Abbey Lodge Care Home Care Home Service Adults Mossneuk Road Westwood Hill East Kilbride Glasgow G75 8QA Telephone:

Transcription

1 Abbey Lodge Care Home Care Home Service Adults Mossneuk Road Westwood Hill East Kilbride Glasgow G75 8QA Telephone: Inspected by: Morag McHaffie Gillian McPake Type of inspection: Unannounced Inspection completed on: 22 January 2013

2 Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 6 3 The inspection 18 4 Other information 35 5 Summary of grades 36 6 Inspection and grading history 36 Service provided by: Abbey Healthcare Homes (East Kilbride) Limited Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: Morag McHaffie Telephone enquiries@careinspectorate.com Abbey Lodge Care Home, page 2 of 38

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 3 Adequate Quality of Environment 3 Adequate Quality of Staffing 4 Good Quality of Management and Leadership 3 Adequate What the service does well Those persons who completed our questionnaires or spoke to the Lay Assessor and Inspectors during the inspection were happy with the care they received, the environment in which they lived and the activities offered. There were variances of opinion regarding laundry and foodstuffs. What the service could do better The majority of people interviewed during the inspection were not able to identify their key-worker or indicated they changed quite a lot "turnover of staff is unbelievable". Factually in October staff commenced and 1 left. Those people spoken to during the inspection stated there were relatives meetings but not many attended due to previous experiences that the agenda was only about fundraising. What the service has done since the last inspection The care home manager had now been in post for 8 months and continues, with the support of the Director-Quality Assurance, to put her own mark on the running of this large service. Abbey Lodge Care Home, page 3 of 38

4 The provider and management have reviewed and changed the shift pattern and number of domestic and laundry staff available to care for the environment and the people who use the service. There are future plans to deliver care in the home as four separate units and this will be monitored and reviewed by the management to team regarding positive outcomes for people who use the service and employees. Conclusion With the support of the Training Director, the management team should continue through supervision and personal development meetings to identify the training requirements of Abbey Lodge staff and continue and increase the positive outcomes for people who use the service. Who did this inspection Morag McHaffie Gillian McPake Lay assessor: Mrs Jenny Goldberg Abbey Lodge Care Home, page 4 of 38

5 1 About the service we inspected Abbey Lodge is a purpose built two storey building situated in the East Kilbride area of South Lanarkshire. It is accessible to public transport routes, bus, train or motorway. Service users are within walking distance of local shops and community amenities. The building offers accommodation for 80 service users', 38 on the ground floor and 42 on the upper floor. There are single bedrooms with full en-suite facilities. The care home has adequate facilities to accommodate couples. People who use the service have access to communal toilets and specialised bathing facilities, shared public spaces which are used for either lounge or dining room and there is a designated smoking facility. The aims and objective for the care home are laid out in their Information Brochure, a copy of which is located in each bedroom. The grounds offer a secure, enclosed landscaped area to the rear of the property and people who use the service have access to garden furniture to sit outside. The view from the dining room and conservatory areas is onto this rear garden. On the day of the inspection Abbey Lodge had three vacancies. Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 3 - Adequate Quality of Environment - Grade 3 - Adequate Quality of Staffing - Grade 4 - Good Quality of Management and Leadership - Grade 3 - Adequate 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 Lodge Care Home, page 5 of 38

6 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 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 The Care Inspectorate will award grades for services based on findings of inspections. Grades for this service may change after this inspection if we have to take enforcement action to make the service improve, or if we uphold or partially uphold a complaint that we investigate. Requirements and recommendations If we are concerned about some aspect of a service, or think it could do more to improve its service, 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 - a requirement is a statement which sets out what is required of a care service to comply with the Public Services Reforms (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 Inspectorate. We wrote this report following an unannounced inspection visit, by two Care Inspectorate Inspectors, Morag McHaffie and Gillian McPake, on 8 January 2013 between the hours of 09:10-17:20 and 9 January :45-14:30. Lay Assessor Mrs J Goldberg on 8 January :30-17:00. Feedback was given to the Manager, Regional Manager and Operations Director and their administrator was also present to take notes of the feedback, on 22 January 2013, 11:30-13:30. In this service we carried out a high intensity inspection. As requested by Care Inspectorate the service sent us an annual return. The service also sent an electronic self assessment form. The service provider was supplied by the Care Inspectorate, Care Standards Abbey Lodge Care Home, page 6 of 38

