Bield Housing Association [Boness] Care Home Service Adults Woodlands Kinneil Drive Bo'ness EH51 0LL Telephone:

Transcription

1 Bield Housing Association [Boness] Care Home Service Adults Woodlands Kinneil Drive Bo'ness EH51 0LL Telephone: Inspected by: Angella Fulton Type of inspection: Unannounced Inspection completed on: 17 January 2014

2 Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 15 4 Other information 31 5 Summary of grades 32 6 Inspection and grading history 32 Service provided by: Bield Housing & Care Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: Angella Fulton Telephone enquiries@careinspectorate.com Bield Housing Association [Boness], page 2 of 34

3 Summary This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change after this inspection following other regulatory activity. For example, if we have to take enforcement action to make the service improve, or if we investigate and agree with a complaint someone makes about the service. We gave the service these grades Quality of Care and Support 4 Good Quality of Environment 4 Good Quality of Staffing 4 Good Quality of Management and Leadership 4 Good What the service does well People using the service and their families have good opportunities and help to be involved. The environment is clean, safe and comfortable and provides a homely atmosphere for people who live at Woodlands care home. The manager and staff are motivated and work hard to provide a service that results in quality outcomes for people using the service. What the service could do better Through the development of staff, the provider could improve how service users' healthcare needs are identified and met. The management team should ensure that all the systems they have in place for quality assurance are further developed to ensure positive outcomes for service users. What the service has done since the last inspection Since the last inspection there have been improvements made in how service users are helped to enjoy their food. Bield Housing Association [Boness], page 3 of 34

4 Some staff in the home have received training in skin care, Parkinson's, oral health and continence. All service users have either had a review meeting or have a meeting planned. Conclusion Positive action had been taken to meet the requirement and some recommendations made at the last inspection of the service. The provider, management and staff are motivated to continually improve the service. The service had important strengths which had a positive impact for people using the service and their families. Who did this inspection Angella Fulton Bield Housing Association [Boness], page 4 of 34

5 1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at The service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April Requirements and recommendations: If we are concerned about some aspect of a service, or think it could do more to improve, we may make a recommendation or requirement. -A recommendation is a statement that sets out actions the care service provider should take to improve or develop the quality of the service but where failure to do so will not directly result in enforcement. Recommendations are based on the National Care standards, relevant codes of practice and recognised good practice. -A requirement is a statement, which sets out what is required of a care service to comply with the Public Services Reform (Scotland) Act 2010 and Regulations or Orders made under the Act or conditions of registration. Where there are breaches of Regulations, Orders or conditions, a requirement must be made. Requirements are legally enforceable at the discretion of the Care Inspectorate. Woodlands Care house is located in Bo'ness in a residential area. The home has some parking and there is nearby access to a main bus route. The home is a purpose built single storey building which is owned and provided by Bield Housing Association. The property has surrounding gardens. The home is registered to provide a care service to a maximum of 11 older people. The home has 11 single occupancy rooms which are referred to as flats. These contain en-suite facilities and all are linked to the alarm call-system. Additional facilities include a communal lounge, conservatory and dining room. Bield Housing Association [Boness], page 5 of 34

6 The philosophy of the service is "to provide personal care and daily living support in a well-designed domestic type environment. Service users are encouraged to maintain ordinary daily living skills with support available as required or requested". Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 4 - Good Quality of Environment - Grade 4 - Good Quality of Staffing - Grade 4 - Good Quality of Management and Leadership - Grade 4 - Good This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change following other regulatory activity. You can find the most up-to-date grades for this service by visiting our website or by calling us on or visiting one of our offices. Bield Housing Association [Boness], page 6 of 34

7 2 How we inspected this service The level of inspection we carried out In this service we carried out a low intensity inspection. We carry out these inspections when we are satisfied that services are working hard to provide consistently high standards of care. What we did during the inspection We wrote this report following an unannounced inspection. This was carried out by Inspector Angella Fulton The inspection visit took place on Tuesday 7 January 2014 from 1pm to 5.45pm and on 13 January 2014 we carried out a telephone survey of relatives of people living at the service. We gave feedback to the manager on 17 January As part of the inspection, we took account of the completed annual return and self assessment forms that we asked the provider to complete and submit to us. During the inspection process, we gathered evidence from various sources, including the following: We spoke with: 6 Residents 4 Relatives The manager 6 members of staff We looked at the following documents: Certificate of registration Insurance certificate Care plans of 5 residents Staff rotas Staff training records Records of staff recruitment Accident and incident records Repair and maintenance log Medication systems Minutes of meetings Bield Housing Association [Boness], page 7 of 34

