Four Hills Care Home Care Home Service Adults 8 Hazlitt Street Ruchill Glasgow G20 9NU

Transcription

1 Four Hills Care Home Care Home Service Adults 8 Hazlitt Street Ruchill Glasgow G20 9NU Type of inspection: Unannounced Inspection completed on: 5 May 2015

2 Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 13 4 Other information 32 5 Summary of grades 33 6 Inspection and grading history 33 Service provided by: Barchester Healthcare 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 Four Hills Care Home, page 2 of 36

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 The staff within the service provides a service designed to meet the changing needs of the people it supports. The service offers a safe and caring service to the people living there. The building has been made homely and comfortable and visitors are made welcome at any time. The management team was very receptive to any suggestions for any areas of improvement that we identified during the inspection and feedback. What the service could do better The service needs to continue to seek the views of people who are no longer using words to communicate with innovative person centred tools to ensure standards are maintained and improved. We found that the service requires to develop the planned activities more effectively to demonstrate improved outcomes for people living in the care home. What the service has done since the last inspection We saw an improvement in people's personal care plans. They were more clearly set out, well organised, up-to date and there is evidence in the plans that other Health Care Professionals are involved with the care of the service users. However, they are still not person centred enough in their content. Four Hills Care Home, page 3 of 36

4 Conclusion Inspection report continued In conclusion, everyone involved in providing this service showed a very strong commitment to offer a homely, caring, personal service to meet the needs of those receiving support. Four Hills Care Home, page 4 of 36

5 1 About the service we inspected This service was previously registered with the Care Commission since 29 January 2007 and transferred its registration to the Care Inspectorate on 1 April This care home is a purpose built facility located within Ruchill which is situated in the North area of Glasgow. There are 120 single en-suite bedrooms within four separate units. The home has lounges, and dining space within each unit. Throughout the home there were quiet private areas for service users and families to enjoy quality visits. The home provides a small self contained flat within the building, should relatives require to be accommodated. The environment is well maintained with a homely and welcoming appearance throughout. The home has well maintained external gardens with seated areas for service users. The home operates in partnership with Greater Glasgow Health Board with 60 contracted NHS places. Further places are currently for use via Local Authority Social Work Departments. The service's aims are: To provide nursing and personal care to people 65 years of age and above of both gender, with care being provided on a short and long term basis. Respite care can also be provided. To foster an atmosphere of care and support, which both enables and encourages our residents to live as full, interesting and independent a lifestyle as possible. The Care Inspectorate regulates care services in Scotland. Prior to 1 April 2011, this function was carried out by the Care Commission. Information in relation to all care services is available on our website at The Care Inspectorate (SCSWIS) is the new regulatory body for care services in Scotland. It will award grades for services based on the findings of inspections. Recommendations A recommendation is a statement that sets out actions that a care service provider should take to improve or develop the quality of the service, but where failure to do so would not directly result in enforcement. Recommendations are based on the National Care Standards, SSSC codes of practice and recognised good practice. These must also be outcomes-based and if the provider meets the recommendation this would improve outcomes for people receiving the service. Four Hills Care Home, page 5 of 36

6 Requirements A requirement is a statement which sets out what a care service must do to improve outcomes for people who use services and must be linked to a breach in the Act, its regulations, or orders made under the Act, or a condition of registration. Requirements are enforceable in law. We make requirements where (a) there is evidence of poor outcomes for people using the service or (b) there is the potential for poor outcomes which would affect people's health, safety or welfare. 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. Four Hills Care Home, page 6 of 36