7 Questionnaires "How satisfied are you with this care service"? for distribution to service users and their carers and friends. Five (5) responses were received prior to writing this inspection report. In this inspection, evidence was gathered from various sources, including the relevant sections of policies, procedures, records and other documents, including: - Activities - Accidents and Incident recording - Complaints Log - Minutes of Relatives, Service Users and Staff meetings - Participation Strategy - Registration Certificate - Insurance Certificate - Service Users Care Plans - Staff - Off Duty Rota; Training Records - Quality Assurance systems; Audits and Risk Assessments - Observation of staff practice - Examination of the environment and equipment. Discussions with various people: - Manager - Staff Nurse - Care Assistant - Hotel Services Staff - chef, domestic and laundry - 11 People who use the service - 6 Relatives and Visitors. Inspection report continued 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 Abbey Lodge Care Home, page 7 of 38

8 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 Lodge Care Home, page 8 of 38

9 What the service has done to meet any requirements we made at our last inspection The requirement Personal Plans must be better maintained, include relevant and up to date information and demonstrate regular engagement with service users and/or their carers. Service users needs must be reviewed regularly. All risk assessments and reviews of care must be recorded accurately in personal plans. Personal Plans should better demonstrate regular engagement with service users and/or their carers. This is in order to comply with SSI 2002/114 Regulation 5(1) and (2)(b)(c) - a requirement that a provider shall prepare a written plan which sets out how the service user's health and welfare needs are to be met and that a provider of a care home shall review and revise the personal plan, notifying the service user and any representative of any such revision of the plan and takes account of: National Care Standards. Care Homes for Older People. Standard 6:Support arrangements Timescale for Implementation: To commence immediately and be completed within three months from the date of issuing of this report. What the service did to meet the requirement Staff were provided with supernumerary time to complete the care plans but the task is not fully completed. Care plans have been transferred to the providers new documentation which appears to be repetitive in some areas. Training was provided for the development of care planning. The requirement is: Not Met The requirement The management of staff practice in relation to looking after peoples clothes must be reviewed and improved so that clothes do not go missing and are not returned to the the wrong bedroom. Infection control procedures relating to the management of soiled laundry by care staff must be reviewed as a priority. This is in order to comply with SSI 114 Regulation 4 (1)(a)(c)(d) Welfare of Users (a) providers shall make proper provision for the health and welfare of service users; (b) providers shall provide services in a manner which respects the privacy and dignity of service users;and (d) Abbey Lodge Care Home, page 9 of 38

10 providers shall have appropriate procedures for the control of infection and the management of clinical waste and takes account of National Care Standards. Care Homes for Older People. Standard 16:Private life Standard 5: Management and Staffing. Timescale for Implementation: Immediately from the date of issuing of this report. What the service did to meet the requirement Inspection report continued Internal review of the staffing and systems within the laundry and been changed to offer positive outcomes for people who use the service. The requirement is: Met The requirement A review of the current staffing levels and deployment of staff should be carried out to check that staff are working efficiently and appropriate to their skills, experience and level of responsibility. This review should take account of the individual dependency needs of service users. This is in order to comply with: SSI 2002/114 Regulation 13 (a) and (c) (i) and (ii)- a requirement where a provider shall, having regard to the size and nature of the service, the statement of aims and objectives and the number and needs of the service users ensure that there are sufficient numbers of suitably qualified and competent staff on duty. The Provider shall ensure that persons employed in the provision of the care service receive training appropriate to the work they are to perform and suitable assistance, including time off work, for the purpose of obtaining further qualifications appropriate to such work and takes account of: National Care Standards. Care Homes for Older People. Standard 5: Management and Staffing. Timescale for Implementation: To commence immediately and be completed eight weeks from the date of issuing of this report. What the service did to meet the requirement We observed all people are directed to the lounge room which is very busy and limited use is made of the other public spaces during the inspection. Management plan to make the home into 4 smaller units with allocated staff and will review the impact for outcomes for people who use the service. The requirement is: Not Met The requirement There must be clear procedures and arrangements in place so that the cleanliness is not affected by insufficient staff or poor infection control standards. The provider must prioritise following areas: The number of available domestic staff should be Abbey Lodge Care Home, page 10 of 38

