Grants Bank Care Home Service Adults Pilmuir Street Dunfermline KY12 0NH Telephone:

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1 Grants Bank Care Home Service Adults Pilmuir Street Dunfermline KY12 0NH Telephone: Inspected by: Marion Ash Type of inspection: Unannounced Inspection completed on: 5 November 2013

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 23 5 Summary of grades 24 6 Inspection and grading history 24 Service provided by: Bield Housing & Care Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: Marion Ash Telephone enquiries@careinspectorate.com Grants Bank, page 2 of 26

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 5 Very Good Quality of Environment 5 Very Good Quality of Staffing 5 Very Good Quality of Management and Leadership 5 Very Good What the service does well The service continues to deliver very good outcomes for residents who often have complex health and care needs. An inclusive culture was evident, with residents and relatives being supported to give their views of the service and offer suggestions for improvement. Grants Bank offers a pleasant and homely environment and staff were found to have a caring and pleasant attitude to residents. It was evident throughout the inspection that residents had developed trusting relationships with staff and management. The staff team were highly motivated and skilled, and supported residents to maintain their independence. Residents we spoke with told us they were very happy with the care and support they received. What the service could do better The service should continue to expand upon the opportunities for all stakeholders to assess the service provision and offer suggestions for further development. Grants Bank, page 3 of 26

4 What the service has done since the last inspection Inspection report continued The service continued to provide a very good standard of care and support to residents.the service had explored additional ways for people to be involved in shaping the service delivery. Conclusion Grants Bank is a well respected care facility within the local community. There were many letters and cards from relatives giving thanks for the care received by their relative. The service continues to explore ways to improve residents' quality of life. They demonstrated a person centred approach to all aspects of service delivery. Who did this inspection Marion Ash Grants Bank, page 4 of 26

5 1 About the service we inspected The Care Inspectorate regulates care services in Scotland. 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 regulation to the Care Inspectorate on 1st April 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 we investigate. Requirements and Recommendations If we are concerned about some aspects of a 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 that sets out what is required of a care service to comply with the Public Services (Scotland) Reform Act 2010 and Regulations or Orders made under the Act, or a condition of registration. Where there are breaches of the Regulation,Orders or conditions, a requirement must be made. Requirements are legally enforceable at the discretion of the Inspectorate. Grants Bank is a modern purpose built accommodation situated centrally in Dunfermline. The service provider is Bield Housing Association. Grants Bank is part of a larger sheltered housing complex. The care home provides accommodation for up to fourteen older people at any time in single en-suite flat-lets. The registered manager for the care home service is responsible for the day to day running of the care home and the supervision of staff. Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 5 - Very Good Quality of Environment - Grade 5 - Very Good Quality of Staffing - Grade 5 - Very Good Quality of Management and Leadership - Grade 5 - Very Good Grants Bank, page 5 of 26

6 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. Grants Bank, page 6 of 26

7 2 How we inspected this service The level of inspection we carried out In this service we carried out a low intensity inspection. We carry out these inspections when we are satisfied that services are working hard to provide consistently high standards of care. What we did during the inspection We wrote this report following an unannounced inspection visit to the home. The inspection was carried out by one inspector, Marion Ash. The inspection took place on Tuesday, 5 November 2013 between 10:00am and 4:00 pm. Feedback of our inspection findings was given to the manager of the service at the end of the day where the findings and grades were agreed. In this inspection, we gathered evidence from various sources including the relevant sections of policies, procedures, records and other documents including; the self assessment sent to us by the service aims and objectives of the service information provided in the annual return minutes of meetings for residents,relatives and staff completed questionnaires personal planning and review records staff training records and supervision notes. Discussions with ; the manager care staff residents and 3 relatives. Information from the above sources has informed this inspection report. Grants Bank, page 7 of 26

8 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 report continued 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 Grants Bank, page 8 of 26

9 What the service has done to meet any recommendations we made at our last inspection Two recommendations had been made at the last inspection. These and the action taken by the home are as follows: Recommendation 1 The provider should ensure that where the meal provided is unsuitable for a service user then an alternative is offered. National Care Standard - Care Homes for Older People - Standard 13 - Eating well. Action Taken The manager assured us that it would be normal practice for service users to be offered an alternative meal if what was served was not to their liking. All staff were reminded of this and the mealtime experience was being monitored by the manager of the service to ensure an alternative choice was offered. Recommendation 2 The provider should ensure that cleaning fluids and materials are not left unattended in an area that is accessible by residents. National Care Standards - Care Homes for Older People - Standard 4 - Your environment. Action Taken The manager had reinforced to all staff the importance of ensuring all cleaning materials were stored securely and not accessible to service users. Cleaning materials were being stored securely at this inspection. We considered the service to have addressed the recommendations made appropriately. Grants Bank, page 9 of 26

