Blackfaulds House Nursing Home Ltd Care Home Service

Transcription

1 Blackfaulds House Nursing Home Ltd Care Home Service Westfield Road Avonbridge Falkirk FK1 2JZ Telephone: Type of inspection: Unannounced Completed on: 27 June 2018 Service provided by: Blackfaulds House Nursing Home Ltd Service provider number: SP Service no: CS

2 About the service The Care Inspectorate regulates care services in Scotland. Information about all care services can be found on our website at This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April Blackfaulds House Nursing Home Ltd (referred to in the report as "the service") is owned by Blackfaulds House Nursing Home Ltd (referred to in the report as "the provider"). The service is registered to provide accommodation and support including nursing care to a maximum of 25 older people. There were 20 adults (referred to in the report as "residents") living at the service at the time of the inspection. Blackfaulds House is situated on a bus route between Bathgate and Falkirk within close proximity to Westfield, Avonbridge and Armadale in West Lothian. The service is a former farmhouse and is set in pleasant landscaped gardens to the front of the building. The building has been extended to provide the present accommodation which is all on one level. Accommodation consists of one bedroom which currently provides shared accommodation for a couple. The remaining bedrooms are for single use although some have the facility to provide shared accommodation. In these instances, the provider is aware the bedrooms should comply with the recommended minimum size. Some bedrooms have en-suites, some with bathing facilities. There are communal toilets and two assisted bathroom/shower rooms available for residents. There are kitchen facilities and a staff room in the building. Laundry amenities are in a building in the grounds. There are two sitting rooms and a dining room for residents' use. At the time of inspection, the interior communal space was being reconfigured with the third sitting room being re-sited to the rear of the building. The provider has submitted an application to the Care Inspectorate to provide care and accommodation to younger people and this is in the early discussion stage, with no agreement reached. The service mission statement includes the aim: "To put people and their individual needs first." What people told us We saw and/or spoke with most residents during the inspection. We also took account of questionnaires which five residents (10 questionnaires were issued) and five carers (10 questionnaires were issued) completed and returned to us before the inspection. Residents who were willing to discuss their views of the service were very complimentary about staff and were happy with the care and food provided. The told us they were happy living at the service. page 2 of 20

3 We used the Short Observational Framework for Inspection (SOFI 2) to directly observe the experience and outcomes of people who were unable to tell us their views. We saw that residents were comfortable around staff who were caring and friendly in their interactions with them. We saw that residents and staff knew each other well. We spoke with six visiting carers during the inspection and all gave positive views about the quality of care and spoke highly of care staff. Carers described the service as a "home from home" with "wonderful staff" who were "caring". One carer described how their relative "had a new lease of life" since coming to live at the service because they are so happy. Mixed views were expressed about the management of the service, with one carer describing management as "always on hand if help required" to others who felt management was not "responsive." Some relatives expressed concern about the reconfigured interior of the building because this reduced communal space at the heart of the building. This is discussed further under quality of environment. From the content of questionnaires, we saw that some residents and carers had limited knowledge of the daily workings of the service. For example, the complaint procedure, if there was a key worker, how views were sought to influence service development or if care plans detailed residents' preferences. The management team should take account of this when developing the service. Self assessment We did not request that the manager complete a self assessment prior to this inspection. From this inspection we graded this service as: Quality of care and support Quality of environment Quality of staffing Quality of management and leadership Quality of care and support Findings from the inspection As the service was small, staff and residents could get to know each other well. We saw warm and kind interactions between them. page 3 of 20

