Peacock Nursing Home Care Home Service Adults Garden Place Eliburn Livingston EH54 6RA Telephone:

Transcription

1 Peacock Nursing Home Care Home Service Adults Garden Place Eliburn Livingston EH54 6RA Telephone: Type of inspection: Unannounced Inspection completed on: 24 February 2015

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 29 5 Summary of grades 30 6 Inspection and grading history 30 Service provided by: Peacock Medicare Ltd. 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 Peacock Nursing Home, page 2 of 33

3 Summary This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change after this inspection following other regulatory activity. For example, if we have to take enforcement action to make the service improve, or if we investigate and agree with a complaint someone makes about the service. We gave the service these grades Quality of Care and Support 4 Good Quality of Environment 4 Good Quality of Staffing 4 Good Quality of Management and Leadership 4 Good What the service does well Peacock Nursing Home provides a clean and comfortable environment. There are a range of communal rooms and spaces for sitting, dining and recreational activities and events. The service has an established core team of staff who know the residents and their relatives/carers well. This supports good continuity of care. What the service could do better The service recognises the importance of listening and responding to the views of people who use the service. They also recognise that this is an ongoing process that they intend to continue. This will enable further developments of the service. Development of some of the home's garden areas was planned. This included improving access to one of these areas. When completed this would provide a safe and comfortable place for people to spend time outdoors. What the service has done since the last inspection The service had taken action to address the two requirements made at the last inspection. Peacock Nursing Home, page 3 of 33

4 The management team have used a variety of quality assurance procedures to ensure that good practice procedures are consistently followed. They have provided support for staff when areas for improvement have been identified. There has been on going refurbishment of the home. Inspection report continued Conclusion Peacock Nursing Home provides good standards of care and support in a clean and comfortable environment. People using the service are kept informed of events and developments in the home and asked their views. The management team and staff are approachable, knowledgeable and responsive. They continue to look for ways to build upon and improve the service. Peacock Nursing Home, page 4 of 33

5 1 About the service we inspected 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 Requirements and recommendations If we are concerned about some aspect of a service, or think it needs to 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 based on best practice or the National Care Standards. 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 ("the Act") and secondary legislation made under the Act, or a condition of registration. Where there are breaches of Regulations, Orders or conditions, a requirement may be made. Requirements are legally enforceable at the discretion of the Care Inspectorate. Peacock Nursing Home is a care home registered to provide care and accommodation for 80 older people. The home provides accommodation in mainly single rooms with 12 double rooms used as single rooms. At this inspection there were 73 residents in the home. The home comprises of two houses, named Peacock (House 1) and Primrose (House 2). Each of the houses has two floors, the upper floor can be accessed by either a lift or stairs. There are separate dining facilities on the ground floor of both houses. All residents' bedrooms have ensuite toilet and wash hand basin facilities. There are bathing facilities on both floors. The home is situated in a residential area and has its own parking and well maintained gardens. The home is owned by Peacock Medicare Ltd. The aims and objectives of the service state: "All residents are assured that they will be treated with dignity, and that their individual needs and wishes will be treated with respect. The purpose is to uphold dignity of all in our care. The spirit of this extends to staff, colleagues and visitors." Peacock Nursing Home, page 5 of 33

6 Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade Quality of Environment - Grade Quality of Staffing - Grade Quality of Management and Leadership - Grade Inspection report continued This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change following other regulatory activity. You can find the most up-to-date grades for this service by visiting our website or by calling us on or visiting one of our offices. Peacock Nursing Home, page 6 of 33

7 2 How we inspected this service The level of inspection we carried out In this service we carried out a medium 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 We wrote this report after we made a series of inspection visits to the service. An inspector made an unannounced inspection visit on Wednesday 18 February 2015, between 7.45am and 4.10pm. A further unannounced inspection visit was made by the inspector on Sunday 22 February 2015, between 4.30pm and 9.20pm. An announced visit was made by the inspector on Tuesday 24 February 2015 to gather further evidence and to feedback to the service's management team. An inspection volunteer attended on the first day of our inspection. Inspection volunteers talk to residents and their relatives/carers to find out what they think about the service. The comments and observations of the inspection volunteer have been incorporated into this report. During the inspection we gathered evidence from a number of sources. We looked at a range of documentation, including the following: Certificate of Registration Residents' personal plans Residents' medication administration records Accident and incident records Duty rotas Staff supervision records Training records Minutes of staff meetings Minutes of residents' meetings Minutes off relatives'/carers' meetings Activities information Maintenance records Residents' dependency assessments Quality assurance records and reports. We spoke with residents, relatives and carers. We had discussions with a range of staff which included the management team, care staff, the activities coordinator, housekeeping staff and catering staff. We looked round the home and observed how staff worked. We considered the information in the action plan devised Peacock Nursing Home, page 7 of 33

