Well Hall Residential Home Care Home Service Adults 60 Wellhall Road Hamilton ML3 9DL Telephone:

Transcription

1 Well Hall Residential Home Care Home Service Adults 60 Wellhall Road Hamilton ML3 9DL Telephone: Inspected by: Fiona Stevenson Gerry Tonner David Marshall Type of inspection: Unannounced Inspection completed on: 16 April 2014

2 Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 16 4 Other information 37 5 Summary of grades 38 6 Inspection and grading history 38 Service provided by: Church of Scotland Trading as Crossreach Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: Fiona Stevenson Telephone enquiries@careinspectorate.com Well Hall Residential Home, page 2 of 41

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 3 Adequate Quality of Environment 4 Good Quality of Staffing 3 Adequate Quality of Management and Leadership 3 Adequate What the service does well We saw that the staff were caring and patient in their approach to the people who lived at Well Hall Care Home. The service continues to support the meaningful involvement of residents and their families and to use their views and comments to develop the service. We saw that there was a good range of activities available for residents, including opportunities for people to go on outings. Residents commented positively about the trips and outings available. What the service could do better There is a continued need to develop resident's personal plans to ensure that they fully reflect how the needs of residents are being met. What the service has done since the last inspection The management team have worked hard to improve the way that residents' medication is managed in the home. We saw that there was an improvement in the management of nutrition in the home specifically for those residents who have increased need for support with their nutritional needs. Well Hall Residential Home, page 3 of 41

4 Conclusion Inspection report continued The service has a new management team who have worked hard with the staff to address the issues identified during the Inspection in September 2013 and improve the quality of the care and support provided by the service. This has resulted in some improvement in the grades awarded by the Care Inspectorate. Who did this inspection Fiona Stevenson Gerry Tonner David Marshall Well Hall Residential Home, page 4 of 41

5 1 About the service we inspected Well Hall Residential Care Home is owned and managed by Crossreach, the social care arm of the Church of Scotland. The service is situated within a quiet, residential area of Hamilton, close to the town centre, local amenities and public transport links. The service is operated from a recently constructed building that was completed and occupied in Before 1 April 2011 this service was registered with the Care Commission. On this date the new scrutiny body, Social Care and Social Work Improvement Scotland (SCSWIS), took over the work of the Care Commission, including the registration of care services. This means that from 1 April 2011 this service continued its registration under the new body, SCSWIS, known as the Care Inspectorate. Requirements and recommendations If we are concerned about some aspect of a service, or think it could do more to improve its service, we may make a recommendation or requirement. - A recommendation is a statement that sets out actions the care service provider should take to improve or develop the quality of the service but where failure to do so will not result in enforcement. Recommendations are based on the National Care Standards, relevant codes of practice and recognised good practice. - A requirement is a statement which sets out what is required of a care service to comply with the Public Services Reform (Scotland) Act 2010 and Regulations or Orders made under the Act or a condition of registration. Where there are breaches of the Regulations, Orders or conditions, a requirement must be made. Requirements are legally enforceable at the discretion of the Care Inspectorate. The service is able to accommodate 38 service users in 34 single bedrooms and two twin bedrooms. At the time of inspection there were 23 service users living in the service. The service's stated aim and objectives includes the following statement: "To provide care for older people in a dignified and respectful setting. Well Hall offers a level of professional and specialist care provided by a committed care team, led by the unit manager. Well Hall offers a dedicated keyworker system and personal care plan, which enables service users to be as independent as possible, whilst providing the warmth and comfort of a safe,caring and supportive environment." Well Hall Residential Home, page 5 of 41

6 Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 3 - Adequate Quality of Environment - Grade 4 - Good Quality of Staffing - Grade 3 - Adequate Quality of Management and Leadership - Grade 3 - Adequate 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. Well Hall Residential Home, page 6 of 41