4 Residents were cared for in a caring and respectful way that protected their dignity. They benefited from being cared for by staff who knew how they preferred their care to be given. Staff knew residents' individual needs and verbal information about this was shared within the staff group. Residents had opportunities to maximise their health because other healthcare professionals were contacted promptly when necessary. However, residents could not be confident that their care plan would accurately reflect their choices, wishes and all aspects of their care needs. The quality of care plans varied because these were not consistently updated to reflect agreements reached at care reviews, when care needs changed or following accidents. Future care needs were not anticipated. There was an over reliance on key personnel to update information which restricted the input and creativity of other knowledgeable staff. Strong quality assurance processes did not support the care planning process. As a result, residents were not guaranteed that they would receive consistent care in the way they wished. (See recommendation 1) When residents do not have the ability to make decisions, it is important that staff know what legal powers people have been given and to whom. Copies of these documents should be in residents' files. (See recommendation 1) Consents were not always in place for the use of equipment that could be considered as restraint. Therefore, it was not always clear why the equipment was used or that it was for therapeutic reasons and in the resident's best interest. (See requirement 1) Residents could not be confident that they would enjoy a positive dining experience. The quality of meal times varied with some relaxed but others were disorganised because staff were not deployed correctly. Residents' meal choices were restricted because they were not consistently offered meal choices - verbally, visually or by table menu. Residents spending time in the smaller sitting room or resting area could not be confident that they could access snacks and drinks between meals because snacks were only available in the main sitting area. This meant that all residents were not offered the same level of choice. (See recommendation 2) Further work was needed to improve medication management to show residents were receiving their medication as prescribed and with positive effects. (See recommendation 3) Residents could engage in a range of social activities and there were strong links with the local community. However, outwith structured activities, opportunities for stimulation were limited to mainly watching television and sitting in the sitting room. This was because care staff were busy providing direct care needs. However, we were pleased that staff made every effort to chat socially to residents when passing through the sitting areas. We will monitor this at future inspections. Requirements Number of requirements: 1 1. By 30 October 2018, the provider must ensure that safety equipment is used in accordance with best practice. In order to comply, they must: a) keep a record of all people who are kept safe by means of restraint b) ensure the care plan indicates why restraint is necessary, demonstrating that this is the least restrictive option, when and what circumstances restraint is used, the duration of use and detail what other measures have been used to meet the person's needs page 4 of 20

5 c) consent should be recorded. f my independence, control and choice are restricted, this complies with relevant legislation and any restriction are justified, kept to a minimum and carried out sensitively. (HSCS 1.3) This is also in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210) Regulation 4(1)(c). Recommendations Number of recommendations: 3 1. The provider should develop residents' care plans to ensure these are right for each person and set out how needs will be met as well as wishes and choices. Plans should: a) Reflect all aspects of residents' care including wound care, nutrition, continence, oral healthcare and social interests b) Be updated when care needs change or following care reviews, accidents and incidents c) The evaluation of care plans should take account of other records, such as fluid charts. Charts should be accurately completed d) Fully implement the audit system to monitor the accuracy of plans e) Include copies of certificates of legal powers in operation should be kept in residents' files. This is to ensure care and support is consistent with the Health and Social Care Standards which state that - My personal plan (sometimes referred to as a care plan) is right for me because it sets out how my needs will be met as well as my wishes and choices. (HSCS 1.15) 2. The provider should review how meals are served at the service to ensure residents enjoy unhurried snacks and meals in a relaxed atmosphere. a) Snacks and drinks are available outwith set meal times and residents are supported to access these b) Visual meal choices are offered at meal times to residents who need this support c) Staff are appropriately deployed and skilled to support residents at meal times. can choose suitably presented and healthy meals and snacks, including fresh fruit and vegetables, and participate in menu planning. (HSCS 1.33) And, also - I can enjoy unhurried snacks and meals in as relaxed an atmosphere as possible. (HSCS 1.35) 3. The provider should ensure that medications are managed in a way that makes sure that residents get all the medicines they need. In particular, ensure: a) the application of topical creams is consistently recorded b) carer notes on the reverse of the MARs (medication administration recording sheets) should be fully completed when appropriate to record why medication is given and the effect c) accurately completed documentation to record the location of medication patches d) fully implemented audit systems are used to monitor medication management and staff practice. page 5 of 20

