service had continued to provide an overall adequate level of care and support to residents. When we spoke with staff and observed staff with residents it was clear that they knew their residents well and treated them in a respectful and positive manner. However this was not always reflected in the documentation which staff completed to show how residents care needs had been met and in particular where some care, such as personal or oral care, was frequently refused by the resident. Regular contact and communication with health professionals such as the dentist, GP, community psychiatric nurse and liaison nurse was evident. Access to advocacy was also available if required. Where residents needed support to make decisions under the Adults with Incapacity legislation, we asked the manager to ensure that they had a register of who had the authority to make welfare and financial decisions on behalf of the resident and to reflect, in personal plans, how this authority was used. Those who required medication to be given covertly had the required documentation in place however more information about other strategies that were used before giving 'as required' medication and the evaluation of effects and outcomes was needed. We found that residents future or end of life wishes were not well recorded in personal plans and it was not always clear who had been involved in 'Do not Resuscitate' decisions or reviews. The manager was aware of anticipatory care planning and currently considering implementation. The inspector volunteer got positive feedback from residents and relatives: 'I am well looked after' 'I am happy in the Home' 'I have no complaints' 'Support is amazing' 'Well looked after in the home' 'Food is good' 'Can't grumble about the food, there's always an alternative' 'No complaints if I had I would speak to the manager' page 3 of 18
'The laundry is generally good' 'Laundry is good; I have clothes which are well marked'. Most people were satisfied with the activities on offer: 'activities are good, fantastic' 'would like to go out in the minibus if told about it' Requirements Number of requirements: 2 1. The provider must ensure that personal plans and related care documentation reflect all the residents care needs and how these are to be met. This is in order to comply with SSI 2011/210 Regulation 4.1(a) - Welfare of Users and Regulation 5 - Personal Plans. Timescale: to commence immediately and be completed within twelve weeks of receipt of this report. 2. The provider must ensure that the administration of medication follows best practice guidance. This is in order to comply with SSI 2011/210 Regulation 4.1(a) - Welfare of Users. Timescale: to commence immediately and be completed within twelve weeks of receipt of this report. Recommendations Number of recommendations: 3 1. The manager should ensure that all accidents and incidents are fully recorded and investigated. National Care Standards for Care Homes for Older People: Standard 9 - Feeling safe and secure. 2. The manager should review and improve the personal hygiene care records. National Care Standards for Care Homes for Older People: Standard 6 - Support Arrangements. 3. The manager should improve the inventory system of resident's personal belongings. National Care Standards for Care Homes for Older People: Standard 9 - Feeling safe and secure. Grade: 3 - adequate page 4 of 18
Quality of environment Findings from the inspection We found that the service continued to provide a good quality of environment for residents to live. Overall the home was found to be clean and free from malodours. There was evidence of ongoing refurbishment within the home, improving the environment for residents. Residents were seen to be using the various areas available to them, some in quieter areas, others where activities were taking place and others freely wandering between areas. Residents' bedroom doors were personalised with their name and pictures indicating the resident's particular interests. Some bedrooms doors without door closures were seen to be wedged open and not all sluice or cupboard doors were kept locked. We asked management to review these practices to ensure that residents were kept safe. We saw that hot water temperatures were checked monthly and all were recorded as being within the acceptable range. We used the King's Fund environmental audit tool to assess how dementia friendly the home' environment was. We found that: - residents were supported to maintain links with their community through a variety of people visiting the home as well as one to one and group outings using their minibus or taxis - the garden area was well maintained and there was seating in sheltered and unsheltered areas for residents to enjoy spending time outdoors although independent access for resident safety and staff availability at particular times could limit this access. Additional areas of interest which could be provided in the garden were discussed with management - although there was a variety of communal areas for residents to use, the chairs were not always arranged in small clusters to encourage interaction and activity resources were not readily available for use anytime - the use of better signage, contrasting colours, clocks and calendars could further improve residents orientation and independence - seating areas at the end of corridors and continuous handrails, across doorways, could encourage residents to walk more regularly and safely. The inspector volunteer found the outdoor area was liked by residents and people were happy with the décor within the home: 'I like my room and the outdoor area' 'my room is always kept clean' 'I like the garden' 'I have a lovely big room'. Requirements Number of requirements: 0 page 5 of 18