7 2 How we inspected this service The level of inspection we carried out In this service we carried out a high intensity inspection. We carry out these inspections where we have assessed the service may need a more intense inspection. What we did during the inspection We wrote this report following an unannounced inspection that took place over two periods starting on the 4 May 2015 from 9.30am to 4.30pm then on the 5 May from 9.30am to 2pm. After which feedback to the manager and staff representatives took place for one hour, thirty minutes. The inspection was carried out by three Care Inspectors and one Inspector Volunteer. When we plan how we will inspect a service, we review the intelligence we hold about the service. This will include: -The self-assessment we ask the service to complete where they evaluate how they are performing. -The 'Annual Return' we ask the service to complete where they provide information about the needs of their service users and detail their staff team. -Notifications the service provides to us informing us of events that impact upon the service. -Any Complaints the Care Inspectorate has received. -Recommendations and Requirements made through inspection or complaints. -The risk assessment we complete. In this inspection we gathered evidence from various sources, including the relevant sections of policies, procedures, records and other documents including: -observation of staff practice and interactions with service users. -Seven family members interviewed. -risk assessments. -falls analysis. -Provider's aims and objectives. -Staff induction checklist. -Insurance certificate. -Accident/incident analysis. -maintenance contracts and records. -Staff Handbook. -Staff personnel files. Four Hills Care Home, page 7 of 36

8 -Supervision minutes. -Action plans for Information letters. -dependency tools used. -protected meal time plans. -notice boards. -Training plans for Activities records and plans. -Outcome based activities- what did we achieve, not achieve. -Activity monitoring log systems in place. -review minutes. -complaints record/log. -Accidents and incident records. -Care plan information including daily notes and monthly evaluation notes. -15 staff interviewed. -15 service users interviewed. -Recent service user meetings. -Recent carer meetings. -staff team minutes. -senior staff minutes. -environmental audits. -organisational audits. -Nine care plans of service users. -registration certificate. -Service's participation information. 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. Four Hills Care Home, page 8 of 36

9 Fire safety issues Inspection report continued 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 Four Hills Care Home, page 9 of 36

10 What the service has done to meet any recommendations we made at our last inspection There were eight recommendations made at the last inspection relating to service users actively involved in care planning, signage and quality assurance systems. Progress has been taken in all areas. Where further developments are needed to in bed changes these have been repeated in this report. 1. The provider should continue to document care plans in formats which make sense to the service user by incorporating person centre tools following staff training where appropriate. This is repeated under Theme 1, Statement The service should continue to develop care plan information which records and implements the individual likes, dislikes, preferences and needs in relation to their care and support. Care plan evaluation should be used to detail progress/ deterioration over the period and changes in care practice, with more unique information being documented, accurately and up-to-date. This should then inform activities for individuals. This is repeated under Theme 1, Statement There needs to be more effective use made of signage to help maintain and improve orientation in line with best practice and evidence based research. This is repeated under Theme 2, Statement Champion roles within staff team should be further developed. Interviews with the staff team, examination of paperwork, clear action plans implemented evidence that this recommendation is met. 5. The manager of the service must ensure that all staff receives the correct supervision to their job description. Those meetings should be planned, accurately recorded, signed and sated by both parties and include the date and time of the next meeting. Interviews with the staff team, examination of paperwork, clear action plans implemented evidence that this recommendation is met. 6. Aims and objectives in consultation with service users and families should be updated to clarify future direction of service provision. This is essential to clarify the criteria and expectations for service users and their relatives in the 'step down' aspect of the services provided. This is repeated under Theme 1, Statement 6. Four Hills Care Home, page 10 of 36

11 7. The service should continue to explore in consultation with all the workers' roles to ensure a clear balance of tasks which would further enhance effective team work and sustain on-going service improvements. Interviews with the staff team, examination of paperwork, clear action plans implemented evidence that this recommendation is met. 8. It is recommended that the service reviews and streamlines the systems being used to help audit all aspects of service delivery. The manager should ensure that these audits help to evidence positive outcomes for individuals rather than focus on systems and processes. Interviews with the staff team, examination of paperwork, clear action plans implemented evidence that this recommendation is met. 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. Services undertake a self-assessment before an inspection. The self-assessment details strengths, areas for improvement and grades the service has awarded itself based on its performance under quality indicators. The Inspector reviews this before inspection and reviews some of the evidence that the provider says they have to evidence their performance. We discussed the self-assessment with the management team and provided examples of how the self-assessment could be more meaningful and outcome focused. Four Hills Care Home, page 11 of 36