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 compiled the report following an unannounced visit over 2 days from 15 April We gave feedback to the manager, depute manager and senior care workers on 16 April The Inspection was carried out by Inspectors Fiona Stevenson, Gerry Tonner with the support David Marshall Professional advisor - Pharmacy for the Care Inspectorate. As requested by us, the care service submitted an annual return; the service also sent us a self assessment form. Prior to the inspection we issued a total of 80 Care Standards Questionnaires to service users, their relatives and carers. 21 completed questionnaires were returned, comments made by both service users and carers informed the inspection and are included in the inspection report. During the inspection we spoke to residents and visitors to find out their views about the care and support provided. We spent time observing how staff supported and interacted with residents. We spoke with the home manager, depute manager, senior care workers and care workers. We also spoke with the activities coordinator, housekeeping staff, the chef and catering staff. Documents sampled included: - Registration certificate - Staffing schedule - Participation policy - Newsletter - Minutes of a range of meetings - Complaint policy and records - Accident and incident records - Personal plans - Care review schedule Well Hall Residential Home, page 7 of 41

8 - Risk assessments - Food and fluid monitoring charts - Medication records - Activities plans and records - Menus - Staff supervision records - Training records - Records of quality audits - Maintenance records - Health and safety audits - Cleaning schedules and records. 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. Fire safety issues We do not regulate fire safety. Local fire and rescue services are responsible for checking services. However, where significant fire safety issues become apparent, we will alert the relevant fire and rescue services so they may consider what action to take. You can find out more about care services' responsibilities for fire safety at Well Hall Residential Home, page 8 of 41

9 What the service has done to meet any requirements we made at our last inspection The requirement 1. The service provider must ensure that they meet the health and welfare needs of residents with regards to the administration of medication. To do this they must ensure that: - medication is administered as instructed by the prescriber - medication is available at the time of administration. What the service did to meet the requirement Information about how the service responded to this Requirement is detailed in Quality Theme 1, Statement 3 of this report. The requirement is: Met - Within Timescales Well Hall Residential Home, page 9 of 41

10 The requirement 2. The service provider must ensure a record of medicines held on the premises for use by the service user. The medication recording system should be safe, up to date and accurate. To do this they must ensure: - there is a complete, accurate and consistent auditable record of all prescribed medicines entering, administered or destroyed, and leaving the service (the audit trail and stock control should be enhanced by recording on the MAR the amount of medication carried forward to the start of each new cycle) - that where a regular medicine is not given as prescribed a reason for this must be clearly annotated on the Medicines Administration Recording [MAR] chart - that staff regularly review the information on each service user's MAR chart to check that it accurately reflects how the medication has been managed by the service. What the service did to meet the requirement Information about how the service responded to this Requirement is detailed in Quality Theme 1, Statement 3 of this report. The requirement is: Met - Within Timescales Inspection report continued Well Hall Residential Home, page 10 of 41

11 The requirement 3. The service provider must ensure that personal plans fully reflect the protocols to guide staff with the use of medication that is prescribed on a "when required" basis for sedative or analgesic use. In order to do this the service must ensure that personal plans include details of: - the person's symptoms of disturbance or pain - what is likely to cause/trigger this behaviour in this person - how the identified care need is best managed for that person - current medication used to manage the care need and the criteria for its use in that person - any monitoring required of the medication of behaviour or pain relief - when the medication's effectiveness will be reviewed by the prescriber. What the service did to meet the requirement Aspects of this Requirement have been met and are detailed in Quality Theme 1, Statement 3 of this report. However, there is a continued need for further development of the information in personal plans regarding "when required" medication. This will continue to be a Requirement. See Requirement 1 in Quality Theme 1, Statement 3 of this report. The requirement is: Not Met Inspection report continued Well Hall Residential Home, page 11 of 41

12 The requirement 4. The service provider must ensure that service users' personal plans set out how the health, welfare and safety needs of the individual are to be met. In order to do this the service must ensure that the personal plans: - reflect a person centred approach and are developed in line with National Care Standards - include information about care and support interventions and are developed to fully reflect the care being provided - regularly complete risk assessment tools to assess and monitor specific risks and use the outcome of the assessments to their full potential to inform care planning - contain information regarding the medication prescribed for individuals including information about possible key side effects - include information regarding the use of special equipment to support the individual - ensure that records are signed and dated by the appropriate parties. What the service did to meet the requirement Aspects of this Requirement have been met and are detailed in Quality Theme 1, Statement 3 of this report. However, there is a continued need for further development of the personal plans. This will continue to be a Requirement. See Requirement 1 in Quality Theme 1, Statement 3 of this report. The requirement is: Not Met Inspection report continued Well Hall Residential Home, page 12 of 41

