Care service inspection report

Transcription

1 Care service inspection report Follow-up inspection Ashgrove Care Home Care Home Service 229 Alexandra Parade Kirn Dunoon Inspection completed on 15 February 2016

2 Service provided by: McKenzie Care Ltd Service provider number: SP Care service number: CS Inspection Visit Type: Unannounced Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and set out improvements that must be made. We also investigate complaints about care services and 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. Contact Us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com page 2 of 15

3 1 About the service we inspected Ashgrove is a purpose-built 3 storey 65 bedded ensuite care home which registered with a new provider on 3 April The home is located in Kirn, Dunoon. The home is registered to provide care including nursing care to older people and people with dementia. Their aims and objectives state: "Ashgrove Care Home aims to provide a caring environment, which has a safe yet warm and homely atmosphere in which the residents can continue to lead as normal a life as possible; and will try to enhance their quality of life." 2 How we inspected this service We wrote this report following an unannounced visit on 15 February This was carried out by two inspectors between 9.15am and 4.30pm. We gave feedback to the management team on 15 February. The focus of this visit was to review progress on areas for improvement identified at the previous inspection. During this visit we looked at: - Participation - Care plans - Activities programme - Training records - Development plan. We walked around the units and looked at the environment. We spoke with six individual residents and also a group of residents. We spoke with two visiting relatives and gathered their views. We spoke with the manager, deputy manager, two nurses, the chef and the administrator. page 3 of 15

4 3 Taking the views of people using the service into account We spoke with six individual residents and also a group of residents. They told us they were happy living there and "everything is fine". 4 Taking carers' views into account We spoke with two visiting relatives who were both happy with the care their relative received. 5 What the service has done to meet any requirements we made at our last inspection Previous requirements 1. There was a new requirement made on the day of this visit. This will be fully reported at the next inspection of the service. The provider must ensure all staff receive up to date training including induction and refreshers. This is to comply with: The Social Care and Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 Staffing 15 - A provider must, having regard to the size and nature of the care service, the statement of aims and objectives and the number of needs of service users:- (b) ensure that persons employed in the provision of the care service receive- (i) training appropriate to the work they are to perform Timescale: all training to be completed by 31 August This requirement was made on 15 February 2016 page 4 of 15

5 We were told mandatory training included moving and assisting, fire training, health and safety, food hygiene, dementia, infection control and adult support and protection. However when we looked at training records we found that some of it was out of date or staff had not received it. An example was moving and assisting training. We found some staff had not had a refresher since March 2012, July 2012, July 2013 and November We were told the refresher should be every 18 months. Another example was infection control. We found some staff had not had any infection control training since starting work in the home. This has the potential to cause harm to residents and staff as infection control is an important area of practice that helps protect residents and staff from harm. We have made a requirement that all staff receive mandatory training and refresher courses within a six month timescale of receipt of this report. Not Met 6 What the service has done to meet any recommendations we made at our last inspection Previous recommendations 1. There was a new recommendation made on the day of this visit. This will be fully reported at the next inspection of the service. Residents and relatives should have opportunities to assess the quality of care and support offered in the home. (See Recommendation under Quality Theme 1, Statement 1.) National Care Standards, Care Homes for Older people, Standard 11, Expressing your views. This recommendation was made on 15 February 2016 page 5 of 15

6 When we looked at participation we found very little had improved since the last inspection. - We found care plans were not signed by the resident or their representative. The care plan should be signed to show that the contents had been discussed and agreed. - There had been no residents/relatives meetings held for a long time. This meant residents/relatives had not had opportunities to assess the quality of the service they received. - When we looked at care plans we found a social assessment and list of activities. This asks the resident to choose which activities they would be interested in. However there was no evidence this information had been used to develop an activity programme. - There was no evidence of residents choosing activities and while we were in the home there were few activities taking place. We observed residents sleeping in chairs in the lounges. As we found few opportunities for residents to participate in assessing the quality of care and support in the home we have made a recommendation this should be improved. 2. There was a new recommendation made on the day of this visit. This will be fully reported at the next inspection of the service. Information in care plans and support provided should be improved. (See Recommendation 1 under Quality Theme 1, Statement 3.) National Care Standards, Care Homes for Older people, Standard 6, Supporting arrangements. This recommendation was made on 15 February 2016 page 6 of 15