6 experience high quality care and support based on relevant evidence, guidance and best practice. (HSCS 4.11) And, also - If I need help with medication, I am able to have as much control as is possible. (HSCS 2.23) Grade: 3 - adequate Quality of environment Findings from the inspection Residents benefited from living in a small, homely environment where everyone was included and made welcome. The atmosphere was calm and the building was free from avoidable and intrusive noise and odour. Residents were encouraged to personalise their bedrooms and staff treated residents' personal belongings with care and respect. The provider had invested heavily in upgrading the facilities and because it is not a purpose-built facility there were limitations to the improvements which could be made. However, there were aspects of the environment that need to improve to ensure residents experience high quality accommodation. More attention needed to be taken to ensure equipment such as wheelchairs and shower chairs were clean and pressure relieving equipment fit for purpose. Some easy chairs were becoming worn and offered residents less support. Residents' access to outside space was restricted because the garden was not secure which meant they could only go into the garden if accompanied by staff or visitors. This limited their choice. The provider intended to install gates to secure the area. Residents had limited access to a bath and the communal shower room was located in the hairdressing salon. This limited residents enjoyment of either showering or attending the hairdresser. We were assured there were plans to improve these facilities as well as the laundry. At inspection, internal construction was underway to reconfigure the communal areas and remove the third sitting room at the front of the building. This meant residents did not have access to quiet space to relax in or meet visitors. Activities took place in the two remaining communal sitting rooms where residents were trying to watch television and meet visitors and carry out their day to day life. Facilities were compromised and impacted negatively on residents' choices. We were assured that when building work was completed, the third sitting room would be re-sited at the rear of the building which would be a quiet space for residents, visitors and activities. As this was well away from the hub of the home, it was unclear how beneficial or easily accessed it would be for residents. The provider had applied to the Care Inspectorate to provide care for six younger people in the current building. The provider needs to discuss this proposal further with residents, relatives and staff and explain any impact there would be on residents to access facilities. Subsequent to the inspection, the provider informed us that it did not intend to proceed with the application to provide care to younger people. There needs to be a better managerial overview of the quality and suitability of the environment and equipment. We have made a requirement about improving the environment. page 6 of 20

7 Requirements Number of requirements: 1 1. By 30 October 2018, the provider must ensure that the premises are suitable for achieving the aims and objectives of the care service. In particular: a) ensure equipment such as wheelchairs, shower chairs, easy chairs, pressure relieving cushions and bedrail bumpers are clean and fit for purpose b) provide the Care Inspectorate with a refurbishment plan detailing how the following will be achieved and timescales, sufficient bathing and showering facilities, secure garden area, upgraded laundry facilities c) ensure sufficient managerial oversight of the quality of the premises and equipment. can use an appropriate mix of private and communal areas, including accessible outdoor space, because the premises have been designed or adapted for high quality care and support. (HSCS 5.1) And, also - The premises have been adapted, equipped and furnished to meet my needs and wishes. (HSCS 5.16) This is also in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210) Regulation 4(1)(b) and 10(a). Recommendations Number of recommendations: 0 Grade: 3 - adequate Quality of staffing Findings from the inspection Everyone was complimentary about the compassionate, caring and respectful way staff cared for residents. We saw positive working relationship between care staff which contributed to a relaxed and welcoming atmosphere for residents to live in. Staff showed a high level of commitment to the service and had enthusiasm to improve, where possible. All this would help residents have confidence in the staff who cared for them. Staff tried to give residents good care but were restricted by a lack of support to improve their knowledge and competence. It was this failure, by the provider, to guarantee that staff were trained, competent and skilled to provide residents' care that had impacted on the overall performance of this quality theme. We were not confident that staff had the necessary skills to meet residents' care needs. They were not supported to gain knowledge and skills as part of a planned training programme. Training records were inaccurate and there was no managerial overview or analysis of the training staff had received or needed. Records completed by the end of the inspection showed significant gaps in important training such as infection control. Staff practice was not evaluated to ensure they had the expertise to meet residents' needs. (See requirement 1) page 7 of 20

