Abbey Gardens Nursing Home Care Home Service Adults Lincluden Road Dumfries DG2 0QB Telephone:

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1 Abbey Gardens Nursing Home Care Home Service Adults Lincluden Road Dumfries DG2 0QB Telephone: Type of inspection: Unannounced Inspection completed on: 27 November 2014

2 Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 12 4 Other information 31 5 Summary of grades 32 6 Inspection and grading history 32 Service provided by: Voyage 1 Limited 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 Abbey Gardens Nursing Home, 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 5 Very Good Quality of Environment 4 Good Quality of Staffing 4 Good Quality of Management and Leadership 5 Very Good What the service does well Abbey Gardens provides continuity and consistency of care, with an established staff team, with many years experience working with the residents. The eight-bedded units allow for a more personalised and intimate level of interaction between the staff and residents. The manager and deputy demonstrated sound principles and commitment to delivering a person centred approach within the service. The home allows ample space for residents to wander around the large central atrium, situated between the four units and have access to the external secure garden areas. The service has managed to cope well with some complex and challenging behaviours. A strong person focused management, a consistent staff team and residents having the freedom to wander and express themselves, has assisted this. What the service could do better The manager and deputy need to ensure that they deliver training in dementia to all the staff team. This should include the framework for excellence model currently available. The manager needs to ensure that the support and supervision of the staff team is Abbey Gardens Nursing Home, page 3 of 34

4 consistent and that all staff appreciate and understand the principles and procedures for delivering this support to the staff team. The manager and deputy need to continue with the completion of the dependency levels assessment they are currently utilising. This should be done monthly to ensure any changes are recognised and addressed. What the service has done since the last inspection The service has continued to maintain the very good standards they have achieved. There has also been progress in addressing the recommendations made in the last inspection report. The service continues to focus on delivering good quality care and support to the residents of Abbey Gardens. The manager and deputy are open to advice and guidance about areas that could improve the quality of service for the residents. There is a positive attitude and willingness to seek to develop and improve the quality of the care and support provided. Conclusion Abbey Gardens provides a very good standard of care and support, there is a committed and consistent management and staff team who have developed a strong person centred ethos and culture within the service. Abbey Gardens Nursing Home, 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 Include one of the following: This 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 a condition of registration. Where there are breaches of the Regulations, Orders or conditions, a requirement must be made. Requirements are legally enforceable at the discretion of the Care Inspectorate. "The Care Inspectorate regulates care services in Scotland. Prior to 1 April 2011, this function was carried out by the Care Commission. Information in relation to all care services is available on our website at This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April Abbey Gardens is a care home for 32 older people with mental health problems. Their vision is to improve the quality of life for service users, customers, staff and investors and their mission is to deliver world-class outcomes for people with disabilities, in the highest quality residential homes, by providing innovative flexible and individual support. Their aims are "to provide a safe environment for those who have enduring mental health problems and require a high level of support, whilst still recognising that these individuals have the right to a life style that is happy, dignified and reflects the Abbey Gardens Nursing Home, page 5 of 34

