Gilmerton Neurodisability Unit Care Home Service

Transcription

1 Gilmerton Neurodisability Unit Care Home Service 9 Moredunvale Road Moredun Edinburgh EH17 7QU Telephone: Type of inspection: Unannounced Inspection completed on: 13 November 2017 Service provided by: Four Seasons Health Care (Scotland) Limited, a member of the Four Seasons Health Care Group Service provider number: SP Care service number: CS

2 About the service Gilmerton Neurodisability Unit (also known as the Wilson Unit) is a care home for 15 adults with neurodisabilties. It specialises in acquired brain injury and motor neurone degenerative illness with palliative care. The Unit is located in a wing of a purpose-built care home, but holds a distinct registration and its own staff and management. Accommodation is on the ground floor and comprises 15 en-suite bedrooms, a communal lounge, dining room with mini kitchen and a small quiet/meeting room. It shares a main entrance, gardens/grounds, catering and laundry facilities with the care home. The home is situated in a residential area, in the south of the city of Edinburgh. There are local amenities nearby, such as shops and local services. The home is also close to main bus routes. The service is provided by Four Seasons Healthcare Group. The service has been registered with the Care Inspectorate since 18 March At the time of the inspection the service was caring for 15 people. Care was delivered by a manager, team leader, a team of nurses, a neuro- physiotherapist and care staff. What people told us Prior to the inspection we received 14 Care Standards Questionnaires (CSQs), most were completed with staff assistance, two were completed with family assistance. People indicated that overall they were satisfied with the quality of care that this service provided. During the inspection we met all of the residents. We spoke to some individually. Due to the extent of their cognitive ability, some people were unable to offer their views on the service. We joined most residents for lunch in the dining room on two days. We also dropped in to the newspaper discussion, a seated ball game session and a bingo afternoon. Comments from residents included: "My care plan sums me up. Staff are helping to get me out in the community more and to get a job. Staff take me out a lot on shopping trips and social outings. I also go out with Artlink to the theatre. I feel safe and know doors are locked at night and staff are always here. I am happy with everything and I am allowed to go and chat with other staff, such as the office staff". "I am happy with everything. Staff are aware that I need to spend a lot of time in my bed due to my condition. I don't like change". "Staff look after me and are good to me. I have confidence in them". "I have a good relationship with staff and residents". "I am happy with my support plan. Staff like working here so they stay for a long time. Staff understand when I need time on my own". page 2 of 8

3 "I am always safe and well looked after. Staff are always happy to make me feel contented. They are excellent with me. Most of the staff have been here since I've been here. The service is excellent. The service does a great job". "I like the service, they look after all my needs. I get the care I need. Staff are good. They have mostly been here for a long time. I am treated very well. They make time to listen when I want to speak to them. I ask staff for something and they always do their best for me. I am happy and content with my home and care given and try not to shout at staff and give my apologies when I do". "I would like to have more independence in and out of the unit. Staff do listen to me and do their best to help. Sometimes I feel staff could give a little bit more time, as when they are busy they say they will come back but I have a tendency to forget what I was saying". We met three family members who were visiting during the inspection and received comments from three more. Comments from relatives included: "I visit regularly and I am satisfied with the care given. My relative seems quite content". "We are happy, there's no issues". "My relative is loved here. There's brilliant and intuitive nursing. The staff are helpful, skilled and trained. They take good care of skin, nails and hair. They anticipate her needs. The younger staff have a vibrant energy. If I were not around, the fact my relative is in here helps me feel it would be fine. We call it a palace. It never smells. The food is amazing, tender and fresh. I can come for Sunday dinner. The staff are proud of the unit and of their knowledge base. The manager runs an incredibly tight ship. They deserve praise for what they do". "Our visits are usually without notice and we never have any issues. There was a recent near miss incident when our relative was fed through his mouth when it clearly stated that he is fed via a PEG tube. This was carried out by an agency worker whose first language was not English. I am not sure whether this was a part of the problem, i.e. comprehension. Because of the difficulties he has in communicating verbally he was not able to stop this happening and this means that staff need to be extremely vigilant with him. However, Gilmerton managed this incident well, were open and honest about what had happened and apologised and indicated that changes would be made so that such an incident would not occur again. His main carers appear to have very good and caring relationship with him and are able to understand his needs. On the occasion of the funeral of our mother earlier this year, the carer's accompanied him to the funeral and took exceptional care of him during a very difficult time. Their sensitivity and level of care was much appreciated by all of the family". "The service is fantastic. It is person centred. The staff know my relative as a person. Some staff have been there for a number of years. There's a warm, nice atmosphere. Since moving there, the difference in him is quite profound. He is content and happy, which makes the rest of family happy. His room is always tidy, his clothes are put away. The staff are proactive, for example, they are prompt in phoning if there's anything. He goes on holiday a couple of times a year. They do group activities but also individual things. He likes to be sociable but also likes the TV and listening to music in his room. I suggested an ipod, and they got this within a couple of weeks. He has physiotherapy. The service has reduced the amount medication he takes, which means we see as much of him (personality and character) as we can, without him being sleepy. I am invited to review meetings. Sometimes we do this over phone. Staff are approachable and knowledge, willing to engage and keep me informed. I am confident in their decision-making and suggestions. I have a lot of trust in them and feel they know him best. I am delighted with the service. It provides a very high standard". Comments from professionals included: page 3 of 8