8 by the service to address the requirements identified at the previous inspection. We also looked at information we had received about the service since the last inspection. 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 Peacock Nursing Home, page 8 of 33

9 What the service has done to meet any requirements we made at our last inspection The requirement In the last inspection report, dated 28 August 2014, we made two requirements. The service sent us an action plan within the agreed timescale detailing how these were to be met. 1. The provider must ensure that a system is implemented to ensure that topical medications are named for individuals and that dates of opening are clearly marked. Records must be maintained to evidence that any prescribed topical preparation has been applied. This is to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services). Regulation 2011 (SSI 2011/210) 4(1) (a) - a regulation about health and wellbeing. National Care Standards, Care Homes for Older People - Standard 15 Keeping well - medication. Timescale for meeting this requirement: For completion by 31 December What the service did to meet the requirement We have reported on how the service was meeting this requirement under quality statement 1.3, quality of care. The requirement is: Met - Within Timescales The requirement 2. The provider must ensure that the environment is safe and service users are protected and that the accommodation is fit for use. In order to achieve this, the provider must: Ensure that there are alerts in place where water temperatures are liable to scald. Ensure that there is a plan in place to address the temperatures of hot water in areas of the home that are accessible to residents. Ensure that there are timescales for completion of any work to be done to regulate temperatures. Provide the Care Inspectorate with a copy of any plan and timescales. Peacock Nursing Home, page 9 of 33

10 This is to comply with The Social Care and Social Work Improvement (Requirements for Care Services) Regulations 2011 SSI 2011/210 Regulation 10 (1) (2) a,b,d fitness of premises. Regulations 2011 SSI 2011/210 Regulation 4 (1) (a) - a requirement about health and wellbeing Timescale for meeting this requirement: To commence on receipt of this report and for completion by 31 December What the service did to meet the requirement We have reported on how the service was meeting this requirement under quality statement 2.2, quality of environment. The requirement is: Met - Within Timescales Inspection report continued 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 service submitted a Self Assessment as requested by the Care inspectorate prior to its previous inspection visit. A further Self Assessment was not required for this inspection. Taking the views of people using the care service into account There were 73 residents in the home at the time of the inspection. We spoke with residents in both houses in the communal areas of the home and spent time observing how staff engaged with residents and how residents spent their day. Residents seemed at ease with staff and most were happy to accept the care offered. We observed that there was monitoring of the communal areas and requests for assistance were promptly responded to. The inspection volunteer spoke individually with five residents. All those spoken with were satisfied with the quality of the service provided. We have referred further to their views and comments in the main body of the report under the appropriate quality statement. Peacock Nursing Home, page 10 of 33

11 Taking carers' views into account Inspection report continued The inspection volunteer spoke with three relatives/carers. They felt that their relative or friend was being well cared for. We have referred further to relatives and carers feedback in the main body of the report under the appropriate quality statement. Peacock Nursing Home, page 11 of 33

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: 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 service was performing to a very good level in the areas covered by this statement. From the evidence we found, we concluded that the service routinely involve residents, relatives and carers in developing the service by using a variety of methods to facilitate their involvement. There was evidence that the service responds positively to the feedback it receives. The entrance area of the home was welcoming and displayed good levels of up to date information about the service and how to give feedback and share ideas. Written information was also displayed on the noticeboards in each of the houses. This included details of activities and entertainment, the home's newsletter, general health information leaflets, the service's complaints procedure and copies of the last inspection report. This supports people using the service to make choices, suggestions or raise concerns. The service's regular newsletter kept people informed about recent activities, trips and other events in the home, as well as forthcoming entertainment, staff changes and how people could give feedback or make suggestions. The service's complaints procedure had been promoted in response to feedback we had given at the last inspection. The service had been working to improve communication within the home, particularly with residents who had dementia. This had involved working with the Peacock Nursing Home, page 12 of 33