8 Staff were not supported to reflect on their practice, raise concerns, discuss training needs or professional and organisational codes. This was because they did not receive regular one to one supervision with a senior staff member and team meetings were irregular. (See recommendation 1) Key elements of safer recruitment processes were ignored. For example, there were no records of the interview process making it hard to establish how candidates' value base had informed recruitment outcomes. Staff inductions to the service were not on file raising concerns about how staff were supported when first working at the service. We concluded there was limited understanding of why all aspects of safer recruitment was important. (See recommendation 2) Residents' care needs were assessed monthly to ensure that there were enough staff on duty each day to meet their direct care needs. However, the staff duty rota was difficult to follow and contained conflicting information about the number of staff on duty. As a result, there were dates when we could not be certain the minimum number of staff required were on duty. Additional information was provided by the manager and clarified that the confusion was caused by inadequate recording methods. (See recommendation 3) Requirements Number of requirements: 1 1. By 30 October 2018, the provider must ensure that persons employed in the provision of care have the skills necessary for the work they are to perform in the service. They must: a) devise a staff training programme b) deliver training timeously c) assess the competency of all staff in respect of their knowledge and skills to provide residents' needs d) where staff do not have the skills required for the work they perform, plan and implement appropriate training; and e) develop and implement a system to assess and improve the effectiveness of any training received in practice within the service. have confidence in people because they are trained, competent and skilled and are able to reflect on their practice and follow their professional and organisational codes. (HSCS 3.14) This is also in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210) Regulation 9(2)(b) and 15(b). Recommendations Number of recommendations: 3 1. The provider should progress all staff supervision sessions and team meetings to make sure that staff have a structured opportunity to discuss their work practice and be supported to follow their professional and organisational codes. have confidence in people because they are trained, competent and skilled and are able to reflect on their practice and follow their professional and organisational codes. (HSCS 3.14) page 8 of 20

9 2. The provider should ensure that all staff are recruited safely and in line with the best practice guidance - Safer Recruitment Through Better Recruitment, am confident that people who support and care for me have been appropriately and safely recruited. (HSCS 4.24) 3. The provider should ensure that the staff duty rota accurately reflects the total number of staff working in the service each day to meet the health, welfare and safety needs of residents. This is to ensure care and support is consistent with the Health and Social Care Standards which state that - My needs are met by the right number of people. (HSCS 3.15) Grade: 3 - adequate Quality of management and leadership Findings from the inspection Residents did not benefit from a service which was well led and managed. Although some managerial strengths were identified, these were compromised by significant weaknesses which substantially affected how well the service was managed and this impacted on residents' and staff experiences. The provider gave assurances at previous inspections that it would make improvement. However, despite a stable management team for the past nine months, the pace of change was too slow and improvement had not occurred. Residents did not benefit from living in a culture of continuous improvement. The quality assurance system used to measure key aspects of the service, was ineffective in showing the impact of any improvement plan. As a result, changes were reactive rather than because of robust evaluation of the service's quality. For example, training records were updated as a result of inspection rather than to provide a clear managerial overview of the training staff needed to care for residents. (See recommendation 1) There was limited evidence that residents, relatives and staff were supported to meaningfully contribute to the vision and development of the service or that the rationale for change was explained. Action plans were not developed following meetings and there was no managerial overview of progress in implementing agreed action. Consequently, there was limited evidence that views were taken account of, except on a superficial level. (See recommendation 2) Staff did not know the organisational managerial structure. This restricted their understanding of roles and responsibilities within the organisation and where to gain support and guidance in decision-making. There was no clear understanding of the manager's role in directing improvement. (See recommendation 3) Staff were not encouraged to develop their leadership skills, take responsibility or contribute to improving the service except at a basic level. As a result, there was an over reliance on key personnel for all decisions, limiting innovative thinking and contributions from staff. (See recommendation 4) We were not confident that complaints were taken seriously because findings and investigations were not page 9 of 20