6 concept of normalisation so that the Residents are seen as valued individuals within the community." The service provider is Milbury Care Services Ltd trading as Voyage. The service is located in a residential area close to a range of small shops and other local community facilities and provides a permanent residential service for older people who have mental health support needs (both organic and functional) and some associated sensory and physical disabilities. These disabilities may be complex and include enduring health conditions and behavioural support needs. The home consists of four units, each providing accommodation and support for eight residents according to their assessed need. Each unit has a sitting room, dining room, kitchen and bathroom/shower room. Everyone has their own bedroom with en-suite facilities. The home is single storey with large enclosed gardens. During the inspection there were 32 service users living in the home. They all received 24 hour care and support including a waking nightshift over seven days. Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 5 - Very Good Quality of Environment - Grade 4 - Good Quality of Staffing - Grade 4 - Good Quality of Management and Leadership - Grade 5 - Very 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. Abbey Gardens Nursing Home, 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 after unannounced inspection visits on the following days, Thursday 20 November 2014 between 13:00 and 17:00 Tuesday 25 November :00 and 14:00 Thursday 27 November 2014 between 12:00 and 17:00 We met with the manager, conducted a walk round of the premises, discussed the progress the service had made since the last inspection and any actions take to address requirements and recommendations made in the last inspection report dated 12 December We talked to residents and some visiting relatives; we reviewed the returned Care Inspectorate questionnaires and looked at the service's own annual review and quality assurance surveys. We received only one completed Care Inspectorate from a relative who was overall satisfied with the standard of service at Abbey Gardens. We looked at the service's own annual quality assurance reviews and found comments from other relatives about their satisfaction with the quality of the service provided. Some comments included, "I think the care is good." When asked, what do you feel works well? One relative commented, "When everyone works well as a team." "More choices of meals, etc sausages and mash instead of haggis." "We have always found the care and support to be excellent." "We find Abbey Gardens to be a very welcoming and friendly place to visit and for relative to live in." Abbey Gardens Nursing Home, page 7 of 34

8 "The layout of the building works well." "Communication between staff and residents always seems to work well." "The activities provided are a good mix and there is always something for everybody." "The menu is well varied and enjoyed by the residents." We received eight completed Care Inspectorate questionnaires from residents. When asked if they were overall satisfied with the quality of care and support provided. Four people strongly agreed with this statement and 3 agreed. One person failed to complete this section of the questionnaire. Some of the comments made included: "The home review of my personality and needs is very accurate." "Clean spacious and noise kept to a minimum." We reviewed the following documentation; * Certificate of registration * Employers liability insurance * Signing in register * Maintenance contracts * Servicing records * Daily weekly monthly maintenance checks * Fire procedures * Care Plans and reviews * Risk assessments * Health assessments * Medication records and procedures * Audits and quality assurance * Minutes of residents meetings * Minutes of relatives meetings * Minutes of staff meetings * Staff supervision and support * Recruitment procedures * Records of contact with other medical heath and social welfare professionals We spoke to the following number of people; Residents - 8 Relatives - 3 Manager - 1 Abbey Gardens Nursing Home, page 8 of 34

9 Deputy - 1 Care staff - 5 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 Abbey Gardens Nursing Home, page 9 of 34

10 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 manager. The service had identified what they thought they did well, and some areas for development. Taking the views of people using the care service into account From the 8 questionnaires we received from residents when asked, they were happy overall with the quality of the service provided. Four strongly agreed with this statement and 3 agreed. One person failed to complete that part of the questionnaire. "The home review of my personality and needs is very accurate." "Clean spacious and noise kept to a minimum." Taking carers' views into account We received one Care Inspectorate questionnaire from a relative. The following comments we noted from the returned quality assurance reviews of the service, undertaken by the manager. We spoke to three relatives during our inspection visits all were very happy with the service and standard of care and support provided. "I think the care is good." What do you feel works well? "When everyone works as a team." "More choices of meals etc sausages and mash instead of haggis." Abbey Gardens Nursing Home, page 10 of 34

11 "We have always found the care and support to be excellent." "We find Abbey Gardens to be a very welcoming and friendly place to visit and for relative to live in." "The layout of the building works well." "Communication between staff and residents always seems to work well." "The activities provided are a good mix and there is always something for everybody." "The menu is well varied and enjoyed by the residents." Inspection report continued Abbey Gardens Nursing Home, page 11 of 34