12 Taking the views of people using the care service into account Comments were generally positive, people felt that they were empowered and supported to live a life style of their own choice. No areas of concern were raised by people using the service during the inspection except a lack of activities, particularly getting out and about. Comments from service users during this inspection included: "Yes, it is quite nice" "I think it is all right. It's pretty good here" "I would just ask them if I needed help" "They work hard" "So far so good" "It's not too bad. If there is anything, I tell them" "The care is very good. If not, I would be telling them. I can tell them what I like and don't like" "Yes, I have been to residents' meetings. They are quite good. You learn a few things" "It depends what people ask. You always put your bit in but it doesn't always come" "I go to residents' meetings when they are on. I am sure they would (resolve things)" "My son asked for a chair for the toilet and they sorted it" "I get a bath, usually once a week. I don't get a bath when I want. I would like more" "I would like a shower but they don't have one. I would love a shower if I could get it". Taking carers' views into account Carers' comments were very complimentary regarding the standard of daily care provided. "The staff are great" "I think they do care. Sometimes they have to prioritise. It doesn't always work" (keep you informed?) "Very much, they keep the family informed" "I think it is fine. I am happy, my relative is cleaned and washed. I can't fault it". "They communicate as much as needs be" "I feel my relative is safe and looked after" "Very much, they keep the family informed" "They see all the residents as individuals". Four Hills Care Home, page 12 of 36

13 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 We assessed how the service involved and responded to service users', relatives' and stakeholders' participation. To do this we: -Sampled some documents made available to us relating to participation. -Met with several service users and relatives and a cross section of the staff team. -Observed the way that staff supported and listened to service users and relatives. -Reviewed the Care Standard Questionnaires returned to us by service users, relatives and staff. Feedback from service users, management team and staff and examination of relevant documents, indicated an excellent performance by the service in relation to this statement. Comments from service users about being involved included: "it's good to sit outside in the fresh air". "there is not enough stimulation, we can go for weeks without something going on". "I'd like more things to do". "I have a postal vote". "we're looked after very well". "you can see that the place is spotless". "The staff are good to me." "It's very nice here and my room is lovely". "The staff are kind but they are always very busy". "I'm happy here; this is my home". Four Hills Care Home, page 13 of 36

14 There was evidence of staff being familiar with the wishes and choices of the service users. Staff interacted with service users in a polite and helpful manner, without being intrusive and service users commented on their kindness. This was also reported in the Care Inspectorate's Care Standards Questionnaires which were returned to this office. Service users and relatives told us that the manager has an open door policy and staff were also available to people at any time. We saw the manager acting quickly to support a service user and we were told that this is a normal response. We found evidence in all the service users' personal files of regular six monthly reviews of their service or sooner where identified. This provided a forum for people to express their views. It was also clear that relatives and other professionals also attended where appropriate. Areas for improvement The Service Manager and staff have found it very challenging when engaging those using the service, relatives and appropriate others in assessing and improving the quality of care and support. It is the Service Manager's intention that they will continue to explore options to increase interest in participation to ensure continued positive outcomes. One recommendation relating to assisting people to take a more active role in care planning has been repeated. (See Recommendation 1 below). Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 1 Recommendations 1. Recommendation with reference to Theme 1, Statement 1: The provider should continue to document care plans in formats which make sense to the service user by incorporating person centre tools following staff training where appropriate. This is in accordance with National Care Standards, Care Homes for Older People, Standard 5: Management and Staffing Arrangements and Standard 11: Expressing your views. Four Hills Care Home, page 14 of 36

