Erskine Edinburgh Home Care Home Service

Transcription

1 Erskine Edinburgh Home Care Home Service 468 Gilmerton Road Edinburgh EH17 7SA Telephone: Type of inspection: Unannounced Inspection completed on: 5 December 2016 Service provided by: Erskine Hospital Service provider number: SP Care service number: CS

2 About the service Erskine Edinburgh is a care home for ex-service men and women and is owned and managed by Erskine Hospital Ltd. It is registered to provide 24 hour nursing care for 72 older people. The home is situated within the Gilmerton area of the city close to local amenities and on local bus routes. There are landscaped gardens which are easily accessed by the service users and visitors. The accommodation is provided in two buildings (seven named houses) which are connected by a covered walkway. Each bedroom has its own en suite toilet, wash hand basin and shower facility. There are a variety of lounges and dining rooms in each building. The philosophy of care of the organisation states that ' dignity, privacy and respect are of paramount importance in delivering our care within a homely environment.' The inspection focused on standards of care for people living with dementia. We are using a sample of 150 care home services to look in detail at the standards of care for people living with dementia and this service is one of those selected as part of the sample. The areas looked at were informed by the Scottish Government's Promoting Excellence: A framework for health and social care staff working with people with dementia and their carers and the associated dementia standards. It is our intention to publish a national report on some of these standards during What people told us We met with 10 residents individually during our inspection and spent time with others around the home. Residents spoke positively about living in the care home and were complimentary about various aspects of the service. Overall, we heard that staff were good, respectful and attended to any requests made by residents. One resident commented that the food could be better, however, they also felt that staff were very attentive. Prior to the inspection, we sent out 45 care standards questionnaires for residents. Twelve of these were completed and returned to us. Overall, the responses from questionnaires were positive and all agreed or strongly agreed that they were happy with the quality of care they received in the home. However, two residents disagreed that they were encouraged to discuss their views and three residents disagreed that the service asked for their opinions on how it can improve. All responses agreed or strongly agreed that staff knew their dislikes and preferences, and did what they could to meet them, and were confident that staff had the skills and knowledge to care for them. Some residents were less able to tell us what they thought about the service or the care they received. However, we saw that residents responded positively to support from staff. Both residents and staff appeared relaxed in each other's company and enjoyed chatting and laughing together. We used the Short Observational Framework for Inspection (SOFI 2) to directly observe the experience and outcomes for people who were unable to tell us their views. It helps us capture the experiences of people using the service who may not be able to express their views. We found that staff supported residents with warmth and respect. There were kind and caring interactions between staff and residents. page 2 of 12

3 On one occasion, we saw that a member of staff asked some residents if they would like to participate in an activity but then left the residents for some time before returning to start the activity. The residents did not start the activity independently and spent this time waiting for the staff member to return. Some people with memory problems need support and guidance to be able to engage in tasks or activities and to remain orientated to this and what is going on around them. We shared our observations with the manager. We spoke with nine relatives/visitors during our inspection. They were very complimentary about staff and told us that staff were welcoming, very attentive and provided good care for their relative. People felt included in decisions about their loved one's care and were very happy with the service provided. We sent out 45 questionnaires for relatives and carers and received 14 completed questionnaires prior to our inspection. Two questionnaire responses disagreed that they knew about the home's complaints procedure and that they were involved in developing the service, such as being asked for ideas and feedback. One questionnaire noted they disagreed that the home was clean and hygienic and that their relative's clothing and property were marked and properly cared for. However, the majority of responses gave very positive feedback on the service and that all relatives/carers agreed or strongly agreed that they were happy with the care their relative received at the home. Comments included: "My husband is happy and contented in Erskine Home. It is spotlessly clean, staff are very pleasant and extremely helpful. Activities are very good. This pleases my husband". "The staff are always very kind and understanding". "I'm pleased to say, independence is encouraged". "When we do visit, it is to find my mother well looked after and never distressed. She seems to be happy and the staff are very attentive and know her well. My mother was a very sociable person and the home provides the hands-on approach that my mother needs". One relative commented on their fathers move to the home and noted "he is much calmer, more comfortable and content. It has been such a relief". Self assessment The Care Inspectorate received a fully completed self-assessment document from the provider. This contained comprehensive, detailed information and was completed to a very good standard. The provider identified what it thought the service did well, some areas for development and any changes it had planned. From this inspection we graded this service as: Quality of care and support Quality of environment Quality of staffing Quality of management and leadership 5 - Very Good 5 - Very Good 5 - Very Good 5 - Very Good page 3 of 12