10 always recorded. The outcome of complaints was not used in any meaningful way to learn from mistakes and improve service quality. (See requirement 1) The provider did not notify us promptly of significant events occurring at the service. (See requirement 2) To formalise the ages of residents who can live at the service, we have recommended that the provider apply to the Care Inspectorate to vary the conditions of registration under which the service operates. (See recommendation 5) To ensure that staff are supported and guided in their work, policies and procedures needed to be reviewed and updated to reflect the most up to date guidance. (See recommendation 6) We concluded that managerial skills were insufficient to support improvement and embed positive changes into practice. We have made requirements in this report because we cannot be confident of the service's capacity to improve. Requirements Number of requirements: 2 1. By 30 October 2018, the provider must ensure that any complaint received under the complaint procedure is fully investigated and the complainant informed of the action (if any) to be taken. f I have a concern or complaint, this will be discussed with me and acted on without negative consequences for me. (HSCS 4.21) This is also in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210) Regulation 18(3)(4). 2. By 30 August 2018, the provider must comply with legislation and Care Inspectorate guidance on notification reporting and ensure that notifications are made timeously. This is to ensure care and support is consistent with the Health and Social Care Standards which state that - I benefit from different organisations working together and sharing information about me where appropriate. (HSCS 4.18) This is also in order to comply with The Social Care and Social Work Improvement Scotland (Registration) Regulations 2011 (SSI 2011/28) Regulation 4 - Notifications. Recommendations Number of recommendations: 6 1. The provider should develop a robust and transparent quality assurance process to ensure that residents benefit from a culture of continuous improvement. To do this, the provider should: a) Collate all information gathered from audits, meetings and surveys b) Devise action plans to implement any areas identified for improvement c) Work through devised action plans d) Re-visit action plans to ensure that they have been completed e) Feedback the outcomes to those who they gathered the information from. page 10 of 20

11 benefit from a culture of continuous improvement with the organisation having a robust and transparent quality assurance process. (HSCS 4.19) 2. The provider should improve how residents are involved in developing the service. am supported to give regular feedback on how I experience my care and support and the organisation uses the learning from this to improve. (HSCS 4.8) And, also - I can be meaningfully involved in how the organisation that supports and care for me work and develop. (HSCS 4.6) 3. The provider should share with staff, clear information about the managerial structure within the organisation, roles and responsibilities. This is to increase staff knowledge of roles and responsibilities within the organisation and where to gain support and guidance in decision making. experience high quality care and support because people have the necessary information and resources. (HSCS 4.27) 4. The provider should develop registered nurses and senior carers' leadership skills to help them in directing the running of the service and contributing to developing the quality of the service. use a service and organisation that are well led and managed. (HSCS 4.23) 5. The provider should apply to the Care Inspectorate for a variation to alter the conditions of registration under which the service operates. This is to formalise the ages of residents who can live in the service. f I receive care and support in a group, the overall size and composition of that group is right for me. (HSCS 1.8) 6. The provider should review and update policies and procedures to ensure that the most up-to-date information is provided and all legal requirements are covered. experience high quality care and support based on relevant evidence, guidance and best practice. (HSCS 4.11) Grade: 2 - weak page 11 of 20

12 What the service has done to meet any requirements we made at or since the last inspection Previous requirements There are no outstanding requirements. What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 The provider should continue to develop the participation strategy to take account of residents' and relatives' views in assessing and improving the quality of care and support. This should also take account of the quality of environment, quality of staffing and quality of management and leadership. The strategy should take account of how the views of people with communication or memory difficulties are gathered. This is in accordance with the National Care Standards, Care Homes for Older People, Standard 11 - Expressing your views. This recommendation was made on 21 November Action taken on previous recommendation The provider had not implemented this recommendation. Positive efforts continued to be made to involve residents and relatives in developing the service and to hear their views. For example, through consultation about the decoration of the building and social activities. As at previous inspections, this could be improved. Residents and relatives could be better supported to influence the quality and development of the service. For example, by involvement in evaluation of staff practice. Devising action plans following meetings would allow residents and relatives to monitor the provider's response to agreed actions. To be a truly responsive environment, the service needed to continue to develop the participation strategy in a way that made sure that everyone had opportunities to have their say, about all aspects of the service, including those residents who found communication more difficult. We will monitor progress at the next inspection. This is discussed under quality of management and leadership. page 12 of 20

