Florence House Care Home Service

Transcription

1 Florence House Care Home Service 70 Nimmo Drive Govan Glasgow G51 3SG Telephone: Type of inspection: Unannounced Inspection completed on: 16 August 2016 Service provided by: Oakminster Healthcare Ltd Service provider number: SP Care service number: CS

2 About the service Florence House Care Home is located within a large converted school building in the Govan area of Glasgow. The care home service is provided by Oakminster Healthcare Ltd formally known as Lambhill Ct Ltd. Florence House Care Home has 58 places and provides care and support including nursing care to older people and adults with physical and sensory impairment. At the time of the inspection there were 38 service users. The accommodation is provided over three floors with 23 bedrooms on the top floor, 23 bedrooms on the middle floor and 12 bedrooms of the ground floor. The upper floors are accessed by a lift or stairs. Work was in progress to create new dining rooms on the top and middle floors. Each floor had a small sitting room and communal bathroom or shower room. The ground floor had a large communal room with sitting and dining areas. This was known as the "Plaza". There was a room at the front of the building known as the "Garden Tea Room". The care home stated that it aims to "enhance the quality of life of residents". What people told us We spoke with five residents during the inspection. Overall, they had positive views about care and support provided and were complimentary towards staff. However, two were dissatisfied with living at the care home and expressed a wish to move on to alternative accommodation. Comments included: "I just put up with it, I want to go out more". "It's not what you'd choose but the staff are nice, they know me and help with things I need". "They're all very good, no complaints. Not a great deal of stimulation. Would like the food to improve". Two residents returned satisfaction questionnaires to the Care Inspectorate. Both agreed they were happy with the quality of care. We spoke with six relatives during the inspection. Three were satisfied with the quality of care, but three were dissatisfied. The main concern was the availability of staff and the time it took to answer buzzers. Seven relatives returned satisfaction questionnaires to the Care Inspectorate. Three agreed they were happy with the quality of care their relative received, but four disagreed. Comments included: "...we have to complain weekly about so many little things. It feels our concerns are not taken seriously. The staff are lovely and caring but understaffing and lack of training has meant my relative often has to wait for a call to be answered. I don't feel dignity is respected, however I think it is safe". page 2 of 20

3 "I don't feel the care is satisfactory. The staff are nice but there is simply not enough of them. My relative's personal needs are generally met. In order to get into the care home we have to wait sometimes 10 minutes for staff to come to the door". "Staff seem mostly caring and kind. However, there seems to be a lack of staff a lot of the time. This means there are long waits for care and makes my relative feel like a nuisance and a bother. The outside area seems to be a smoking area and is not inviting to sit there. The indoor corridor smells of smoke from the smokers room. There's a lack of stimulation and interaction". "Most staff are caring and attentive. One or two are reluctant carers. Maintenance in the bedroom is very slow or isn't requested". "When we press the buzzer you have to wait a long time for another member of staff to come to help. There's a lot of agency staff. Bedding and clothing have been lost. Sometimes they don't change the bedding often enough". 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. This service did not return a self assessment. See quality of management and leadership section of this report. From this inspection we graded this service as: Quality of care and support Quality of environment Quality of staffing Quality of management and leadership 2 - Weak 3 - Adequate 3 - Adequate 2 - Weak Quality of care and support Findings from the inspection Although there was satisfaction in many areas there were significant issues which need to be addressed. Feedback from residents and relatives was mixed. The main concern was a lack of staffing and long waits for care. Other issues raised included the quality of the food and a lack of stimulation. We observed staff were busy. On the day of the inspection two staff were absent and at times residents did have to wait for staff to attend to them. We were told by relatives and staff that sometimes this meant residents were not changed or helped to toilet promptly and this could lead to discomfort and lack of dignity. Some residents appeared dishevelled with food stains on clothing. Personal care records indicated a weekly bath or shower was usually provided. There was little detail about personal preferences for personal care recorded in personal plans. This meant we could not see if choices and preferences were being met for personal care. page 3 of 20