8 Feedback from people using the service and their families Quality assurance records We also looked at the environment and equipment for cleanliness, safety and dementia friendly features. Grading the service against quality themes and statements We inspect and grade elements of care that we call 'quality themes'. For example, one of the quality themes we might look at is 'Quality of care and support'. Under each quality theme are 'quality statements' which describe what a service should be doing well for that theme. We grade how the service performs against the quality themes and statements. Details of what we found are in Section 3: The inspection Inspection Focus Areas (IFAs) In any year we may decide on specific aspects of care to focus on during our inspections. These are extra checks we make on top of all the normal ones we make during inspection. We do this to gather information about the quality of these aspects of care on a national basis. Where we have examined an inspection focus area we will clearly identify it under the relevant quality statement. Fire safety issues We do not regulate fire safety. Local fire and rescue services are responsible for checking services. However, where significant fire safety issues become apparent, we will alert the relevant fire and rescue services so they may consider what action to take. You can find out more about care services' responsibilities for fire safety at Bield Housing Association [Boness], page 8 of 34

9 What the service has done to meet any requirements we made at our last inspection The requirement Requirement with reference to Theme 1, Statement 3: The provider must improve the methods in place to ensure that residents are helped to have adequate levels of nutrition and hydration. In order to demonstrate this the provider must take the following actions: Ensure that there are sufficient numbers of staff present at mealtimes and that their practice supports residents to receive and enjoy their food in comfort. Ensure that all staff assessing the nutritional needs of service users, planning for their nutritional care and implementing planned care have received specific training to meet those needs Training given to staff to meet the above requirement is sufficient to ensure that staff have a demonstrable understanding of the appropriate management of the nutritional and fluid requirements of service users, including therapeutic diets. Ensure that the actions and strategies set out in each service user's personal plan for eating and drinking are implemented by staff and submit written evidence to the Care Inspectorate of how this has been achieved. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 SSI 2011/210 Regulation 4(1) (a) - Welfare of users. Timescales: We made a verbal requirement for the provider to take action on the day of the inspection. Written evidence of these improvements should be sent to the Care Inspectorate within 4 weeks from receipt of this report. What the service did to meet the requirement Please refer to Quality Theme 1, Statement 3 for progress on this requirement. The requirement is: Met - Within Timescales What the service has done to meet any recommendations we made at our last inspection Ten recommendations were made at the last inspection of the service. During this inspection we followed up progress on these recommendations and have reported on this under the relevant quality statement. Bield Housing Association [Boness], page 9 of 34

10 1. Recommendation with reference to Theme 1, Statement 1:It is recommended that the service ensures tenants' reviews of their care and support is done with full involvement of tenants and where appropriate their representative. National Care Standards 8 Care Homes for Older People - Making Choices You can make choices in all aspects of your life.1 You achieve the aims set out in your personal plan helped by the support and care of skilled staff. Please refer to Quality Theme 1, Statement 1 for progress on this recommendation. 2. Recommendation with reference to Theme 1, Statement 3:It is recommended that the service provides a range of social events, outings, activities and entertainment and help for tenants to take part in these if they choose to do so. The service could involve tenants and their relatives in developing the programme of activities. Tenant's participation should be recorded within their personal plans. National Care standards 17 Care homes for Older people- Daily life You make choices and decisions about dayto-day aspects of your life and about how to spend your time. 3. Recommendation with reference to Theme 1, Statement 3:It is recommended that the service monitors the system being used to assess staffing levels and deployment of staff. The four weekly assessments being carried out should include resident's physical, social, psychological and recreational choices and take into account the physical layout of the building, staff training and staff supervision needs. This is to ensure that staff levels and skills mix are appropriate to meet the needs of residents. National care standards 5 Care homes for older people- management and staffing arrangements 7 You are confident that at all times the number of staff who are trained and who have the necessary skills will be sufficient to meet your support and care needs. The levels are agreed between the Commission's Inspectors and the home owner or manager. 4. Recommendation with reference to Theme 1, Statement 3:It is recommended that steps are taken to increase staff understanding of service users' health conditions. Actions should be taken to ensure that care plans are in place to provide staff with information on common symptoms and how these should be managed. National Care Standards 14 Care Homes for Older People - Lifestyle - Keeping Well - Healthcare You are confident that the staff know your healthcare needs and arrange to meet them in a way that suits you best. 3 During your first week in the home, and at least every six months after that, you will receive a full assessment to find out all your healthcare needs, and the staff will ensure that these needs are met. Staff will record all assessments and reviews of your healthcare needs. Bield Housing Association [Boness], page 10 of 34