11 appropriate to allow the cleaning schedule to be maintained every day. The smoking area and servery areas must be reviewed to improve the standards of cleanliness and ventilation. The bathrooms which are used by service users to have a bath should not be used as an area for storing laundry trolleys and laundry bags. A more suitable arrangement must be found. This is in order to comply with: SSI 114 Regulation 4(1)(a) and (d) Welfare of users - a requirement to make proper provision for the health and welfare of service users and to have appropriate procedures for the control of infection and clinical waste. The Provider should refer to best practice guidance. (see Infection Control in Adult Care Homes. Final Standards. Blackwell Publications ) And SSI 2002/114 Regulation 12(b) - a requirement that providers shall provide such other equipment for the general use of service users as is suitable and sufficient having regard to their health and personal care needs. Timescale for Implementation: To commence immediately and be completed within two weeks from the date of issuing of this report. What the service did to meet the requirement Inspection report continued Internal review of the staffing and systems within the laundry and domestic staff have been changed to offer positive outcomes for people who use the service. The ventilation in the smoke room has been reviewed to limit encroachment on bedroom areas. General overall cleanliness in shared bathing areas and the servery areas was visually acceptable. The requirement is: Met Abbey Lodge Care Home, page 11 of 38

12 The requirement Personal Plans must be better maintained and the language easier to understand. They must include relevant and up to date information and demonstrate regular involvement with service users and/or their carers. Service users needs must be reviewed regularly. All risk assessments and reviews of care must be recorded accurately in personal plans. This is in order to comply with SSI 2011/210 Regulation 5(1) and (2)(a)(b)(c) - a requirement that a provider shall prepare a written plan which sets out how the service user's health and welfare needs are to be met and that a provider of a care service shall review and revise the personal plan, notifying the service user and any representative of any such revision of the plan and takes account of: National Care Standards. Care Homes for Older People. Standard 6:Support arrangements Timescale for Implementation: To commence immediately and be completed within three months from the date of issuing of this report. What the service did to meet the requirement Inspection report continued The care plans sampled were informative of the individual and their history and preferences but still could be more person centred. Assessments were in place but still could be more explicit of "how to" meet the needs of the individual. The requirement is: Met The requirement The management of staff practice in relation to looking after peoples clothes must be reviewed and improved so that clothes do not go missing and are not returned to the the wrong bedroom. Infection control procedures relating to the management of soiled laundry by care staff must be reviewed as a priority. This is in order to comply with SSI 2011/210 Regulation 4 (1)(a)(b)(d) Welfare of Users (a) make proper provision for the health and welfare of service users; (b) provide services in a manner which respects the privacy and dignity of service users;and (d) have appropriate procedures for the prevention and control of infection and takes account of National Care Standards. Care Homes for Older People. Standard 16:Private life Standard 5: Management and Staffing. Timescale for Implementation: To commence within 24 hours from the date of issuing of this report. What the service did to meet the requirement Internal review of the staffing and systems within the laundry and domestic staff have been changed to offer positive outcomes for people who use the service. The requirement is: Met Abbey Lodge Care Home, page 12 of 38

13 The requirement A review of the current staffing levels and deployment of staff should be carried out to check that staff are working efficiently and appropriate to their skills, experience and level of responsibility. This review should take account of the individual dependency needs of service users. Prompt action must be taken by the provider to improve staff deployment and address the inter-department staffing issues that are affecting the delivery of person-centred care. This is in order to comply with: SSI 2011/210 Regulation 15 (a) and (b) (i) and (ii)-a requirement where a provider shall, having regard to the size and nature of the service, the statement of aims and objectives and the number and needs of the service users ensure that there are sufficient numbers of suitably qualified and competent staff on duty. A provider must ensure that persons employed in the provision of the care service receive training appropriate to the work they are to perform and suitable assistance, including time off work, for the purpose of obtaining further qualifications appropriate to such work. and takes account of: National Care Standards. Care Homes for Older People. Standard 5: Management and Staffing. Timescale for Implementation: To commence immediately and be completed four weeks from the date of issuing of this report. What the service did to meet the requirement Inspection report continued Management plan to make the home into 4 smaller units with allocated staff and will review the impact for outcomes for people who use the service. Further development of the training calendar and courses to meet the needs of all roles and responsibilities of staff is necessary. Regular frequency of supervision and staff meetings is not happening at present to identify the needs of the staff to meet the assessed needs of the people who use the service. The requirement is: Not Met The requirement The management of staff practice in relation to looking after peoples clothes must be reviewed and improved so that clothes do not go missing and are not returned to the the wrong bedroom. Infection control procedures relating to the management of soiled laundry by care staff must be reviewed as a priority. This is in order to comply with SSI 114 Regulation 4 (1)(a)(c)(d) Welfare of Users (a) providers shall make proper provision for the health and welfare of service users; (b) providers shall provide services in a manner which respects the privacy and dignity of service users;and (d) providers shall have appropriate procedures for the control of infection and the management of clinical waste and takes account of National Care Standards. Care Homes for Older People. Standard 16:Private life Standard 5: Management and Abbey Lodge Care Home, page 13 of 38