12 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: 5 - Very 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 grade awarded for this quality statement in the last inspection report date 12 December 2013 was 4 - Good. After meeting with the manager and talking to residents and relatives, we reviewed the documentation and evidence presented to support the strengths of this quality statement. We decided the service had improved over the year and has made progress in the participation and involvement of residents and relatives, in assessing the quality of the care and support provided. We have therefore increased this grade to 5 - Very Good. The service has met all three of the recommendations made under this quality statement in the last inspection report. The actions taken by us to review the progress of the service in addressing these recommendations are as follows: Recommendation 1 The service manager should ensure that all information included in the support plan is signed and dated by all people recording information in these. These should include, staff, service users and relatives. Where support plan information is specific, details should be clearly recorded showing the exact level of support needed to be carried out. National Care Standards, Care Homes for Older People Standard 5: Management and Staffing Standard 6: Support Arrangements Standard 8: Making choices Abbey Gardens Nursing Home, page 12 of 34

13 Actions taken to review the progress made in addressing this recommendation. We reviewed the care planning procedures and documentation; we found a very good ethos of person centred approach adopted within the written content. The style and layout of the files also reflected a user-friendly system with evidence of participation and involvement from residents, relatives, staff and other professionals. We discussed the care planning process and reviews, spoke to the manager and deputy about the kind of culture they wished to promote and develop within the staff team at Abbey Gardens. Both and the manager deputy demonstrated very good understanding and motivation towards implementing the principles of a person centred approach within the service. We checked documents and noted residents and relatives had signed as appropriate or other person holding legal authority. We noted that the descriptions of the physical assistance required were clear and easy to follow. Risk assessments we read, staff had completed with good detail and explanations. This recommendation is met. Recommendation 2 The service manager should consider how all service users in each unit of the home can be involved in assessing and improving the quality of care provided by the service, especially service users with communication difficulties. The service manager should consider distributing results from annual surveys to service users and relatives. National Care Standards, Care Homes for Older People Standard 5: Management and Staffing Standard 6: Support arrangements Standard 8: Making choices Actions taken to review the progress made in addressing this recommendation; Over many years, the staff team at Abbey Gardens have developed a close intimate personal knowledge of each individual resident, their support needs and in particular any communication issues. A consistent core of staff provides continuity to the delivery of the care and support. Staff understand the different ways dementia or other neurological or physical challenges affect an individual's ability to communicate verbally and succinctly. The manager and the deputy demonstrated a commitment to ensuring that the staff team supported all residents to express their choices, wishes and opinions. The service continue to investigate methods to ensure that people have the opportunity raise concerns or just be able to communicate their level of satisfaction and Abbey Gardens Nursing Home, page 13 of 34

14 happiness with the quality of the service provided. The service should continue to evidence and record the good work they have achieved in this area. This recommendation is met. Recommendation 3 The service manager should review the procedure for gaining feedback from service users, relatives and friends about staff performance as part of their supervision. They should review how this information is processed and recorded and how this reflects in any future learning and development and change in staff practice. National Care Standards, Care Homes for Older People Standard 5: Management and staffing Standard 6: Support arrangements Standard 8: Making choices We checked the staff support and supervision records and noted that although there was some good principles in play the general practice highlighted some gaps. There is a very good system of communication within the service; staff have the opportunity on a daily basis to talk with the manager or the deputy, both demonstrated openness and willing to listen. The management was committed to gaining information and feedback about the quality of the service provided. There was pride in their standard of work and desire to generate and garner ideas for future developments and improvements. This recommendation is met. Inspection report continued The manager printed off a daily chat newsletter with nostalgic items, memory tasks and quizzes that staff can sit with residents and discuss. There was a brunch club for residents and relatives to come and join for a coffee, cake and chat. Providing an informal support network for relatives and encourage some interaction, out with the formalised review meeting settings. This helped people feel at ease and welcome in the home. There was a compliments and complaints book for people to write down their issues of concern or express their appreciation with the home. This also offered the opportunity to make suggestions and ideas for developments within the home. Abbey Gardens Nursing Home, page 14 of 34