11 8 You can expect staff to be aware of issues around the assessment and management of any symptoms you may have, including pain, and how to access any specialist services. 10 You will receive information about preventive healthcare (for example, screening, immunisation and regular check-ups). If you want to take part in any of these, staff will help you to do so. 5. Recommendation with reference to Theme 1, Statement 3:It is recommended that the service should ensure assessments, care plans and recording procedures are in place to evidence that service user's oral care is being attended to. National Care Standards 5 Care Homes for Older People - Management and Staffing Arrangements You experience good quality support and care. This is provided by management and staff whose professional training and expertise allows them to meet your needs. The service operates in line with all necessary legal requirements and best-practice guidelines. 4 You are confident that all the staff use methods that reflect up-to-date knowledge and best-practice guidance, and that the management are continuously striving to improve practice. 6. Recommendation with reference to Theme 1, Statement 3: It is recommended that staff in the service have training to understand and be able to use a skin assessment tool to identify tenants who are at risk of skin breakdown. Tenants who are identified as being at risk should have a care plan in place to guide staff on pro-active and preventative measures to skin care. National Care Standards 14 Care Homes for Older people - Keeping Well - HealthcareYou are confident that the staff know your healthcare needs and arrange to meet them in a way that suits you best. 8 You can expect staff to be aware of issues around the assessment and management of any symptoms you may have, including pain, and how to access any specialist services Please refer to Quality Theme 1, Statement 3 for progress on these recommendations. 7. Recommendation with reference to Theme 2, Statement 2:It is recommended that the service reviews and improves the systems in place to prevent and control infection. Preventing Infection in Care learning training could be used to inform this review and staff training to ensure that practice is in line with current regulations and good practice guidance. National Care Standards 4 Care homes for older people - environment will enhance your quality of life and be a pleasant place to live. 2 You can expect that the home is run in a way that protects you from any avoidable risk or harm, including physical harm and infection. The nature of its design, facilities and equipment also protect you Please refer to Quality Theme 2, Statement 2 for progress on this recommendations. Bield Housing Association [Boness], page 11 of 34

12 8. Recommendation with reference to Theme 3, Statement 2:It is recommended that the manager improves the processes for developing staff. The manager could ensure that the systems for observation of practice, assessing staff competencies, supervision and appraisal are applied according to the provider's policy. This could help to ensure that staff have the knowledge, understanding, skills and behaviours to provide positive outcomes for tenants. National Care Standards 5 Care Homes for older people - management and staffing arrangements 4 You are confident that all the staff use methods that reflect up-to-date knowledge and best practice guidance, and that the management are continuously striving to improve practice. 9 You know that the service has a staff development strategy and an effective yearly training plan for all its staff. Please refer to Quality Theme 3, Statement 2 for progress on this recommendations. 9. Recommendation with reference to Theme 3, Statement 3:It is recommended that the manager's time is identified and staff rotas reflect the manager's supernumerary time. This is to ensure that the home is operating according to their conditions of registration and that the manager has adequate time to develop and improve the service. National Care Standards 5 Care homes for older people - management and staffing arrangements. 7 You are confident that at all times the number of staff who are trained and who have the necessary skills will be sufficient to meet your care and support needs. The levels are agreed between the Commissions inspectors and the home owner or manager. Please refer to Quality Theme 3, Statement 3 for progress on this recommendation. 10. Recommendation with reference to Theme 4, Statement 4:The provider could improve the quality assurance processes to ensure that discrepancies are identified and positive actions are taken for improvements. It is recommended that regular checks and monitoring are carried out in the following areas:nutrition care plans, environmental checks, tenants' health care needs and how these are being assessed and met National Care standards 5 Care homes for older people - management and staffing arrangements 2 You are confident that all the staff use methods that reflect up-to-date knowledge and best practice guidance, and that the management are continuously striving to improve practice. Please refer to Quality Theme 4, Statement 4 for progress on this recommendations. Bield Housing Association [Boness], page 12 of 34