13 Institute of Research in Social Services and the Joint Improvement Team. Residents, relatives and carers had been kept informed of this through the home's newsletter and meetings. Residents' and relatives' meetings continue to be held regularly. The minutes showed that people using the service were involved in making decisions within the home such as the activities they enjoyed as well as gaining feedback on the standard of service being provided. Progress of agreed actions were seen reported on in the following set of minutes and in the home's newsletter. Staff knew residents and many of their relatives/carers well which helps to support good communication. At staff handover staff demonstrated that they were able to pick up on residents' non verbal communication. This is particularly valuable in gaining feedback from residents who have difficulty giving verbal comments due to frailty and or dementia. Both residents and relatives/carers we spoke with told us that they felt comfortable discussing with the staff or the management team any concern or worry they may have. Areas for improvement Some of the residents and relatives/carers with whom we spoke with were unsure about who their key worker was. The manager advised us that each resident is allocated a key worker and named nurse when they are admitted to the home and this is detailed in their admission letter. They agreed to promote the role of the key worker through the home's newsletter. Enlarging the print size on the displayed activities programme would make it easier to read. The service recognise that meeting this statement is an ongoing process. They plan to continue to encourage people using the service to give comments and offer suggestions. The management team had identified that improving the way six monthly reviews of care were carried out and recorded could support the service to do this. We will follow up progress of these areas for development at future inspection visits. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Statement 3 Peacock Nursing Home, page 13 of 33

14 We ensure that service users' health and wellbeing needs are met. Service strengths Inspection report continued We concluded from the examination of the evidence seen that the service continued to perform to a good level in the areas covered by this statement. In reviewing this statement we looked at the progress the service had made toward meeting the requirement made under this statement in the last inspection report. We found sufficient evidence to indicate that this was being met. We looked at a sample of residents' medication administration records, topical administration records, wound assessments and treatment plans and personal plans. We observed staff practice. We also gathered feedback from staff, residents and relatives/carers about the care given. At the previous inspection we asked the service to implement a system to ensure that topical medications were named for individuals and dates of opening clearly marked. Records were to be maintained to evidence that any prescribed topical preparation had been applied. There was sufficient evidence to indicate the service had implemented such a system. The service had introduced new documentation which was used when residents were prescribed topical preparations. This recorded the name of the cream or ointment to be used, where it was to be applied, how much to use and the frequency of application. Staff then recorded when an application had been made. The service told us that care staff had been informed of best practice guidelines in relation to dating and signing when topical creams had been used. We saw from notes of staff meetings that staff were kept informed about expected practice. The management team recognised that on going checks were needed to ensure that staff consistently followed such practice. We saw that the management team carried out audits on medication administration records, topical medication administration records, wound assessment records as well as care plans to ensure that they contained the correct information to direct staff practice and to ensure appropriate monitoring. From care records and discussion with staff we saw that the service had established good links with an appropriate range of other health care professional which included GPs, dentists, opticians, podiatrists and other specialist practitioners. Their input was seen to support staff in meeting residents' needs. Reviews of care indicated that residents and relatives/carers attending were satisfied with the care being provided. Peacock Nursing Home, page 14 of 33

15 At each of our visits we saw that residents looked well cared for and were dressed in appropriate clean and tidy clothing. Staff were seen to be respectful, patient and considerate in their approach to residents. We observed lunch being served. There were lots of positive comments given about the food. We saw that staff were supportive, attentive to residents' needs and demonstrated an awareness of residents' preferences and dietary requirements when supporting residents at meal times. When using moving and handling equipment we saw that staff communicated well with the residents needing this level of assistance and were confident in using the equipment. Wellbeing was promoted through a range of activities which included a swim group. Key aspects of health were monitored by the management team. In overviewing nutrition the management had adapted the information they collated to include admission weight and previous weights. This provided a better overview of residents' wellbeing. Improvement to the laundry service had been made through the introduction of small net bags for small items of clothing. We saw that clothing inventories were completed for new residents. Residents spoken with during the course of our inspection told us that they were happy living in the home. Residents who were not able to verbally express their views on the care received due to dementia and/or frailty were seen to respond positively to staff assistance. Relatives and carers spoken with were positive about the standard of care provided. They told us that they were kept well informed of their relatives/friends wellbeing. We discussed residents' care needs with staff. They demonstrated a good knowledge of residents' care and support needs and were aware of any recent changes. Comments from the inspection volunteer included: The menu is on view in the nursing home dining area and it was up to date and in view. In my opinion the food looked nice and residents were offered help if it was needed and clothing protection. There were activities on the notice board. Activities seem to be on fairly frequently. Some residents seem to go out regularly. Swimming is now included in the activities for those who can manage and it seems very much enjoyed by those who are able to go. Peacock Nursing Home, page 15 of 33