15 Areas for improvement The service should continue to maintain the very good standards they have achieved under this quality statement. 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 users' health and wellbeing needs are met. Service strengths The grade awarded for this quality statement in the last inspection report date 12 December 2013 was 4 - Good. After meeting with the manager and talking to residents and relatives, we reviewed the documentation and evidence presented to support the strengths of this quality statement. We decided the service had improved over the year and has made progress in ensuring resident's health and well-being needs continue to be met. We have therefore increased this grade to 5 - Very Good. We made two recommendations under this quality statement in the last inspection report. The progress the service had made in addressing these recommendations are as follows. Recommendation 1 The service manager should review the process of carrying out routine checks such as weighing everyone and assess each service user individually to ascertain whether routine checks are needed or not. Where restrictions have been placed on service users to access their personal belongings such as money, cigarettes and alcohol this should be routinely reviewed and evaluated with involvement of service users, advocates, relatives and any legal bodies involved in their care and support such as welfare guardians and powers of attorney. National Care Standards, Care Homes for Older People Standard 1: Informing and deciding Standard 3: Your legal rights Standard 6: Support arrangements Actions taken to review the progress of this recommendation; Abbey Gardens Nursing Home, page 15 of 34

16 The service has given residents a lockable safe in their bedrooms for the safekeeping of personal belongings. The service records all items of value and deals with any issues raised by residents and relatives relating to finances and personal monies. We checked the documentation in place covering adults with incapacity and power of attorney certificates. We noted all the documents we inspected were up to date and evaluated as part of the resident's regular care and support review procedures. We noted throughout the care plan documentation we inspected, evidence of regular involvement of other medical professionals, doctors and consultants in the assessment evaluation and review of individuals mental capacity. The manager and staff ensured that residents and their relatives were fully involved in this process. This recommendation is met. Recommendation 2 The service manager should review the process of staff completing service user daily activity sheets. She should consider how to discover service users personal aspirations and how they are encouraged to maintain their independence, retain current skills and relearn new ones to support them to remain as independent for as long as possible. This should be reviewed as part of the person centred care planning process. National Care Standards, Care Homes for Older People Standard 1: Informing and deciding Standard 3: Your legal rights Standard 6: Support arrangements Actions taken to review the progress of this recommendation We spoke to residents and relatives about how the staff and management interact with them to discover their personal aspirations, maintain independence, retain or learn skills to remain as independent as possible. As previously mentioned we reviewed the care planning documentation procedures that ensure residents wishes, choices and level of independence are maintained. These issues are regularly reviewed by the care staff as part of the monthly care planning evaluation process. This recommendation is met. Inspection report continued We checked the medication administration procedures and observed staff undertaking these procedures. The medication administration sheets were tidy and well presented with photographs of the individuals their prescribed medications and any allergies noted. There was a separate folder for as required medications. We checked that staff were following appropriate procedures and best practice Abbey Gardens Nursing Home, page 16 of 34

17 guidelines in the completion of the records. The manager and deputy implemented an auditing system to review the standards the staff were implementing. Overall, we found a good system of consistency and audits with action plans identifying errors and areas for improvement. We reviewed the care planning system in operation and spoke to the manager and the deputy about the philosophy and principles they hoped to install within the care planning system. There was a strong sense of purpose towards implementing a person centred approach and focus for the care plans. We saw evidence of participation and involvement with residents and relatives in gathering the information and presenting this with a person centred emphasis. The care plans contained information about the person's care and support needs, this was described in good detail and easily accessible within the documentation. We saw evidence of contact with other medical professionals and advice sought in dealing with issues that challenge the service. We witnessed staff interacting with residents in a dignified and personal caring manner. Residents and relatives we spoke to during this inspection visit confirmed their involvement in the development of the care plan in addressing their support needs. Areas for improvement The service needs to maintain the very good standards they have achieved under this quality statement. The manager needs to continue to document and record the evidence of the continued participation and involvement of the residents and relatives in assessing and evaluating the quality of the care and support provided. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Abbey Gardens Nursing Home, page 17 of 34