7 There were areas of care plans and support that should be improved. We found: - Photographs of residents with no dates, therefore no information about how old the photograph was. - Individual fire evacuation plans had not been reviewed since May One page profiles were not dated or signed. - Some care plans had good person centred information but there was no evidence staff used this information to offer support in a way the resident preferred. Examples: We looked at a care plan that had noted the resident did not like orange juice but this was on her tray. Another care plan had noted the resident liked to have a cardigan on and a blanket round her when sitting in her chair but we did not see this, the care plan also identified the resident needed a hearing aid but she did not have one in. - Summary of care was not dated or signed. - The activities lists that showed residents preferred activities were not dated or signed. - We did not find consent to bedrails in care plans. There should be a consent form signed by the resident or their representative that they agreed to the use of bedrails. We also found risk assessments for bed rails were only signed by the nurse with no involvement from the resident or their representative. - We found no evidence of resident involvement in any care plans we looked at. 3. There was a new recommendation made on the day of this visit. This will be fully reported at the next inspection of the service. Improvements should be made to ensure health care needs are being met. (See Recommendation 2 under Quality Theme 1, Statement 3.) National Care Standards, Care Homes for Older people, Standard 14, Keeping well-healthcare. This recommendation was made on 15 February 2016 page 7 of 15

8 There are areas of healthcare that should be improved such as: - We found an "as and when required" (PRN) medication for stress and distress had not been reviewed since May We would expect a review of all medication at least once a year. This would ensure the resident still required the medication and the medication continued to meet their changing needs. - We spoke with a resident in her bedroom and noticed she did not have an emergency buzzer. This would allow her to summon help if needed. We asked a staff member about this and were told she was unable to use a buzzer. However we did not find any reference to this in her care plan. - There was no end of life care plan in the care plan we looked at. - There was no evidence of one of the residents having any dental care despite having their own teeth and having lived in the home for a number of years. We were told this resident had seen a dentist but there was no evidence of this. - We spoke with a lady whose nails needed cleaned. - We looked at paperwork relating to an incident that had been notified to the Care Inspectorate. We found that although two staff members had been involved there was a report from only one of them. We would expect a report from all staff involved in an incident. This would give a full picture of what had happened. On reading the report we found it stated that the resident had old bruising but when we looked at their care plan there were no reports of bruising recorded. We found staff were not recording if they followed up GP phone calls. An example was, in the notes it was written that staff had called the GP but the GP did not call back. The notes advised staff to observe the resident overnight. There were no further entries or updates. This meant no further evidence the home had contacted the GP again or the GP had called back. 4. There was a new recommendation made on the day of this visit. This will be fully reported at the next inspection of the service. Information recorded in food/fluid charts should be improved. page 8 of 15

9 (See Recommendation 3 under Quality Theme 1, Statement 3.) National Care Standards, Care Homes for Older people, Standard 14, Keeping well-healthcare. This recommendation was made on 15 February 2016 When we looked at food/fluid charts we found the information was poor such as: - There was no target amount of fluid intake identified. - Fluid charts showed that residents were offered fluids at 7pm then no further recordings until 9am. - Food charts did not give enough detail about what foods and the amount of food being eaten examples, food intake was recorded as ¾ main meal but no note of what the meal was or how much was offered and then eaten, ¼ pudding with no note of what it was and how much was offered. - The chart showed few recordings of snacks being offered. There are now two nutritional champions but they have not had any training. 5. There was a new recommendation made on the day of this visit. This will be fully reported at the next inspection of the service. The service development plan should be regularly reviewed and updated. (See Recommendation 1 under Quality Theme 4, Statement 4.) National Care Standards, Care Homes for Older people, Standard 5, Management and staffing arrangements. This recommendation was made on 15 February 2016 We looked at the development plan-september 2015 to March We could see that the service identified areas they wanted to improve. However there was no progress noted in any of the areas identified. page 9 of 15

