Henderson House. Care Home Service Adults 2 Links Road Dalgety Bay KY11 9GW Telephone:

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1 Henderson House. Care Home Service Adults 2 Links Road Dalgety Bay KY11 9GW Telephone: Inspected by: Molly Clunie Susan White Type of inspection: Unannounced Inspection completed on: 31 May 2011

2 Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 13 4 Other information 27 5 Summary of grades 28 6 Inspection and grading history 28 Service provided by: Roseguard Properties Limited, a Member of the Four Seasons Health Care Group Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: Molly Clunie Telephone enquiries@scswis.com Henderson House., page 2 of 30

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 The service has responded very well to the requirements made at the last inspection. Staff have worked hard to improve their practice. Managers have introduced better auditing processes to ensure residents receive care and support to meet their assessed needs. What the service could do better The service should continue to deliver the standard of care and support demonstrated at this inspection. The service should continue developing an activities programme which is reflective of the interests and hobbies of individual people. What the service has done since the last inspection We found the service had improved their practice in all areas reviewed at this inspection. Requirements made at the last inspection have been addressed and in most cases the requirement was met. Conclusion This was a positive inspection. We found the service had worked hard and had improved the quality of recording in the care plans which meant staff were given clear direction about the care and support to be delivered Henderson House., page 3 of 30

4 Who did this inspection Molly Clunie Susan White Lay assessor: N/A Henderson House., page 4 of 30

5 1 About the service we inspected Social Care and Social Work Improvement Scotland (SCSWIS) is the new regulatory body for care services in Scotland. It will award grades for services based on the findings of inspections. The history of grades that services were previously awarded by the Care Commission are also available on the SCSWIS website. Henderson House is situated in a residential area of Dalgety Bay. The care home, a three storey building of contemporary design, was purpose built by Four Seasons Health Care. The care home provides residential accommodation for older people offering long term residential nursing care. Respite care may be provided when there are vacancies arising. It is registered to accommodate a maximum of 60 older people on a residential basis. There is a specialist unit for people with dementia. This facility is located on the ground floor. The accommodation provides single occupancy bedrooms, all with en-suite facilities. Service users' accommodation is located on the ground and upper floors which are served by a passenger lift. There are six lounges in total; a large lounge with a dining area, which has facilities for the making of simple snacks and a further two smaller lounges on each floor. The kitchen, laundry and staff facilities are located on the lower ground floor. A secure garden is located at the rear of the property and is accessed from the lower ground floor. There is an adequate number of bathrooms, a sufficient number of toilets and ancillary provision to meet the needs of the service users. This care home was deemed registered by SCSWIS on 1st April The stated aim of Henderson House is to 'respect the rights, dignity, individuality and lifestyle of the service user'. Henderson House., page 5 of 30

6 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 Inspection report continued 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. Henderson House., page 6 of 30

7 2 How we inspected this service The level of inspection we carried out In this service we carried out a high intensity inspection. We carry out these inspections where we have assessed the service may need a more intense inspection. What we did during the inspection The inspection was carried out by SCSWIS inspectors Molly Clunie and Susan White. We made 2 visits to Henderson House The first visit on 17 May from 5pm to 7:30pm was unannounced. A second visit was made on 31 May from 10am till 4pm. The service was given short notice of this visit. We delivered feed back to the care manager and area manager at this visit. As requested by us the care service submitted an annual return and a self assessment of the care and support they deliver to those who use the service. We issued 15 questionnaires to service users/friends/relatives/carers of people who used the service. Two were returned prior to the inspection. We have used this information to inform the report. In this inspection we gathered evidence from a range of sources including the relevant sections of policies, procedures, records and other documents including Evidence from the service's most recent self assessment Personal plans of people who use the service Training records Health and safety records Accident and incident records Questionnaires distributed to those who use the service. Discussions with the manager, care staff, service users, visitors and relatives Observation of practise Examine equipment and the environment. We also examined the progress the service had made with the requirements and recommendations made at the last inspection. The progress made has been reported on within the body of the report. Henderson House., page 7 of 30

8 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 report continued 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 Henderson House., page 8 of 30