13 The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: Yes - Electronic Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. The Care Inspectorate received a self-assessment document from the provider. We were satisfied with the way the provider completed this and with the relevant information included for each heading that we grade services under. The provider identified what it thought the service did well, some areas for development and any changes it had planned. The provider told us how the people who use the care service had taken part in the self-assessment process. Taking the views of people using the care service into account We spoke with 6 residents during the inspection. All residents we spoke with made positive comments about the service they received and all were complimentary about staff. Below are some of the comments we received: I really can't fault the place. It's good. You can come and go as you please. Staff are excellent. I'm really content here. Quite happy here. It's fine. Bield Housing Association [Boness], page 13 of 34

14 Taking carers' views into account We spoke with 4 relatives of people using the service during the inspection. These discussions were conducted by telephone. Below are some of the comments we received: Brilliant. No problems. They are very good to my family member. He likes his room and can get out and about when he likes. Can ask the staff anything and I can talk to them. Happy and content. Quite happy with the food. Seems to be quite happy and the staff are always nice. I'm not sure about what training staff have had. There is sometimes a lack of understanding of the condition. I don't know about the activities. No review meetings in the home but we do have an annual one with social work. I would feel ok about speaking to some of the staff. The food always looks ok. There is a member of staff who is always offering snacks. The manager is really good, very helpful. Quite happy with all the staff. My family member is very happy there. Fell in love with the place right away. So welcoming, nice and pleasant. No complaints. Lovely place. The staff are so nice and the manager is made of gold. My family member goes out and about, to the garden centre and into the garden. This is his own home. It's like a lovely wee private cottage. The manager sits and speaks to my dad and asks for his opinion. They do look after him. If he needs help; just press the buzzer and staff would give him a cup of tea and have a blether if he can't sleep. They keep me up to date and staff gets healthcare if there are any concerns. It's lovely and clean and dad has a lovely room. Excellent; can't fault it at all. All round I'm really pleased and we can work around any problems. Well cared for there. The manager keeps in touch and they get the GP or nurse if any concerns. They do have a lot of activities going on like bingo and quizzes but my family member likes her own time as well. It's a good size flat and can accommodate equipment. Staff are very friendly and like a family; the "Woodlands" family. We are asked for our opinions on care. It's a well run home. I could speak with any staff they are all approachable. Bield Housing Association [Boness], page 14 of 34

15 3 The inspection We looked at how the service performs against the following quality themes and statements. Here are the details of what we found. Quality Theme 1: Quality of Care and Support Grade awarded for this theme: 4 - Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths At this inspection we found that the service was performing at a good level for this quality statement. Residents and their families were given opportunities to be involved in their care and support. During the inspection we spoke with residents and their relatives, management and staff and we looked at the following records: Staff training records Feedback received by the service Resident meeting minutes Consultation with residents and relatives Participation strategy We saw that the manager had carried out some work to obtain views and opinions and used feedback received to develop and improve the service. There were examples of how the service had listened to suggestions and ideas and taken these forward. This included asking for opinions on food, activities and preferences for care and support. Staff were attentive to service users' needs and offered choice at all opportunities. During our time in the service we saw that residents were asked for their opinion and staff took time to listen to residents. It was pleasing to see a high level of involvement from residents in the house meetings. The manager could develop action plans from these meetings which could help to track how the service has responded to residents' comments and suggestions. Bield Housing Association [Boness], page 15 of 34

16 As part of their ongoing development the service has been working towards a Customer Service Excellence award. We found that this has helped to ensure that the experience of people using the service was at the centre of all aspects of the service. Areas for improvement The service had a previous recommendation under this quality statement to ensure that residents were involved in reviews of their care and support. We saw that key workers were responsible for monthly evaluation meetings with residents however, in some instances there was limited evidence to show these had take place. We saw that whilst the service had made progress in ensuring residents had six monthly review meetings some of these were behind schedule. We have repeated the recommendation made at the last inspection and asked that the service considers the use of advocacy and communication tools to maximise residents level of involvement in the care and support. (See Recommendation 1 below). Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. Recommendation with reference to Theme 1, Statement 1: It is recommended that the service ensures tenants' reviews of their care and support is done with full involvement of tenants and where appropriate their representative. National Care Standards 8 Care Homes for Older People - Making Choices You can make choices in all aspects of your life.1 You achieve the aims set out in your personal plan helped by the support and care of skilled staff Bield Housing Association [Boness], page 16 of 34