15 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths We assessed how the service involved and responded to service users, relatives and stakeholders relating to health and welfare. To do this we: -Sampled some documents made available to us including care plans and risk assessments. -Met with several service users and relatives and a cross section of the staff team. -Observed the way that staff supported and listened to service users and relatives. -Reviewed the Care Standard Questionnaires returned to us by service users, relatives and staff. Feedback from service users, management team and staff and examination of relevant documents, indicated a very good performance by the service in relation to this statement. We found that care plan information was generally in a good level of detail. Each person had a care plan with some information about them and their life before coming into the home. Risk assessment in relation to service users' safety, fire safety, slips/trips and falls, medication, moving and assisting and outings were in place. We noted that updated review minutes were held within care plans. Accident and incident records were examined to determine if there had been a rise in incidence due to recent lack of moving and assisting training. It was felt that the lack of updated training did not have a negative impact on incidence. The service recorded all falls and monitored them regularly; the manager produced an electronic update on the level of falls within the home. We spoke with the chef and he showed us the individual information he had gathered on service users' likes and dislikes, allergies, special diets and special textured foods. We observed service users at lunch and breakfast and the food was well presented and everybody was clearly enjoying their meal. Service users told us that "the food is always good and there's always a choice" and "the soup is excellent". We saw staff assisting service users in a calm unhurried manner and when people required assistance with eating, this was carried out in a dignified, caring way. Activities included, parties for various events which are well attended, photos of these events were evident. We noted that there is a schedule of daily activities displayed throughout the care home. There is a list of people's birthdays that are being celebrated. Four Hills Care Home, page 15 of 36

16 There is a notice displaying the "Resident of the Day". During the inspections we observed that most of the people living here were either sitting or sleeping in the lounges with the TV on, or in their rooms watching TV. There is a small album at the front desk containing pictures of residents taking part in activities. When asked about the quality of the activities on offer, the views were very mixed. Service users said: "I don't really get bored". "There is only one of them that does anything". "I go to bingo and the Salvation Army". "I like dominoes but they don't do it very often". "It's been a long while since we were out in the garden". "Last year maybe but it's been a long time". "I love to knit so I have asked my daughter to bring me some up. That's about all I can do". "Watch TV all day. You are not allowed to walk about". Relatives said: "I think there should be more activities". "There is only bingo. The odd time there is a concert but it has been a long time (since we had one)". "My relative has not been out on a trip since last year". "My relative has been out on a trip twice in three years". "In the evening they are all in their rooms early as there is nothing on in the evenings". "I would like to see my relative go out more often". "They take my relative to bingo sometimes". "I have mentioned it a few but he never gets out". We saw in service users' individual plans that each person had a signed contract of residency. We also saw that up-to-date care planning took place which included when necessary risk assessments, dependency assessments with evidence that staffing levels have been increased to meet increasing needs. We saw that where there were concerns fluid charts were kept and saw that juice, squash or water were available in the lounges. The staff came round with tea, coffee or hot chocolate at regular intervals. We saw that each service user had an identified named worker who was responsible for keeping the individual care plans and files up-to-date. Four Hills Care Home, page 16 of 36

17 Areas for improvement As highlighted earlier in this report, the Service Manager and staff have made good progress in engaging those using the service, relatives and appropriate others in assessing and improving the quality of care and support. It is the Service Manager's intention that this will be sustained to ensure continued positive outcomes. However, care plans sampled showed a task orientated approach to care planning, they were clinical in their nature, although they showed a good level of detail for their purpose of providing relevant care and support. Activities for the service users appeared sparse. One staff member when asked about their input to the care plans stated that, "it is the responsibility of the trained Nurse to update the care plan", we advised during feedback that care plans should have a brief history of the service user, for example "this is me". When completing daily notes, staff should say what the outcome was for that person on that particular day as opposed to just details in the tasks complete, "washed", "Dressed", "shaved", etc. etc. Risk assessments for service users should be further developed to help them become more user friendly. The service should also explore various formats for care planning to help them become more Person Centred, containing unique information for each person. (See recommendation 1 below). Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. Recommendation with reference to Theme 1, Statement 3: The service should continue to develop care plan information which records and implements the individual likes, dislikes, preferences and needs in relation to their care and support. Care plan evaluation should be used to detail progress/ deterioration over the period and changes in care practice, with more unique information being documented, accurate and up-to-date. This should then inform activities for individuals. National Care Standards, Care Homes for Older People, Standard 5: Management and Staffing Arrangements. Four Hills Care Home, page 17 of 36