4 Some residents were in bed and we could not see why they were not offered time up each day. Some residents spent their day in the ground floor "plaza". We could not see if this was their choice or the preference of staff. There were issues of dignity and respect observed. For example, a resident calling out for help in a distressed state. The buzzer was out of reach and only one staff member was present on that floor. A resident who had been told she could not go out independently to attend a meeting despite this being a usual routine. There was no risk assessment or care plan to explain this. It appeared staff were restricting this resident from socialising without using the appropriate approaches to document and agree care and support. A resident had a care plan stating she should be showered in a wheelchair. This was inappropriate and inappropriate wording was used in the care plan to describe this activity. These observations gave examples of poor outcomes which need improvement (see requirement 1 and recommendation 1). There were some good indicators noted in terms of low incidence of pressure sores. New care plans were in the process of being implemented. Personal plan records needed to improve to ensure they were up-to-date and accurate. Although legal status was recorded we found some areas that needed more explanation and next of kin details were not always complete (see recommendation 2). Goals and aspirations were not identified using the current personal plans. Some activity records were in place. Although more able residents were able to take part in groups and outings others had more limited input. The opportunity to take part in physical activities to maintain physical independence and ability could be developed further. The six monthly review of personal plans was mostly up-to-date and work was in progress to improve the records of discussion and agreements to care plans. Medication management issues were found. This included insecure fridge with insulin storage, poor records of medications, quantities and administration. Some administration directions were inaccurate and no review had been sought to correct this with G.P.'s. We also noted medications being crushed to ease swallowing without written instructions from pharmacist and medications being disguised in food or drink without proper understanding of staff. Two medications had gone out of stock for more than five days (see requirement 2). Requirements Number of requirements: 2 1. The service provider must provide the service in a manner which promotes quality and safety and respects the independence of service users and affords them choice in the way the service is provided to them. In order to do this the following must take place: - consultation and agreement over risk assessments and personal plans - care outcomes must be met in terms of personal care and the management of stress/distress - choices must be offered as to how a resident spends their day. This is in order to comply with SSI 2011/ 210 Regulation 3 Principles page 4 of 20

5 Timescale: by The service provider must ensure medication is available, administered correctly, stored appropriately and records are accurate. In order to do this the following must take place: - medication fridge must be locked - quantities of medications arriving must be recorded - medication administration records give accurate directions to staff - medication administration records are completed accurately by staff - medications are available and obtained quickly if out of stock - medications must not be crushed without taking advice from pharmacy - covert medications must only be administered if essential and agreed - homely remedies are agreed. This is in order to comply with SSI 2011/ 210 Regulation 4(1)(a) welfare of users. Timescale: by This requirement takes into account the Care Inspectorate document 'Records that care services must keep' (February 2012). Recommendations Number of recommendations: 2 1. The service provider should ensure that person-centred care is promoted. To show this: - choices for personal care should be offered - preferences recorded - efforts made to ensure preferences are met. National Care Standards, care homes for older people, standard 6.1: support arrangements. This recommendation is: unmet and therefore repeated. 2. The service provider should ensure the records show: - clear records of legal status - who the legal representative is - family tree or record of who family members are (when there are more than two) - clear record of contact details and service users preferences for contact. National Care Standards, care homes for older people, standard 11: expressing your views. This recommendation is: unmet and therefore repeated. Grade: 2 - weak page 5 of 20