13 The requirement 5. The service provider must put in place and implement systems which will ensure that the nutrition needs of those service users identified as being at risk of malnutrition are being regularly assessed and adequately met. In order to do this the service must ensure the following: - the tool used for monitoring risk of malnutrition (MUST) is regularly completed for each resident - the system to monitor the care of service users who are at risk of malnutrition is kept up to date - that the measures to monitor the fluid intake of service users identified as being at risk of dehydration are being regularly assessed and fully completed. This is with reference to ensuring that the charts used for monitoring risk of fluid intake record the target intake for the 24 hour period and that there are clear records of the steps taken if the targets are not achieved. What the service did to meet the requirement Information about how the service responded to this Requirement is detailed in Quality Theme 1, Statement 3 of this report. The requirement is: Met - Within Timescales Inspection report continued What the service has done to meet any recommendations we made at our last inspection There were 10 Recommendations identified at the last inspection in September The service has worked hard to meet 7 of the Recommendations. There are 3 Recommendations that will continue and these are detailed as follows: 1. Recommendation regarding the quality of handwritten entries in medication records is detailed in Quality Theme 1, Statement Recommendation regarding the auditing of accidents and incidents is detailed in Quality Theme 2, Statement Recommendation regarding the evaluation of training is detailed in Quality Theme 3, Statement 3. Well Hall Residential Home, page 13 of 41

14 The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: Yes - Electronic Inspection report continued Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. We received a fully completed self assessment document from the service provider. We were satisfied with the way the service provider had completed this and with the relevant information they had given us for each of the headings that we grade them under. The service provider identified what they thought they did well, some areas for development and any changes they planned. Taking the views of people using the care service into account We spoke to several of the residents on a one to one basis and in small groups. Residents told us that they were happy with the care and the staff. We spent time observing interactions between residents and staff; we saw that the staff approach to residents was caring, polite and respectful. Comments included: "I like living here, the staff are lovely; they take good care of me." "There is plenty to do, I like getting out to the lunch club." "The food is good; there is plenty of choice and home baking with the afternoon tea which is lovely." "The staff are great and couldn't look after me any better." There is further information about our observations regarding resident's care and support detailed throughout the report. Well Hall Residential Home, page 14 of 41

15 Taking carers' views into account We spoke to relatives and visitors who commented that they saw an improvement in the way the home was being managed and with the care residents received. Most commented that they saw this as a result of the changes to the management team. The completed questionnaires we received indicated that overall people agreed or strongly agreed that they were happy with the quality of care their relative received at Well Hall Care Home. Comments included: "The improvement is without doubt remarkable, from the courtesy of the management team to the range of activities available for residents." "I am very happy with the care my relative gets. I have found the staff to be knowledgeable, helpful and caring." "The change in the management team have made an enormous difference to the service." "All the staff are very attentive to the residents." "I have been very pleased at the amount of stimulation there is for my relative through the many and varied activities available." "I am extremely satisfied with all aspects of my relatives care." There are further comments from relatives throughout the report. Inspection report continued Well Hall Residential Home, page 15 of 41

16 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: 3 - Adequate Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths We found the service performance was good in the areas covered by this statement. We came to this view after we: - spoke with people who use this service - spoke with the staff team - looked at documentation. People who use the service can voice their views and suggestions about their care in a variety of ways including satisfaction surveys, one to one and group meetings and review meetings. There was a suggestion box for written comments. The service was in the process of collating the responses from a recent survey involving residents and relative. The manager was planning to develop an action plan to address issues arising and feedback the results to residents and relatives. We will look at the progress with this at the next inspection. People we spoke with commented about the improvement in the level of communication between themselves and the staff teams. They said that there was better information available about what was happening in the home. There was a key worker system in place. The key workers are care staff who are identified to help to coordinate an individual resident's care, support that resident with communication and maintain links with their relatives and friends. Well Hall Residential Home, page 16 of 41

