Trinity Lodge Nursing Home Care Home Service

Transcription

1 Trinity Lodge Nursing Home Care Home Service Spring Gardens Edinburgh EH8 8HT Telephone: Type of inspection: Unannounced Inspection completed on: 27 September 2016 Service provided by: Trinity Lodge Care Limited Service provider number: SP Care service number: CS

2 About the service This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April Trinity Lodge Nursing Home currently operates out of the former Elsie Inglis Care Home. The service moved there four years ago on a temporary basis whilst a new purpose-built care home was to have been built on the previous site of the home. However circumstances now mean that the service is being managed by administrators until it is decided what the future of the service will be. The residents accommodation is provided over two floors and provides single bedrooms with ensuite toilet facilities. There are a variety of lounge and dining facilities for residents to use. The home is close to open parkland and local amenities in central Edinburgh. The home is registered for up to 39 older people. There were 29 residents at the time of the inspection. The service's registration only allows it to use rooms that have been agreed with the Care Inspectorate. The service's stated aims and objectives are: "To provide all service users a life that is as normal as possible, given their individual health and needs in homely surroundings. To provide all service users with care which will enable them to live as independently as possible with privacy, dignity and with the opportunity to make their own choices. To ensure that assessments of need will be used to develop individual care plans with the objective of meeting the aims of the home for each service user. To provide each service user with a home, equipment and competent staff to enable the aims and objectives of the home to become a reality for the service users." What people told us We received one completed relatives/carers care standard questionnaire prior to the inspection visit. This indicated that the relative was generally happy with the quality of care their relative received. They thought that there were insufficient activities and social events that their relative could join in with. They were concerned about the increased use of agency staff who they felt did not know their relative as well as regular staff. They told us that there had been a lack of information about what was to happen to the home and of changes in the management team. During our inspection we met with most of the residents. We spoke with three relatives. All were generally complimentary about the service including the quality of care provided. Comments received included: "I have no immediate concerns for the care and welfare of my relative, however concerned about lack of activities". "Couldn't ask for more". page 2 of 21

3 "The dining room can be noisy, I don't like that". "Staff alright". "We're well looked after". "Staff - very nice people". "She's well looked after". "Excellent care". "Nurses and carers good". "Lovely room" - referring to her bedroom. "There has been a distinct lack of information since the receivers took over the nursing home." Relatives told us they were unsure of the current management arrangements in the home but felt that they could go to the nurse or "to the office" if they had any concerns. Some of the residents were not able to tell us their views of the service due to the progress of their dementia and/or their frailty. We therefore observed how they spent their time and their interactions with staff so that we could consider the quality of care being provided. Although we saw many positive interaction between residents and staff, particularly with regular staff, we identified that some staff would benefit from further training and support to make everyday interactions more meaningful. Self assessment The services' assessment of the quality of the service, submitted on 14 July 2016, did not correspond with our findings at this inspection. The service had graded themselves "4 - good" or "5 - very good" on all the Quality Statements. There was little evidence of an improvement plan to develop the service in a systematic way. The current manager demonstrated that they had a more realistic view of how the service was performing and where it needed to improve. Therefore we suggested that they review and resubmit the self-assessment document to evidence this and to help focus their improvement plan. From this inspection we graded this service as: Quality of care and support Quality of environment Quality of staffing Quality of management and leadership 2 - Weak 2 - Weak page 3 of 21