9 What the service has done to meet any requirements we made at our last inspection The requirement In order to meet SSI 114 Regulation 4 (1) Welfare of Users The service must demonstrate that all available information is used to assess the care and support needs of service users. This information must be included in the care plan and used to inform and guide staff practise to protect the service user. Timescale four weeks What the service did to meet the requirement We reported on our findings under the statement 3 Theme Care and support The requirement is: Met The requirement In order to meet SSI 114 Regulation 4 (1) Welfare of Users On going significant changes and events must be included as part of the assessment process. This is with particular reference to CHAPs, risk assessment and care planning. Timescale four weeks What the service did to meet the requirement We reported on our findings under the statement 3 Theme Care and support The requirement is: Met The requirement In order to meet with SSI 114 Regulation 5 The service provider should ensure staff who deliver activities have sufficient skills and knowledge to be able to support the individual in a meaningful way which benefits the person. Time scale six weeks What the service did to meet the requirement We reported on our findings under the statement 5 Theme Care and support. The requirement will continue to be monitored on a regular basis through the submission of monthly reports and be revisited at the next inspection of the service. The requirement is: Not Met The requirement In order to meet with SSI Regulation 4 Welfare of users and 5 Personal plans The service provider must ensure all service users' risk assessments are person centred, Henderson House., page 9 of 30

10 guiding and directing the care and support to reduce the risks protect the service user. All aspects of a per son's life style should be taken into account when undertaking an assessment to guide and direct staff. What the service did to meet the requirement We reported on our findings under the statement 5 Theme Care and support The requirement is: Met Inspection report continued The requirement In order to meet with SSI 114 Regulation 4 (1) Welfare of Users Risk assessments to reduce the risk to service users must be put in to practice and be evaluated regularly to ensure they are effective in reducing the risk to the service user. What the service did to meet the requirement We reported on our findings under the statement 2 Theme Environment The requirement is: Met The requirement In order to meet with SSI 114 Regulation 4 Welfare of users (2) and 5 personal plans (2). The service provider must be able to demonstrate and evidence how agency staff are supported to access and use records and documentation to deliver the care and support to protect and safe guard service users. What the service did to meet the requirement We reported on our findings under the statement 2 Theme Staffing The requirement is: Met The requirement In order to meet with SSI 114 Regulation 13 Staffing The service should demonstrate and evidence how training and learning undertaken by staff has been evaluated and introduced into care practise. What the service did to meet the requirement We reported on our findings under the statement 3 Theme Staffing The requirement is: Met Henderson House., page 10 of 30

11 The requirement In order to meet with SSI 114 Regulation 5 Personal plans The service provider should ensure all records used to pass and share information are dated and signed. Information should be clear and accurate and audubitable. Time scale two weeks. What the service did to meet the requirement We reported on our findings under statement 3 Theme management and leadership The requirement is: Met Inspection report continued The requirement In order to meet with SSI 114 Regulation 13 Staffing The service provider should review the existing strategy for covering known long term absences and vacancies and introduce a long term strategy to reduce the dependence on short term agency staff to cover shifts within the care home. The manager should also undertake a review of the current staffing throughout the care home to ensure there are sufficient skilled and experienced staff in each unit. Time scale two weeks What the service did to meet the requirement We reported on our findings under statement 3 Theme management and leadership The requirement is: Met 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 self assessment document had been submitted as requested. we used the information to inform the basis of this inspection. Taking the views of people using the care service into account We spoke with five residents. They told us they liked living in the care home. They considered the meals to be tasty. Choice was always availalble 'including steak and fish'. Henderson House., page 11 of 30

12 Taking carers' views into account Inspection report continued We spoke with three relatives who told us staff were approachable and took account of their concerns. One relative told us there was not always a choice of menu in the evening. We asked the manager about this. She reported the kitchen is always open including evenings. She advised staff will be reminded to offer choice. Staff we spoke with advised they offered choice and knew the kitchen was accessable in the evenings. It is suggested a list of available snacks be included as part of the menu. We received two questionnaires from those we asked the care home to distribute. The comments were positive. Henderson House., page 12 of 30

13 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 Overall 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 The was very good evidence to confirm the service continues to routinely involve service users and their families in the discussion about how the service can be improved. For example minutes showed relatives have been part of an audit carried out to evaluate the dining experience for service users. Remedial action plans were in place showing how the service planned to introduce and implement agreed changes. Activities are discussed and evaluated by staff and service users. For example a recent outing to the Union Canal had been very much enjoyed by those who chose to go. The manager reporting one relative who was unsure about this outing being suitable, advised their partner had enjoyed the outing immensely. Planned reviews of the care and support delivered are carried out regularly. Family and named carers are invited to these and are asked to share their views and opinions of the service. This practice was confirmed in a recent social work report. Residents who do not have close family support are encouraged to access an advocacy service. The files we examined confirmed contact details for advocates and guardians were in place and are updated at each review. The service also carries out annual customer satisfaction surveys. The outcome of the survey is displayed on the notice board and also in the Newsletter as well as being discussed with residents, relatives and staff. We could see that the rear garden had been highlighted for improvement. Residents we spoke with told us they enjoy living in the care home. Relatives told us they were very satisfied and felt any issues were discussed and resolved. Monthly reports sent to the us confirmed residents are consulted about the service. Henderson House., page 13 of 30