10 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 provider of the service. We were satisfied with the way the service had completed this and with the relevant information they had given us for each heading that we grade them under. The self assessment contained information on strengths and some self identified areas for improvement. Taking the views of people using the care service into account We sent out 10 Care Standard Questionnaires of which nine were completed and returned. We also spoke in person during the inspection with 4 of the 12 residents in the home on the day of the inspection. All comments made were extremely positive with residents holding the staff and manager of the service in high regard. Comments made included ; "I am very happy with Grant's Bank, we are well looked after here. I am fortunate to be here with new friends and comfortable surroundings". "I have no complaints, I have been here for some time now and not once have I had cause to complain. The girls are all very nice and kind and keep me supplied with plenty to drink. I enjoy having my own private space with the benefit of knowing there is always someone around if I need any help". Additional comments have been recorded within the body of this report. Taking carers' views into account We sent 10 Care Standard Questionnaires out to relatives of which 7 completed questionnaires had been received by the Care Inspectorate prior to the inspection visit. 100% of respondents either agreed or strongly agreed to care statements including, "I am confident that staff have the knowledge and skills to care for me" and "Overall, I am happy with the quality of care I receive". Grants Bank, page 10 of 26

11 Comments made in the questionnaires included; "I am extremely happy with the care my mother receives at Grant's Bank. The staff are all caring and professional. The food is very good and she is well looked after". "Grant's Bank are caring and considerate to the family and my relative". "I couldn't praise the staff highly enough". Inspection report continued Grants Bank, page 11 of 26

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: 5 - Very Good 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 We found the service to evidence a very good performance against this quality statement. There were a number of opportunities for residents and their relatives/ carers to be involved in assessing the service and offering sggestions for further development of the service. We concluded this from: speaking with the manager and her staff having informal discussions with residents and relatives looking at responses made in completed questionnaires checking the minutes of residents', relatives' and staff meetings checking information on noticeboards and in the organisation's newsletters verifying the information provided in the care home self assessment. The service had an established participation policy which detailed how people could get involved in the development of the service and influence decision making. Some examples of the opportunities available include; resident/relative involvement in care planning and reviews of care, regular meetings for residents/relatives and staff bi-annual quality assurance surveys recruitment of staff complaints procedure. Grants Bank, page 12 of 26

13 We observed a 'handover meeting' which evidenced that staff had a good knowledge of residents' needs and the level of support they required. The information shared between the staff was detailed and sensitive to individual health and care needs. There was a copy of the latest inspection report displayed on notice boards throughout the home. Other information displayed included minutes of meetings and local events. Residents and relatives that we spoke with, made positive comment about the service provision and the quality of the staff comments made included; "I am extremely happy with the care my mother receives from Grant's Bank. The staff are all very catting and professional, the food is very good and she is well looked after. I am pleased that my mother was given a place at Grant's Bank. It was the only place that she wanted to go". "I am very thankful for the way my mum is being looked after. I couldn't praise the staff highly enough". "The care in Grant's Bank is very good. They are caring and considerate to both the family and my relative". Areas for improvement The manager may wish to consider the height and font size used in some of the notices in the reception area and elsewhere in the home for the benefit of those residents with visual impairment or who are wheelchair users. Some of the comments made included suggestions for further improvement of the service such as, "There is a small drawback in the service and that is staffing levels, there is limited time for one to one between staff and residents. If there were more staff there may be more time to go for coffee or a walk". Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths The service was found to evidence a very good performance against this quality statement. We concluded this from sampling care plans, speaking with residents and their relatives, in serving staff interactions with residents and reviewing comments Grants Bank, page 13 of 26