4 "When (service user's name) came for his first visit to our day service he was accompanied by the manager of the Unit. It was helpful to meet her in order to set up his placement, his initial support plan and future communication channels between the two services. A member of staff from the Unit also attended his new member's interview. He appeared to get on very well with her and seemed to trust her. She knew him well and was able to support him effectively to participate in his interview. Her contributions were also helpful in order to get to know him and set out his care needs, aspirations and desired outcomes. This staff member brings him to our service most days, thus we have met her regularly and communication has been good. The service user is very enthusiastic about special events at our service and at his home, but the anticipation in the run up to an event can also increase his overall anxiety. The two services have kept each other up to date on this, so we can support him to enjoy the occasions fully. Staff at the Unit supported him to come dressed as Elvis and bring his guitar to our recent Fashion Show. In this way he could make a fantastic contribution to the show, which made him and others very happy. I understand that he speaks positively about his life at home. He mentions the evening meals that he likes, events and visits to the theatre. A couple of times he was picked up late and we understand that unexpected events at the Unit may require immediate attention. We have communicated that it would be helpful to know if staff might be late and this was taken on board and they will now be in touch with our receptionist to let her know". "The service is doing really well with people's oral care. Staff are going to be undertaking the 'Caring for Smiles' foundation level of training". Self assessment We are not requesting self-assessments from providers for this inspection year. Issues relating to quality assurance, acting on feedback from people using the service and the quality of the service's improvement plan are considered throughout the inspection. From 1 April 2018 the new "Health and Social Care Standards" will replace the existing Care Standards. These Standards seek to provide better outcomes for people who experience care, and services should now be familiarising themselves with these. We would encourage services to prepare for the implementation of the standards by working with staff and people experiencing care to raise awareness and explore what they mean in their specific setting, and consider how they impact on their work. From this inspection we graded this service as: Quality of care and support Quality of environment Quality of staffing Quality of management and leadership 5 - Very Good 5 - Very Good not assessed not assessed What the service does well We observed caring and genuine interactions with residents. People could be reassured that the service was maintaining its high standard of compassionate care, in accordance with the new Health and Social Care Standards, available at: page 4 of 8