16 All of the residents seemed to be generally content and all I spoke to intimated to me that they were happy in the nursing home. Comments given by residents included: " I can have a long lay in bed in the morning if I want and I can go to bed if I want", " The food is alright and I get enough to drink", " There is a good woman doing activities and I get taken out", " I got help to vote", " I like the food and am very fond of milk and they give me lots", " The church comes in and I get taken out", " I love the singers they bring in", " When we watch the football we get beer to drink", " I have a key worker", " The food is excellent", " I don't have to wait long for help should I need it". Family and friends comments included: " There is a care plan", " Family member likes the food and gets help if he needs it", " They get taken swimming and to watch the football", " The food is excellent", " There are plenty of activities on", " There is open visiting", " I have seen the care plan and have an input to it", " Family member loves the food, they get a choice and their drinks are monitored", " They have been taken to the Falkirk wheel and the barge". Areas for improvement Staff were observed to be particularly busy when we carried out our evening visit. New staffing arrangements have been implemented since then. We have reported on this further under in quality statement 3.3. The management audits on the completion of medication administration records, topical administration records, wound assessments and treatment plans and personal plans demonstrated that some staff required further support. From our own review of this documentation we concluded that the management team had a realistic view of what needed to improve and we saw that they were taking the necessary actions to achieve this. This is therefore reflected in the grading of this statement. Peacock Nursing Home, page 16 of 33

17 On going checks and providing appropriate support for staff will help the service to maintain and enhance the grade awarded for this statement. Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 0 Inspection report continued Peacock Nursing Home, page 17 of 33

18 Quality Theme 2: Quality of Environment Grade awarded for this theme: Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the environment within the service. Service strengths We concluded that the service was performing to a very good level in the areas covered by this statement. The strengths identified in quality statement 1.1, quality of care and support also support residents, relatives and carers to participate in assessing and improving the quality of the environment within the service. This included written information about the service, as well as how they can make suggestions or raise concerns. Residents, relatives and carers were kept informed about improvements to the environment through the home's newsletter and meetings. Areas for improvement The service plans to continue to look at ways of involving residents and their relatives/carers in improving the quality of the environment. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Statement 2 We make sure that the environment is safe and service users are protected. Service strengths We concluded from the examination of the evidence seen that the service continued to perform to a good level in the areas covered by this statement. In reviewing this statement we looked at the progress the service had made toward meeting the requirement made under this statement in the last inspection report, dated 28 August There was sufficient progress to indicate that this requirement Peacock Nursing Home, page 18 of 33

19 was being met. We looked round the home to see if there were any safety issues and gathered feedback from people who used the service. At the previous inspection we had found that some hot water temperatures in bathrooms or ensuite facilities felt very hot to touch. We thought that this posed a risk of scalding to residents. We had been informed of plans to fit thermostatic mixing valves. We had asked that alerts were in place where water temperatures were very hot and that a timescaled plan was put in place to address the temperatures of hot water in areas of the home that were accessible to residents. This requirement was met. The service informed us in their action plan that thermostatic mixing valves were to be installed to hot water outlets in residents rooms, toilets and bathrooms, and alerts put in rooms awaiting the fitting of these to alert residents and staff. At our inspection we found that the work had been prioritised with higher risk areas such as baths having had the thermostatic mixing valves fitted. Many of the sinks in resident areas had also had the valves fitted and there was evidence of regular checks on hot water temperatures to ensure that the valves were regulating the water at the correct temperature. Plans had been made for the remaining sinks, in lower risk areas, to have the valves installed by the beginning of May. Alert stickers were seen in place at these sinks. At each of our visits we walked round the home and saw the communal areas and some of the bedrooms. The home was seen to be generally clean and tidy. Regular checks on the environment were also conducted by the maintenance man and the management team. Records of these and any actions taken were seen recorded. We looked at the repair reporting book. We saw that entries were made against all reported repairs indicating that the repairs had been either completed or action was being taken in making the required repair At the previous inspection we had observed that there could be better cleaning of some of the equipment. We saw that they was a plan for cleaning equipment and the senior staff in each house signed to confirmed that this had been completed. Wheelchairs were seen labelled and checklists were completed to ensure that they were kept clean and safe to use. A "Pass" food hygiene certificate was displayed in the reception area, dated July 2014, which confirmed that the kitchen had been inspected and met the required legal standards for food hygiene. Peacock Nursing Home, page 19 of 33