Recommendations Number of recommendations: 0 Grade: 4 - good Quality of staffing Findings from the inspection We found that the service provided an adequate level of support and training opportunities for staff in order to provide the required level of care and support to residents. From the training records viewed, we highlighted that some staff training could be improved. Staff spoken with felt that they had the training they needed to do their job although acknowledged that further training in topics such as continence, dementia and stressed behaviour would be beneficial. Though some staff had completed on-line dementia training, no progress had been made with dementia training which related to the Promoting Excellence Framework. The development of staff skills would have a positive impact on the resident's quality of experience. The manager was aware of this training and we were told that this was planned. Activity staff had received some additional activity training and the use of doll therapy, sensory books, rosary beads and the development of music playlists for the younger residents was evident. However this could be further enhanced with the use of Namaste, Sonas or playlists for life for people with living with dementia. From the supervision records viewed most staff had received recent supervision and staff spoken with were positive about the support they received. However it was evident that not all staff received regular supervision. We saw that some staff meetings had taken place but these had not been regular or include all staff groups. All of the staff we observed were seen to be attentive to the needs of residents and carried out care in a caring and sensitive manner. Residents were particularly complimentary about the activity staff and it was clear that they played a key role in the life of the home. The majority of the residents we spoke with said staff were very good. Requirements Number of requirements: 1 1. The provider must ensure that all care staff are appropriately registered with the Scottish Social Services Council (SSSC) and keep a register to show the date of application, registration, expiry, annual renewal and the position applied for. Management must submit a complete staff register showing that all care staff working in the home is registered or in the process of registering. page 6 of 18
This is in order to comply with SSI 2011/210 Regulation 9 - Fitness of employees. Timescale: within two weeks of receipt of this report. Recommendations Number of recommendations: 2 1. The manager should ensure that all staff receive relevant training and support. National Care Standards for Care Homes for Older People: Standard 5 - Management and Arrangements. 2. The manager should ensure that staff receive relevant support through supervisions and the opportunity to meet to be involved in discussions with other staff regularly as well as being able to develop further in their role within the home. National Care Standards for Care Homes for Older People: Standard 5 - Management and Arrangements. Grade: 3 - adequate Quality of management and leadership Findings from the inspection We found that the systems and processes used by the service provided an adequate level of quality assurance. Since the last inspection, the service had carried out meetings, questionnaires and audits which had involved residents, relatives and staff. We could see that some action plans had been developed but improved outcomes for residents were not always evident as a result. Some staff we spoke with were aware of the aims and objectives of service and most felt empowered and/or encouraged to make decisions. Senior care staff were completing an in-house leadership course as well as undertaking a management qualification at SVQ level 4. We discussed other available leadership training such as 'Step into Leadership' provided by the SSSC. The Clinical Lead and Care and Support Lead roles had been developed since the last inspection. Staff in these posts and in other senior posts were given supernumerary time to monitor quality assurance. The register of care staff who had submitted applications to register with the Scottish Social Services Council (SSSC) was not complete. We were therefore not able to see if all of the care staff working in the service were registered or had applied for registration. Subsequently we were informed by management that they had found that not all of the care staff working in the service were registered with the SSSC. A plan was being put in place to ensure that all care staff were appropriately registered. page 7 of 18