14 Staffing. Timescale for Implementation:Immediately from the date of issuing of this report. What the service did to meet the requirement Internal review of the staffing and systems within the laundry and domestic staff have been changed to offer positive outcomes for people who use the service. The requirement is: Met Inspection report continued The requirement The provider and management must complete the transfer of care plan documentation with a set target date which is shared with all staff. Information in the care plans must be clear, informative and accessible in an appropriate format. This is to comply with SSI 2011/210 Regulation 4(1)(a) - Welfare of Users - a provider must make provision for the health, welfare and safety of service users AND SSI 2011/210 Regulation 5 - Personal Plans Timescale for improvement: To start immediately and be completed within 12 weeks. What the service did to meet the requirement The transfer to the new documentation is almost complete. The care file is only in the written format and is a large document which is not easy to read and user friendly for those who ask for a copy of their own care plan. The requirement is: Not Met The requirement The provider and management must review the arrangements in place for the appropriate staffing levels to complete housekeeping duties in an 80 bedded care home. To ensure that practice meets training received and best practice guidance and staff have the competency skills to practice Infection Control procedures and meet all necessary health and safety legislation. The health and wellbeing of people who use the service and all stakeholders should be the outcome from a clean, homely and odour free environment. This is to comply with SSI 2011/210 Regulation 4(1)(a) - Welfare of Users - a provider must make provision for the health, welfare and safety of service users AND SSI 2011/210 Regulation 15 (a) (b) - a provider having regard to the size and nature of the care service, the statement of aims and objectives and the number and needs of service users - (e) ensure that at all times suitably qualified and competent persons are working in the care service in such numbers as are appropriate for the health, welfare and safety of service users: and (f) ensure that persons employed in the provision of the care service receive - (b) training appropriate to the work they are to perform; and (ii) suitable assistance, including Abbey Lodge Care Home, page 14 of 38

15 time off work, for the purpose of obtaining further qualifications appropriate to such work Timescale for improvement: To start immediately and be completed within 4 weeks. What the service did to meet the requirement Inspection report continued The number of domestic staff has been reviewed and cover day and back shift. Presently awaiting delivery of cleaning equipment and laying of new corridor carpet. The requirement is: Met What the service has done to meet any recommendations we made at our last inspection The care service should review the effectiveness of the methods of communication with all stakeholders and how they influence and contribute to both the self assessment required by the regulator and continuous improvement of the care service. NCS Care Homes for Older People, Standard 11 - Expressing Your Views Progress: Minutes of various meetings held with people who use the service and relatives were available although they are held irregularly. Providers questionnaires are distributed to other professionals who visit the care home. MET The provider and management should review the external environment. In consultation with people who use the service, staff and visitors and consider the development of the grounds as an extension of the interior of the care home taking cognisance of individual choices, best practice guidance for people with cognitive, visual or physical impairment. NCS Care Homes for Older People, Standard 4 - Your Environment and Standard 9 - Feeling Safe and Secure Progress: Maintenance person relaid slabs and tidied the garden. Garden development is the topic for the January 2013 Relatives meeting. MET Abbey Lodge Care Home, page 15 of 38

16 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 Inspection report continued 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. We received a fully completed self assessment document from the service provider. We were satisfied with the way the service provider had completed this and with the relevant information they had given us for each of the headings that we grade them under. The service provider identified what they thought they did well, some areas for development and any changes they planned. Taking the views of people using the care service into account Please refer to the comments recorded by the Lay Assessor and included at Theme 1 Statement 1. Two Care Inspectorate Questionnaires were completed by people who use the service. Response to question - Overall I am happy with the quality of care I receive at this home. Agree = 100% Taking carers' views into account Three Care Inspectorate Questionnaires were completed by relatives and friends of people who use the service. Response to question - Overall I am happy with the quality of care I receive at this home. Agree = 100% Written Comments: Abbey Lodge Care Home, page 16 of 38