20 The home was now 26 years old. Its appearance had been maintained through on going redecoration and refurbishment. Gloves and aprons were seen available for staff to use in order to follow good practice with regard to infection control procedures. Where bedrails were used we saw that staff had the appropriate guidance to ensure that these were correctly installed and checked. There was a programme to replace the older beds with beds which had integral bedrails. We saw that staff were supported to maintain safe working practices and help to maintain the safety of residents through training and monitoring of practice. Staff training included moving and handling, infection control and fire safety training. Risk assessments were seen regularly reviewed and updated. Comments from the inspection volunteer included: In my opinion Peacock Nursing Home is clean, warm and comfortable. Residents are allowed to bring in their own furniture and possessions if they like and can personalize the rooms. They are not roomy but are comfortable, they have an ensuite toilet. The garden will be upgraded this year to include a new seating area. There is a newsletter published for both residents and family members to read. Comments given by residents included: " There is a daily newspaper called Chat and I read the notice boards", " I have a nice cosy room", " My visitors can come in anytime they want", " My room is small but lovely" " I got a welcome pack and a brochure" " I love it here". Family and friends comments included: " It's always warm", " There is open visiting, we can visit anytime we want", " We are often offered a meal", " The room is personalized to my family members taste", " The garden is about to be upgraded", " There is a newsletter and it is always up to date". Areas for improvement Inspection report continued Outside office hours visitors access the home via a secure entry system at the entrance to each house. The entry system at the front of Peacock, house 1, was a little Peacock Nursing Home, page 20 of 33

21 confusing as there were two buzzers. The manager agreed to look at how this could be improved. On our first visit we noted some inappropriate storage of items in bathrooms and toilet areas. We reported this to the manager and saw improvements at our following visits. The service should continue to use environmental audits and checks to ensure consistent high standards of tidiness are maintained. During our walk round of the home we saw that the majority of doors identified as to be kept locked were locked. However, we found on separate visits that two sluice rooms were unlocked and had bottles of cleaning agents stored in them. Another store-room was labelled as to be kept locked and was found to be open. These may pose a risk to some residents. Staff should ensure that these areas are kept secure. See recommendation 1. During our discussions the management team showed a good understanding of the need to maintain the quality of the environment and develop it to meet the needs of the residents. The management team should consider including improvements to the sluice facilities when reviewing the home's on going refurbishment plan as currently staff have to clean commode pots manually which is not best practice. On going redecoration and refurbishment will ensure the home remains a safe and pleasant place to be. Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. Staff should ensure that potentially hazardous areas within the home are kept secure when not in use. This takes account of National Care Standards, Care homes for older people, Standard 4 Your environment. Peacock Nursing Home, page 21 of 33

22 Quality Theme 3: Quality of Staffing Grade awarded for this theme: Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service Strengths We concluded that the service was performing to a good level in the areas covered by this statement. The strengths identified in the quality statement 1.1 also support residents, relatives and carers to participate in assessing and improving the quality of staffing in the service. This included written information about the service as well as how they could make suggestions or raise concerns. People using the service were kept informed of staff changes through the home's newsletter and minutes of meetings. The wearing of name badges helped visitors and residents to identify staff and to know who to raise concerns with. Areas for improvement The home's newsletter indicated that several relatives had expressed an interest in being involved in staff recruitment and staff induction. This was an area that the management team were looking to develop. We will look at how this is progressing at future inspections. Grade awarded for this statement: 5 - Very 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. Peacock Nursing Home, page 22 of 33

