Dun Eisdean (Care Home) Care Home Service

Transcription

1 Dun Eisdean (Care Home) Care Home Service 44 Westview Terrace Stornoway HS1 2LD Telephone: Type of inspection: Unannounced Inspection completed on: 8 August 2017 Service provided by: Comhairle Nan Eilean Siar Service provider number: SP Care service number: CS

2 About the service This service registered with the Care Inspectorate on 1 April The care home has however been operational within the same premises for approximately four decades. The care home is owned and managed by the local authority, Comhairle na Eilean Siar. Dun Eisdean is registered as a care home for up to 38 older people. One bedroom is allocated for emergency provision and the remaining bedrooms are available on a long terms basis. Although historically the home has had twelve beds which they identified as being a "dementia unit" they are now in the process of changing how they organise the service, and allocate staffing, to reflect the needs of the whole home population, many of whom are living with dementia or other cognitive impairment. All bedrooms in the home are en suite (toilet and wash basin only) and there are also a number of communal sitting areas as well as a separate dining room. What people told us We were able to get the views of some people experiencing care in the service, and also from their relatives and carers. We spoke with and heard the views of 4 people living in the home, and 8 relatives and carers, during the inspection. We also had questionnaires returned to us from 17 relatives/carers and from 7 residents. Comments made were as follows : "The service is very expensive for the quality that is offered. There are often no staff in the dementia day unit at the weekend when we visit ( busy elsewhere) and this does cause concern when residents disagree with each other. It is also a cause for concern in case my relative should decide to try and go to the toilet by herself and falls. What would happen? The meals are of a poor quality despite being told that they are of a good nutritional value, e.g cold, low quality fish fingers and mashed potatoes - no veg". "We as a family feel Dun Eisdean is a wonderful care home and all the staff are remarkable, very fortunate to have such a great care home on the Island knowing that our loved one is safe and well taken care off". "Dun Eisdean is a wonderful home - the staff are fantastic, they look after my relative so well. I can't imagine her getting better care anywhere.... visit often, they are always so welcoming or helpful to us. They are also great at keeping me up to date on my relative's health, and are very friendly when I call, no matter how often and how busy they are. I am, and will always be so grateful to them all". "Planned activities and entertainment- my relative is always asked to join but often refuses, but has attended some activities - her choice. Meals - There is always 2 choices - if my relative refuses a meal, she is always given a sandwich, yoghurt, fruit, tea so that she will have something to eat. - new staff I know it takes time for new staff to know each person, and their care plans and their personality. Care of hearing aids, making sure batteries are working and placed in hearing aids are important for my relative to communicate. Change of staff Lately staff have been rotating in different parts of care home. Unfamiliar faces can unsettle my relative, changes are unsettling. I feel rotation of staff is fine when they are short of staff but I feel it is better that long term staff in unit should always be there, they know each person's ways and they know their care page 2 of 9

3 plans. Also I feel when the usual staff are there I am more at ease. All staff are very caring and attentive, it is changes that bother me". Our family are totally happy with the care he ( our relative) is getting". " Very well treated and seems to be happy and enjoys her outings and the ceilidhs". " Prior to being admitted my relative went to other care homes in Stornoway for a visit and advised me of a desire to live in Dun Eisdean should a place become available. Fortunately it did... and I have peace of mind knowing she's there. The only real issue I have, and its a small one (relative to the standard of care and the excellent way she is cared for is : the home are rotating staff now so that all staff can work in either the dementia unit or the main side of the home, but on occasions I have phoned to see how my relative is, and I find that staff aren't quite sure although they do check her care log sheet and answer any questions I might have. But previously when the unit had their own staff team they knew how my relative was and were able to give information quite readily. I just wonder how the residents cope with this. I can appreciate why it's done though. Dun Eisdean has always had very high standards. It's clean and welcoming, and has staff committed to providing a high standard of care, all approachable, and manager is lovely. In closing I have to say I wouldn't want my relative anywhere else, she is definitely in good hands". Self assessment The Care Inspectorate has not requested services to complete a self assessment for this inspection year. The service has begun to collate their development plan. We were able to see that these, albeit still informal, evidenced what areas the service had identified for further development and improvement. 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 not assessed not assessed What the service does well We assessed that Dun Eisdean was providing very good standards of care and support. There were important strengths which made a significant contribution to the residents' health and happiness. There was a warm, welcoming atmosphere evident in the care home. Staff supported people in a kind and caring manner and we observed people to look well cared for, with an attention paid to detail, as regards personal care and grooming. The care home premises are clean and tidy. Although the building may now have limitations, we observed them to retain a comfortable and homely feel. Residents are supported to personalise their own bedrooms, and sitting rooms are arranged in a way so as to encourage small groups to converse. page 3 of 9