14 Areas for improvement The service should continue with the very good practice of involving residents and relatives in how the care home could better support the resident. Meeting minutes confirmed the manager routinely asks residents to contribute to the agenda items of meetings held. This an area which key workers could explore with residents on a one to one basis. This recognises that some individuals are more confident when sharing their views on a one to one basis. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Statement 3 We ensure that service user's health and wellbeing needs are met. Service strengths We made two requirements at the last inspection. Firstly 'The service must demonstrate all available information is used to assess the care and support needs of service users. This information must be included in the care plan and be used to inform and guide staff practise to protect the service user', and secondly 'Ongoing significant changes and events must be included as part of the assessment process. This is with particular reference to Care Health Assessment Profile (CHAP), risk assessment and care planning'. We examined 7 residents' personal files. We found that information within the personal file and detail gathered at the initial assessment had been used in preparing the care plan and influenced the care and support delivered to the service user. For example, residents who required to have their diabetes monitored daily had a care plan to support and direct staff practise. Records examined confirmed staff carried out daily monitoring and diets were adjusted accordingly. We saw one pre admission assessment which was considered to be very good. There was clear guidance for staff to follow, future health care appointments logged. Other professionals who supported the service user were aware of the admission and had been contacted to confirm information held and care practise to be delivered. All service users had been allocated a key worker. The key worker is someone who liaises with the resident and their family or named carer about life style, choices and preferences. One key worker described the role as being 'work in progress' as there are 'always choices to be made'. Henderson House., page 14 of 30

15 Care and support was reported to be evaluated monthly by named nurses for all residents. Files we examined confirmed this practise. We could see when other professionals had contributed to the care and support of individuals, influencing the care plan. One relative advised 'their parent had a better quality of life now '. Discussion with staff confirmed information is shared between shift changes (handovers) daily, information was more accessible. Care staff confirmed they now contributed to the care plans regularly. Monthly assessments are carried out by lead nurses on each floor. There was good evidence to confirm this. One lead nurse confirming all care plans are being reviewed and updated appropriately and in some cases the care plan is to be rewritten with residents and family involvement. This means the care and support delivered to the resident will meet the assessed needs of the resident. We considered the service had made sufficient progress and had met these requirements. Areas for improvement We spoke with staff about the assessment tools, the information gathering process and how outcomes are used to influence the care and support. We found this was an area which could be improved.it is important there is a shared understanding of how information is gathered and used to inform the assessment process. As an area of improvement the service should encourage all staff to discuss the how information is gathered and what is meant by 'maintaining mobility' and 'nutritional support'. This will mean information gathered will be consistent and inform the assessment process in a more meaningful way. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Statement 5 We respond to service users' care and support needs using person centered values. Service strengths We made two requirements at the last inspection; ' The service provider should ensure staff who deliver activities have sufficient skills and knowledge to be able to support the individual in a meaningful way which benefits the person', and 'The service provider must ensure all resident ' risk assessments are person centred, guiding and directing the care and support to reduce the risks, protect the service user. All aspects of a person's life style should be taken into account when undertaking an assessment to guide and direct staff'. Henderson House., page 15 of 30

16 We monitored the progress of the first requirement which considered staff skills and knowledge to deliver activities in a meaningful way. Henderson House., page 16 of 30