14 made in the Care Inspectorate Questionnaire 'How satisfied are you with this care service'. We sampled three care plans and found these to contain suitably detailed health and risk assessments. A range of assessment tools were used and these included continence and skin care, pain management, falls, risk assessment and nutritional assessment. Staff had been trained in the use of these assessments and training included when to seek service user's permission to get professional advice. Detailed care plans had been put in place for each identified need. These were sufficiently detailed to give guidance to staff on how each person wished their needs to be met. The care plans were very individualised and identified specific goals that could be achieved. The plans also evidenced involvement of other healthcare professionals where required. Any advice given had been entered into the care plan. It was evident from the plans that service users and their families had been involved in their development. We looked at the risk assessments that were in place and these were seen current having being recently reviewed to reflect changes. Risk assessments had taken into account the abilities of individual residents and allowed them to take appropriate risks with support. The plans evidenced regular reviews and the information in the care plans had been updated accordingly. Care plans evidenced that residents had access to wide range of health professionals including G.Ps, district nurses, chiropodists, and dieticians. The residents that we met with and talked to looked well and told us they were very happy with the care and support they received at Grant's Bank. The feedback we recieved from relatives was equally positive and comments made in interview included; "I am very glad we chose to bring our relative to Grant's Bank. The staff and manager are very good, kind, caring, approachable and keep us informed of any changes to our relatives health. We are always made to feel very welcome and are encouraged to continue to be involved in the care of our relative. They haven't just taken over the care, they encourage our relative to remain as independent as physically possible but are always there to lend a hand if needed". "We are so glad that our relative is here. He is so settled and comfortable and enjoys the company of the other residents and staff. I am happy when I leave here to know that he is being well cared for, I have no concerns". We spoke with four residents in a one to one situation during the inspection visit. All four were happy with the care and support staff gave them. Comments included; "What is there not to like, I have a lovely room with my own things in. The meals are good, I have good company, the staff are very helpful and I feel safe here". Grants Bank, page 14 of 26

15 We observed the lunchtime meal service and residents were seen to be offered an alternative meal if they did not like what was on the menu. The tables were nicely set with condiments being available on the tables. Areas for improvement The provider should continue to build on the very good practice evidenced at this inspection. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Grants Bank, page 15 of 26

16 Quality Theme 2: Quality of Environment Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the environment within the service. Service strengths Evidence recorded under Quality Theme 1, Statement 1 is also valid for this Quality Statement and has been taken into consideration when awarding the grade for this statement. Residents had personalised their bedrooms with small pieces of furniture from their own homes and the walls displayed their photographs and pictures. This made the rooms more familiar and welcoming to individual residents. Relatives spoken with confirmed that they were kept informed of any proposed changes in the home and any redecoration was discussed with them and their relative to give them the opportunity to choose colours and patterns. Minutes of meetings evidenced that suggestions made had been implemented. Areas for improvement As recorded under Quality Theme 1 Statement 1. 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 At this inspection we found the performance of the service was very good for this statement. We concluded this from sampling maintenence records, repair books, accident records and general observation of the environment and staff practice. Grants Bank, page 16 of 26

17 On arrival to the service we found the home to be clean and fresh.throughout the inspection we noted high standards of hygiene within the communal areas of the care home while still achieving a homely environment. There were a range of policies and procedures regarding health and safety including infection control, accident and incident reporting and property maintenance. There were also appropriate policies in relation to staff recruitment ensuring all necessary background checks were carried out on applicants prior to appointments being made. All accidents and incidents were fully recorded by staff and this was monitored by the management team to ensure that any additional safety measures required were put in place to safeguard the resident. Each resident had a written contract and residency agreement in place which detailed the terms and conditions of their stay at the home. These were seen to follow best practice guidance as per The National Care Homes contract guidelines. All rooms had a call point from which residents could summon assistance from staff if required. These were seen to be in good working order and easily accessible to residents. The service displayed a valid Public Liability Insurance certificate. Regular maintenance checks both internally and externally were carried out. There was also contracts in place from outside contractors and they visited the home to carry out repairs and annual checks. Bield had recently moved to a 'one stop' maintenance organisation to promote better efficiency to the reair and maintenance system. A comment made by a relative in the Care Inspectorate Questionnaire supported our findings, it read; "Sometimes my relatives behaviour can be quite challenging. The staff have put in place a number of safety measures including pressure mats and door alarms which help to keep her safe". Medications coming into the home and for return to the pharmacy were stored securely and an appropriate system was in place for safe administration. Areas for improvement There was very little signage around the home that would assist people with orientation to particular rooms. This however, did not appear to have a negative impact on the current residents of the home. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Grants Bank, page 17 of 26

18 Quality Theme 3: Quality of Staffing Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service Strengths Evidence recorded under Quality Theme 1, Statement 1 is also valid for this Quality Statement and has been taken into consideration when awarding the grade for this statement. Respondents to the Care Inspectorate Questionnaire had either agreed or strongly agreed with the statements, "My privacy is respected by staff and other residents" and "The service asks for my opinion on how it can improve". We had the opportunity during the inspection to sit in on a staff handover meeting. Staff demonstrated a good knowledge of the residents in their care and an understanding of the challenges some of them faced with everyday tasks due to medical conditions and the support that was required to assist them with this. Comments made by staff in the Care Inspectorate Questionnaire included; "I feel as an employee that this service is very supportive of the staff, service users, and their families. Service users are encouraged to make their own choices in their daily lives. It is a pleasure to work for this service and the service users." Areas for improvement As recorded under Quality Theme 1 Statement 1. 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. Grants Bank, page 18 of 26