18 Statement 6 People who use, or would like to use the service, and those who are ceasing the service, are fully informed as to what the service provide. Service strengths People who use the service, who may be thinking of using the service, or who wish, or may need, to move on from the service are fully informed of what the service provides. To do this we: -Sampled some documents made available to us including care plans, risk assessments and the service's brochure. -Met with several service users and relatives and a cross section of the staff team. -Observed the way that staff supported and listened to service users and relatives. -Reviewed the Care Standard Questionnaires returned to us by service users, relatives and staff. Feedback from service users, management team and staff and an examination of relevant documents, indicated a good performance by the service in relation to this statement. When looking at the part of the service for people moving from hospital to care home for rehab, now being known as Intermediate Care, interviews with service users and staff confirmed that it appeared to work well. There was evidence of evaluation and review which showed how service users were achieving or moving towards their goals. Comments from service users were positive in relation to staff members and the support received. Reviews were being held regularly and these were being attended by a range of individuals who had an identified role in supporting service users with their needs. This demonstrated a holistic approach to the way in which the service is delivered. Copies of review minutes and agreed personal plans were being provided to service users. Areas for improvement The service brochure wasn't clear enough regarding this aspect of service provision, it was generic to the organisation, and some of the information was out of date. The service should develop a more up-to-date and relative service brochure. (See Recommendation 1 below). Care plans required to be developed further in relation to people's future wishes and issues around death and dying and spirituality which were not all evidenced sufficiently. Issues around making transitions and planning future long term goals have been explored, but records need to be more comprehensive. Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 1 Four Hills Care Home, page 18 of 36

19 Recommendations Inspection report continued 1. Recommendation with reference to Theme 1, Statement 6: Aims and objectives in consultation with service users and families should be updated to clarify future direction of service provision. This is essential to clarify the criteria and expectations for service users and their relatives in the intermediate aspect of the services provided. This is in accordance with National Care Standards, Care Homes for Older People, Standard 5: Management and Staffing National Care Standard Number 6: Care Homes for Older People - Support Arrangements. Four Hills Care Home, page 19 of 36

20 Quality Theme 2: Quality of Environment Grade awarded for this theme: Statement 2 We make sure that the environment is safe and service users are protected. Service strengths We assessed how the service involved and responded to service users, relatives and stakeholders relating to both the internal and external environment. To do this we: -Sampled some documents made available to us including five care plans, risk assessments, management team, environmental audits, observed the environment, care staff and quality assurance audits including external audits. -Met with several service users and relatives and a cross section of the staff team. -Observed the way that staff supported and listened to service users and relatives. -Reviewed the Care Standard Questionnaires returned to us by service users, relatives and staff. Following consideration of sampled written evidence, and feedback from management, staff and service users, this service was found to have a good performance in relation to this statement. The home was clean and odour free. Standards of cleanliness and hygiene throughout the service were very high. Overall we found the environment to be safe and well maintained. We saw the well decorated lounges and individual rooms, with the service users stating that they were consulted in choosing the colours and paper. We looked at maintenance records for equipment, for example, hoists and wheelchairs and found the records to be up-to-date and the equipment was well maintained and in good repair. We were told by some service users that they liked living in the home. Service users and carers spoken with expressed satisfaction with the environment. Service users confirmed they felt safe within the service. Four Hills Care Home, page 20 of 36