Although key workers had been identified for each resident, residents and relatives needed to know who they were and the role could be further developed by promoting better communication and building on relationships with residents and relatives. Individual staff could be identified as a 'link person' or 'champion' for specific areas of practice which would lead to consistency, improvements in care and an enhanced experience for residents. We were told that it had been difficult to maintain the key worker system and progress with link people/ champions due to the changes in the staff group. The manager and provider continued to show commitment in working with external regulators and health professionals to develop the service and improve resident care. They were keen to hear the findings of the inspection and action the areas highlighted. The inspector volunteer found the noticeboards had a lot of information such as minutes of residents meetings and the newsletter giving information about what was happening in the home. A regular attendee at the meetings said that management take heed of what is said. Staff seemed to know the residents well and treated them with respect: 'staff are nice, I am always well treated' 'staff are very good, most of the time there's enough' 'some staff do not like being bothered'. Requirements Number of requirements: 0 Recommendations Number of recommendations: 1 1. The manager needed to continue to demonstrate that quality assurance processes were being followed and progress was being made, where areas for improvement were highlighted. National Care Standards for Care Homes for Older People: Standard 5 - Management and Arrangements. Grade: 2 - weak page 8 of 18
What the service has done to meet any requirements we made at or since the last inspection Previous requirements Requirement 1 The provider must ensure that personal plans and related care documentation reflect all the residents care needs and how these are to be met. This is in order to comply with SSI 2011/210 Regulation 4.1(a) - Welfare of Users and Regulation 5 - Personal Plans. Timescale: within four weeks of receipt of this report. This requirement was made on 18 December 2015. Action taken on previous requirement Similar issues, as reported at the last inspection, were found in relation to the lack of information recorded in support plans and risk assessments which should clearly and accurately reflect how residents were supported with their identified care needs. Staff group folders showed some improvement in the completion of relevant charts which monitored residents' behaviour, fluid or food intake however these records were not always completed as they should be therefore it was not always clear if residents' needs were being met (see Requirement 1 - Care and Support). Not met Requirement 2 The provider must ensure that the administration of medication follows best practice guidance. This is in order to comply with SSI 2011/210 Regulation 4.1(a) - Welfare of Users. This requirement was made on 18 December 2015. page 9 of 18
Action taken on previous requirement From the medication records and audits viewed, we found that a running total of the amount of 'as required' medication was not being kept. The total amount of 'as required' medication should be carried forward so that staff are aware of the amount of available medication and that the required medication is always available to administer to residents. We saw that 'as required' medication support records were not always being completed with instructions for use, frequency and maximum dose information. The recording of the administration of topical medication ie creams and ointments continued to need improved. Several of the records viewed did not show that the medication had been applied to residents as prescribed. We saw that the daily medication checks were not always completed as required and although the weekly and monthly checks had action plans it was not always clear that the areas highlighted were being actioned effectively as similar issues were recurring (see Requirement 2 - Care and Support). Not met Requirement 3 The provider must ensure that all required agencies are notified when a serious incident / assault takes place. This includes: Immediate referral to Police Scotland An adult protection referral to the responsible local authority A detailed notification to the Care Inspectorate within 24 hours The family/next of kin of the service users involved must be informed within 24 hours Complaint responses must be in keeping with the provider's complaints procedure. This is in order to comply with SSI 2002/114 Regulations 21-24 and section 53(6) of the Public Services Reform (Scotland) Act 2010. This requirement was made on 1 February 2016. Action taken on previous requirement We were satisfied that relevant notifications had been submitted in relation to accidents and incidents. We discussed with the manager about the opportunity for staff to discuss and learn from the findings of any serious accident, incident or complaint. Met - within timescales page 10 of 18