17 Relatives commented: "As I do not live locally I rely on the weekly phone calls from my relative's key worker to keep me up to date regarding my relative's well-being and health." "Communication between the staff and relatives is much improved." The service have started to use 'Skype' to assist some residents to keep in touch with relatives who live abroad or too far away to visit regularly. We saw evidence that there were regular meeting for residents and relatives to attend. The service were utilising the feedback from residents and relatives to inform the development and improvement of the service. We found good examples showing that people's views were listened to and acted upon such as additional choices at breakfast of hot filled rolls, more variety of snacks at supper time and further development of the activities and outings available. There was a newsletter which provided information about what was happening in the home and about plans for future activities and events. There was an electronic notice board in the foyer which displayed the activities schedule for the day and photographs of recent activities and events. The calendar of upcoming activities and events was also available in each resident's bedroom. We saw that there was a schedule in place to ensure that resident's personal plans were being reviewed on a six monthly basis. The review process ensures that residents and relatives have a formal opportunity to express their views regarding the care and support they receive and whether it is meeting the individual's needs effectively. We saw that there was information on display about how to raise concerns and complaints. People we spoke with during the inspection told us that they were aware of who they would speak to about concerns and about how to make a complaint. There was information available about independent advocacy services for residents. An advocacy service helps provide residents with impartial advice and assist them to help to express their views, opinions and wishes. Areas for improvement We looked at resident's personal plans in the units we visited; we noted that some plans contained a better level of information reflecting the preferences and choices of individuals than others. The service should continue to consult with residents and Well Hall Residential Home, page 17 of 41

18 their relatives to gather information about the choices and preferences of individuals to develop the personal plan. This information could be used to reflect a person centred approach to care and support. There are further details about our findings regarding personal planning in Quality Statement 1.3 within this report. The service had a "You said - We did" notice board to inform people about the outcomes of meetings and the progress with improvements. This was not currently being fully utilised to inform people of the outcomes of comments and suggestions. We discussed this with the manager who detailed plans to re-introduce this format of feedback. We will monitor progress with this at the next inspection. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Well Hall Residential Home, page 18 of 41

19 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths We found the service performance was adequate in the areas covered by this statement. We came to this view after we: - spoke with people who use this service - spoke with the staff team - looked at documentation. We saw that the staff approach to residents was caring and respectful. The management and staff team demonstrated a good level of knowledge of the care and support needs of individual residents. The staff team demonstrated a good level of knowledge of the local community healthcare networks and had links with the community healthcare teams for individual residents such as GPs, dieticians and community nurses. It is important medicines are administered as intended and in a safe and dignified way to ensure the welfare and quality of life for residents. It is also important to have an accurate, up-to-date record of how medicines have been managed by a service as this can reduce the occurrence of poor care. During the previous inspection in September 2013 we made Requirements and Recommendation regarding the need to improve medication management in the home. This included issues about the following: - the administration of medication - the records of medicines held on the premises for use by the individual resident - the maintenance of records that detailed a complete, accurate and consistent auditable record of all prescribed medicines entering, administered or destroyed, and leaving the service - stock control. A Care Inspectorate Professional Advisor for Pharmacy carried out part of the inspection in relation to medication management and looked at residents MAR (Medicine Administration Recording) charts and residents' personal plans. Well Hall Residential Home, page 19 of 41

20 The medication records in the care home were pre-printed MAR charts supplied by the community pharmacist. Repeat medication was supplied to the care home with the MAR on a 28 day cycle. The MAR charts are a record of how the service has managed medication for the resident. We found the recording and administration of medication to be effective with most medicines administered as prescribed and intended, to ensure the welfare and quality of life for residents. When we looked at the MAR charts we noted a record of medicines received and administered by the home. Medicines leaving the home were recorded separately. Where there was a variable dose prescribed, the actual amount given was recorded on the MAR chart. This was done neatly and the records could be easily read. The amount of medicine carried forward from the previous cycle was recorded on the MAR. The manager also monitored medicines with periodic stock reconciliation audits. Where an anomaly was highlighted this was investigated with actions taken to improve handling of medicines. Where a regular medicine was not given a clear reason for this was annotated on the MAR chart. Overall we feel there has been a significant improvement in the management of medication and these Requirements and Recommendations regarding the management of medication in the care home are met. At the previous inspection in September 2013 we made a Requirement with regards the need to improve the management of residents' nutritional needs. We looked at personal plans for residents who had been assessed as at risk of malnutrition, we spoke with care staff and the chef we also looked at menus and records about specific diets. We noted that the Malnutrition Universal Screening Tool (MUST) to assess and monitor individual's nutritional needs was regularly and appropriately completed. This allows staff to recognise changes to the level of nutritional risk and to take action to reduce the risk. The staff were accessing support and advice from healthcare professionals such as the dietician and speech and language therapist appropriately. We spoke with the chef who demonstrated a good level of knowledge about individual resident's preferences and their special dietary needs. Well Hall Residential Home, page 20 of 41