4 Quality of care and support Findings from the inspection During our inspection we observed there was a relaxed and welcoming atmosphere in the home. We saw that residents appeared well cared for and were supported in a respectful and caring manner by staff. There was a range of ways for people to contribute to the service, with residents and relatives involved in various groups and committees. We could see that residents and relatives views were represented in most decisions, changes and developments in the service. Personal plans were in place for each resident. These were well written, personalised and contained detailed information on resident's care and support needs. A range of assessments were used to help identify potential risks or care needs for residents. These helped inform the development of care plans for residents. Personal plans were regularly evaluated and audited which helped ensure the information was detailed and current. The service used specific documentation to record the treatment and management of skin wounds. We discussed with the management team that some were completed in more detail than others, and that these should be consistently completed to more clearly record wounds and plan for the management of dressings. We will follow this up at future inspections. Care reviews were held around every six months. Residents and relatives were involved as appropriate. We saw that, whilst residents and relatives were involved in reviews, often their feedback was not well recorded. There should be a more consistent approach to recording feedback. This will be looked at again at future inspections. A regular choice of social activities was on offer to residents, along with organised events such as fetes, visits from local schools and a regular memory café. It was evident from spending time with people, and information in personal plans, that residents were supported to participate in hobbies and pastimes they enjoyed, including those that had been part of their life before moving in to the home. Whilst acknowledging the many good social opportunities on offer, the service should look at how they can provide further opportunities for residents to socialise outwith the home on an individual basis with staff and for activity provision to continue to accommodate residents changing needs or choices. Charts were used to record care given by staff such as when residents at risk of skin damage were helped to change their position. Some re-positioning charts were not completed consistently to the same standard. Whilst this was only observed on a few charts, it is important that services are able to show that residents have received care according to their assessed needs, in order to help prevent pressure related skin damage. The service should ensure that all charts are completed consistently when in use. We will look at this again at the next inspection. Requirements Number of requirements: 0 page 4 of 12

5 Recommendations Number of recommendations: 0 Grade: 5 - very good Quality of environment Findings from the inspection The home had a large, bright and welcoming entrance with a secure door entry system at the front of the building. The building was easily accessible from a large car park at the front, with a number of stairs and lifts providing easy access throughout all areas of the home. Residents bedrooms and communal areas of the home were nicely decorated and appeared clean and well maintained. We saw that resident's bedrooms were personalised with their own items of furniture, cherished possessions and decorated to their individual taste. In order to provide points of interest and help create a sense of purpose and meaningful activity, some communal areas of the home had been designed to include tactile objects and artwork, and features such as collections of items related to the armed forces. Two areas of the home provided separate relaxation/sensory rooms for residents. There were secure, enclosed gardens to the rear of the home. These were easily accessible from ground floor areas of the home and included seating areas, raised plant beds, areas of lawn and landscaped borders and pathways. We discussed with the manager about looking at how they could further develop areas of the garden to provide added sensory experiences for residents. We used the Kings Fund al Assessment Tool as part of our assessment of the home environment. This helps identify areas where the environment could be improved to be more supportive for people with dementia. Prior to our inspection, the service had also completed this assessment in order to identify areas that could be developed. We discussed with the manager about developing action plans to progress any areas they had identified for improvement in order to continue to provide a positive and enabling environment for residents with dementia. A system of routine maintenance and safety checks on the environment and equipment was in place and completed both by the provider and external contractors. A variety of moving and handling equipment was available to staff. Whilst we had no concerns about the safety of the environment, we found that documentation relating to safety checks was held at various locations, making it difficult for the service to easily evidence that all checks were carried out regularly. The manager took steps to obtain all necessary documentation and will look at how this can be consolidated to allow for easier completion and monitoring. We will look at this again at future inspections. Some residents living in the home were at increased risk of falling. A system was in place to document, monitor and minimise the risk of residents having falls. During our inspection, the home was tidy and free from obstacles and call bells were within reach of residents when they were in their own rooms. These actions contributed to reducing the likelihood of residents having falls. page 5 of 12

6 The service should ensure that all perishable food and drink kept in the unit kitchens is labelled and dated when opened. This helps staff store them in line with best practice in food hygiene and manufacturers guidelines. We will look at this again at future inspections. Requirements Number of requirements: 0 Recommendations Number of recommendations: 0 Grade: 5 - very good Quality of staffing Findings from the inspection We observed staff to be respectful, caring and supportive towards residents during our visits. Staff were very familiar with residents and knowledgeable about their health and support needs. Staff appeared professional and confident in the service they provided. Staff seemed motivated to provide a good standard of care for residents and responded positively to the inspection process. Safe recruitment checks and procedures were used when employing new staff. We saw that, where applicable, staff were registered with the Nursing and Midwifery Council (NMC) or the Scottish Social Services Council (SSSC) according to their role and these had been checked prior to all new staff starting work in the service. The service had recently introduced workshops to support staff in meeting registration requirements. Residents and relatives could be involved in the recruitment process if they wished. A training and induction programme was in place for all staff. A system was in place that helped that manager monitor all training and learning completed by staff and we saw that all mandatory training set out by the provider was up-to-date. Staff told us they were given time to complete training and were positive about undertaking learning and development. Whilst some non-nursing care staff had completed training on skin care and pressure ulcer prevention appropriate to their role, we would encourage the service to promote this with all staff. Staff were encouraged to develop within their roles and take on specific responsibilities in areas, such as dementia, and to promote learning and good practice with the staff team. We found that staff at all levels had completed training in dementia appropriate to their role and had a good awareness of the condition. The service should continue to look at how they can promote and raise awareness of the dementia care standards within the staff team and how these related to the care and support provided for residents. Staff had regular opportunities to discuss their work, development and training at staff team meetings, individual one-to-one supervision meetings and yearly staff appraisals. We could see that individual supervision and page 6 of 12