What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 The manager should ensure that all accidents and incidents are fully recorded and investigated. National Care Standards for Care Homes for Older People: Standard 9 - Feeling safe and secure. This recommendation was made on 25 February 2016. From accidents records and personal plans viewed, we were not always able to see what measures had been put in place to minimise recurrence, where accidents or incidents had occurred. This Recommendation has not been met (see Recommendation 1 - Care and Support). Recommendation 2 The manager should review and improve the personal hygiene care records. National Care Standards for Care Homes for Older People: Standard 6 - Support Arrangements. This recommendation was made on 18 December 2015. We looked at a sample of personal and oral hygiene records and found that these records were not always completed as they should be therefore it was not always clear if residents' needs were being met. This Recommendation has not been met (see Recommendation 2 - Care and Support). Recommendation 3 The manager should improve the inventory system of resident's personal belongings. National Care Standards for Care Homes for Older People: Standard 9 - Feeling safe and secure. This recommendation was made on 18 December 2015. We looked at a sample of resident inventories in personal plans from the intermediate care unit and main home. We found that these records were not always completed as they should be. In the intermediate care unit an inventory was completed on admission to the unit however not always updated when additional clothing was brought in. No inventories were seen in the personal plans viewed in the main home. It was therefore not evident that the home had an accurate record of residents clothing and belongings. This Recommendation has not been met (see Recommendation 3 - Care and Support). page 11 of 18
Recommendation 4 The manager should ensure there is an inventory available for all personal possessions which are brought into the care home and returned following discharge. National Care Standards for Care Homes for Older People: Standard 16 - Private Life. This recommendation was made on 25 February 2016. As per recommendation 3. This Recommendation has not been met. Recommendation 5 The service should review the practices in the management and storage of resident's laundry in the service. This to reduce the chances of residents clothes becoming mixed up and going missing. National Care Standards for Care Homes for Older People: Standard 16 - Private life. This recommendation was made on 18 December 2015. Feedback from residents and relatives reflected that there had been no concerns about the care of their laundry since the last inspection. This Recommendation has been met. Recommendation 6 The manager should ensure positive dining experiences for all residents. National Care Standards for Care Homes for Older People: Standard 13 - Eating well. This recommendation was made on 18 December 2015. Overall we found that the experiences for residents had improved since the last inspection and that there was good support and interactions with staff. Menu questionnaires completed with residents in April 2016 showed positive responses to the dining experience, access to menu, the variety and quality of food. Mealtime audits were overall positive but also reflected some areas for improvement and these needed to be actioned effectively. Better use of 'mealtime monitoring books' in each unit could help to improve this further. This Recommendation has been met. Recommendation 7 The manager should ensure staff meet the continence needs of service users and follow best practice guidance regarding catheter care. National Care Standards for Care Homes for Older People: Standard 6 - Support arrangements. page 12 of 18
This recommendation was made on 25 February 2016. From speaking with staff, observing them with residents staff and checking records, we found that staff supported residents to meet their continence needs. This Recommendation has been met. Recommendation 8 The manager should ensure service users have access to an alarm system to summons the assistance of staff. National Care Standards for Care Homes for Older People: Standard 6 - Support arrangements. This recommendation was made on 25 February 2016. From feedback from residents and observation of bedrooms and communal areas, we were satisfied that residents had access to an alarm system which staff responded to. This Recommendation has been met. Recommendation 9 The manager should ensure all equipment to carry out personal care is readily available at the point of use for staff. Procedures to restock supplies within bedrooms and sluice areas should be reviewed and improved upon. National Care Standards for Care Homes for Older People: Standard 4 - Your environment. This recommendation was made on 3 February 2016. From feedback from staff and observation of bedrooms and sluice areas, we were satisfied that staff had access to appropriate supplies. This Recommendation has been met. Recommendation 10 The manager should ensure staff use appropriate cleaning materials when carrying out personal care tasks. National Care Standards for Care Homes for Older People: Standard 16 - Private Life. This recommendation was made on 3 February 2016. From feedback from staff and observation of supplies available, we were satisfied that staff had access to appropriate supplies. This Recommendation has been met. page 13 of 18