6 Quality of environment Findings from the inspection The environment was of an adequate standard. However, there were some issues that needed immediate improvement. New dining rooms were in progress on the top and middle floors. These would bring the benefit of smaller more homely dining experience. The lounges in the units were pleasant and homely but not used often. All areas of the home were found to be clean and no odours were detected. A new bath had been installed in the top floor bathroom and this was an improvement. The shower rooms lacked homely appearance and only basic shower chairs were available on the top and middle floors. A more supportive shower chair was present in the building but staff seemed unsure of its whereabouts and whether it could be used in other areas. There was no accessible bath available on ground floor. The bath on the middle floor appeared not to be in use. This gave limited options and must be improved (see requirement 1). The provider plans to improve en-suite facilities in the future. The facilities for housekeeping staff to fill and tip buckets for cleaning was inadequate. There were some cleaning products seen with no labels. It was unclear how a spill of body fluid would be cleaned. Cleaning of equipment such as shower chairs also needed improvement (see requirement 2). Linen was observed to be of a poor standard. New supplies were available, but had not been put into use (see recommendation 1). The design and layout of the home could be improved to take account of the needs of people with dementia. This would include improved colour contrasts, signage and safe access to outdoor space (see recommendation 2). Some important health and safety checks had not been carried out in the last month. Previous months had indicated issues which needed to be addressed. These included water temperatures, window restrictors and bed bumpers. We also noted a number of slings for hoist use were being shared by residents. This meant they were not individually allocated to ensure good infection control and availability. These issues must be addressed (see requirement 3). Requirements Number of requirements: 3 1. The service provider must improve the bathing and showering facilities to ensure staff use them and offer a choice. Supportive shower chairs must be available to allow facilities to be used safely and with dignity. This is in order to comply with SS1 2011/210 Regulation 14(b) facilities in care homes. page 6 of 20

7 Timescale: by The service provider must improve the facilities and standards used for infection control and management of substances hazardous to health. In order to do this: - facilities must improve for housekeeping staff to fill and tip buckets - cleaning agents must be labelled appropriately - staff must be aware of how and have appropriate cleaning agents to clean spillages of body fluids. This is in order to comply with SS1 2011/ 210 Regulations 14(b) facilities in care homes & Regulation 4(1)(a). Timescale: by The service provider must ensure health and safety checks are carried out regularly and appropriate actions taken in response to issues identified. This is with specific reference to: - water temperatures - window restrictors - bed rail bumpers - allocation of slings - extractor fans. This is in order to comply with SS1 2011/210 Regulation 4(1)(a) Timescale: by This requirement takes into consideration Health and Safety Executive publication 'Health and Safety in Care Homes'. Recommendations Number of recommendations: 2 1. The service provider should ensure bed linen of a suitable quality is available and in use. National Care Standards, care homes for older people, standard 4: your environment. 2. The design and layout of the home should be improved further to take account of the needs of people with dementia. National Care Standards, care homes for older people, standard 4: your environment. Grade: 3 - adequate page 7 of 20

8 Quality of staffing Findings from the inspection The quality of staff was at an adequate level. However, at times staff availability or lack of knowledge and competence was effecting the care outcomes. There were some day shifts with only seven or eight staff on duty. The spread out nature of the building made it hard for staff to be visible and respond to needs. Feedback from residents and relatives about staffing was very positive in that they were "caring and kind". Many staff were well liked and good relationships had built up. However, there were comments about a lack of availability of staff and lack of attendance to buzzers. We heard comments from relatives and staff that this had led to residents having to wait for care. We were told by relatives that at times residents had not had their continence or repositioning needs attended to as often as felt necessary. This could result in a lack of dignity and potential distress for residents. Observation of staffing showed they were busy. Agency staff were sometimes being used to cover shifts. Recruitment was in progress, but in the meantime, this left a staff group who were sometimes lacking in knowledge about the residents they needed to care for. Handover information could be improved to ensure more written information is available to help support continuity of care (see requirement 1 & recommendation 1). A new induction format had recently been introduced. This has not yet been completed for new start staff. Recruitment practices were mostly satisfactory. Records need to be retained to show checks have been carried out with professional registers prior to the employee start date (see recommendation 2). Staff supervision was taking place, but not as frequently as intended. Some staff had not had supervision for over six months. This needed to develop further in order to ensure support for staff to develop better practice. Best practice was not always being followed. For example, in the management of residents with stress/distress we did not see clear plans of care for staff to follow in the records we examined. Records were not always being maintained as intended. For example, care files intended for use in bedrooms were stored centrally. The development of stronger clinical leadership was needed to ensure better care practices (see recommendation 3). Requirements Number of requirements: 1 1. The service provider must ensure there are sufficient staff available to meet the needs of service users. In order to do this there must be: - a review of dependency calculation that takes into consideration the layout of the building and complexity of the client group sufficiently to inform staffing numbers needed - closer staff observation to assess competency in meeting care outcomes for service users - feedback from residents and relatives to assess the staffing sufficiency and consider how improvements could be made. This is in order to comply with SSI 2011/210 Regulation 15(a). page 8 of 20