4 Quality of care and support Findings from the inspection From the evidence we found we concluded that the service was working to an adequate level in the areas covered by this quality theme. The service should work toward improving this grade. Both residents and relatives/carers told us that they were generally satisfied with the standard of care and support the service provided. However from their feedback and from our observations of staff practices the previously good standards of care were not consistently provided. There was some written information about the service displayed in the reception area. Some of this needed to be updated. The service had a participation strategy although this was not seen to be fully implemented at this time, with residents and relatives/carers meetings not happening as frequently as stated. This meant that people were unsure of the current management arrangements of the service, which had recently changed. The day to day provision of activities needed to improve. There was no dedicated activities coordinator. The new manager told us they had plans to improve this through providing additional input from staff who could facilitate activities. We saw some positive interactions between staff and residents, particularly the home's own staff. Communal areas were monitored and staff regularly checked on residents who preferred to spend time in their bedrooms. Staff were kept informed of changes through reasonably effective shift handovers. The use of monitoring charts should be improved to ensure they were effectively used. Each resident had a personal plan which included the completion of a range of health assessment tools which identified key aspects of risk. These were not always promptly updated to reflect change. The corresponding care plans and evaluations did not provide sufficient detail to direct and support staff or to fully evidence the actions that staff were taking to manage these risks. (See requirements one and two, and recommendation one). The potential risks of tissue damage and nutritional wellbeing appeared carefully monitored. Although again record keeping did not match the support given. Over the course of our visits we saw evidence that improvements had begun to be made. This included the management of medications. Improvements should be made to the use of topical medications, such as creams and ointments. (See recommendation two). A pharmacy audit was planned so that the manager and the service's supplying pharmacy could review current practice. Requirements Number of requirements: 2 1. The provider must make proper provision for the health, welfare and safety of residents. In order to do this, the provider must ensure that care charts are accurately completed. This must include, but not be exclusive of residents who require monitoring and recording of their fluid balance, position changes, food intake and oral page 4 of 21

5 care. This should include the timely recording of this information to ensure all information is accurate and to allow for corrective action to be taken where identified. This is to comply with Social Care and Social Work Improvement Scotland, (Requirements for Care Services) Regulations 2011 (SSI 2011/210) Regulation 4(1) (a) proper provision for the health, welfare and safety of service users. This also takes into account National Care Standards, Care homes for older people, Standard 14 Keeping well - health care. Timescale: The service should send us details of how it is meeting this requirement within three weeks of receiving this report. 2. The approach to skin care and tissue viability requires to be improved. In order to do this the provider must: - Ensure that staff assess and manage skin care in line with best practice. - Ensure a pain assessment tool is fully used to demonstrate that staff assess and manage all symptoms. - Improve care plan documentation to ensure that a clear, complete and accurate record of skin care is kept. This is in order to comply with Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210) Regulation 4(1)(a) A provider must - make proper provision for the health, welfare and safety of users; regulation 5(1) - requirement for personal plans. This also takes into account National Care Standards, Care homes for older people, Standard 14 Keeping well - health care. Timescale: The service should send us details of how it is meeting this requirement within three weeks of receiving this report. Recommendations Number of recommendations: 2 1. In order to sustain improvement in the quality and consistency of care planning and record keeping the service should: - Identify the essential information including risk assessments that must be included in service users' personal plans and specific care plans. - Put in place regular monitoring procedures to identify areas of care planning, risk assessment and record keeping that have not been undertaken correctly and take action to improve procedures and staff practice. This takes account of National Care Standards, Care homes for older people, Standard 5 Management and staffing and Standard 14 Keeping well - healthcare. 2. It is recommended that the service regularly reviews how, when residents are prescribed topical creams/ ointments, accurate records for the application of topicals are maintained. page 5 of 21

6 This takes account of National Care Standards, Care homes for older people, Standard 15 Keeping well - medication. Grade: 3 - adequate Quality of environment Findings from the inspection From the evidence we found we concluded that the service performed to an adequate level in the areas covered by this quality theme. The service should work toward improving this grade. Residents areas were generally clean, tidy and free from unpleasant smells. Feedback from residents and relatives/carers informed us that they were satisfied with the accommodation provided and thought their room was kept clean. Attention should be given to ensure staff only areas and storage areas were also kept clean and tidy. Housekeeping hours were to be increased to ensure domestic cover was provided seven days per week. There was a programme of regular maintenance checks. This helped the service to ensure that the home and any equipment used within the building were checked for safety and maintenance issues. The management team should regularly check these records to ensure they are fully completed and to prioritise any required repairs. (See requirement 1).. A "Pass" food hygiene certificate confirmed that the kitchen had been inspected in May 2016 and met the required legal standards for food hygiene at that time. On the first day of our visit we identified that the kitchen needed a thorough clean and this was promptly carried out. The kitchens cleaning rota was to be reviewed and regularly checked by the management team. (See requirement 2). On checking the clean laundry in the individual boxes in the laundry, we found some of the labels had become extremely faded and were difficult to read. Staff were to be reminded to check if the labelling needed to be replaced. Risk assessments needed to be completed on unretained wardrobes and on the use of the balcony. (See recommendations 1 and 2). Flip top bins needed to be replaced with pedal operated bins. (See recommendation 3). The home is not a purpose built care home for older people and this presents challenges to the service in respect of the design and layout. Refurbishment needs to continue to ensure that this older home maintains a good appearance, and is a pleasant and safe place to be. Replacement bedroom furniture should include a lockable space for personal belongings and the availability of a lock on the bedroom door. In planning improvements to the environment we would direct the management team to the Care Inspectorate's guidance "Building better care homes for adults - Design, planning and construction considerations for new or converted care homes for adults" and the good practice tool "The King's Fund Enhancing the Healing page 6 of 21