10 An example was recruitment and staffing. This had been identified as an area for improvement with a timescale of three months. There was no progress noted at the inspection visit in February. We found the plan was not signed or dated. We have made a recommendation the manager reviews the development plan on a regular basis and updates it to show progress. This will ensure the home continues to improve the quality of care and support. 6. There was a new recommendation made on the day of this visit. This will be fully reported at the next inspection of the service. Medication audits should show issues are dealt with. (See Recommendation 2 under Quality Theme 4, Statement 4.) National Care Standards, Care Homes for Older people, Standard 5, Management and staffing arrangements. This recommendation was made on 15 February 2016 We found that medication audits had been recorded on the wrong paperwork for a year. We would have expected the manager to have picked this up when reviewing the audits. We found when issues were raised or discrepancies were found nothing was being done. We were disappointed to find that Tipex was being used. We have made a recommendation that the manager oversees the audits to ensure issues are dealt with. 7. There was a new recommendation made on the day of this visit. This will be fully reported at the next inspection of the service. The service should ensure all doors that require to be locked are locked. (See Recommendation 1 under Quality Theme 2, Statement 2.) page 10 of 15

11 National Care Standards, Care Homes for Older people, Standard 9, Feeling safe and secure. This recommendation was made on 15 February 2016 We walked around the home and found doors opened that should be locked. This included the cleaner's cupboard, a wheelchair store and a sluice. This has the potential to cause harm to residents as there are cleaning products stored in these rooms. 7 Complaints No complaints have been upheld, or partially upheld, since the last inspection. 8 Enforcements We have taken no enforcement action against this care service since the last inspection. 9 Additional Information There were various improvements highlighted in the inspection report dated 3 July The update on them are recorded below. Please also see under requirements and recommendations. Participation: The previous inspection identified that residents and relatives did not know who their key worker was. We found a letter had been sent to relatives informing them who their family member's key worker was. The letter stated that although they had a named key worker they could contact all staff who were more than happy to help them. page 11 of 15

12 We also found key workers photographs in each resident's bedroom as a reminder. This meant residents and relatives had a named person they could contact if they wanted to discuss anything. We found that the recording of "meaningful moments" in some care plans was not appropriate. An example was a resident who spent time alone in her bedroom watching television. This was recorded each day as a "meaningful moment". We would not regard this as a "meaningful moment". This could have been a "meaningful moment" if a staff member had spent some time with the resident in her bedroom chatting or sharing a cup of tea. Staff should not feel that they need to write something in for every day as this has led to repetition and is not meaningful. There may be a training need for staff on what counts as "meaningful moments". Health and Well-being: We looked at care plans and found some good information about how the resident preferred their care carried out. We could see that resident weights were being recorded and if any concerns the dietician had been informed. We could also see input from other professionals such as the chiropodist and vision care. We found treatment plans for stress and distress gave staff guidance on triggers to look out for and the actions they could take to try to de-fuse the situation. We found that covert medication was dealt with well with a Mental Welfare Commission tool in place. We observed lunch and found staff interaction was very good, liquidised meals were well presented and staff took their time with residents. Although lunch was a good dining experience and we could hear residents offered choices this could be improved by use of visual choices. Staffing: A new training planner was about to be put in place. This included moving and page 12 of 15

13 assisting, dementia/challenging behaviour, fire training/evacuation, oral hygiene, food hygiene, health and safety, infection control, palliative care, adult support and protection. We found staff meetings were not regularly taking place. This meant staff were not being given the opportunity to come together to discuss topics such as practice issues or training. The home should develop a system to monitor staff registration with the SSSC and dates when staff need to renew. This would give staff the opportunity to re-register before their registration runs out and they are unable to work in their role. Management and Leadership: We looked at the accident/incident report for We found a system in place to audit accidents with five noted in January. There was an audit trail and system in place to monitor patterns. This contributed to keeping resident safe. There is no evidence that residents or relatives were asked about the quality of management and leadership and how it could be improved. 10 Inspection and grading history Date Type Gradings 3 Jul 2015 Unannounced Care and support 3 - Adequate Environment 4 - Good Staffing 4 - Good Management and Leadership 3 - Adequate 22 Jan 2015 Unannounced Care and support 3 - Adequate Environment 4 - Good Staffing 3 - Adequate Management and Leadership 3 - Adequate page 13 of 15

14 28 Aug 2014 Unannounced Care and support 3 - Adequate Environment 3 - Adequate Staffing 3 - Adequate Management and Leadership 3 - Adequate page 14 of 15

15 To find out more This inspection report is published by the Care Inspectorate. You can download this report and others from our website. You can also read more about our work online. Contact Us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY 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 c?nain eile ma nithear iarrtas. page 15 of 15