23 Service strengths Inspection report continued We concluded from the examination of the evidence sampled that the service continued to perform to a good level in the areas covered by this statement. In reviewing this statement we observed staff in the course of their work, looked at how staff were kept up to date about expected practice and gathered feedback from people who use the service. We observed staff assisting residents. We saw that they were gentle in their approach and encouraged residents to make choices. We also saw the same of the non care staff, such as domestic and kitchen staff, who when passing chatted with residents. From our observations of staff practice and listening to staff handover we saw and heard some very good examples of staff listening to verbal and non verbal communication from residents and using this information to provide appropriate care and support. We discussed residents' care needs with staff. They demonstrated a good knowledge of residents' care needs and were respectful in describing the care. Care staff could access residents' care records and were seen to use these. The service use a dependency tool to identify the staffing levels required. This was updated when there were new residents and/or changes to the care needs of other residents. We saw that accidents were recorded and patterns such as frequency, time and location were monitored. This is useful in the evaluation of staffing levels and helping to establish ways of reducing such accidents. The service had recently revised their staffing levels in the evening in response to an increase in residents' care needs. See areas for improvement below for further details of findings. Minutes of staff meetings indicated that staff were kept informed of expected standards of practice and encouraged to contribute to making suggestions toward developing the service. We saw that staff training was planned and monitored in an organised way. A training matrix was used which included mandatory training as well as areas that had been identified to help meet residents needs. At the last inspection we noted that some staff were not up to date with infection control training. We saw that training on this had been carried out shortly after this visit. Completion of required training was monitored by the management team and through formal supervision. Peacock Nursing Home, page 23 of 33

24 Care staff who were not registered nurses had or were in the process of registering with the Scottish Social Services Council (SSSC). The SSSC is responsible for registering people who work in social services and regulating their education and training. This helps to make sure that people receive effective services from a safe and skilled workforce. Comments from the inspection volunteer included: I observed that all the staff were polite and friendly to both the residents and their families. There seemed to be a pleasant atmosphere in the home. In my opinion the staff seemed to be happy and all seemed to be very capable. The staff seemed to listen to the residents and kept interacting with them. Comments given by residents included: " The staff are ok they are alright", " Yes they do well, they are very nice", " I like my carers, there is lots of banter and they are very attentive", " The staff are great", " I go to meetings with the staff". Family and friends comments included: " The staff are good with them all", " The staff are good at listening and do accommodate everyone as much as possible", " The least little problem and they call the doctor", " The staff rotate. They are very good", " They treat everyone with dignity and respect", " I have been asked if I would like to be involved in staff recruitment". Areas for improvement Inspection report continued When we visited in the evening we noted that staff were particularly busy after 7pm. This had previously been noted by the management team and additional staff recruited in order to provide increased staffing in the evening. The new staffing arrangements had been implemented at our next visit. The service should continue to monitor staffing levels through the continued use of a dependency tool, reviews of accidents and incidents and regular observation of practice. Additional information to include details of placing authorities adult protection emergency contact details was to be added to the nurse in charge's folder. Currently it was only the local authority's contact details that were given. This would help staff to promptly report issues when appropriate. Peacock Nursing Home, page 24 of 33

25 We would support the service to carry out regular supervision of all staff to support their development. Effective staff supervision reviews staff training needs, identifies any support needed and agrees objectives for staff to achieve. Its on going use would support and develop the staff and enable them to meet this statement to a higher level. Continuing to carry out checks on care records and supporting staff to ensure that good practice guidance is consistently followed, as recorded under quality statement 1.3 quality of care and support, will also support the service in meeting this statement. We will follow up progress of these areas for development at the next inspection visit. Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 0 Inspection report continued Peacock Nursing Home, page 25 of 33

26 Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 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 We concluded that the service was performing to a very good level in the areas covered by this statement. When we reviewed this statement we found that the strengths identified in the previous participation statements also supported residents, relatives and carers to participate in assessing and improving the quality of the management and leadership of the service. This included written information about the service as well as how they could make suggestions or raise concerns. Comments from the inspection volunteer included: In my opinion almost everyone seemed to know who the manager was and that it was her to whom they would discuss any problems or complaints with. She seemed in my opinion very approachable. Comments given by residents included: " I know the manager by name. I can tell her anything. She is very helpful", " I think its well run", " I am included in review meetings about the home". Family and friends comments included: " I talk to the manager all the time. She is very approachable. If anything needs changed or done she arranges it right away", " We are asked about our opinion on any planned changes or developments", " I know who the manager is and I would be able to speak to her if there were any problems", " I knew about the Care Inspectorate", " I am totally satisfied with the home". Peacock Nursing Home, page 26 of 33