17 The care plans we examined showed staff include more detail about the individual's life history. There is good evidence of key workers meeting with service users to discuss personal preferences. One relative told us her mother still had the same GP who attended her when she lived at home. Care plans for more independent service users confirmed they wished to spend more time in the bedroom and attend activities of their choice. One service user told us how they had enjoyed a family meal in the care home. Other service users confirmed they had personal time with their partners. Staff we spoke with told us they had more time to gather information and the information was recorded in the care plans. The manager reported there continued to be areas which required to be improved. We considered the service had made good progress and had met most aspects of the requirement. We will continue to monitor the progress made by the service. The second requirement referred to the need for risk assessments to be person centred. We examined risk assessments held in care plans and also those which were part of the overall Fire risk assessment of the service. We found the risk assessments were person centred and clearly informed practice. For example, one risk assessment advised how one service users who suffers from claustrophobia should be supported at night, other examples within care plans examined also demonstrated the person had been consulted about the risks and how these risks could be reduced eg the use of bed rails and pressure mats. Staff we spoke with could describe how risks were reduced by making changes to practise. This requirement has been met. Areas for improvement The manager advised staff continue to receive support from a Senior Nurse Care Assistant (SNCA) to deliver activities which are person centred. In addition, the service is continuing to embed the skills and knowledge gained when they achieved their bronze PEARL award. The service should continue to improve activities offered to residents. As an area of improvement the service could draft a list of preferred activities, likes and dislikes form resident life histories and use this information to plan future activities. A regular evaluation of how residents engaged in these activities would inform future planning. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Henderson House., page 17 of 30

18 Quality Theme 2: Quality of Environment 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 environment within the service. Service strengths In addition to Statement 1.1 There was very good evidence confirming the service had consulted with residents and their relatives about the care home and how it could be improved. Minutes of one relatives' meeting confirmed relatives had suggested a clock be purchased to help residents distinguish between day and night, access to the front door when pushing a wheel chair should be improved. The decoration of some bedrooms was also discussed. The manager advised a charity has been set up by relatives to raise funds for service users of the care home. The relatives' group has undertaken to carry out improvements to the secure garden to the rear of the care home. Hard paths have been laid and additional seating put in place for service users to enjoy the garden. A link has been made the nearby garden centre, who have agreed to provide expertise and plants in support of the care home. Areas for improvement The service should continue to work with relatives encouraging and supporting their ongoing involvement with the care home. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Statement 2 We make sure that the environment is safe and service users are protected. Service strengths We made a requirement at the last inspection asking the service to ensure risk assessments were used to influence the care and support for service users. As previously reported, risk assessments examined were person centred. Staff could confirm they were aware of alternative technology used to reduce the risk for residents, for example the use of pressure mats for overnight safety for some individuals. There was good evidence of incident and accidents being evaluated and if the risk assessment continued to be effective. Henderson House., page 18 of 30

19 The manager confirmed she continues to carry out a monthly audit to evaluate the effectiveness of risk assessments. We made a recommendation referring to the reporting procedure for repairs and equipment. When we spoke with staff, we found they had a good knowledge of the procedure and who was responsible for monitoring the outcome. SNCAs confirmed they reviewed the maintenance book daily to ensure repairs were actioned. The manager confirmed she carried out monthly audits to ensure any outstanding repairs are prioritised and actioned. An outdoor shelter has been purchased and sited to the rear of the care home in a secure setting for those service users who smoke. Service users we spoke with advised they were aware of the need for change, however, considered the shelter to be 'ineffective when it was windy'. A recent Fire Safety inspection carried out by Fife Fire Service was satisfactory. Staffing rotas are planned in advance, staff vacancies identified and are covered appropriately. Areas for improvement The service should continue to build on the current good practice of ensuring all staff continue to be aware of the need for service users to be safe and protected at all times. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Statement 3 The environment allows service users to have as positive a quality of life as possible. Service strengths The service use the Pool Activity Level (PAL ) assessment to ensure the right kind of activity is offered to the individual at an appropriate level of engagement for the individual. We saw some evidence of the assessment being used to inform activities for individuals. Residents are encouraged to move freely about the care home using the smaller lounges on each floor for activities or meeting with family. The cafe on the upper floor is used regularly by some residents for morning coffee. Residents in the later stages of dementia mostly use one of the smaller lounges. In this lounge we saw individual care including hand massage, music and one to one time with key workers. Henderson House., page 19 of 30

20 We made a recommendation at the last inspection about the need for the service to eliminate mal odours in the care home. Each time we visited we found the care home to be fresh smelling in the areas we visited. A lead nurse told us bedrooms and corridor carpets are shampooed regularly, some on a daily basis. It was also reported the service is recruiting for additional ancillary staff to support the current team. Areas for improvement As an area of ongoing improvement, the service should continue to link activities to individual life histories, interests and hobbies. The PAL assessment should be used to influence how an activity can be delivered appropriately. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Henderson House., page 20 of 30