21 Comments included: "They keep it clean". "Yes they do, keep it clean". "Oh yes, they keep it clean". Relatives said: "Yes, it is brilliant". "It is a difficult situation and I see them making an effort but on occasion there is an odour". There were a lot of lounges available for service users to choose. People were free to walk wherever they chose. There were no locked doors in the home. We saw that staff knew the service users well and we observed a member of staff watching a person to ensure that if she was unable to get up from her chair the staff member would help. This allowed the service user a measure of independence while ensuring her safety. We felt the rooms were well presented and that people had been encouraged to bring in their own things and this made them feel homely. Areas for improvement The service has plans to improve signage around the home. These had arrived at the start of this inspection. (See recommendation 1 below). They should ensure that there is relevant and accurate signposting within the home. This would aid people in their quest to find the dining room, toilets and sitting areas. Some of the toilet areas need to be clutter free to reduce the risk of infection. (See recommendation 2 below). Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 2 Recommendations 1. Recommendation with reference to Theme 2, Statement 2: There needs to be more effective use made of signage to help maintain and improve orientation in line with best practice and evidence based research. National Care Standard Number 4: Care Homes for Older People - Your Environment 2. Recommendation with reference to Theme 2, Statement 2: To maintain a pleasant environment in all areas the service should ensure that all of the toilet areas are clutter free to reduce the risk of infection. National Care Standard Number 4: Care Homes for Older People - Your Environment. Four Hills Care Home, page 21 of 36

22 Statement 3 The environment allows service users to have as positive a quality of life as possible. Service strengths We assessed how the service involved and responded to service users, relatives and stakeholders relating to both the internal and external environment. To do this we: -Sampled some documents made available to us including environmental risk assessments, management team meetings, environmental audits, observed the environment and the spaces used, care staff and quality assurance audits. -Met with several service users and relatives and a cross section of the staff team. -Observed the way that staff supported and listened to service users and relatives. -Reviewed the Care Standard Questionnaires returned to us by service users, relatives and staff. Following consideration of sampled written evidence, and feedback from management, staff and service users, this service was found to have a good performance in relation to this statement. We concluded this after we: -spoke to the management team. -care staff. -reviewed care plans regarding lifestyle choices. -talked to people who use the service. -observed meal times. -minutes of various meetings. Staff interacted with service users through mealtimes, this was a positive experience for people as they were able to discuss what was for lunch, and make informed choices. Mealtime experience witnessed was positive for the service users, People were supported to sit with each other, and this produced spontaneous conversation between them. Comments from the Inspector Volunteer who observed a meal time experience were positive. "The tables were set nicely with linen tablecloths and contrasting coloured linen napkins. There were cups, saucers, knives, forks and spoons along with water glasses, salt, pepper and place mats. A menu was on each table with the day's lunch on one side and dinner on the other. When people were seated they were all offered a choice of drinks, water, juice, milk, tea or coffee. More drinks were offered throughout the meal. The staff showed each person the choice of food that was on offer that day. The menu on the day of inspection was, green lentil soup followed by a choice of Pork Fricassee with steamed scented rice or sausages with scrambled eggs and chips. Four Hills Care Home, page 22 of 36

23 One service user asked three different members of staff if she could get sauce for her sausage and chips and was told on all occasions that there wasn't any. I mentioned this during the feedback session with the management and staff and was told that this was not the case and they would look into it. I had the soup and the fricassee and I found that they were well cooked, well presented and tasty. Some service users were offered clothes protectors". We felt that the staff interacted well with service users and it was a pleasant dining experience. Comments from service users regarding meal time experiences included: "The food is very good. Yes you get a choice". "The food is quite nice". "The food is not bad". "The food is lovely, very nice. Yes, you get a choice". "One thing I want is tomato soup. The staff know that there are some things I can't eat". "Some days it is good and some days not so good. Mostly it is quite nice". "They never asked me to go to the meeting with the chef. I would have gone if they had asked me". "If there are meetings on, I go". A relative said: "They usually make set menus. There is enough choice". Inspection report continued When asked about safety around the home and seeking assistance when required, comments from service users included: "I have a buzzer in my room. I use it if I am sitting there. They come quickly". "I have a buzzer. They are very good in response". "We have no buzzer here. (The day room) There is a buzzer over there (small button on the wall) but we can't reach it". "They come quickly if they are not busy. I have not had to wait a long time in my room". "There is no buzzer in the lounge. Sometimes they are not coming in. I usually go to the door to get someone". When asking people about the laundry service, everyone was happy with this service. The service had a nice garden area for the service users to meet and sit in. The home was odour free. The home had various sitting areas for service users which were decorated to a high standard. Four Hills Care Home, page 23 of 36