19 Service strengths Inspection report continued We found this service to have a very good performance in the areas covered by this statement. We concluded this after we : observed staff interactions with the residents talked with staff members spoke to and received feedback from staff members sampled staff training records. There was a comprehensive induction process in place for all staff. This covered a range of information that staff would need to provide a quality service. Staff told us they felt the training was of a good standard. They were able to talk about what they had learnt and how this had influenced their practice for the better. All but one member of staff had achieved an SVQ (Scottish Vocational Qualification) assessment award. The training plan for 2013 evidenced a wide variety of training which included; moving and handling, fire safety, first aid, food hygiene and risk assessment. Complimentary training in areas such as dementia, medication, healthy eating, diabetes, palliative care, falls prevention and challenging behaviour had also been undertaken by staff. Staff were further supported through regular supervision meetings every 6-8 weeks where they could meet their line manager to discuss their performance and any concerns they may have on a one to one basis. The service also held regular staff meetings where operational matters could be discussed as a group. Comments made to us from residents and relatives in interview included; "The staff here are wonderful, nothing is too much trouble for them. They respond to challenges with nothing but kindness and patience". "I am very happy here, the staff are very good to me. I don't want for anything so what's not to like". "I think the organisation is very good at staff selection. Everyone here is an absolute treasure and they are very good at their job". Staff we spoke with were aware of the National Care Standards and SSSC codes of practice. Grants Bank, page 19 of 26

20 Areas for improvement The provider should continue to build on the development of staff ensuring they are kept up to date with best practice guidance. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Grants Bank, page 20 of 26

21 Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 5 - Very Good 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 Evidence recorded under Quality Theme 1, Statement 1 is also valid for this Quality Statement and has been taken into consideration when awarding the grade for this statement. Residents we spoke with knew the manager well and said they would be happy to take any concerns to her. Relatives said the manager was accessible and were confident that any concerns raised would be addressed appropriately and quickly. Areas for improvement As recorded under Quality Theme 1, Statement 1. Grade awarded for this statement: 5 - Very 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 We found the service to evidence a very good performance against this Quality Statement. We concluded this from observing how staff, including the management responded to residents' suggestions and comments made in completed questionnaires, reviewing records related to participation, including minutes of meetings and informal discussions with residents and relatives. The service was able to demonstrate auditing and monitoring systems were being used to assess and improve on all aspects of the care home service. Grants Bank, page 21 of 26

22 Residents and relatives confirmed they were comfortable approaching the management team if needed. In returned Care Inspectorate Questionnaires, 100% of respondents to statements made about management and leadership strongly agreed the the service had involved them in developing the service and that management had taken their feedback and ideas seriously. The strengths recorded under Quality Theme 1 Statement 1 is also relevant for this statement and has been taken into consideration when awarding the grade. Areas for improvement At the time of this inspection the service did not give visiting health care professionals the opportunity to give their views of the standards of care and support delivered at Grant's Bank. The provider should include visiting health care professionals when using quality assurance systems to monitor the performance of the service. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Grants Bank, page 22 of 26

23 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 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). Grants Bank, page 23 of 26

24 5 Summary of grades Quality of Care and Support Very Good Statement 1 Statement Very Good 5 - Very Good Quality of Environment Very Good Statement 1 Statement Very Good 5 - Very Good Quality of Staffing Very Good Statement 1 Statement Very Good 5 - Very Good Quality of Management and Leadership Very Good Statement 1 Statement Very Good 5 - Very Good 6 Inspection and grading history Date Type Gradings 4 Jan 2013 Unannounced Care and support 5 - Very Good Environment 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good 21 Oct 2010 Unannounced Care and support Not Assessed Environment Not Assessed Staffing Not Assessed Management and Leadership 5 - Very Good 10 May 2010 Announced Care and support 5 - Very Good Environment Not Assessed Staffing Not Assessed Management and Leadership 5 - Very Good Grants Bank, page 24 of 26

25 15 Mar 2010 Unannounced Care and support Not Assessed Environment Not Assessed Staffing Not Assessed Management and Leadership 5 - Very Good 27 Aug 2009 Announced Care and support 4 - Good Environment 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good 2 Mar 2009 Unannounced Care and support 5 - Very Good Environment 4 - Good Staffing 5 - Very Good Management and Leadership 4 - Good 2 Jul 2008 Announced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 4 - Good All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Grants Bank, page 25 of 26

26 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: Grants Bank, page 26 of 26

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