17 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths We found that the service was providing at a good level for this quality statement. In order to assess this statement we spoke with residents, relatives and staff, observed practice and looked at care plans, staff training records and evidence of how the service was helping people to eat well and have good levels of hydration. The manager and staff had taken positive action to improve how people were helped to eat well, enjoy their food and have good levels of hydration. We saw that five staff had attended training in nutrition and hydration, protected mealtimes had been introduced and the manager had an overview of practice around helping people to eat and drink. We looked at care plans and saw that a nutritional assessment was being used to help identify residents who were at risk. Residents who were at risk were being provided with fortified diets and regular snacks. This helped to ensure that residents had extra calories and as a result residents were being helped to gain or maintain their weight. It was pleasing to see that staff had an increased awareness of residents' healthcare needs and conditions. In care files we saw evidence of healthcare professionals input and it was good to find that advice and guidance from healthcare professionals was recorded and being followed. This can help to ensure that residents' healthcare needs are identified and met. We saw that staff had received training in how to help residents with oral care and some residents had accessed dental services. This had resulted in improved assessment and care planning to help ensure residents' oral care needs were being met. Staff were using Caring for Smiles documentation and we advised that this is extended to ensure records are retained to demonstrate when oral hygiene is administered. Areas for improvement We observed a mealtime in the evening and found that the two care staff on duty were responsible for preparing and serving the meal (The cook was not on duty). At the time of this inspection there were nine residents in the home: eight chose to eat in the dining room and one person had their meal in their room. The meal time we observed was well organised and residents were provided with assistance when they required it however, we could not be confident that this would be the case if the home was fully occupied or if a resident required assistance away from the dining room. Bield Housing Association [Boness], page 17 of 34

18 The provider was in the process of reviewing shift times for catering and domestic staff to help address staffing levels in the evenings. We have made a recommendation for the service to ensure residents have assistance at meal times. (See Recommendation 1 below). Residents that we spoke with told us about the range of activities that they could choose to take part in. There was a high level of personal choice exercised by residents. Some people enjoyed spending time in their rooms, others liked to go out and about in the local community and the gardens of the home. We did not see a set programme of activities however, we saw staff spending time engaging with residents; having a chat and a sing-song. Residents seemed content with their choice of activities (as evidenced from our observations and from house meeting minutes) but we would expect a wider range of things to do and some exercise based activities on offer. The manager told us of plans to recruit staff for two hours per day which would be dedicated to offering activities and helping residents to take part. (See Recommendation 2 below). We followed up on a recommendation made about staffing levels at the last inspection. The manager was using two assessment tools to inform staffing levels and we saw that minimum levels of staffing, as stated by the Care Inspectorate, were being adhered to. Through their assessment the manager had identified that changes could be made to the deployment of staff to more effectively meet the needs of residents however, at the time of this inspection the changes had yet to take place. (See Recommendation 3 below). We looked at how the service helped residents to look after their skin. Some staff including the manager had received training, a skin assessment tool was being used and specialist equipment was in place for some residents however, the systems being used were not effective in identifying risks for all residents and did not always lead to care plans being in place. We have put a revised recommendation in place. (See Recommendation 4 below). Bield Housing Association [Boness], page 18 of 34

19 Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 4 Recommendations 1. Recommendation with reference to Theme 1, Statement 3: It is recommended that the manager reviews staffing rotas and continues to monitor meal times to ensure that there are sufficient staff available to help residents enjoy their food. National Care Standards. Care homes for Older people - Eating well. 2. Recommendation with reference to Theme 1, Statement 3: It is recommended that the service proceeds with their plans to extend the range of activities on offer. The service could involve residents and their relatives in developing the programme of activities. National Care standards 17 Care homes for older people - Daily life. 3. Recommendation with reference to Theme 1, Statement 3: It is recommended that actions are taken following assessment of residents' needs to ensure that staff levels and skill mix are appropriate to meet the needs of residents. National Care Standards 5 Care homes for older people - management and staffing arrangements. 4. Recommendation with reference to Theme 1, Statement 3: It is recommended that the service reviews and improves the systems in place to help ensure residents skin care needs are identified and met. The tool being used and staff understanding of this should be monitored to ensure that all residents who are at risk of skin breakdown are identified and appropriate care plans implemented. National Care standards 14 Care homes for older people - Keeping well - Healthcare. Bield Housing Association [Boness], page 19 of 34