24 Bedrooms were personalised with people's own belongings. We saw that birthdays and special occasions are celebrated and service users stated they enjoyed those. We saw that the service has an open door policy which allows relatives and friends to visit at any time. Areas for improvement The home was not barrier free in that clothes rails were out on every floor, hoists were left in corridors and domestic trolleys were left outside bedrooms, causing a potential trip hazard. The service should look to their laundry service to complete the rounds of laundry by giving people their clothing, negating the need to leave clothes rails in corridors in order to reduce trip hazards. Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 0 Four Hills Care Home, page 24 of 36

25 Quality Theme 3: Quality of Staffing Grade awarded for this theme: Statement 2 We are confident that our staff have been recruited, and inducted, in a safe and robust manner to protect service users and staff. Service strengths We are confident that our staff have been recruited, and inducted, in a safe and robust manner to protect service users and staff. To do this we: -Sampled some documents made available to us including recruitment files, induction processes, training audits, observed the staff practices, care staff and quality assurance audits including external audits. -Met with several service users and relatives and a cross section of the staff team. -Observed the way that staff supported and listened to service users and relatives. -Reviewed the Care Standard Questionnaires returned to us by service users, relatives and staff. Following consideration of sampled written evidence, and feedback from management, staff and service users, this service was found to have a very good performance in relation to this statement. In relation to the strengths identified earlier in the report, this service also communicated well with the staff team. Staff said they attended regular meetings which they found helpful and felt that their views were taken into account. Service users and relative comments regarding staff included: "They work hard". "Yes, I do think they are all well trained and they understand my situation". "The staff are very good, very nice". (understand your needs?) "I think so, yes. I would be telling them (if not). The girls are very nice. They help me all they can". Relatives said: "I find them efficient in their duties. Maybe more efficient than warm". "I don't see it as often as I used to, them speaking to the residents one to one". Four Hills Care Home, page 25 of 36

26 On inspection all staff who should be registered with the relevant body had done so, and were appropriately PVG checked. Staffing levels appeared to be at the agreed level. Most staff appeared to have a long service in place from 5 years to 18 years, although most stated that formal supervision was every "six months or so", staff confirmed that they felt comfortable to seek support from the management team when needed. Staff spoken to were aware of the National Care Standards, and if they had any issues they could discuss with management. One staff member interviewed, with six months service, stated that she went through an induction programme, it was also explained to her about her duty to register with the SSSC which she has done. The provider had all the legally required policies and procedures. The service had policies for adult support and protection with on-going training planned to ensure that all staff are aware of the contents. It was clear through interviews with staff, that they were fully aware of the processes which should be followed when required to do so. Staff were observed to offer support to service users in a manner which respected their dignity and privacy. Areas for improvement The service should continue to explore ways of evidencing clearly service users' involvement in the recruitment process. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Four Hills Care Home, page 26 of 36

27 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths We assessed how the service involved and responded to service users, relatives and stakeholders relating to staff being trained and motivated. To do this we: -Sampled some documents made available to us including training audits, supervision dates, observed the staff practices, various minutes from meetings, care staff, reviewed recruitment and induction packs for staff and quality assurance audits. -Met with several service users and relatives and a cross section of the staff team. -Observed the way that staff supported and listened to service users and relatives. -Reviewed the Care Standard Questionnaires returned to us by service users, relatives and staff. Following consideration of sampled written evidence, and feedback from management, staff and service users, this service was found to have a good performance in relation to this statement. There was a training programme in place which included both mandatory and nonmandatory training. This included: Effective Communication Fire Drills Fire Safety Food Safety Health and Safety Infection Control Protection of Vulnerable Adults We saw through records and speaking to staff that good training was in place to ensure that they had the skills to deal with dementia, frailty and life limiting conditions, risk assessment, and other training events designed around meeting service users' needs. We saw staff working with service users and treating them with care, respect and dignity. We also saw staff having a laugh with service users and being thoughtful and caring while assisting them to eat. Four Hills Care Home, page 27 of 36