21 Quality Theme 3: Quality of Staffing Grade awarded for this theme: 4 - Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service Strengths In addition to statement 1.1 and 2.1 We saw evidence to confirm relatives and service users are asked to take part in the recruitment process for new staff. Minutes of the relatives' meeting confirmed relatives are encouraged to share their views and opinions about staff training and how practice could be improved. Areas for improvement To support and encourage residents' participation in staff recruitment, it is suggested the service discuss with residents what attributes they would like to see in new staff. Their views and opinions can be taken into account as part of the selection process. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 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 sampled the recruitment process for staff who had been employed within the last six months. We saw good evidence to show the service had followed organisational recruitment policy and procedure. Records confirmed applicants are asked to give the names of those who would supply references. Records confirmed these are applied for by the service. Background checks were requested. A risk assessment of employment was undertaken for one new employee due to a disclosure being delayed. The risk assessment was found to be appropriate. Records confirmed Nurse registrations are check against the NMC register on a regular basis. By following organisational policy and procedure and undertaking regular checks of staff registration, the service is demonstrating they recruit staff in a safe manner. We made a requirement at the last inspection about agency staff being made aware of organisational policies and procedures. Henderson House., page 21 of 30

22 The induction process includes all staff being aware of organisational policies and procedures, undertaking mandatory training. Agency staff are required to be inducted to the care home. Records confirmed agency staff are inducted monthly to reaffirm their knowledge of the service and how to access policies and procedures. One agency staff we spoke with confirmed the practice of revisiting induction was useful as it reminded them of which care home they were working in. This requirement has been met An SNCA confirmed induction and orientation to the care home is undertaken prior to new staff commencing work. All new staff are mentored by senior staff until they are assessed as competent. Areas for improvement We discussed one personal file with the manager. She confirmed appropriate action was taken to support the individual, however, agreed the outcome had not been recorded in the individual file. As an area of improvement the service should ensure the outcome of one to one discussions with staff are recorded appropriately. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths A requirement was made at the last inspection about how the service evaluated staff training and how training had improved practise. Records we examined confirmed that staff had attended a range of training pertinent to their role within the care home. We asked lead nurses and SNCAs how they evaluated training delivered through the e-learning programme. They told us they observed practise and discussed specific training with staff during one to one supervision sessions. We spoke with staff about their training. They told us their skills and knowledge had improved, they were able to speak with their supervisor regularly and had a better understanding about their role and, as a result, the service user had a better quality of life. Staff advised they are 'reminded to complete mandatory training' by the deputy manager on a regular basis. This requirement has been met. Henderson House., page 22 of 30

23 It was reported the introduction of the SNCA had been beneficial. Observation of staff practise demonstrated they worked well together; sharing and communicating good information throughout the shift period. Care staff felt they had more time to interact with service users. One carer told us they had more time to speak with individual service users, did not feel hurried and under pressure to complete tasks. A lead nurse reported they had more time to assess and update care plans. This means care plans are updated to reflect the care and support delivered to the service user. An SNCA advised the induction to the role had lasted twelve weeks and covered a range of tasks for example supervision of staff, simple dressings, monitoring daily records, contributing to care plans and liaison with other professional under the guidance of the lead nurse. Competency of practise was evaluated through supervision. This was confirmed in the records we examined. This means staff who deliver care and support are knowledgeable, delivering good care using learned skills which will lead to improved care for the individual. Areas for improvement The service should continue to build on the good practise using the strategies and systems introduced. Staff should continue to be encouraged to access training which will further develop their skills and knowledge. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Henderson House., page 23 of 30

24 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 In addition to statements 1.1, 2.1 and 3.1. The service offers relatives and service users the opportunity to influence the management and leadership of the service through regular meetings. A monthly evening open door session is a regular feature. The clinical governance committee includes relative representation. This group meets on a regular basis to discuss practise issues and any concerns. The complaint procedure is openly displayed for any one to use. Areas for improvement The manager reported meeting agendas for service user and relative meetings are usually drafted by the care home. Encouragement is given for others to contribute to these meetings. As an area of improvement the service should offer the relatives' group the opportunity to hold their own meeting to discuss the service and how it can be improved. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Statement 3 To encourage good quality care, we promote leadership values throughout the workforce. Service strengths We made two requirements at the last inspection, firstly about the sharing of information within the care home, with particular reference to handover between shifts and secondly we asked the service to review the long term strategy for covering shifts for known staff absences. We examined the handover records and found these were dated, signed and held on file. Staff told us they were able to refer to these sheets to confirm information shared. Care plans we examined confirmed staff had improved their record keeping by dating and signing records. Henderson House., page 24 of 30