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 The grade awarded for this quality statement in the last inspection report date 12 December 2013 was 4 - Good. After meeting with the manager and talking to residents and relatives, we reviewed the documentation and evidence presented, to support the strengths of this quality statement. We decided the service had improved over the year and has made progress in the participation and involvement of residents and relatives, in assessing the quality of the environment within the service. We have therefore increased this grade to 5 - Very Good. Please refer to the comments we have made in quality statements 1.1, 3.1 and 4.1, to support the grade we have awarded under this quality statement. The smaller eight bed units allowed for a more intimate and personal feel to them. Residents were able to furnish their own bedrooms with personal items, pictures and ornaments to create a recognisable environment. In discussions with the manager, we saw other developments within the home that happened as a result of resident and relative input. Some of the changes to the large atrium area with couches to sit on, partitions to create private space for relatives to meet up, chat and have a coffee, stemmed from this input. Abbey Gardens Nursing Home, page 18 of 34

19 Areas for improvement The service should continue to maintain the very good standards they have achieved, under this quality statement. This should include continuing to gather evidence to support residents and relatives involvement and participation in assessing and improving the environment. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Statement 2 We make sure that the environment is safe and service users are protected. Service strengths The grade awarded for this quality statement in the last inspection report date 12 December 2013 was 4 - Good. After meeting with the manager and talking to residents and relatives, we reviewed the documentation and evidence presented to support the strengths of this quality statement. We decided the service had maintained this grade at 4 - Good. We made four recommendations under this quality statement in the last inspection report. The progress the service had made in addressing these recommendations are as follows. Recommendation 1 The service manager should consider how they could include service users and their relatives in their risk assessments. They should ensure that all people included in these are recorded and they are signed and dated. National Care Standards, Care Homes for Older People. Standard 5: Management and staffing Standard 9: Feeling safe and secure Action taken to review the progress of this recommendation We reviewed the risk assessment procedures and documentation. The manager and deputy ensured the completed documents identified issues of health and safety that could potentially result in injury. We noted again that residents and relatives were fully involved in this process in helping to identify areas of concern. Documents we inspected were signed and dated as required. Abbey Gardens Nursing Home, page 19 of 34

20 This recommendation is met. Recommendation 2 The service manager should consider the use of service user dependency levels to determine staff deployment on a daily and weekly basis. They should consult with service users and their relatives as part of this process. National Care Standards - Care Homes for Older People. Standard 1: Informing and deciding Standard 5 Management and staffing Standard 6: Support arrangements Standard 8: making choices. Action taken to review the progress of this recommendation We reviewed the dependency level assessment completed by the manager and the deputy. We advised on a more frequent review of the information to ensure any changing levels of individuals dependency is appropriately reflected. The manager uses this information to assist with the deployment of the staffing resources throughout the home. This recommendation is met. Recommendation 3 The service manager should ensure that service users have access to the care call system at all times. They should consider in particular how service users who are unable to access care calls can contact staff when they need them. The service manager should also review the process of routine checks taking place for all service users in each unit. Each service user should receive an ongoing assessment and review of their needs over a 24 hour period which is clearly detailed in their support guidance. National Care Standards, Care Homes for Older People. Standard 5 Management and staffing Standard 6: Support arrangements Standard 8: making choices. Standard 9: Feeling safe and secure Action taken to review the progress of this recommendation The manager had ensured that a full review of each individual resident's ability to utilise the care call system was undertaken. Instruction and guidance using the call system is part of the introduction procedures for new residents and this will become part of the review of care and support needs. Abbey Gardens Nursing Home, page 20 of 34

