Appin House Care Home Service Adults 27 Appin Crescent Kirkcaldy KY2 6EJ Telephone:

Transcription

1 Appin House Care Home Service Adults 27 Appin Crescent Kirkcaldy KY2 6EJ Telephone: Type of inspection: Unannounced Inspection completed on: 13 March 2015

2 Contents Page No Summary 3 1 About the service we inspected 4 2 How we inspected this service 5 3 The inspection 9 4 Other information 18 5 Summary of grades 19 6 Inspection and grading history 19 Service provided by: Fife Council Service provider number: SP Care service number: CS If you wish to contact the Care Inspectorate about this inspection report, please call us on or us at enquiries@careinspectorate.com Appin House, page 2 of 21

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 4 Good Quality of 4 Good Quality of Management and Leadership 4 Good What the service does well Residents and their families told us that they feel that staff support them well. Residents and staff were excited about moving to the new home later in the year. What the service could do better The support for residents with changing health needs means that community health staff work in partnership with care staff to ensure needs are met. This will involve the development of further training and skills for care staff. What the service has done since the last inspection We were concerned at the last inspection about some aspects of support needs and how this affected life at Appin House. The manager and staff team have worked in partnership with social work teams to help resolve some of the issues that had a serious impact on life in the home. Conclusion Appin House building does not meet the requirements of good care and support but staff work hard to ensure that residents feel well cared for. The replacement building is said to be progressing well and is expected to be ready to move into on schedule. Appin House, page 3 of 21

4 1 About the service we inspected The Care Inspectorate regulates care services in Scotland. It awards grades for services based on the findings from inspections. These grades, including any that were previously awarded by the Care Commission, are available on This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April Appin House is a care home for older people, offering 24-hour care and accommodation for 24 older people, plus eight, for respite care. The care home is owned by Fife Council. Appin House is situated about three miles from the centre of Kirkcaldy, within a residential area, and is easily accessible by public transport services. The accommodation is an older building, although it was purpose-built and provides single occupancy bedrooms on two floors and has an internal passenger lift. There is a garden in the grounds for the use of service users. There are a sufficient number of public rooms, bathrooms, WCs and ancillary provisions. The registered unit manager is responsible for the supervision of staff and the day-to-day running of the care home and the day care provision. The Aims and Values statement of the service includes: "The care provided will enhance the independence of service users and will be based on the principles of choice, privacy and spiritual needs". 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 - Grade 4 - Good Quality of - 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. Appin House, page 4 of 21

5 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 This report was written following an unannounced inspection of the service on Friday 13 March 2015 between 9am and 4pm. The inspection was carried out by one Inspector from the Care Inspectorate. The manager of the care service sent us an annual return and a self assessment form. We talked to the manager, staff in the service and service users during the inspection. We sent questionnaires to service users/relatives and received eight responses which we took into account for this report. Before we visited the service we asked the manager to provide us with a number of documents, including:- We looked at records and documents during the visit. These included:- -certificate of registration -public liability insurance -written risk assessments -a sample of four care and support plans -audits and quality assurance systems -information on the office noticeboard We talked to senior staff on duty. We reminded the manager about recent changes to legislation - The Public Services Reform (Scotland) Act 2010 and we discussed the need to update policies and procedures in light of these changes. We explained our Regulatory Support Assessment which is part of our preparation for the inspection. Appin House, page 5 of 21

6 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 Appin House, page 6 of 21

7 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 fully completed self assessment document from the service provider. We were satisfied with the way the service provider had completed this and with the relevant information they had given us for each heading that we grade them under. The service provider identified what they thought they did well, some areas for development and any changes they had planned. The service 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 'I feel very fortunate to be looked after in this excellent home' 'I am very happy with my care' ' is warm and caring' 'I am happy, my room has been recently decorated and I have been given new furniture'. Taking carers' views into account 'I am confident that the staff take good care of my relative and the other residents. I can pop in at any time and am always made to feel welcome by all the staff'. 'I am confident that my relative's care covers all her needs. I visit every week and take them out as well. I have no doubts at all about my relative living in Appin House'. Appin House, page 7 of 21

8 'The carers are good but sometimes they are run off their feet, so they could do with more carers. Like everything, it boils down to money. Some Agency carers are not as pleasant as the carers employed by the Council'. 'My relative uses the respite service at Appin House. Those weeks, I visit at least daily and was invited to have a meal at lunchtime. The food had good variety and was well cooked. The only thing, I felt more activity could have been provided (TV on at all times). I had to keep asking if the noticeboard stated an activity was on, so I could join in with my relative'. Appin House, page 8 of 21