17 "Care plan has not been reviewed since admission and the current named nurse is not detailed. Impressed by level of encouragement to eat fresh fruit between meals but there could be more encouragement to drink more water. A water cooler is provided but not all patients are capable of reaching it independently" "From our observations the manager of the home does not respect her staff unless they are part of the "in group". The direct result is morale is very low and quite a number of good, experienced carers have left. The loss of carers has obviously resulted in many agency staff being used which is most certainly not in the best interests of the residents". Abbey Lodge Care Home, page 17 of 38

18 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: 3 - Adequate 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 I spoke to 11 people using care services and 6 carers / friends. Quality of Care and Support: Most of the residents were happy with the care and support they received. Residents' comments were: * Too comfy in here * No complaints * Like everything * Staff are nice * Never had a complaint * Every one of the nurses are wonderful. One resident commented * Sometimes things go missing. Relatives commented * Nice home. Staff seem happy enough * Some of the staff are the best I have met * Relatives home and treated like that * Super, wonderful Abbey Lodge Care Home, page 18 of 38

19 * Care has been very good * Care on shop floor very good. Some of the residents were happy with their food and there is choice of hot food at lunchtime. At night the choice is hot food or sandwiches. Residents' comments on food were: * Food all right, not sumptuous * No complaints. Plenty * Quite like it. No complaints at all * Rotten, meat not cooked long enough * If they don't cook it properly, what's the point. Relatives' comments on the food was: * Sandwiches are fine. The rest leaves a lot to be desired. All of the relatives took part in care reviews of their relative. I observed two activities on the day I visited, one in each of the main areas. The minutes of residents meetings on activities is displayed on the notice board. The hairdresser visits three times a week. Residents and relatives comments on activities were * Never get bored * I go to lunch at the Baptist Church * Everyone gets a turn (to go out) * No lots to do * Aye I get bored * Gets out * Have been out with the club * Need a new bus * Bus desperate, could get pneumonia in it * (activities co-ordinator) right hard worker * (activities co-ordinator) took me out for Christmas dinner Quality of the Environment: Many residents have their own possessions in their rooms and this enhances their living environment. A few of the residents had small fridges in their rooms. The residents were happy with their environment and mostly gathered in the two large rooms, one on each floor. There is a smoking room and a room designed as a shop on the outside but this was not in use on the day of the visit. Being winter the outside Abbey Lodge Care Home, page 19 of 38

20 area was not in use. Residents and relatives comments on the environment were * All right, not sumptuous * Too comfy in here * Everything satisfactory * Got buzzer if I need help * More money spent on downstairs * Super. Wonderful * Got my own phone in my room Quality of Staffing: People were happy with the staff. Residents' comments were * Staff are nice * Every one of the nurses are wonderful Relatives' comments were * Cares been very good * Super wonderful job * Staff has changed * Some of the staff are the best I have met * Relative has been well looked after * Carers on shop floor very very good Quality of Management: One resident could identify the manager but most thought they could complain and get help if it was needed. Most of the relatives had regular meetings about their relative. There are regular relatives meetings. There is a regular reminiscence newsletter. Abbey Lodge Care Home, page 20 of 38

21 Areas for improvement Quality of Care and Support: Two relatives commented: * Laundry a bit of an issue. Don't know if anyone in over the weekend * Clothes go missing. Only the good ones. During a discussion with a resident in her room, I observed a nurse coming in to the room with the medication for the resident. The nurse did not stay with the resident and supervise the individual taking the medication. The outcome was that the resident choked and I had to leave the room and go and find the nurse to help her. The incident was reported back to the manager of the home. (Please refer to theme 1 Statement 3) Relatives' comments on the food was: * Sandwiches are fine. The rest leaves a lot to be desired * Can bring in food if bought * Don't have an idea of soft diet * Some days you can sole your shoes with it. On the day of inspection one relative brought in lunch. I observed one other resident eating cold meat brought in the day before by a relative that had been stored for her overnight. It was confirmed that there has been use of "bank chefs". None of the residents knew who their key worker was although a few knew the name was on a sheet in the room. The relatives too were unsure of the name of the key worker as they said, "staff has changed". In most resident's rooms that were visited with the resident, there were sheets on care plans and a page with the names of the key worker and nurse. In some cases there were two copies of the name sheet with different names. There was a diary in most rooms for relatives to make comments and ask questions about a residents care. It was noted that these were not used regularly and one relative commented that she "stopped using diary as she got no replies. "If I have anything to say I will say it". (see recommendation 1) I observed on the notice board that the residents had requested a trip to see the Christmas lights. The residents told me this had not taken place as the heater on the mini bus was broken. (see recommendation 1) The manager confirmed that was the case and on the day of the inspection they were still waiting for it to be fixed. Abbey Lodge Care Home, page 21 of 38