21 Each individual resident with capacity and physical ability to use the call system was given physical instruction and guidance to use the care system. The manager recognises that despite showing people how to operate the call system some may experience problems remembering this. We checked the evidence of these during this inspection process. The manager also ensured that each resident's level of understanding and ability would be included in their review of dependency levels. This recommendation is met. Recommendation 4 The service manager should review the process of storing service user's money in a locked area within the staff office and consider having locked areas in each service user's bedrooms. This process should be risk assessed and discussed with all members of their care team. National Care Standards, care homes for older people. Standard 5 Management and staffing Standard 6: Support arrangements Standard 8: making choices. Nursing Home, page 28 of 41 Standard 9: Feeling safe and secure Standard 16: Private Life Action taken to review the progress of this recommendation The service has developed implemented changes to this and has put safes in each resident's bedrooms to allow safe storage of personal items and monies. This was working well for some residents who retained the ability to gain some benefit from this facility. However, other residents due to cognitive impairment have limited use of this and relied on staff to supervise and control the content of the safes. The service continues to monitor the residents and their ability to utilise this facility. This recommendation is met. Inspection report continued The home has a secure keypad entry system, to ensure that no-one can access the building without authorisation. There is a small rectangular entrance vestibule, which then opens out into a large central foyer atrium. We reviewed the maintenance records and servicing histories for the utilities. We checked the gas safety certificates, servicing records for manual handling equipment, PAT testing, legionella, fire alarms and call systems. There was an overall good standard of documentation covering all appropriate areas of care home maintenance. There was access to a maintenance person who provided support to the manager in meeting the requirements of providing a safe environment Abbey Gardens Nursing Home, page 21 of 34

22 for the residents. The main doors to each unit are unlocked and allow freedom to wander access and for residents to wander in and out their own individual units and into the large central atrium area. We witnessed several residents with various levels of dementia or other neurological difficulties enjoying the freedom to just wander and be free to express themselves. This helped to reduce agitated behaviour and reliance on medications. There was a large room used for group activities, crafts and arts, meetings and training for staff. There was access to the garden areas at the end of each corridor in the sitting room areas of the individual units. This allowed residents with the physical ability and opportunity to push open doors and walk out into the garden on their own volition. The large central atrium was used for entertainment and larger events. This gave relatives and residents the opportunity to meet and chat somewhere out with their bedroom. This large open area gave residents the chance to wander freely between the different areas of the home. We saw several residents enjoying their time wandering and watching the traffic of the daily life of a care home. Areas for improvement The service has done well to maintain the grades for this quality statement. However, they need to consider ways to make the improvements to communal areas of the home such as bathrooms to ensure they are up to date and of a good standard. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Abbey Gardens Nursing Home, page 22 of 34

23 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 The grade awarded for this quality statement in the last inspection report dated 12 December 2013 was 4 - Good. After meeting with the manager and talking to residents and relatives, we reviewed the documentation and evidence presented to support the strengths of this quality statement. We decided the service had improved over the year and has made progress in the participation and involvement of residents and relatives, in assessing the quality of the staffing in the service. We have therefore increased this grade to 5 - Very Good. Please refer to the comments we have made in quality statements 1.1, 2.1 and 4.1, to support the grade we have awarded under this quality statement. The manager encouraged an open dialogue with residents and relatives, to assist with the communication about issues relating to the staffing. Several methods from formal reviews, satisfaction surveys or informal discussions helped the manager to collate and respond in various ways to the information about the quality and standard of the staff team. Areas for improvement The service should continue to maintain the very good standard they have achieved under this quality statement. The manager needs to continue to gather and document evidence to support the good work of the staff team at Abbey Gardens. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Abbey Gardens Nursing Home, page 23 of 34