9 Timescale: by Recommendations Number of recommendations: 3 1. The service provider should ensure staff have sufficient information in order to be able to care for service users safely. In order to do this: - consideration should be given to the quality of handover and improvements made to the written information provided - clarity over nursing support for residential service users should be provided. National Care Standards, care homes for older people, standard 5.4: management and staffing arrangements. 2. The service provider should ensure evidence of checks with professional registers are carried out prior to the employees start date and induction procedures are followed. National Care Standards, care homes for older people, standard 5.3 & 5.5: management and staffing arrangements. 3. The service provider should ensure staff are supported with training and clear leadership to develop best practice in subjects such as infection control, dementia care and continence promotion/ management of incontinence. National care standards, care homes for older people, standard 5.2 & 5.4: management and staffing arrangements. Grade: 3 - adequate Quality of management and leadership Findings from the inspection Various audits and management reports were compiled to monitor aspects of the service. We checked accident and incident records and noted the reports did not include all of the paperwork intended to show follow up had been carried out to analyse and prevent re-occurrence. For example, there were medication errors and accidents which did not have action points identified and a management sign off (see requirement 1). A management analysis of accident and incidents was compiled on a monthly basis. Records showed unexplained bruising had occurred for a resident, but we could not see an adult protection referral had been made and what actions had been taken to investigate the cause (see requirement 2). page 9 of 20

10 A number of the incidents occurred that should have been notified to the Care Inspectorate. For example, a choking incident, medication errors, unexplained bruises, an external fire and an incident of unrestricted window which a resident climbed through (see requirement 3). Although various audits had been carried out and issues identified which were recorded in action plans. We could not see sufficient actions being taken to ensure improvements were made. For example, medication audits showed repeated deficits and nutrition audits showed weights repeatedly not being recorded. This shows the quality assurance systems are not sufficiently robust to ensure serious health and safety issues are corrected or care improvements are made (see recommendation 1). There was no record used to track concerns, suggestions or complaints. A complaints policy was displayed and complaints forms were available. However, although concerns had been raised these had not been recorded as complaints other than on a management report. This system needed development to ensure responses were clearly provided and could be tracked to show trends and common issues arising (see recommendation 2). Current policies and procedures were not available to staff. There was an intention this would be made available on-line but this had not yet been put in place. This meant staff could not refer to these easily (see requirement 4). Although some formal systems of obtaining feedback from residents and relatives were available in the form of meetings and suggestion boxes. Feedback from residents and relatives was mostly informal and not recorded. The participation strategy was out-of-date and did not take account of people with dementia. Development could take place to ensure feedback is recorded more fully to help establish areas for improvement and satisfaction. A poster with "your views matter" was positive to show listening and actions taken, but there was no date and it would be useful to see how the views had been obtained. No self assessment had been submitted to the Care Inspectorate and some of the information within the annual return of information was incomplete. Requirements Number of requirements: 4 1. The service provider must ensure accidents and incidents are recorded appropriately including any follow up actions. - the type of record must be agreed and used consistently with training for staff if necessary. This is in order to comply with SSI 2011/ 210 4(1)(a) Timescale: by The service provider must ensure adult protection procedures are followed by staff. This is in order to comply with SSI 2011/ 210 4(1)(a) Timescale: immediately on receipt of this report. page 10 of 20