7 appraisal meetings supported staff to discuss and reflect on their practice and set objectives in order to continually develop. The service could further enhance this by selecting a national care standard to discuss with staff as part of this. Staff told us that they felt well supported, there was good team working and senior staff were approachable. We saw that the service invested in staff, both in training and development and in activities and resources, such as yoga classes, that supported staff in having healthy working lives. Requirements Number of requirements: 0 Recommendations Number of recommendations: 0 Grade: 5 - very good Quality of management and leadership Findings from the inspection A quality assurance system was in place that showed regular audit checks were completed on various aspects of the service. The quality assurance checks we looked at showed that issues and areas for improvement had been identified and actions had been taken in response to these. The audits were comprehensive and were incorporated into quarterly reports for senior management. This was monitored by the provider to ensure that the service continued to perform at a level that was expected by the provider and helped inform an on-going development plan for the service. We felt that documentation and audits relating to the home environment and maintenance would benefit from being consolidated and simplified to help the management team monitor these on an on-going basis. We discussed this with the manager during our inspection who had started to look at ways to put this in place. Residents, relative and staff opinions were sought through a variety of ways, including contributing to the Care Inspectorate's self-assessment. This is where the provider identifies what it thought the service did well, some areas for development and any changes it had planned. We discussed with the manager some areas the service may wish to further develop. This could include looking at how they can fully reflect all the very good work being carried out, for example, in an end of year report. They could also look at and continuing to involve relatives in the service such as developing a 'buddy' type service to support relatives of residents new to the home. Flash meetings were held on a daily basis involving heads of departments and senior staff. These gave staff an opportunity to share information from each department and to have an awareness of any issues or events occurring around the home. page 7 of 12

8 Resident dependency levels were calculated regularly and used to inform staffing levels throughout the home. We saw from a sample of staff rotas that, on occasion, the service did not meet the skill mix of staff as set out in their staffing schedule. At times, there had not been the required number of senior carers on duty overnight but a combination of carers and senior carers. The manager explained that this was due to long-term sickness and that they had replaced the senior carer with experienced carers and ensured there was adequate trained nurse cover to ensure residents needs were being met. The manager advised that they expected the situation to be resolved soon, however, we discussed other strategies for addressing the situation or for them to consider requesting their staff schedule and staffing to be reviewed by the Care Inspectorate. Whilst we were confident that the service had taken appropriate steps to ensure residents needs were being met and that the manager would take action to rectify this on a longer term basis, this will be looked at again at the next inspection. The management team were receptive to the inspection process and to discussions about how the service could continue to develop. They had a good awareness of how the service was performing, what it did well and areas where improvements were needed. It was evident that there was strong leadership and guidance from the management team and other senior staff. Requirements Number of requirements: 0 Recommendations Number of recommendations: 0 Grade: 5 - very good What the service has done to meet any requirements we made at or since the last inspection Previous requirements There are no outstanding requirements. page 8 of 12

9 What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations There are no outstanding recommendations. 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. Inspection and grading history Date Type Gradings 22 Dec 2015 Unannounced Care and support Management and leadership 22 Jan 2015 Unannounced Care and support Management and leadership 25 Feb 2014 Unannounced Care and support Management and leadership page 9 of 12

10 Date Type Gradings 29 Oct 2013 Unannounced Care and support Management and leadership 27 Nov 2012 Unannounced Care and support 3 - Adequate Management and leadership 3 - Adequate 6 Aug 2012 Unannounced Care and support 3 - Adequate Management and leadership 3 - Adequate 14 Nov 2011 Unannounced Care and support 2 - Weak 3 - Adequate 3 - Adequate Management and leadership 3 - Adequate 9 Aug 2011 Unannounced Care and support 3 - Adequate Not assessed 3 - Adequate Management and leadership 2 - Weak 27 Apr 2011 Unannounced Care and support 2 - Weak 3 - Adequate 2 - Weak Management and leadership 2 - Weak 25 Mar 2011 Re-grade Care and support 2 - Weak Not assessed Not assessed Management and leadership Not assessed 23 Nov 2010 Unannounced Care and support 3 - Adequate Not assessed Management and leadership Not assessed page 10 of 12

11 Date Type Gradings 26 May 2010 Announced Care and support 3 - Adequate Not assessed Management and leadership Not assessed 18 Mar 2010 Unannounced Care and support Not assessed Management and leadership Not assessed 9 Jul 2009 Announced Care and support Management and leadership 31 Mar 2009 Unannounced Care and support Management and leadership 31 Oct 2008 Announced Care and support Management and leadership page 11 of 12

12 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 12 of 12