24 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths The grade awarded for this quality statement in the last inspection report date 12 December 2013 was 4 - Good. After meeting with the manager and talking to residents and relatives, we reviewed the documentation and evidence presented to support the strengths of this quality statement. We decided the service had maintained this grade at 4 - Good. Service strengths Recommendation 1 The service manager should ensure that all staff have a good awareness and understanding of the Dumfries & Galloway Council's Multi-Agency Adult Support and Protection Procedures, which will include intervention when a specific situation arises that puts them and others at risk of harm. The service provider should also ensure that their policies and procedures refer to local ASP guidelines for staff to follow. National Care Standards, Care Homes for Older People Standard 3: Your legal rights Standard 4: Your environment Standard 5: Management and staffing arrangements Standard 9: Feeling safe and secure Action taken to review the progress of this recommendation We reviewed the service's policy and procedures for adult support and protection. We checked previous notification history and saw that the service acted appropriately when addressing any potential ASP reporting incidents. We spoke to the manager, deputy and staff members about ensuring the safety of vulnerable adults and found them to be knowledgeable of the issues and principles involved. The manager ensured that through individual supervision and team meetings with the staff this would become part of their competency based assessments for the staff team. We were satisfied that the service was competent in dealing properly with any potential adult protection incidents. This recommendation is met. Inspection report continued Abbey Gardens Nursing Home, page 24 of 34

25 Recommendation 2 The service manager should ensure that all staff have a good understanding of the person centred planning process including working in partnership with service users and relatives. Staff should display good values towards service users and relatives at all times. National Care Standards, Care Homes for Older People Standard 3: Your legal rights Standard 5: Management and staffing arrangements Action taken to review the progress of this recommendation During our inspection visits, we spoke to several members of staff, the manager and the deputy. Everyone expressed a desire and motivation in assisting people to be as independent as possible. This was evident in the positive interactions between residents and staff we witnessed. The care staff we spoke to demonstrated a good understanding of the importance of ensuring the person is the focus of any care interventions. This means that they are able to express their views, wishes and aspirations. This recommendation is met. The manager arranged regular meetings for the staff team at Abbey Gardens. We saw agendas, minutes and action plans recording the developments and changes implemented because of these communication meetings. The manager and deputy were keen to receive this input from the staff and the response from the service was to improve and develop the service. We reviewed the staff training plan and noted the manager was aware of the training requirements for the staff and had implemented appropriate levels of training opportunities to address these issues. Staff we spoke to confirmed they felt the service offered them good opportunities for training. We checked the staffing rotas and noted that the home operated within their staffing schedule and utilised their dependency assessments to ensure they were enough staff on duty to meet the needs of the residents. As previously mentioned in one of the recommendations made in the last inspection report, we reviewed the support and supervision of the staff team and found the manager had undertaken this. Although, some staff stated in their questionnaires that they did not receive regular supervision from the manager. (See areas for development.) Abbey Gardens Nursing Home, page 25 of 34

26 Areas for improvement In the returned Care Inspectorate questionnaires two staff answered no when asked if they received regular supervision from the manager. The manager needs to ensure that all staff feel supported and that they fully understand who is responsible for their regular supervision. The manager needs to ensure that all staff fully understand the support and supervision procedures and policies. The manager needs to ensure that the training opportunities for the staff continues. This should include all mandatory requirements, updates and refresher courses. The manager should monitor this and continue to make this part of the personal development of individual staff. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Abbey Gardens Nursing Home, page 26 of 34

27 Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 5 - Very 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 The grade awarded for this quality statement in the last inspection report date 12 December 2013 was 4 - Good. After meeting with the manager and talking to residents and relatives, we reviewed the documentation and evidence presented, to support the strengths of this quality statement. We decided the service had improved over the year and has made progress in the participation and involvement of residents and relatives, in assessing the quality of the management and leadership of the service. We have therefore increased this grade to 5 - Very Good. The manager and staff team utilise a number of methods to gain feedback and evaluation assessment and evaluation of the quality of the service provided. They ensure that residents and relative's opinions are collated and analysed to assist with the development of the service. The manager operates an open door policy and is approachable and welcoming in encouraging feedback and contact with residents and relatives to ensure that people have an opportunity to talk and discuss areas of concern as well as giving positive responses and positive comments. We confirmed this positive feedback and service level satisfaction whilst talking to residents and relatives during our inspection visits and reviewing the responses from Care Inspectorate questionnaires and the service's own quality satisfaction surveys. Areas for improvement The service should continue to maintain the very good standards they have achieved under this quality statement. This should include evidence to support the continued Abbey Gardens Nursing Home, page 27 of 34