28 We saw the training plan for the service and saw the evidence in staff files of them attending training and obtaining qualifications. Staff spoken with during this inspection all stated that they felt that their training had enabled them to feel confident in carrying out their duties with confidence. We looked at individual staff files and saw that they were well organised and included evidence of supervision and personal development taking place. Areas for improvement As identified in the last report the frequency and documentation of observed practice to demonstrate competencies should be further implemented. Staff training has slipped due to the trainer having left. This was evident in the statistics provided for example, over 25% of staff required to be refreshed or trained in Moving and Assisting (Manual handling), the previous report stated 91% completion, this has now slipped to just fewer than 73% - included in this number was 11 new staff who were working their way through induction. However, during the inspection staff had been identified and had started training to enable the service to develop 'champion roles' where someone has expressed an interest. This should help the service quickly address any gaps in training. Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 0 Four Hills Care Home, page 28 of 36

29 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 assessed how the service involved and responded to service users, relatives and stakeholders relating to management and leadership. To do this we: -Sampled some documents made available to us including staff minutes, management team minutes, training audits, observed the staff practices and reviewed quality assurance systems. -Met with several service users and relatives and a cross section of the staff team. -Observed the way that staff supported and listened to service users and relatives. -Reviewed the Care Standard Questionnaires returned to us by service users, relatives and staff. Following consideration of sampled written evidence, and feedback from management, staff and service users, this service was found to have a good performance in relation to this statement. In addition to the strengths identified in statements earlier in this report, the service also had the following positives. The Management team had a high profile within the service. Service users comments included: "I feel safe to talk to her. My son can talk to her too". "I speak to the staff nurse". "Yes I do feel it is well managed". Four Hills Care Home, page 29 of 36

30 Staff did feel they could influence change within the service, although stated that you may get an answer, but not necessary the one you wanted. Other staff comments included: "Lovely place to work. The atmosphere is wonderful and there is great team spirit". "We are like a family here and I love it because my family are very far away from me. The management team are great and very supportive". "I have full support from the manager". "All staff seek to make the place the best". "Would like more opportunities to further my education". "Excellent support network". "Good training opportunities". On the days of the inspection the service was found to be clean, with areas of the premises used to good effect by staff and service users. Staff interviewed were clear on everyone's health and safety responsibilities. Everyone was observed to conduct themselves in a professional warm manner. We observed staff working as a team and supporting and encouraging each other to deliver the best service to the service users. We observed some very caring support being given to people, for example staff getting down to the same level as the person in the chair to talk with them and waiting to be answered when they knocked on a service user's room door in the morning. We also heard the service user being asked if they wanted their curtains opened or not. Areas for improvement The Manager was considering ways in which the existing systems of quality assurance could be further developed to evidence staff, service user and carer participation in the quality of management and leadership. Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 0 Four Hills Care Home, page 30 of 36

31 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 assessed how the service involved and responded to service users, relatives and stakeholders relating to management and leadership. To do this we: -Sampled some documents made available to us including various minutes from meetings, care staff, staff questionnaires, reviewed quality assurance audits with evidenced outcomes. -Met with several service users and relatives and a cross section of the staff team. -Observed the way that staff supported and listened to service users and relatives. -Reviewed the Care Standard Questionnaires returned to us by service users, relatives and staff. Following consideration of sampled written evidence, and feedback from management, staff and service users, this service was found to have a very good performance in relation to this statement. Staff presented as being committed to improving the lives of service users. A wide range of Quality Assurance systems were in place including regular detailed external quality assurance checks. The management team were aware of their responsibilities around notifications to the SSSC and to the Care Inspectorate and actively ensured that clear communication was regularly undertaken. A robust complaints procedure was in place. Information advising on the Care Inspectorate's complaints procedure was displayed on the notice boards. Areas for improvement There was very good leadership skills observed when the management team were interacting with both service users, staff team and carers/family members. This approach ensured that the care home maintained a relaxed atmosphere. The service have identified the need for greater involvement from service users and where appropriate family members in all aspects of service delivery. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Four Hills Care Home, page 31 of 36

32 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 N/A. 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). Four Hills Care Home, page 32 of 36