4 A key strength of this service is the stability, motivation, and extensive experience of individual staff in all different roles, throughout the home. Staff turnover has been low, and many of those working in the service have extensive experience of delivering care. The interactions between staff and residents was good, and it was clear that staff clearly knew individuals well. Staff demonstrated that they had a good understanding of each person's different needs, and also of preferences and preferred routines. We saw evidence that there was a responsive approach towards ensuring health care needs were being met. Healthcare professionals, nurses and GP's were called quickly when this was required and we observed staff to be vigilant towards any changes that took place or to any advice that they needed to follow. Mealtimes seemed well organised occasions. There was a choice of meals, and we concluded that the menus offered a good variety of traditional home cooked meals. We observed that specific requests made for alternatives at mealtimes were easily made available. Appropriate levels of support were available to those who needed this assistance to enjoy their meal so that people could enjoy their meal in a pleasant and dignified manner. The organisation was working to further develop meal provision within care homes, working alongside dieticians, to inform menu planning, and meeting the needs of people with specific dietery needs. There were different ways people using the service, or their families, could give their views on the service. People we spoke with during the inspection told us that staff and management were approachable and that they felt that they were listened to, and they felt confident that any points they raised would be acted upon. People told us that they were kept up to date with any changes to their relatives' health needs. We concluded that this standard of communication promoted the overall evident satisfaction with the service which people seemed to experience. We felt that the service had made some good progress in how they arranged and organised activity provision. This included both from the activity worker on the three days she is present, and care staff on the other days. The service has devised a good activity daily planner which we concluded had a good range of interesting and meaning activities on offer. We saw people being supported to enjoy the garden area during pleasant weather, and we heard from a resident who had enjoyed being in the poly tunnel for gardening activities. We discussed at feedback areas where activity provision could be further developed in the service so as to ensure that the needs of all residents were considered. We could see that the management and staff team had been working hard over the last while to maintain and improve standards in the home. We saw that a more focussed approach towards service improvement had been started, and we now look forward to following up on progress at the next inspection. What the service could do better Care plans should be more detailed and should better inform staff as to needs. Although some care plans had some very good personal information, and in particular, details about individual preferences, there was an apparent variation in the standard of content and there were apparent inconsistencies in how assessments (e.g skin care, nutrition, falls, mobility, health needs) were completed, and subsequently in the detail of information contained within support plans. While reviews were clearly taking place, there are ongoing issues within the timeframes for these, and the care service continues to experience difficulties in ensuring the attendance of key professionals, such as social page 4 of 9