28 involvement and participation of residents and relatives in the process of assessing the quality of the management and leadership. Grade awarded for this statement: 5 - Very 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 The grade awarded for this quality statement in the last inspection report date 12 December 2013 was 4 - Good. After meeting with the manager and talking to residents and relatives, we reviewed the documentation and evidence presented to support the strengths of this quality statement. We decided the service had improved over the year and has made progress in the participation and involvement of residents and relatives, staff and stakeholders in assessing the quality of the care and support provided. We have therefore increased this grade to 5 - Very Good. We made two recommendations under this quality statement in the last inspection report, the progress made by the service and how we reviewed this is as follows. Recommendation 1 The service manager should review the quality assurance checks they have in place. They should consider how the 'support plan audit' and 'monthly' and 'three monthly' quality assurance checks can include clear detailed information which shows areas for improvement identified and how they have been successfully addressed. National Care Standards, Care homes for older people Standard 5: Management and staffing arrangements Action taken to review the progress of this recommendation We reviewed the service's quality assurance systems and auditing procedures. We checked completed audits and the subsequent action plans detailing the response to findings from the audits. Abbey Gardens Nursing Home, page 28 of 34

29 The organisation's operations manager supports the home manager in reviewing the monthly audits. We saw evidence to support the manager actively sought information and feedback from residents and relatives as part of these processes. We spent time discussing with the manager the deputy their understanding of these procedures, their experience and expertise as well as their values and attitudes when undertaking these audits. Overall, we found a good base of knowledge and competence in these processes were satisfied they had addressed the issues of this recommendation. This recommendation is met. Recommendation 2 The service manager should ensure that where any audits and quality checks identify any issues around poor staff practice, this is recorded and discussed as part of staff supervision, and at the next supervision identify what action has been taken to ensure the issue had been resolved. National Care Standards, Care homes for older people Standard 5: Management and staffing arrangements Action taken to review the progress of this recommendation We discussed with the manager and the deputy the support and supervision procedures within the care home. We inspected the documentation and talked to the staff about the contact and support offered from the management. We spoke to residents and relatives about their involvement with assessing and evaluating the quality of the staff within the service. We reviewed the documentation and saw that the manager and deputy had forward planned dates for support and supervision with the various members of the staff team. This recommendation is met. Inspection report continued The manager and the deputy provided evidence of regular correspondence and communications with medical professionals and other agencies to ensure they implemented a multi disciplinary approach within the service. There was a sense of confidence and professional respect for the way the service managed challenging cases. The environment and ethos of care allowed people with dementia or behaviours that challenge an opportunity to express themselves safely whilst living in Abbey Gardens. Abbey Gardens Nursing Home, page 29 of 34

30 Areas for improvement The manager needs to continue to maintain the good standard of auditing that we inspected during our visits. The manager should continue to implement the use of action plans to address any issue raised. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Abbey Gardens Nursing Home, 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 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). Abbey Gardens Nursing Home, page 31 of 34

32 5 Summary of grades Quality of Care and Support Very Good Statement 1 Statement Very Good 5 - Very Good Quality of Environment Good Statement 1 Statement Very Good 4 - Good Quality of Staffing Good Statement 1 Statement Very Good 4 - Good Quality of Management and Leadership Very Good Statement 1 Statement Very Good 5 - Very Good 6 Inspection and grading history Date Type Gradings 12 Dec 2013 Unannounced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 4 - Good 11 Jan 2013 Unannounced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 4 - Good 8 Sep 2011 Unannounced Care and support 4 - Good Environment 4 - Good Staffing Not Assessed Management and Leadership Not Assessed Abbey Gardens Nursing Home, page 32 of 34

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