25 The manager reported additional staff had been recruited to cover long term vacancies. The rota confirmed this strategy. In discussion with staff they confirmed there was consistency within the staff teams and this meant working relationships improved. These requirements are met. We also made a recommendation the rota format be reviewed to improved to ensure information was easily accessible. The manager had considered this and had improved the rota format. We found the new format easier to understand, with information about staff on shift much easier to extract. Areas for improvement The service should continue to build on the good practice demonstrated at this inspection. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued 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 made a requirement at the last inspection asking the service to ensure audits undertaken were meaningful and did influence change appropriately. These audits should include; action taken following reviews of care, accident and incident records, maintenance of the building and repairs to equipment, and the evaluation of staff practise. When we examined the care plans we could see the care and support was evaluated on a monthly basis. Most evaluations were relevant and confirmed the care plan remained accurate. Ad hoc audits by senior managers of the care plans were confirmed by lead nurses. The manager confirmed a sample of care plans were audited each month. A recent social work reviews confirmed care plans were accurate and reflected the assessed care and support for the service user. We reviewed records of accidents and incidents within the care home. We found the deputy or the manager had reviewed the action taken by staff to support the service users, risk assessments were reviewed as necessary and changes to care plans were made. Reviewing these records regularly can mean the individual receives the appropriate care and support to meet their assessed needs. Henderson House., page 25 of 30

26 We asked staff about how they reported broken equipment and how this was monitored. In discussion they told us they recorded repairs needed in the maintenance book kept in the front foyer. This book was read daily by the maintenance man who then carried out the repair, referring more complex repairs and specialised maintenance to the manager for external contractors to be employed. The manager confirm this. We were able to confirm this practise over the two days we visited the care home. Lights were replaced promptly, we observed the SNCA checking the repairs book during the shift. As previously reported we found staff training was evaluated through supervision and observation of practise. This requirement has been met. The strengthened auditing processes are confirming good practise and identifying where improvement is needed. For example the audit has shown staff need to gather better life story history and information to inform of the range of meaningful activities which can be offered to individual service users. Areas for improvement The service should continue to build on the good practise demonstrated at this inspection. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Henderson House., page 26 of 30

27 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 The service should continue to submit monthly reports to demonstrate how improved practice identified at this inspection is maintained and how the areas of improvement highlighted in this report are developed and introduced to the service. 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 SCSWIS re-grading the Quality Statement within the Management and Leadership Theme as unsatisfactory (1). This will result in the Quality Theme for Management and Leadership being re-graded as Unsatisfactory (1). Henderson House., page 27 of 30

28 5 Summary of grades Quality of Care and Support Good Statement 1 Statement 3 Statement Very Good 4 - Good 4 - Good Quality of Environment Good Statement 1 Statement 2 Statement Very Good 4 - Good 4 - Good Quality of Staffing Good Statement 1 Statement 2 Statement Good 4 - Good 4 - Good Quality of Management and Leadership Good Statement 1 Statement 3 Statement Good 4 - Good 4 - Good 6 Inspection and grading history Date Type Gradings 7 Apr 2011 Unannounced Care and support 2 - Weak Environment 2 - Weak Staffing 2 - Weak Management and Leadership 2 - Weak 10 Mar 2011 Re-grade Care and support Not Assessed Environment Not Assessed Staffing Not Assessed Henderson House., page 28 of 30

29 Management and Leadership 2 - Weak 22 Nov 2010 Unannounced Care and support Not Assessed Environment Not Assessed Staffing Not Assessed Management and Leadership 4 - Good 21 Sep 2010 Unannounced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 4 - Good 14 May 2010 Announced Care and support 3 - Adequate Environment 4 - Good Staffing 3 - Adequate Management and Leadership 3 - Adequate 5 Mar 2010 Unannounced Care and support 2 - Weak Environment 3 - Adequate Staffing 2 - Weak Management and Leadership 2 - Weak 29 Sep 2009 Announced Care and support 2 - Weak Environment 3 - Adequate Staffing 2 - Weak Management and Leadership 2 - Weak 15 Jan 2009 Unannounced Care and support 3 - Adequate Environment 3 - Adequate Staffing Not Assessed Management and Leadership 3 - Adequate 1 Oct 2008 Announced Care and support 3 - Adequate Environment 3 - Adequate Staffing 3 - Adequate Management and Leadership 3 - Adequate All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Henderson House., page 29 of 30

30 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 SCSWIS. 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@scswis.com Web: Henderson House., page 30 of 30

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