27 Areas for improvement The areas for improvement as identified in the previous participation statements when applied to this statement would further develop how the service meets this statement. 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 From the evidence we found we concluded that the service continued to perform to a good level in the areas covered by this statement. Our inspection findings indicated that good standards of care and support were given. The management team takes action on areas identified as needing to improve and recognises that meeting this statement is an ongoing process. The service promptly returned their action plan to inform us of how they would address the two requirements made in the last inspection. These requirements have been met. The strengths identified in the previous participation statements supported residents, relatives, carers and staff to participate in assessing and improving the quality of service that Peacock Nursing Home provides. The management team continue to carry out regular checks to make sure that things run well in the home. The examples we saw at inspection included: * Observation of staff practice, * Audits of care records, * Environmental checks, * Equipment checks, * Following up all accidents and incidents to ensure appropriate action has been taken, * Gathering the views of people who use the service, * Medication audits. Staff meetings, including staff handover were seen used to follow up any actions and interventions required of staff as a result of the findings of these checks. Peacock Nursing Home, page 27 of 33

28 Our inspection findings and the findings from the service's audits and checks indicated that the management team had a realistic view of how the service was performing and where it needed to improve. This is therefore reflected in the grading of this statement. We had received notification of any accidents or incidents that required to be reported to us. These included any actions taken as a result of the accident or incident. Comments from the inspection volunteer included: The manager seemed in my opinion keen to provide good quality care. There are regular family and resident meetings and these are advertised on the notice board. It is my opinion that the service and staff seem well organised. Areas for improvement Actioning the areas for improvement identified in this report and from the service's own audits and checks will further support the service to meet this statement and ensure improved outcomes for people using this service. Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 0 Inspection report continued Peacock Nursing Home, page 28 of 33

29 4 Other information Complaints No complaints have been upheld, or partially upheld, since the last inspection. Enforcements We have taken no enforcement action against this care service since the last inspection. Additional Information The service's current Certificate of Registration and staffing schedule were seen displayed in the entrance area of the home. 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). Peacock Nursing Home, page 29 of 33

30 5 Summary of grades Quality of Care and Support - Statement 1 Statement Very Good Quality of Environment - Statement 1 Statement Very Good Quality of Staffing - Statement 1 Statement Very Good Quality of Management and Leadership - Statement 1 Statement Very Good 6 Inspection and grading history Date Type Gradings 28 Aug 2014 Unannounced Care and support Environment Staffing Management and Leadership 14 Jan 2014 Unannounced Care and support Environment Staffing Management and Leadership 22 Feb 2013 Unannounced Care and support Not Assessed Environment Not Assessed Staffing Management and Leadership Peacock Nursing Home, page 30 of 33

31 29 Nov 2012 Unannounced Care and support Environment Staffing Not Assessed Management and Leadership Not Assessed 1 Feb 2012 Unannounced Care and support Environment Staffing Not Assessed Management and Leadership Not Assessed 30 Jun 2011 Unannounced Care and support Environment 3 - Adequate Staffing Management and Leadership 4 Nov 2010 Unannounced Care and support 5 - Very Good Environment Staffing Not Assessed Management and Leadership 5 - Very Good 23 Jun 2010 Announced Care and support 5 - Very Good Environment Staffing Not Assessed Management and Leadership 5 - Very Good 9 Feb 2010 Unannounced Care and support Environment 3 - Adequate Staffing 5 - Very Good Management and Leadership Not Assessed 26 May 2009 Announced Care and support Environment 3 - Adequate Staffing Management and Leadership 20 Feb 2009 Unannounced Care and support Environment Staffing Not Assessed Management and Leadership Not Assessed Peacock Nursing Home, page 31 of 33

32 3 Jul 2008 Announced Care and support 5 - Very Good Environment Staffing Management and Leadership All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Peacock Nursing Home, page 32 of 33

33 To find out more about our inspections and inspection reports Read our leaflet 'How we inspect'. You can download it from our website or ask us to send you a copy by telephoning us on This inspection report is published by the Care Inspectorate. You can get more copies of this report and others by downloading it from our website: or by telephoning Translations and alternative formats This inspection report is available in other languages and formats on request. Telephone: enquiries@careinspectorate.com Web: Peacock Nursing Home, page 33 of 33