13 Recommendation 2 It is recommended that the service should continue to develop the content of residents' care plans to ensure these: a) Reflect all aspects of residents' care including wound care, nutrition, continence, oral healthcare and social interests b) Are updated when care needs change or following care reviews, accidents and incidents c) The evaluation of care plans should take account of other records, such as fluid charts. Charts should be accurately completed d) Fully implement the audit system to monitor the accuracy of plans. This is in accordance with the National Care Standards, Care Homes for Older People, Standard 6 - Support arrangements. This recommendation was made on 11 April Action taken on previous recommendation The provider had not implemented this recommendation. As at the last inspection, we acknowledged the service was working hard to update and improve the quality of residents' care plans. However, this work remained in the early stages with one member of staff mainly undertaking the responsibility. By this stage we would have expected to see significant progress in involving all staff in developing plans that accurately reflected all aspects of residents' care needs. Consequently, the content of residents' care plans did not always reflect their care needs or staff knowledge of residents' care needs. The quality of plans continued to vary with some plans containing good information about care needs, but others contained less up-to-date information. This was because plans were not consistently updated following accidents, when care needs changed or following care reviews. This would not help staff deliver consistent care in the way the residents wished. Quality audits needed to be used in a more robust way to improve the overall care plan accuracy and quality. This is discussed under quality of care and support. Recommendation 3 It is recommended that the provider carry out regular evaluation of staff practice to ensure they have the expertise to meet residents' needs. Staff should be supported to gain knowledge and skills as part of a planned training programme. This is in accordance with the National Care Standards, Care Homes for Older People, Standard 5 - Management and staffing arrangements. This recommendation was made on 11 April Action taken on previous recommendation The provider had not implemented this recommendation. We concluded that little progress had been made since the last inspection. page 13 of 20

14 The provider is aware that under the Scottish Social Services Council's codes of practice, employers are expected to support staff to continually improve their work practice. However, most staff had not had their practice evaluated. Documentation to support the process was still being developed. By now we would have expected to see more progress in such a significant area. It was difficult to establish if staff had received training necessary to help them develop the knowledge and skills needed to provide competent care. This was because training records were not up to date. As stated at the last inspection, there needs to be a better managerial overview of staff training records to ensure these are kept upto-date and accurately reflect the training staff received and future training needed. This is discussed under quality of staffing. Recommendation 4 It is recommended that the provider should review how meals are served at the service to ensure: a) Snacks and drinks are available outwith set meal times and residents are supported to access these b) Visual meal choices are offered at meal times to residents who need this support c) Review meal times to ensure there are suitable time lapses between meals. This is in accordance with the National Care Standards, Care Homes for Older People, Standard 13 - Eating well. This recommendation was made on 11 April Action taken on previous recommendation The provider had not fully implemented this recommendation. Element (a) had not been implemented. While snacks were available for residents sitting in the main sitting room, residents in other parts of the building, did not have access. Element (b) had not been implemented. Visual meal choices varied depending on staff skills. All residents who require visual choices should consistently be offered this support to help them enjoy their food and maintain their health and wellbeing. This is discussed under quality of care and support. Element (c) had been implemented. The time of the evening meal had been reviewed. This was now served later to ensure a suitable time lapse between meals. Recommendation 5 It is recommended that the provider continues to review and update polices and procedures to ensure that the most up-to-date information is provided and all legal requirements are covered. This is in accordance with the National Care Standards, Care Homes for Older People, Standard 5 - Management and staffing arrangements. This recommendation was made on 11 April Action taken on previous recommendation The provider had not implemented this recommendation. page 14 of 20