9 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 We found the service was performing to a very good standard for this quality statement. We spoke with residents and their visitors. We spoke with staff. We inspected a sample of four care and support plans. We looked at minutes of meetings and we saw photographs posted on the noticeboard in the home. Residents told us that they feel happy and secure at Appin House. We found the atmosphere was calm throughout the inspection visits. We saw examples of how residents were involved in making decisions about their day-to-day life. In care and support plans we saw that residents and their relatives were invited to regular meetings to review the care and support offered by Appin House. We saw how residents' views were taken into account during the review process and that care plans were then updated. The menu changes seasonally and we saw minutes of meetings where choices were discussed and taken into account for the menu. We did see examples of individualised meals where this was requested by residents. Staff told us about plans to visit the new care home with some interested residents. We saw photographs of residents' visits at earlier stages of the build. Areas for improvement The managers of Appin House and the sister home Raithgates are planning ways to involve residents and their families in moving to the new home in September Appin House, page 9 of 21

10 Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Appin House, page 10 of 21

11 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths We found the service was performing to a good standard for this quality statement. We inspected a sample of four care and support plans and we spoke with four residents. We observed staff practice. We spoke with care staff and with senior staff on duty during the inspection. We saw that staff were supporting residents with a range of different support needs. We spoke with the district nurse who was visiting a patient and she confirmed that the specific care needs of some residents meant a change in the skills needed from members of the staff team. She told us she usually delivered a tutorial for staff on duty on how to meet some of these specific needs when she visited. We saw in the care and support plans inspected that residents also had the support of local GP service and podiatry, dietician and physiotherapy service where needed. We saw improvements since the last inspection of actions taken after a care plan review. Areas for improvement We saw that some resident had noted a weight loss. The service has protocols in place to help staff support residents to increase weight. One aspect of this support is monitoring what food have been offered and what has been taken. This can highlight times when the person is hungry and this would be a point to offer a nutritious snack. We saw some of the records of fluid and food charts. We were disappointed to see that in one file these had been poorly completed. (See requirement 1 below). Grade awarded for this statement: 4 - Good Number of requirements: 1 Number of recommendations: 0 Requirements 1. Requirement with reference to Theme 1, Statement 3: Where fluid charts are required, these must be accurately completed and monitored to ensure the best quality of care is given. This is to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations, Scottish Statutory Instruments SSI 2011/210 Regulation 4(1)(a) A provider must make proper provision for the health, welfare and safety of service users. Appin House, page 11 of 21

12 Quality Theme 2: Quality of Grade awarded for this theme: 4 - Good Statement 2 We make sure that the environment is safe and service users are protected. Service strengths We found the service was performing at a good standard for this quality statement. We made observations around the home. We spoke with residents and with staff. We took account of plans for the replacement of the home, expected in September We saw that contracts were in place for servicing and maintaining large items of equipment, such as hoists and the lift. We saw that annual checks and six monthly required checks were done. Any maintenance issues were promptly addressed. On the day of inspection we met Council workmen who visited to check on a recent repair. We were reassured to see that the provider was ensuring the building continued to be maintained to a good standard. We were pleased to see that the provider had continued to the increase of overnight staff on duty, in response to an identified increase in the support needs of the resident group. Areas for improvement The provider should ensure that all areas of the home continue to be maintained to a good standard in the run up to the move to the new building. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Appin House, page 12 of 21

13 Statement 3 The environment allows service users to have as positive a quality of life as possible. Service strengths We found the service was performing at a good standard for this quality statement. We made observations around the home. We spoke with residents and we took account of views from visitors in the care standard questionnaires returned to us before the inspection visit. We took account of the National Care Standards, Care Homes for Older People. The service is organised in 'small group living' arrangements. This means that there is a shared lounge and kitchen to support residents in eight bedrooms close by. Each lounge has a variety of seating which enables visitors and other residents to choose to spend time in any of the lounges. This can mean that the lounge area can be quite full at times and some residents then choose to spend time in their room. Appin House has a secure garden which is used in the summer months. We saw that the area was accessible from the stairwell and seemed well maintained at the time of this inspection. Areas for improvement Bedrooms are compact and all have a television set available for use. We saw that the arrangement of seating can make watching the TV screen a bit tricky. We also saw that the television screens had timers to go into 'off' mode periodically. We felt that staff should ensure that televisions remain 'on' when residents are involved in watching a programme, where residents are unable to manage this independently. Reasons for replacing the home include no en-suite toilets or bathrooms are available in the home. Plans are for small group living arrangements in the new home. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Appin House, page 13 of 21

14 Quality Theme 3: Quality of 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 We found the service was performing to a good standard for this quality statement. We spoke with four residents. We interviewed three staff and we spoke with two other staff on duty in the care home. We found that some staff have been in post for over 10 years. We met a few staff who had been recently recruited and we confirmed that the recruitment procedures had followed the provider's policies. Staff told us about induction to their role and how the provider has a corporate induction meeting but that the home has a local induction programme for the role in supporting residents. Staff said that they felt well prepared to carry out the duties of their post. The service is supporting staff to apply to the Scottish Social Services Council (SSSC). This is the body which regulates the social care workforce. Being on the register ensures that staff have the qualifications and experience to carry out the duties of their post and ensures they keep up-to-date with training. We were pleased to see that most staff are already on the register. The staff team is aware that not being on the register means that their employment is at risk, as legislation advises providers that they require to check that each person is registered with an appropriate professional body in order to carry out the duties for which that person is employed. Since the last inspection, the manager has ensured that the need for Agency staff has been minimised. This ensures that residents are supported by staff they know. Previous strategies for having the same Agency staff on duty to cover shifts was the best that could be managed at the time. The provider had given permission for direct employment with the provider. This is welcomed by residents, staff and the Care Inspectorate as it minimises changes in the staff team supporting individuals. Areas for improvement Senior staff told us there had been a couple of 'hiccups' in the recruitment process and that the process would soon be complete. Appin House, page 14 of 21