5 People were valued and respected as individuals and their opinions were listened to. Their needs were assessed and regularly reviewed to ensure that they received the right care. Staff had an enabling attitude which helped people to get the most out of life. The service had a dedicated activities leader (PAL) who organised day-to-day activities in the home, such as a chair exercises, a Halloween party, as well as regular outings and special events. There was an activities plan on display for each week and new ideas were welcomed. Some people chose to spend more of their time in their own rooms and we saw that this was recorded and respected. People could also opt for some individual activities rather than group events, for example, Christmas shopping trips. Improving or maintaining people's independence, comfort and health was paramount: - Over the course of a year one person was regaining strength and confidence in walking and was proud to show his progress using a new walking aid. - Hydrotherapy sessions were much enjoyed and delivered benefits for several residents. - A new ergonomic shower chair had been purchased, enabling those with very limited mobility to get the best experience. - Two new overhead hoists meant safer care for taller people. - One person had a new postural support sleep system. These special pillows meant they were much more comfortable, potentially reducing head and neck pain. The service was proactive in solving problems: - Exploring all options for better communication with people. - There had been successful intervention with continence management. - Liaison and agreement with the GP meant one person could be given preventative treatment for chest infections, reducing the likelihood of hospital admission. The service worked very well with professional colleagues/agencies. For example: the service was working well with Caring for Smiles (Scotland's national oral health promotion, training and support programme); there was very good communication with a day service attended by one person. Prompt action following a recent incident had reduced the risk of harm. The manager said that use of agency staff was minimal and that changes had been made to the tasks which would be allocated to any agency staff to reduce the likelihood of a repeat occurence. The manager had kept all parties informed. Care records, including personal plans, risk assessments, reviews and medication records were very well maintained and up to date, providing clear guidance for staff. In each person's room there were individual booklets recording people's preferences, what's important and how to support them and a journal where residents, staff and visitors could add comments. We welcomed the provider's plans to develop more of a personal outcomes approach to care planning. The manager was considering a 'life star' tool for measuring and recording change and progress. Staff maintained high standards in the unit, ensuring an attractive, homely and safe environment. People had been supported to personalise their own rooms and to make themselves as comfortable as possible in their surroundings. Records evidenced regular quality and safety checks. The staff team was settled, knowledgeable and enthusiastic. Staff were qualified or being supported to achieve appropriate qualifications. Staff worked well together to the benefit of service users, ensuring a harmonious environment. The service had performed highly in the provider's recent staff engagement survey. page 5 of 8

6 The service kept up to date with good practice. For example, two managers had attended adult support and protection training with the City of Edinburgh Council and found this to be very informative. Training had been requested for more members of the team. The service had acted on our suggestions from the previous inspection and had demonstrated an improvement focus by seeking additional guidance in between inspections. What the service could do better An increase in the activities provision would allow people more one to one time and more regular hydrotherapy sessions. One shower room had intermittent drainage problems which were still to be resolved. The service should explore how to meet new health and social care standard 5.7: 'the premises are designed and organised so that I can experience small group living, including access to a kitchen, where possible'. As this is the only specialist neurodisability service the provider operated in Scotland, we repeated a suggestion for a dedicated development/strategic plan for this service. We made a small number of additional suggestions and directed the manager to some information/resources, for example: Arts in Care, available at: Requirements Number of requirements: 0 Recommendations Number of recommendations: 0 Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at page 6 of 8

7 Inspection and grading history Date Type Gradings 17 Nov 2016 Unannounced Care and support 5 - Very good Environment Not assessed Staffing 5 - Very good Management and leadership Not assessed 8 Mar 2016 Unannounced Care and support 5 - Very good Environment 5 - Very good Staffing 4 - Good Management and leadership 5 - Very good 25 Nov 2014 Unannounced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and leadership 4 - Good page 7 of 8

8 To find out more This inspection report is published by the Care Inspectorate. You can download this report and others from our website. Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and help services to improve. We also investigate complaints about care services and can take action when things aren't good enough. Please get in touch with us if you would like more information or have any concerns about a care service. You can also read more about our work online at Contact us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com Find us on Facebook Other languages and formats This report is available in other languages and formats on request. Tha am foillseachadh seo ri fhaighinn ann an cruthannan is cànain eile ma nithear iarrtas. page 8 of 8