11 3. The service provider must ensure notifications are made to the Care Inspectorate as set out in the notifications document. This is in order to comply with The Public Services Reform Act Timescale: immediate on receipt of this report. 4. The service provider must ensure staff can access current policies and procedures at all times in order to be able to refer to them and guide practice appropriately. This is in order to comply with SSI 2011/ 210 Regulation 3 Principles. This requirement also takes into account - National Care Standards, care homes for older people, standard 5.1: management and staffing arrangements. Timescale for meeting this requirement: by Recommendations Number of recommendations: 2 1. The service provider should continue to develop quality assurance systems to take account of issues identified in this report. Closer monitoring/development of: - care plan updates - medication audits - use of induction process - staff observation - audits to show personal care outcomes are being met and choices offered - strengthen feedback methods from staff, stakeholders, service users and relatives - completion of self assessment/annual return - use of service development plan to ensure actions are fully completed and improvements made. National Care Standards, care homes for older people, standard 5.4: management and staffing arrangements. 2. The service provider should develop the recording of concerns, suggestions and complaints to ensure full information is provided to the service user or their representative and an overview of common issues raised is monitored and acted upon. National Care Standards, care homes for older people, standard 11.3: expressing your views. Grade: 2 - weak page 11 of 20

12 What the service has done to meet any requirements we made at or since the last inspection Previous requirements There are no outstanding requirements. What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 The service provider should ensure that records show: - clear records of legal status - who the legal representative is - family tree or record of who family members are (when there are more than two) - clear record of contact details and service users preferences for contact. National Care Standards, care homes for older people, standard 11: expressing your views. Personal plan records were of a variable quality and inconsistency of recording was still present. This recommendation is: not met and therefore repeated (see quality of care and support). Recommendation 2 The service provider should ensure that the six monthly review meeting with service user or their representative: - allows discussion, review and update of the care plans and risk assessments - records clearly views of how care is going - copy is held in the care plan. National Care Standards, care homes for older people, standard 11: expressing your views. Review records were in place and details of the records were developing. page 12 of 20

13 This recommendation is: met. Recommendation 3 The service provider should ensure that person-centred care is promoted. To show this: - choices for personal care should be offered - preferences recorded - efforts made to ensure preferences are met. National Care Standards, care homes for older people, standard 6.1: support arrangements. See quality of care and support section of this report. This recommendation is: not met and therefore repeated. Recommendation 4 The service provider should ensure that service users with swallowing problems have: - fluids thickened correctly at all times if this has been discussed and agreed - tablet medications risk assessed and supplied in liquid form if so agreed. National Care Standards, care homes for older people, standard 6.1: support arrangements. Medication management issues were checked and a requirement has been made in this report that includes the need to ensure medications are safe to swallow and only crushed if pharmacy advice has been sought. This recommendation is: not met (see quality of care and support). Recommendation 5 The service provider should ensure that medication records and checks are carried out more robustly so that: - medications are stored securely - expiry dates are checked - homely remedies are agreed - medication reconciliation takes place on admission for all new service users - quantities in are always recorded - used CD patches are returned to pharmacy and records show this - swallowing status is included on the alerts section of the photo page with the MARS - creams are recorded on the T-MAR if prescribed two or three times/day (and not just in the morning). National Care Standards, care homes for older people, standard 15: keeping well - medication. page 13 of 20

14 A requirement has been made in this report with regards to medication management issues. This recommendation is: not met (see quality of care and support). Recommendation 6 The service provider should ensure that service users attending for respite care have a named worker who oversees their care and ensures: - the personal plan is checked within 72 hours of admission to ensure all the information received is sufficient - if further information is needed this is requested - the needs of the carer or representative are taken into account - records for previous respite admissions should be audited and an action plan put in place to ensure deficits do not recur. National Care Standards, short breaks and respite care services, standard 7: starting to use the service. There were no service users at the service for respite care. This will be checked at future inspection. This recommendation is: not met. Recommendation 7 The service provider should improve equipment/facilities further to be able to offer choice of care with privacy and dignity. Improvements should be made to: - provide a supportive shower chair - improve the top floor bathroom to allow use - begin a programme of improving en suites to allow ease of access - provide supportive armchairs to allow people to get out of bed. National Care Standards, care homes for older people, standard 4: your environment and standard 6: support arrangements. The top floor bathroom had improved. However, other issues were identified on this inspection. A requirement has been made in relation to the provision of supportive shower chairs. This recommendation is: not met (see quality of environment). page 14 of 20