20 Quality Theme 2: Quality of Environment Grade awarded for this theme: 4 - Good Statement 2 We make sure that the environment is safe and service users are protected. Service strengths At this inspection we found that the service was performing at a good level in how the environment was kept safe and residents protected. We spoke with residents, relatives and staff; observed the environment and practice and looked at the following records: Repairs and maintenance log Accident and incident records Notifications to the Care inspectorate Residents care plans Food safety records Falls prevention and management At the time of this inspection we found that the home was clean and well maintained. It was pleasing to see that the manager and staff had taken positive actions to improve infection prevention and control in the home. Staff were using the learning resource "Preventing Infection in Care" and a member of staff had taken on the lead role of Infection control champion. The manager had introduced good systems to help improve staff understanding of infection prevention and control and to ensure that measures were being followed. There was a monthly focus area where infection control was discussed at staff meetings and supervision and regular environmental audits where discrepancies were identified and addressed. Residents we spoke with told us they felt safe and could easily summon assistance from staff when they needed it. All residents had access to personal pendants and an intercom system in their room. During our time in the service we saw that staff responded promptly to requests for assistance. Bield Housing Association [Boness], page 20 of 34

21 Areas for improvement The manager had started using good practice guidance on falls prevention and management. This work was in the very early stages and should be taken forward. Actions taken could include the introduction of exercise based activities to help residents who wish to participate to improve stamina, strength, balance, coordination and overall mobility. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Bield Housing Association [Boness], page 21 of 34

22 Statement 3 The environment allows service users to have as positive a quality of life as possible. Service strengths At this inspection we found that the service was performing at a very good level for this quality statement. We spoke with residents, relatives and staff and observed the environment to assess this statement. The home was clean and tidy and free from unpleasant odours. All residents' rooms were personalised and very homely and contained personal belongings and furniture. The home was bright and spacious and residents told us they valued the homely atmosphere. Most bedrooms looked onto the gardens and residents told us they enjoyed sitting looking out from the windows, looking at the plants, watching the wild life and enjoying the views. We concluded that the home allowed service users to have a pleasant place to live and helped to enhance the quality of life for service users. Areas for improvement The provider should maintain and improve the environment with the involvement of residents and their families. Steps could be taken to enhance access to the gardens for all residents and some activities could include learning about and observing, the plants and animals that residents enjoy observing. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Bield Housing Association [Boness], page 22 of 34

23 Quality Theme 3: Quality of Staffing Grade awarded for this theme: 4 - Good Statement 2 We are confident that our staff have been recruited, and inducted, in a safe and robust manner to protect service users and staff. Service strengths At this inspection we found that the service was performing at a good level for this quality statement. We spoke with residents, relatives and staff and looked at records of staff induction and training to assess this quality statement. The provider had a recruitment policy and procedures in place which includes checks on staff prior to commencing employment. This can help to ensure that residents are protected. It was pleasing to see that residents had the opportunity to be involved in recruiting staff. At a house meeting the manager asked residents about what qualities they would like to see in the successful candidate for the domestic post. Residents had said it would be important for the person to be able to mix and talk and feel comfortable spending time talking. Most of the staff team had worked at Woodlands for a long time and knew residents well. The provider also has a small group of casual staff who work in the service to cover absences and holidays. This can help to ensure that there is consistency of staff and staff who know residents' needs and preferences for care. The provider has an induction programme for new staff which is completed over their first six months in post. This can help new staff to gain the relevant skills and knowledge to meet residents' needs. Areas for improvement It was pleasing to see that the provider had developed a People Performance framework. This set out staff competencies and learning objectives under the following headings: A focus on our customers. Communication. Flexibility and openness to change. Managing relationships with others. Bield Housing Association [Boness], page 23 of 34

24 Motivating and leading. Organisational awareness. Proactive and creative problem solving. Striving for Excellence. At the time of this inspection the service had not yet implemented this programme. We have made a recommendation for this to be implemented. (See Recommendation 1 below). Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. Recommendation with reference to Theme 3, Statement 2: It is recommended that the manager implements the provider's staff development framework. This could help to assess staff competencies and ensure that staff are helped to gain the skills and knowledge to meet residents' needs. National Care standards 5 Care homes for older people - Management and staffing arrangements. Bield Housing Association [Boness], page 24 of 34