22 Quality of the Environment: The residents were mostly gathered in the two large rooms, one on each floor. The room designed as a shop on the outside was not in use on the day of the visit. (see recommendation 1) Residents and relatives comments on the environment were: * Mini bus done * Need a new mini bus. Quality of Staffing: People were happy with the staff. Residents' comments were: * (Key worker) Changed quite a lot. Quality of Management: Due to changes in staff most of the relatives could not identify the key worker linked to their relative. One relative commented "Turnover of staff is unbelievable". (see recommendation 1) There are regular relatives meetings but most relatives do not attend. One relative commented "Previous manager meetings were restricted to fundraising". (see recommendation 1) Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The care service should review the effectiveness of the methods of communication with all stakeholders and how they influence and contribute to the self assessment required by the regulator and continuous improvement of the care service. National Care Standard, Care Homes for Older People, Standard 11 - Expressing your Views Statement 3 We ensure that service users' health and wellbeing needs are met. Abbey Lodge Care Home, page 22 of 38

23 Service strengths Inspection report continued Each person who uses the care service has a personal care plan. Those care plans sampled contained good information about the individual's previous history of hobbies, favourite holiday destinations, where they lived, employment and other relevant information to aid staff interaction and communication. Where an individual had a specific health issue there was evidence that the staff had sourced and printed out information and best practice guidance on how to care for that person. We observed some nice interaction but staff in general seemed very busy. The care service has a 4 weekly menu cycle and comments regarding the quality and choice of foodstuffs can be read at Theme 1 Statement 1. The requirements raised at the August 2012 inspection identified a lack of robust systems and processes in the laundry area. On visiting the laundry room we observed that the care service management had reviewed this concern and positive outcomes for people who use the service had been created. For example new staff and increase in hours; new audit systems to prevent delays in completing the laundry; new soap and softeners have been put in place "sheets smell nicer and softer". Areas for improvement We discussed with the management the new care plan paperwork was in various stages of completion. The service planned to provide supernumerary hours for staff to progress the updating of paperwork. We observed during the inspection that the new paperwork is repetitive of content. The care plan is only available in one format and there is no indication how the service plans to provide a copy to service users. (see requirement 1) The care files sampled lacked details for a number of important areas of care for the individual: * Care plans are not person centred with no evidence that the care service promotes independence. * A cumbersome document to navigate way through. Not clear how to immediately identify individuals specific needs. * After completing risk assessments there was poor content of management of needs and "how to" care for individuals direction to staff members. For example "offer fortified diet at all times and encourage snacks between meals". How? * Records could be more descriptive or pictorial on how staff meet the needs of those who sit for long periods in wheelchair; limited use of body map for administration of creams or tissue viability issues; manage and record food and fluid requirements of the individual and progress the outcome of this intervention. * Does not identify specific healthcare management plan according to service users medical history. * Wound care no identity of dressing. Abbey Lodge Care Home, page 23 of 38