15 Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Appin House, page 15 of 21

16 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 We found the service was performing at a good level for this quality statement. We spoke with four residents and we read information posted on the noticeboard in the home. We spoke with staff and we took account of information in the care standard questionnaires returned to us before the inspection visit. Staff told us that they felt supported in their work. They said that any training they needed was organised for them. Comments from resident include: 'I have stayed here for five years and have been treated well in every aspect' 'The environment is warm and caring' 'I am happy. My room has been recently decorated and I have been given new furniture' 'I am very fortunate to be looked after in this excellent home'. The senior staff told us that relatives are kept up-to-date with aspects of their relatives' care and also through meetings. Recent meetings have been held to talk about the new building and plans are in place for these to continue as the date for completion of the new home draws near. Areas for improvement The plans for the new home include a more senior manager and we hope the provider considers ways to include residents and their families in the recruitment process. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Appin House, page 16 of 21

17 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 We found the service was performing at a good standard for this quality statement. We inspected a sample of four care and support plans. We looked at audits of care files and we saw how the service monitored that care and support were delivered to a good standard. Some of the care plans were written very nicely and we could see that the residents was well known to the writer. We saw that files were audited on a regular basis with checks made on individual care plans to ensure that all aspects of care were carried out in a professional manner. We were pleased to see that the service continued to have three staff on night shift in order to meet the changing needs of the resident groups. Systems were in place to ensure the building and equipment in the building were in good order and safe for use. Areas for improvement We found that the service can be supporting residents with increasingly complex needs. This has an impact on the knowledge needed by care staff and procedures developed to ensure that staff have the knowledge and understanding to support residents throughout their life. For example, we found that some residents were at increased risk of skin fragility due to a range of reasons. While staff have previously had experience of preventing skin breaks, this needs to be reviewed given the increased fragility, often due to age and other health factors, of the current resident groups. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Appin House, page 17 of 21

18 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 Theme) as unsatisfactory (1). This will result in the Quality Theme being re-graded as unsatisfactory (1). Appin House, page 18 of 21

19 5 Summary of grades Quality of Care and Support Good Statement 1 Statement Very Good 4 - Good Quality of Good Statement 2 Statement Good 4 - Good Quality of Good Statement Good Quality of Management and Leadership Good Statement 1 Statement Good 4 - Good 6 Inspection and grading history Date Type Gradings 7 Oct 2014 Unannounced Care and support 4 - Good 3 - Adequate 4 - Good Management and Leadership 4 - Good 9 Oct 2013 Unannounced Care and support 4 - Good 5 - Very Good 5 - Very Good Management and Leadership 5 - Very Good 5 Oct 2012 Unannounced Care and support 4 - Good 5 - Very Good 5 - Very Good Management and Leadership 5 - Very Good Appin House, page 19 of 21

20 13 Mar 2012 Unannounced Care and support 4 - Good Not Assessed Not Assessed Management and Leadership 4 - Good 26 Jul 2011 Unannounced Care and support 4 - Good Not Assessed Not Assessed Management and Leadership 4 - Good 20 Jan 2011 Unannounced Care and support 2 - Weak Not Assessed Not Assessed Management and Leadership Not Assessed 15 Jul 2010 Announced Care and support 5 - Very Good Not Assessed Not Assessed Management and Leadership 5 - Very Good 25 Jan 2010 Unannounced Care and support 5 - Very Good 4 - Good Not Assessed Management and Leadership Not Assessed 6 Aug 2009 Announced Care and support 4 - Good 4 - Good 4 - Good Management and Leadership 5 - Very Good 17 Mar 2009 Unannounced Care and support Not Assessed Not Assessed 5 - Very Good Management and Leadership 5 - Very Good 18 Jul 2008 Announced Care and support 5 - Very Good 5 - Very Good 5 - Very Good Management and Leadership 5 - Very Good All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Appin House, page 20 of 21

21 To find out more about our inspections and inspection reports Read our leaflet 'How we inspect'. You can download it from our website or ask us to send you a copy by telephoning us on This inspection report is published by the Care Inspectorate. You can get more copies of this report and others by downloading it from our website: or by telephoning Translations and alternative formats This inspection report is available in other languages and formats on request. Telephone: enquiries@careinspectorate.com Web: Appin House, page 21 of 21