21 There was evidence that communication between the care staff and the catering staff had improved and there was up to date information available in the kitchen about resident's current nutritional needs. The service had identified residents who were at risk of dehydration and malnutrition and had implemented food and fluid charts to monitor those residents intake over a 24 hour period. We looked at the charts for these residents and noted that there contained good detail about individuals intake and that they were accurate and up to date. This Requirement is met. It is important that service users have access to a range of meaningful activities on a day to day basis. Meaningful activities can help provide structure to day to day life, pleasure to individuals and promote good physical health, mental health and wellbeing. During the inspection we saw residents taking part in one to one activities and in group activities such as dominoes, music and movement - a gentle exercise group, a newspaper group and a sing along group. We observed that care staff were good at encouraging and supporting residents with participation in activities. We saw care staff engaging with one to one activity sessions with residents. At the previous inspection we had made a Recommendation regarding the need to improve the records of activities residents had participated in. We talked with the activity coordinator who detailed the range of activities and events that were available within the home. The activities coordinator demonstrated a good level of knowledge of resident's preferences regarding activities and social events. There were good records detailing the activities individuals took part in and evaluation of how enjoyable and meaningful the activity was. The activity coordinator was using this information to inform the activity diary and plan events for the future. There was photographic evidence which supported the written records. The service had developed good links with local churches, schools and community groups. Residents and relatives we talked with commented that there had been an improvement regarding the range of activities and outings available in the home. This Recommendation is met. Areas for improvement Care services must develop personal plans for individual residents which detail the actions staff will implement to support the individuals assessed care needs. The plans should be regularly evaluated and kept up to date to provide guidance for staff about how the individuals care and support needs are to be met. Well Hall Residential Home, page 21 of 41

22 During the previous inspection in September 2013 we made a Requirement about the need to improve the quality of the content of resident's personal plans. We looked at the personal plans for several residents and talked with staff involved in the development of the plans. We noted that staff had been working hard to develop the personal plans and that the management team had recently introduced protected time for staff to undertake this. The plans were better organised and the format allowed for specific information to be recorded about residents assessed needs and how those needs were to be met. However, the plans continue to need development to ensure that they fully reflect the person centred care and support that we observed staff delivering. Some of the plans contained better information than others; the service needs to have a consistent approach to the content and quality of plans. We did not see that personal plans were being regularly audited. We saw that there was improved evidence of consultation with residents and relatives regarding the development of the plans and in decision making about specific aspects of care and support. We saw that daily records for residents evidenced the advice and support from visiting healthcare professionals. However we saw minimal evidence that this was informing care planning. The service was using appropriate risk assessments to assess specific risks such as falls, skin integrity and nutrition. We saw that these assessments were completed and kept up to date. However, the outcomes of the assessments were not being used to their full potential to inform the planning of care. The personal plans contained a 6 weekly summary of care which was intended to evaluate the validity of the plan and indicate if it needed updated. However, we saw that these summaries were being used as an overview of the previous 6 weeks and were not evaluative or indicating the need to update the specific assessed care need. During the previous inspection we identified a need for the service to improve the information in personal plans to guide staff with the use of medication that is prescribed on a "when required" basis for sedative or analgesic use. Only one resident was prescribed a "when required" medication for the management of stress and distress. Their personal plan did detail how the care need is best managed for that person, their current medication and how and when to use this. However, the plan did not indicate what monitoring staff should do for the condition or clarify when the medicine's effectiveness would be reviewed. Well Hall Residential Home, page 22 of 41