25 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths At this inspection we found that the service was performing at a good level for this quality statement. We spoke with residents, relatives and staff and looked at the following records to assess this statement: training needs analysis, training records, staff rotas and supervision records. Staff we spoke with had knowledge of National Care standards and were committed to providing a good standard of care and positive outcomes for service users. Residents and their relatives were complimentary about staff. It was pleasing to see that staff had undergone training since the last inspection. The training that had taken place included nutrition, skin care, Parkinson's, oral care and continence care. The manager had completed a training needs analysis and from this had identified further training that staff could benefit from. We saw that further training was planned for Palliative care, dementia care and diabetes. This approach to developing staff can help to ensure that staff are trained and the home is operating to standards, legislation and good practice. At the last inspection of the service we made the following recommendation: It is recommended that the manager's time is identified and staff rotas reflect the manager's supernumerary time. This is to ensure that the home is operating according to their conditions of registration and the manager has adequate time to develop and improve the service. We saw evidence of supernumerary time being used to organise training, mentor staff and on service development activities although the supernumerary time was not always identified on the rota. The manager should ensure that records are retained to demonstrate deployment of staff. Areas for improvement Staff working in the home help residents to take their prescribed medication however, we did not find evidence of recent training or refresher training or competency assessment for staff who carried out this task. We have made a recommendation for the service to ensure all staff with the responsibility for medication management have initial and updated training and have their competencies assessed. This is to ensure that residents are helped to take their prescribed medication safely. (See Recommendation 1 below). Bield Housing Association [Boness], page 25 of 34

26 The service could develop care for residents who have dementia through using good practice guidance and learning resources. We spoke with the manager about National Dementia standards, the Promoting Excellence framework and signposted the service to the Dementia skilled learning resource. The manager told us how these resources have been used by the provider in other services and we found the manager to be motivated to use these to develop dementia care in Woodlands care home. We found that the system in use for staff appraisal and supervision was not implemented effectively. For example, records showed that staff appraisal had last been carried out in 2012 and some staff supervision was not taking place at a six to eight weekly interval (as per the service's procedure). As we have mentioned previously in this report the provider has launched a new framework for developing staff. This is closely linked to staff supervision, appraisal, training and overall development. We have made a recommendation previously in this report for the framework to be implemented as this could help to ensure that staff have the skills and knowledge to provide care that meets residents' needs. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. Recommendation with reference to Theme 3, Statement 3: It is recommended that staff who are involved in medication management have access to training and have their competencies assessed. This is to ensure that residents are helped to take their prescribed medication safely. National Care standards Care homes for older people - Medication. Bield Housing Association [Boness], page 26 of 34

27 Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 4 - Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the management and leadership of the service. Service strengths At this inspection we found that the service was performing at a good level for this quality statement. We spoke with residents, relatives, the manager and staff and looked at quality assurance records to assess this statement. We found that residents and relatives spoke regularly with the manager of the service and were able to approach the manager or senior staff if they had any concerns. Overall, people we spoke with felt confident that actions would be taken to address their concerns and any issues would be addressed. The service sought the views of residents and their relatives through meetings, surveys and informal discussion. We saw through records from meetings and surveys and from the service's newsletter that actions were taken on feedback received from residents and relatives. We saw that the manager had put a sign in place to show which staff were on duty on a particular day. This was well received by residents and their relatives and some said it made it easier to approach staff if they wished to speak with them about anything. The provider has a Quality assurance policy and this sets out ways in which service users and their families can be involved in improving the service. We found good evidence that demonstrated how this was put into practice. One example, was the involvement of residents in the home's self assessment. Areas for improvement Although the service holds house meetings and minutes of these showed a good level of participation from residents we found that these were not held frequently and action plans were not drawn up following these. In their self assessment the service told us that regular service user and care meetings are conducted by the management team however, we did not see evidence of relative meetings. The manager should consider ways in which resident and relative meetings could be improved to ensure people have opportunities to be part of the continuous development of the service. Bield Housing Association [Boness], page 27 of 34

28 The service should continue to develop ways of involving people in the management and leadership of the service to ensure that residents and relatives can influence the day-to-day running of the home and the wider development. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Bield Housing Association [Boness], page 28 of 34