24 * Service user & relative participation on the development and review of the care plan requires signature once or on every page where the area is provided and this is outstanding. * No copy of certificate for Power of Attorney or Welfare Guardian evidence to reflect appropriate power to sign documents on behalf of the person who uses the service. (see requirement 2) The Lay Assessor observed a lack of attention to detail with regards to the administration of medication which compromised the welfare of an individual. (see requirement 3) The public spaces, lounge and the dining room, on both floors were observed to be very busy places and wonder how visitors are accommodated in these areas. There were other smaller rooms or conservatory areas to choose to sit in but we did not observe these to be in use throughout the day. We observed people being ushered from dining room to the lounge to participate in a game directly on finishing lunch. We were unsure if choice had been offered due to the number of people in the room. Those who did not want to partake of the game were unable to view the television because a number of people were sitting in front of the TV. The lounges were cluttered and not homely with other people sitting in front of the fireplace. Later in the day we observed that there was a lack of side tables in the lounge areas for people to rest their personal items and snacks upon. There was a lack of attention to detail of the personal appearance of people who use the service, especially at mealtimes where dentures are not in situ to aid digestion, or hearing aids to support communication. Although there were a number of staff in the dining room when individuals asked for assistance there request was not met promptly. For example an individual asked for a tissue for their nose and this was reiterated by the Inspector and it was not forthcoming. Other person's clothes were stained but there did not appear to be a practice of assisting that person to return to their room to change into clean top or trousers at the end of the meal. We could only conclude that staff were working in a task focussed environment and not person centred care and support. We concluded that staff were there to monitor the public rooms rather than stimulate the individuals through conversation or activities. They did not appear to recognise when individuals were sitting too long, requested toilet visit or the individual needs varied throughout the day relating to the event or venue. For example they were slow to respond to an individual whose beaker of tea was leaking down their clothes and onto the floor. (see requirement 4) The management was planning to pilot dividing the care home into four units to improve outcomes for people who use the service. Abbey Lodge Care Home, page 24 of 38

25 When spoken to people who use the service and staff were unsure what week of the menu cycle they were on or what was on the menu for that day or mealtime. There were no menus in the dining rooms for people to refer to. During the August 2012 and this inspection it was an "agency" or "bank" chef working in the kitchen. This provider does not use catering staff to plate meals or take round the tea trolley. On shift the senior care assistant or care assistant had been allocated catering duties. (see requirement 4) The previous 3 requirements of August 2012 inspection are repeated as there was insufficient evidence that they had been met in full. Grade awarded for this statement: 3 - Adequate Number of requirements: 4 Number of recommendations: 0 Requirements 1. The provider and management must complete the transfer of care plan documentation with a set target date which is shared with all staff. Information in the care plans must be clear, informative and accessible in an appropriate format. This is to comply with SSI 2011/210 Regulation 4(1)(a) - Welfare of Users - a provider must make provision for the health, welfare and safety of service users AND SSI 2011/210 Regulation 5 - Personal Plans Timescale for improvement: To start immediately and be completed within 4 weeks. 2. Staff must be appropriately trained to keep accurate records and understand the consequences of not so doing for people who use the service. For example risk assessments and care plans must be clear, informative, specific and direct staff to what they must do to sustain independence, good health, nutritional needs and social care. This is to comply with SSI 2011/210 Regulation 4(1)(a) - Welfare of Users - a provider must make provision for the health, welfare and safety of service users AND SSI 2011/210 Regulation 15 (a) (b) - a provider having regard to the size and nature Abbey Lodge Care Home, page 25 of 38

26 of the care service, the statement of aims and objectives and the number and needs of service users - (a) ensure that at all times suitably qualified and competent persons are working in the care service in such numbers as are appropriate for the health, welfare and safety of service users: and (b) ensure that persons employed in the provision of the care service receive - (i) training appropriate to the work they are to perform; and (ii) suitable assistance, including time off work, for the purpose of obtaining further qualifications appropriate to such work Timescale for improvement: To start immediately and be completed within 4 weeks. 3. Staff must be appropriately trained to administer medication and adhere to best practice guidance to promote positive outcomes for people who use the service. For example staff to stay with and observe the individual taking the medication dispensed so that the MARs record keeping is wholly accurate. This is to comply with SSI 2011/210 Regulation 4(1)(a) - Welfare of Users - a provider must make provision for the health, welfare and safety of service users Timescale for improvement: To start immediately and be completed within 4 weeks. 4. The provider must provide staff in sufficient numbers and deployed to meet the direct care and social needs of the people who use the service to sustain their mental and physical wellbeing on a day to day basis. SSI 2011/210 Regulation 15 (a) (b) - a provider having regard to the size and nature of the care service, the statement of aims and objectives and the number and needs of service users - A - ensure that at all times suitably qualified and competent persons are working in the care service in such numbers as are appropriate for the health, welfare and safety of service users: and b - ensure that persons employed in the provision of the care service receive - (i) training appropriate to the work they are to perform; and (ii) suitable assistance, including time off work, for the purpose of obtaining further qualifications appropriate to such work Timescale for improvement: To start immediately and be completed within 12 weeks. Abbey Lodge Care Home, page 26 of 38