5 workers, at review meetings, which can create difficulties for people who do not have other representation and who have impaired capacity. ( See Recommendation 1) Although overall we noted that the administration of medication was being well supported in the service, we highlighted that the standard of record keeping for topical medicines was inconsistent and required closer monitoring to ensure that these prescribed medicines were being used as directed by the medical practitioner. ( See Recommendation 2) Sometimes detailed recording tools had been put in place to help staff accurately assess what was required in key areas of health and wellbeing. We saw that these were being appropriately put in place to track, for example, food and fluid intake or skin care needs (including repositioning). However, these needed to be accurately completed, so that they could then be used to inform any changes to support plans, or to guide any health interventions that may be necessary. (See Recommendation 3). We also concluded that while good standards in terms of supporting good skin care were apparent, staff would benefit from further knowledge regarding the use of pressure relieving equipment. We highlighted that a more rigorous application of audits in some of the areas outlined above would, along with additional staff development, assist the service to make the necessary improvements. ( See Recommendation 4). On a similar note we identified that PAT testing (although started while the inspection was on going) had been out of date for over two months and outstanding remedial factors with the latest Fire Masters Report had not, (although now has) been actioned. We concluded that more regular checks across all areas of service provision would assist them to identify issues requiring resolution. We observed a couple of arm chairs in use in the home which we concluded required replacement as we noticed they had become stained, despite frequent cleaning. We advised that the service should ensure that they check that all seating is appropriate to the needs of residents, and also takes into account the best practice advice issued by the NHS Infection Control Nurse Specialists who audited the home following a recent outbreak of infection. (See Recommendation 5). At the last inspection we made a requirement about how accidents and incidents were documented and monitored. Positively the organisation had made some progress with this, by convening a health and safety and governance committee who meet regularly to oversee this aspect of service. The service provider had also begun some work on falls management and prevention, which had been identified as a risk which some residents were vulnerable to. However, we noted a number of areas where improvements were still indicated to promote a safe care environment. Some accident and incident form were still not being completed in enough details to support the subsequent formal evaluation of what had occurred. It was not always clear that risk assessments were properly completed, or routinely reviewed as a result of any occurrence. We also noted that the service had not alerted us to a number of accidents which took place in the home as they were required by law to do. ( See recommendation 6). We made a recommendation at the previous (2016 ) inspection regarding staff training opportunities. We concluded that many of the issues identified at that time remained outstanding and that tangible progress in training provision was difficult to identify. The service have themselves worked well to improve training records and have devised a work plan that will allow for the delivery of in house training in some key areas. However, page 5 of 9

6 training can still be hard to access, new staff can be working for some time without accessing training assessed as being core, some training on the plan seems to not be provided, medication and training identified last year as crucial for this staff group (stress and distress in dementia, although planned has yet to be provided. ( See previous recommendation). Requirements Number of requirements: 0 Recommendations Number of recommendations: 6 1. The service should have in place care plans which inform, and will support staff to provide consistent care which meets service user needs. To ensure this the manager should ensure that : a) Care plans are completed in a timely manner when people are admitted. b) Care plans are updated as necessary and when needs change. c) Care Plans are regularly reviewed every six months and detailed records are held to support the outcomes of these discussions. d)detailed risk assessments in all areas relevant to the person are in place, are regularly updated, and are used to properly assess support needs. National Care Standards Care Homes for Older People Standard 6 Support Plans 2. The service should ensure that appropriate records are maintained which support and evidence the administration of topical medication. National Care Standards Care Homes for Older People Standard 15-9 Keeping Well - Medication 3. The service should ensure that any supplementary records such as food and fluid charts, repositioning charts, deemed necessary to inform the planning, evaluation and provision of care are accurately completed by staff. These should then be used evaluatively to inform care. National Care Standards - Care Homes for Older People - Standard 5-1 Management and Arrangements 4. The service should review their audit system to ensure that these are effective in identifying gaps, or where improvements can be made. National Care Standards - Care Homes for Older People - Standard The service should replace chairs which are not of a standard appropriate to a care service. In replacing worn or stained items the service should take into account the best practice guidance issued to them in terms of up to date infection prevention and control. National Care Standards - Care Homes for Older People - Your - Standard 4-3 page 6 of 9

7 6. The service need to further improve how they document, evaluate, and demonstrate that when required, they adjust support plans, following an accident or incident. The service also needs to inform Care Inspectorate of incidents or accidents, as the law requires. Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at Inspection and grading history Date Type Gradings 3 Nov 2016 Unannounced Care and support Management and leadership 13 Jan 2016 Unannounced Care and support Management and leadership 24 Nov 2014 Unannounced Care and support Management and leadership 3 Dec 2013 Unannounced Care and support Management and leadership 7 Dec 2012 Unannounced Care and support 5 - Very good 5 - Very good 5 - Very good Management and leadership 5 - Very good page 7 of 9

8 Date Type Gradings 12 Aug 2011 Unannounced Care and support 5 - Very good Management and leadership 5 - Very good 14 Feb 2011 Unannounced Care and support Management and leadership 9 Jul 2010 Announced Care and support 2 - Weak Management and leadership 4 Mar 2010 Unannounced Care and support 6 - Excellent 2 - Weak Management and leadership 21 Aug 2009 Announced Care and support 6 - Excellent 5 - Very good 5 - Very good Management and leadership 5 - Very good 24 Feb 2009 Unannounced Care and support 6 - Excellent Management and leadership 12 Aug 2008 Announced Care and support Management and leadership page 8 of 9

9 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 9 of 9