23 These issues will be the subject of a continued Requirement. See Requirement 1. We looked at the way the service assess, monitor and manage the risk of residents falling. We looked at accident and incident reports and personal plans. We saw that the service recorded accidents and notified the Care Inspectorate of falls which have resulted in an injury. The personal plans we looked at contained variable detail of the strategies in place to minimise risk, we noted that there was not always a revisiting of the plan following a fall to evaluate if it was continuing to address the risk. The service had copies of the Care Inspectorate guidance to assess, monitor and manage the risk of falls in care homes - 'Managing falls and fractures in care homes for older people' but had not fully implemented it. These issues will be the subject of a Recommendation. See Recommendation 1. We observed mealtimes during the inspection visit. The tables in the dining areas were set with condiments and menus available for residents. Residents had a choice to have their meals in the dining room, sitting room or in their own bedroom. The menus on display reflected the meals that were being served; residents therefore could make choices about what they wanted to eat prior to mealtimes. We saw that there was a variable quality of the experience over the two days of our visit. We noted that on the first day the lunchtime was not as well managed as on the second day. On the first day we saw that there was a need for staff to be appropriately deployed to ensure that they consistently supervised and assisted residents with their meals. We saw that some staff offered a visual choice of meals and drinks to residents but this was not consistently done. On the second day we noted that mealtimes were being better managed and were calmer. We did not see residents being offered the opportunity to wash their hands before their meal. This will be the subject of a Recommendation. See Recommendation 2. It is important that the rights of people in care services are protected. We noted that the personal plans for residents who lack the capacity to make decisions about their own care and support contained a certificate of incapacity issued by the GP which records that the individual lacks capacity to make decisions about their own care and support. These certificates are issued under section 47 of the Adults with Incapacity (Scotland) Act Well Hall Residential Home, page 23 of 41

24 However, we had difficulty in determining if all the certificates were valid as many of the certificates were photocopies of poor quality. This will be the subject of a Recommendation. See Recommendation 3. To protect the decisions made by residents and their representatives regarding the actions to be taken should the individual resident need resuscitation a formal record is made using a 'DNACPR' (Do Not Attempt Cardio Pulmonary Resuscitation) form. These forms record the decision taken by the individual, their representative and the GP. We saw that there were DNACPR forms in place for many residents. However, the service did not have an overview of the dates for review of the forms to ensure that they were current and fully reflected the decision made regarding resuscitation. This will be the subject of a Recommendation. See Recommendation 3. The service has introduced a system to record the application of resident's topical medication. We looked at Topical Medication Administration Records (TMAR); we saw good information regarding the site of application. However, not all applications were consistently signed for. We looked at the quality of the handwritten entries and amendments to MAR charts; we noted that they had improved. However, there was a continued need to fully adhere to best practice guidance for example the Royal Pharmaceutical Society of Great Britain (RSPGB) "The Handling Of Medicines In Social Care", October 2007; Nursing and Midwifery Council " Record keeping: Guidance for Nurses and Midwives", April These issues will be the subject of a Recommendation. See Recommendation 4. Grade awarded for this statement: 3 - Adequate Number of requirements: 1 Number of recommendations: 4 Requirements 1. The service provider must continue to develop service users' personal plans to ensure that they fully reflect how the health, welfare and safety needs of the individual are to be met. In order to do this the service must ensure that the personal plans: - detail the care and support interventions and are developed to fully reflect the care being provided - are regularly evaluated and any changes used to update the specific plan of care and support - utilise risk assessment tools that assess and monitor specific risks to Well Hall Residential Home, page 24 of 41