Recommendation 11 The manager needed to keep clearer registration records for all care staff including the date of application, registration and the position applied for. National Care Standards for Care Homes for Older People: Standard 5 - Management and Arrangements. This recommendation was made on 18 December 2015. The staff register showed 21 care staff with no SSSC registration number. The majority of these staff had been employed since February 2016 and should be in the process of submitting their application for registration. Management must submit a complete staff register showing that all care staff working in the home is registered or in the process of registering. A Requirement has been made in relation to this issue (see Requirement 1 - ). Recommendation 12 The manager should ensure that all staff receive relevant training and support. National Care Standards for Care Homes for Older People: Standard 5 - Management and Arrangements. This recommendation was made on 18 December 2015. From the training records viewed, we saw that some training had been completed by the majority of staff however the completion of other training could still be improved. Staff spoken with acknowledged that further training in some topics was needed such as continence, dementia, stress and distress although they overall felt that they had the training they needed to do their job. Since the last inspection, there had been no progress made with dementia training which related to the Promoting Excellence Framework. This Recommendation has not been met (see Recommendation 1 - ). Recommendation 13 The manager should ensure that staff receive relevant support through supervisions and the opportunity to meet to be involved in discussions with other staff regularly as well as being able to develop further in their role within the home. National Care Standards for Care Homes for Older People: Standard 5 - Management and Arrangements. This recommendation was made on 18 December 2015. We saw that there had been some progress made with staff supervision with reviews of work performance and training needs evident. However the completion of supervisions for all staff and the frequency of staff meetings could be improved further. This Recommendation has not been met (see Recommendation 2 - ). page 14 of 18
Recommendation 14 The manager needed to continue to demonstrate that quality assurance processes were being followed and progress was being made, where areas for improvement were highlighted. National Care Standards for Care Homes for Older People: Standard 5 - Management and Arrangements. This recommendation was made on 18 December 2015. We saw that audits had continued to be carried out to monitor staff practice and residents care since the last inspection however it was not always clear that the areas highlighted were being actioned effectively and that outcomes for residents were improving as a result. Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at www.careinspectorate.com. Enforcement No enforcement action has been taken against this care service since the last inspection. Inspection and grading history Date Type Gradings 18 Dec 2015 Unannounced Care and support Not assessed Not assessed Not assessed Management and leadership Not assessed 28 May 2015 Unannounced Care and support Management and leadership 19 Dec 2014 Unannounced Care and support page 15 of 18
Date Type Gradings Management and leadership 2 - Weak 20 Jun 2014 Unannounced Care and support Management and leadership 29 Jan 2014 Unannounced Care and support Management and leadership 27 Jun 2013 Unannounced Care and support Management and leadership 24 Dec 2012 Unannounced Care and support 5 - Very good Not assessed Management and leadership 10 Sep 2012 Unannounced Care and support 5 - Very good Not assessed Management and leadership Not assessed 21 Mar 2012 Unannounced Care and support Management and leadership Not assessed 12 Oct 2011 Unannounced Care and support 2 - Weak Management and leadership Not assessed 18 May 2011 Unannounced Care and support page 16 of 18
Date Type Gradings Management and leadership 25 Nov 2010 Unannounced Care and support Management and leadership 13 Jul 2010 Announced Care and support 2 - Weak Management and leadership 15 Jan 2010 Announced Care and support 2 - Weak 2 - Weak 2 - Weak Management and leadership 2 - Weak 14 Sep 2009 Unannounced Care and support 2 - Weak 2 - Weak Management and leadership 2 - Weak 23 Mar 2009 Unannounced Care and support 2 - Weak 2 - Weak 2 - Weak Management and leadership 2 - Weak 22 Sep 2008 Care and support 2 - Weak Management and leadership page 17 of 18
To find out more This inspection report is published by the Care Inspectorate. You can download this report and others from our website. Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and help services to improve. We also investigate complaints about care services and can take action when things aren't good enough. Please get in touch with us if you would like more information or have any concerns about a care service. You can also read more about our work online at www.careinspectorate.com Contact us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com 0345 600 9527 Find us on Facebook Twitter: @careinspect Other languages and formats This report is available in other languages and formats on request. Tha am foillseachadh seo ri fhaighinn ann an cruthannan is cànain eile ma nithear iarrtas. page 18 of 18