15 We expected there to be a better managerial overview of the use and development of policies and procedures to ensure staff are supported and guided in their work practice. This is discussed under quality of management and leadership. Recommendation 6 It is recommended that the provider develop medication management including: a) Ensure residents' prescribed medication is in stock and available when needed b) Ensure handwritten narratives are dated and signed when changes are made and record who authorised the changes. This is in accordance with the National Care Standards, Care Homes for Older People, Standard 15 - Keeping well - medication. This recommendation was made on 11 April Action taken on previous recommendation The provider had implemented this recommendation. a) Medication was in stock, which helped ensure that residents could receive their medication as prescribed. b) The recording of handwritten narratives had improved. Recommendation 7 The provider should develop registered nurses and senior carers' leadership skills to help them in directing the daily running of the service. This is in accordance with the National Care Standards, Care Homes for Older People, Standard 5 - Management and staffing arrangements. This recommendation was made on 11 April Action taken on previous recommendation The provider had not implemented this recommendation. The day-to-day running of the service was smooth and carers knew their roles. As a result, the atmosphere was calm and organised which made living at the service more pleasant for residents. Some staff had started to undertake responsibilities within their job remit and they were keen to do this. This would help them develop their knowledge and skills. However, there was still an over reliance on the management team for completion of tasks which should be within the scope of competence of registered nurses. For example, updating care plans and risk assessments. This is discussed under quality of management and leadership. page 15 of 20

16 Recommendation 8 It is recommended that the service progresses all staff supervision sessions and team meetings to make sure that staff have a method to discuss their work and be supported. This is in accordance with the National Care Standards, Care Homes for Older People, Standard 5 - Management and staffing arrangements. This recommendation was made on 11 April Action taken on previous recommendation The provider had not implemented this recommendation. There had been no significant progress since the last inspection. We were advised that the majority of staff were not offered the opportunity to participate in regular support and supervision sessions. The provider is aware that under the Scottish Social Services Council's codes of practice, employers are expected to provide effective staff supervision to support staff to develop their work practice through reflective practice. It was difficult to measure how effective staff meetings were because there was no evidence that progress in achieving agreed actions was monitored. Team meetings could be used more effectively to develop the service. This is discussed under quality of staffing. Recommendation 9 It is recommended that the provider should develop the quality assurance system so that all information gathered from audits and meetings is used to measure and develop the quality of all aspects of the service and influence the service development plan. This is in accordance with the National Care Standards, Care Homes for Older People, Standard 5 - Management and staffing arrangements. This recommendation was made on 11 April Action taken on previous recommendation The provider had not implemented this recommendation. No significant progress had been made since the last inspection. This is discussed under quality of management and leadership. Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at page 16 of 20

17 Enforcement No enforcement action has been taken against this care service since the last inspection. Inspection and grading history Date Type Gradings 24 Jan 2018 Unannounced Care and support Not assessed Not assessed Not assessed Not assessed 11 Apr 2017 Unannounced Care and support 4 - Good 21 Nov 2016 Unannounced Care and support Not assessed Not assessed Not assessed Not assessed 13 Apr 2016 Unannounced Care and support 4 - Good 26 Nov 2015 Unannounced Care and support Not assessed Not assessed Not assessed Not assessed 2 Apr 2015 Unannounced Care and support 19 Nov 2014 Unannounced Care and support page 17 of 20

18 Date Type Gradings 12 May 2014 Unannounced Care and support 29 Nov 2013 Unannounced Care and support 30 Apr 2013 Unannounced Care and support 4 - Good 11 Oct 2012 Unannounced Care and support 4 - Good 9 May 2012 Unannounced Care and support 14 Nov 2011 Unannounced Care and support 4 - Good 27 May 2011 Unannounced Care and support 4 - Good 23 Nov 2010 Unannounced Care and support page 18 of 20

19 Date Type Gradings 8 Jun 2010 Announced Care and support 23 Dec 2009 Unannounced Care and support 1 - Unsatisfactory 29 Jun 2009 Unannounced Care and support 1 - Unsatisfactory 1 - Unsatisfactory 1 - Unsatisfactory 1 - Unsatisfactory 17 Mar 2009 Unannounced Care and support 1 - Unsatisfactory 3 Feb 2009 Care and support 1 - Unsatisfactory page 19 of 20

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