25 their full potential to inform care planning - contain information regarding the medication prescribed for individuals including information about possible key side effects - detail the monitoring needed following the use of medication that is prescribed on a "when required" basis for sedative or analgesic use and when the medicine's effectiveness is to be reviewed - evidence that the advice and support from healthcare professionals is used to inform care and support - the individual reflect a person centred approach and are developed in line with National Care Standards. This is to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI2011/210), Regulations 5(1) Timescale - The provider must meet this Requirement within 3 months of receipt of this report. Recommendations 1. The service should fully implement systems to assess, monitor and manage of the risk of falling. In order to do this the service provider should ensure the following: - that the information within personal plans regarding the management of the risk of falls fully and consistently reflects the support needed by the individual, that it is accurate and up-to-date - fully utilise best practice guidance regarding the assessment, monitoring and management of falls. Standard 6 - Support arrangements Standard 9 - Feeling safe and secure National Care Standards for care homes for older people. Inspection report continued 2. The service provider should review the management of mealtimes to ensure that it is a sociable and pleasant experience for residents. This includes the following: - improving the deployment of staff to ensure consistency of the support and supervision for residents who need assistance with eating and drinking - offering residents the opportunity to wash their hands before their meal Standard 5 - Management and staffing arrangements Standard 13 - Eating well National Care Standards for care homes for older people. Well Hall Residential Home, page 25 of 41

26 3. The service provider should develop and implement a system to ensure that the certificates in place issued under section 47 of the Adults with Incapacity (Scotland) Act 2000 and the DNACPR records for individual residents are valid and regularly reviewed. Standard 5 - Management and staffing arrangements Standard 6 - Support arrangements Standard 9 - Feeling safe and secure National Care Standards for care homes for older people. 4. The service provider should ensure consistency of good practice in the following areas: - The administration of creams and ointments - these should be given as prescribed and recorded as such, or a reason given to indicate why this was not done. - Amendments or changes to the MAR charts - staff should cross reference any changes to the named authority responsible for the change, or where such information can be found. Standard 5 - Management and staffing arrangements Standard 15 - Keeping well - medication National Care Standards for care homes for older people. Well Hall Residential Home, page 26 of 41

27 Quality Theme 2: Quality of Environment Grade awarded for this theme: 4 - Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the environment within the service. Service strengths We found the service performance was good in the areas covered by this statement. We came to this view after we: - spoke with people who use this service - spoke with the staff team - looked at documentation. We spoke to several people who use the service and they commented that they were happy with the quality of the environment at Well Hall Care Home. We noted that residents had been supported to personalise their bedrooms and that many residents had their own pictures and ornaments decorating their bedrooms. Residents and relatives had commented that there was a need for an improvement of the garden area. The service have responded to this and have started to make plans for improving the garden including employing a gardener. We will monitor progress with the development of the garden at the next inspection. The evidence reported under Quality Theme 1,Statement 1 is applicable here. Areas for improvement The service should continue to gather the views of people using the service to inform development and improvement regarding the quality of the environment and the garden area. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Well Hall Residential Home, page 27 of 41

28 Statement 2 We make sure that the environment is safe and service users are protected. Service strengths We found the service performance was good in the areas covered by this statement. We came to this view after we: - spoke with people who use this service - spoke with the staff team - looked at documentation. There was a range of policies and procedures in place to guide staff regarding health and safety. This included fire safety, control of infection, moving and handling and medication management. There was an accident and incident reporting system in place. The management and staff teams demonstrated an understanding of their role and responsibilities regarding the monitoring and maintenance of the health and safety of the environment of the home. We looked at the records of the monitoring and maintenance of the health and safety of the environment of the home. There was a range of regular safety checks carried out such as water temperatures, fire alarm checks and lift and boiler maintenance. We saw that appropriate records were kept of the outcome of these checks and of any actions taken to address issues identified. The home was clean and tidy; this was positively commented on by residents and relatives during the inspection. We saw that there were schedules in place to guide housekeeping staff about the daily and weekly cleaning that was to be carried out. There were records to evidence that this work was being carried out. Areas for improvement The management team had an overview of the number of accidents and incidents that had happened. At the previous inspection in September 2013 we identified the need for the service to develop a system to audit the accidents and incidents to identify any patterns or trends and implement action plans to address any issues arising to minimise future risk. This issue continues to need to be actioned. This will be the subject of a continued Recommendation. See Recommendation 1. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Well Hall Residential Home, page 28 of 41