27 Quality Theme 2: Quality of Environment Grade awarded for this theme: 3 - Adequate Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the environment within the service. Service strengths Please refer to Theme 1 Statement 1 Areas for improvement Please refer to Theme 1 Statement 1 Grade awarded for this statement: 4 - 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 Since the August 2012 inspection the external environment and maintenance has been upgraded by the maintenance person and the previous recommendation is met. For example the pathway leading from the patio area to the rear of the property and around the building has been tidied, cleaned and slabs relayed. The management continues to monitor the designated smoke room on the ground floor and ensure the measures and equipment in place are sufficient to prevent the smell of smoke to linger in the corridor or invade individual bedrooms in this area. Since the August 2012 inspection the domestic and laundry staffing levels, shifts, equipment, systems and processes had all been reviewed and amended by the provider. In the laundry area located on the second floor of the building we found it to be clean, neat and tidy and there were no outstanding bags of clothes for washing. The requirements are relating to the protection of infection control have been met. Abbey Lodge Care Home, page 27 of 38

28 Areas for improvement Inspection report continued On arrival for the second day of the inspection we observed that the delivery of boxed continence equipment had been left in the foyer. These boxes were still stacked in the foyer outside the manager, administrator and dining room doors as we concluded the inspection visit five hours later. The Inspectors observed and assisted an individual who uses the service who was in distress and anxious because they were sure there was a toilet facility outside the ground floor dining room. The Inspectors directed the person who uses the service to a toilet that could not be seen by the individual due to the signage being hidden behind the delivery boxes. The provider has advised the Inspectors that people who use the service have access to a number of toilets on the ground floor, for example in their own room; outside the dining room next to the lounge and next to the treatment room. The toilet described above is designated for visitors and staff. (see requirement 1) Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 1 Requirements 1. The service must have clear procedures in place to accept deliveries and the appropriate storage of these deliveries in a timeous manner. This is to prevent intrusion into the individuals home generated by time delays to remove the delivery to its identified storage area within the building and prevent the recurrence of the example described in areas for improvement. This is to comply with SSI 2011/210 Regulation 4(1)(a) - Welfare of Users - a provider must make provision for the health, welfare and safety of service users Timescale for improvement: To start immediately and be completed within 1 weeks. Abbey Lodge Care Home, page 28 of 38

29 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 Please refer to Theme 1 Statement 1 Areas for improvement Please refer to Theme 1 Statement 1 Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths The provider has a recruitment policy and procedure which ensures all checks are completed prior to staff commencing. New employees receive an induction course and shadow an experienced member of staff. Staffs receive core and specialised training relevant to their roles and responsibilities. Courses provided during 2012 have included: * Capacity and Adults with Incapacity * Moving and Handling * "Getting to know me" * Anticipatory Care Planning * Palliative Care * Activity Masterclass * Diabetes. The care home makes use of external training providers for health topics: Abbey Lodge Care Home, page 29 of 38

30 * Infection Control * Managing Medication * Catheter Care Verification of Death and DNACPR. Staff complete evaluation forms at the end of each course. Staff are also provided with Scottish Vocational Qualification training to permit them to register with the Scottish Social Services Council. A number of staff have participated in the "Football Memorabilia Group" provided by Alzheimer Scotland to assist communication with people who have diagnosis of Dementia. Areas for improvement Inspection report continued There was a lack of evidence that staff competency levels and capacity to implement the training received is monitored by the line management structure or through the supervision process. The training calendar lacked management specific courses for new or promoted employees. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Abbey Lodge Care Home, page 30 of 38

31 Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 3 - Adequate 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 Please refer to Theme 1 Statement 1 Areas for improvement Please refer to Theme 1 Statement 1 Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 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 provider has a file of policies and procedures. Management and staffs receive supervision and personal development meetings. Staffs have access to staff meetings and daily flash meetings where they can influence the agenda. The manager has been supported by the providers Directors and attended care home managers meetings which take place in England. People who use the service and their carers participate in the assessment and care plan reviews. Each unit holds its own residents meetings and for friends and relatives there is a Relative Forum. There was also a Food and Activity meeting. These were evidenced by written records of who attended and decisions agreed. Abbey Healthcare distributed questionnaires to people who use the service, carers and all stakeholders involved with the service. People who use the service and their Abbey Lodge Care Home, page 31 of 38