29 Statement 4 We use quality assurance systems and processes which involve service users, carers, staff and stakeholders to assess the quality of service we provide. Service strengths At this inspection we found that the service was performing at a good level for this quality statement. We spoke with residents, relatives and staff and looked at the following records to assess this statement: kitchen audit, audit of mealtime experience, senior team meeting minutes, survey results from July 2013 and benchmarking exercise. The provider has a range of policies and procedures in place to help guide staff in their work. It was pleasing to see improvements in this quality statement since the last inspection. The introduction of audits and management systems and the development of the senior team had contributed to improving how the quality assurance systems were being used. The survey carried out by the service earlier in the year showed positive results and was focused on outcomes for service users. During the inspection we identified that an action plan could be developed following on from the survey to communicate to others how the service is using this feedback to drive improvements forward. Areas for improvement We did not see how actions from the recent kitchen audit had been taken forward. The manager could develop the recording systems being used to help evidence what outcomes have been achieved from improvement actions. The range of audits could be extended to include medication, care plans and health and well being outcomes for residents. We did not see evidence of these areas being monitored in the time period since the last inspection. This could help to ensure that all aspects of the quality of the service are being monitored and improved. The manager carried out a daily walk around the home and assured us that any environmental improvements or repairs are prompted by his observations however, there were no records retained to demonstrate this work being carried out. The manager could develop a checklist which could help to ensure that this aspect of quality assurance is being monitored. Bield Housing Association [Boness], page 29 of 34

30 We found that procedures for admission to the service were not always followed and have made a recommendation to ensure that a pre-admission assessment is carried out, written down and communicated to staff. This is to ensure that new residents' needs and preferences are identified and there are plans in place for how these will be met. (See Recommendation 1 below). We spoke with the manager about putting in place an overall service development plan with the involvement of residents, their relatives, staff and other stakeholders. This could help to communicate to others how inspection, audits, the provider's initiatives and feedback to the service is being used to improve the service. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. Recommendation with reference to Theme 4, Statement 4: It is recommended that all new residents have the opportunity to be involved in a pre-admission assessment. There should be records to show this has taken place and includes the residents needs and preferences and how these will be met. Preadmission assessments and initial plans should be shared with the resident, staff and any other relevant person, where appropriate prior to admission to the service. National Care standards Care homes for older people - Moving in Bield Housing Association [Boness], page 30 of 34

31 4 Other information Complaints No complaints have been upheld, or partially upheld, since the last inspection. Enforcements We have taken no enforcement action against this care service since the last inspection. Additional Information N/A. Action Plan Failure to submit an appropriate action plan within the required timescale, including any agreed extension, where requirements and recommendations have been made, will result in the Care Inspectorate re-grading a Quality Statement within the Quality of Management and Leadership Theme (or for childminders, Quality of Staffing Theme) as unsatisfactory (1). This will result in the Quality Theme being re-graded as unsatisfactory (1). Bield Housing Association [Boness], page 31 of 34

32 5 Summary of grades Quality of Care and Support Good Statement 1 Statement Good 4 - Good Quality of Environment Good Statement 2 Statement Good 5 - Very Good Quality of Staffing Good Statement 2 Statement Good 4 - Good Quality of Management and Leadership Good Statement 1 Statement Good 4 - Good 6 Inspection and grading history Date Type Gradings 24 Jul 2013 Unannounced Care and support 2 - Weak Environment 4 - Good Staffing 4 - Good Management and Leadership 3 - Adequate 30 Oct 2012 Unannounced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 4 - Good 20 Sep 2010 Unannounced Care and support 5 - Very Good Environment Not Assessed Staffing Not Assessed Management and Leadership 5 - Very Good Bield Housing Association [Boness], page 32 of 34

33 29 Jul 2010 Announced Care and support 5 - Very Good Environment Not Assessed Staffing Not Assessed Management and Leadership 5 - Very Good 5 Feb 2010 Unannounced Care and support Not Assessed Environment Not Assessed Staffing Not Assessed Management and Leadership 5 - Very Good 28 Jul 2009 Announced Care and support 5 - Very Good Environment 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good 10 Mar 2009 Unannounced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 4 - Good 11 Jun 2008 Announced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 4 - Good All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Bield Housing Association [Boness], page 33 of 34