29 Recommendations 1. The service provider should regularly audit the accidents and incidents that happen within the service to identify any patterns or trends and implement action plans to address any issues arising to minimise future risk. Standard 5 - Management and staffing arrangements Standard 9 - Feeling safe and secure National Care Standards for care homes for older people. Inspection report continued Well Hall Residential Home, page 29 of 41

30 Quality Theme 3: Quality of Staffing Grade awarded for this theme: 3 - Adequate Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service Strengths We found the service performance was good in the areas covered by this statement. We came to this view after we: - spoke with people who use this service - spoke with the staff team - looked at documentation. People we spoke with commented positively about improvement in the home regarding how the staff communicated with them and the better level of knowledge they demonstrated about residents' needs and their progress. We saw that staff were better at offering choice to residents regarding many aspects of their day including taking part in activities and where they wished to eat meals. The evidence reported under Quality Theme 1, Statement 1 is applicable here. Areas for improvement The management team detailed the involvement residents had had during the recruitment of care staff. However, there were no records of how this involvement had impacted or influenced the recruitment and selection process. The management team acknowledged that could develop records to evidence the involvement of residents in this process. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Well Hall Residential Home, page 30 of 41

31 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths We found the service performance was adequate in the areas covered by this statement. We came to this view after we: - spoke with people who use this service - spoke with the staff team - looked at documentation. People we spoke with during the inspection commented positively about the knowledge and skills of staff. We observed that the staff approach to residents was caring, polite and respectful. The staff were seen to offer choice to people and sought individuals' opinions about their care and support. Staff demonstrated a good knowledge of individual preferences. We observed an improvement in team work within the home and improved communication between departments such as the care, activity and catering teams. We spoke with staff on duty during the inspection visit, they commented positively about the support they received from the management team and the improved access to training. Staff we talked with commented that the training they had attended was relevant and useful to their role. They had recently had training on dementia awareness, infection control and falls management. The management team had introduced protected time for staff to develop the teams, update records and undertake training. This initiative was viewed positively by the staff we talked with. There were records indicating that the mandatory training was being kept up to date for the staff group and that scheduled refresher training was in place. Many of the care staff had achieved the qualifications required in order to register with the Scottish Social Service Council (SSSC).The SSSC is responsible for registering people who work in social services and regulating their education and training. This helps to raise standards of practice, strengthen and support the workforce and increase the protection of people who use services. We saw that there was a schedule of regular staff meetings, this included care team meetings, department meetings and full staff meetings. There were minutes for the meetings which detailed discussions including the expectations regarding staff practice and conduct, upcoming training and a range of practice issues. Well Hall Residential Home, page 31 of 41

32 Areas for improvement Care services need to develop a training plan for the full staff group to identify the long and short term training objectives for developing the teams' knowledge base and improving their practice. The management team were in the process of developing the staff training plan for the coming year. The identified training needs of individual staff were being used to inform the content of the plan. We will monitor the implementation of the training plan at the next inspection. It is important that staff have access to regular supervision sessions to support them, to discuss concerns, look at their practice and discuss their training and development needs. It also gives management the opportunity to evaluate that any training has had a good impact in improving staff practice. The organisation was in the process of reviewing the format for staff supervision and appraisals. There was a need to establish a schedule for appraisals and for the management team to have an overview of the schedule of supervisions conducted and planned. This will be the subject of a Recommendation. See Recommendation 1. We looked at the records of supervision sessions that had recently taken place. The quality of the records was variable; some records were better than others and we saw some that detailed a mutual process between the supervisor and supervisee and the setting of clear goals and objectives. This was an area of development that the management team were aware of and were working to establish a stable team of senior care workers. We will monitor their progress with this at the next inspection. During the previous inspection in September 2013 we identified a need for the service to evaluate the training staff have undertaken and the impact this was having on staff practice. There were no formal systems in place to ensure that this had been carried out. This Recommendation will continue. See Recommendation 2. Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 2 Recommendations 1. The service provider should develop and implement a schedule to ensure that regular staff supervision sessions are being carried out and that all staff received an appraisal as per the organisations policy. Standard 5 - Management and staffing arrangements National Care Standards for care homes for older people. Inspection report continued Well Hall Residential Home, page 32 of 41