15 Recommendation 8 The service provider should ensure action is taken to remove odours from: - toilets off the "plaza" main lounge - top floor bathroom drains. National Care Standards, care homes for older people, standard 4.3: your environment. No odours were detected. This recommendation is: met. Recommendation 9 The service provider should ensure that use of dirty utilities (sluice rooms) is improved in line with infection control best practice. This should include: - repair to the flooring - removal of inappropriate items - ensure staff know to take items for cleaning to the laundry. National Care Standards, care homes for older people, standard 4.3: your environment. Further issues were identified on this inspection and a requirement has been made to improve the facilities for housekeeping staff. This recommendation is: not met (see quality of environment). Recommendation 10 The service provider should ensure that application forms ask care workers to provide information about their registration with the SSSC, so this can be cross checked. National Care Standards, care homes for older people, standard 5.5: management and staffing arrangements. Application forms now include this information. This recommendation is: met. Recommendation 11 The service provider should ensure induction processes are followed for new staff. page 15 of 20

16 National Care Standards, care homes for older people, standard 5.3: management and staffing arrangements. A new process had been introduced. However, this was still in progress of implementation (see quality of staffing). Recommendation 12 The service provider should continue to develop quality assurance systems to take account of issues identified in this report. Closer monitoring/development of: - care plan updates - medication audits - use of induction process - completion of mandatory training - strengthen feedback methods from staff, stakeholders, service users and relatives. National Care Standards, care homes for older people, standard 5.4: management and staffing arrangements. Quality assurance systems still needed to improve (see quality of management and leadership). This recommendation is: unmet and therefore repeated. Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at Enforcement No enforcement action has been taken against this care service since the last inspection. page 16 of 20

17 Inspection and grading history Date Type Gradings 9 Mar 2016 Unannounced Care and support Not assessed Not assessed Not assessed Management and leadership Not assessed 15 Oct 2015 Unannounced Care and support 3 - Adequate 3 - Adequate Management and leadership 27 Jan 2015 Unannounced Care and support Management and leadership 5 - Very good 30 Jun 2014 Unannounced Care and support 3 - Adequate 2 - Weak 3 - Adequate Management and leadership 3 - Adequate 5 Mar 2014 Unannounced Care and support 3 - Adequate 3 - Adequate 3 - Adequate Management and leadership 3 - Adequate 4 Oct 2013 Unannounced Care and support 2 - Weak 2 - Weak 2 - Weak Management and leadership 2 - Weak 25 Feb 2013 Unannounced Care and support Not assessed Management and leadership page 17 of 20

18 Date Type Gradings 17 Oct 2012 Unannounced Care and support 5 - Very good Management and leadership 25 Jan 2012 Unannounced Care and support Not assessed Not assessed Management and leadership Not assessed 8 Jul 2011 Unannounced Care and support 5 - Very good Not assessed Management and leadership Not assessed 8 Nov 2010 Unannounced Care and support 5 - Very good Not assessed Not assessed Management and leadership Not assessed 8 Jun 2010 Announced Care and support 5 - Very good Not assessed 5 - Very good Management and leadership Not assessed 14 Dec 2009 Announced Care and support Management and leadership 7 May 2009 Unannounced Care and support Management and leadership Not assessed 22 Jan 2009 Unannounced Care and support 3 - Adequate 3 - Adequate Management and leadership Not assessed page 18 of 20

19 Date Type Gradings 21 Aug 2008 Announced Care and support 3 - Adequate 3 - Adequate Management and leadership 3 - Adequate page 19 of 20

20 To find out more This inspection report is published by the Care Inspectorate. You can download this report and others from our website. Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and help services to improve. We also investigate complaints about care services and can take action when things aren't good enough. Please get in touch with us if you would like more information or have any concerns about a care service. You can also read more about our work online at Contact us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com Find us on Facebook Other languages and formats This report is available in other languages and formats on request. Tha am foillseachadh seo ri fhaighinn ann an cruthannan is cànain eile ma nithear iarrtas. page 20 of 20