7 Care Home Assessment tool" which helps service's to develop a more supportive environment for people with dementia. Requirements Number of requirements: 2 1. The provider should ensure that maintenance checks are regularly reviewed and any necessary repairs prioritised according to identified risk. This should include reviewing the current heated serving trolleys, repairing or replacing hot water thermostatic mixing valves, replacing damaged small tables, clearing guttering, completing mattress checks and replacing damaged glazing. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations Scottish Statutory Instrument 2011/210 4 (1)(a) Welfare of users and 10 (1) Fitness of premises. This also takes account of National Care Standards, Care homes for older people, Standard 4 Your environment. Timescale: An action plan indicating how the service will meet this requirement should be submitted to us within three weeks of receiving this report. 2. The provider should ensure that there are regular audits of the service to ensure cleaning rotas are followed and/or amended where needed so that all areas of the home are kept clean and tidy. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations Scottish Statutory Instrument 2011/210 4 (1)(a) Welfare of users and 10 (1) Fitness of premises. This also takes account of National Care Standards, Care homes for older people, Standard 4 Your environment. Timescale: An action plan indicating how the service will meet this requirement should be submitted to us within three weeks of receiving this report. page 7 of 21

8 Recommendations Number of recommendations: 3 1. It is recommended that risk assessments are undertaken in respect of the wardrobe provision and any necessary action as a result of the risk assessments is carried out. This takes account of National Care Standards, Care homes for older people. Standard 4 Your environment. 2. A risk assessment should be completed on the use of the balcony and staff made aware of any necessary action as a result of this risk assessment. This takes account of National Care Standards, Care homes for older people. Standard 4 Your environment. 3. It is recommended that flip top bins should be replaced with pedal bins to maximise infection control. This takes account of National Care Standards, Care homes for older people, Standard 4 Your environment. Grade: 3 - adequate Quality of staffing Findings from the inspection We acknowledge that the service had some strengths under this quality theme however poor recruitment practices, lack of evidence of staff training or follow up of poor practice and lack of formal supervision gave cause for concern and therefore we have graded this quality theme as 2 - weak. The sample of staff recruitment files we reviewed did not indicate that expected robust recruitment procedures were being completed prior to staff starting work in the service. There was lack of documented evidence that a comprehensive induction had been completed when staff first started. (See recommendation 4). An audit of all staff files should commence to ensure that all recruitment files contain evidence that the provider's recruitment procedures have been completed. (See requirement 1). levels and skill mix currently matched the service's agreed staffing notice. However the previous months duty rotas indicated frequent breaches of the staffing notice with gaps in the skill mix and numbers of staff provided. This would have effected the provision of care provided. We were assured that current staffing levels would be maintained. Current staffing levels relied on frequent use of agency staff. It was however noted from the duty rotas that regular agency staff were used, thereby helping to provide some continuity of care. From our observations of staff practice we saw numerous inconsistencies. Some staff were very attentive and skilled in engaging residents in meaningful activities whilst other staff did not demonstrate these skills. We did not see that formal supervision took place to support and develop staff or that previous concerns about staff practice had been followed up. (See recommendation 1). page 8 of 21

9 There was no clear overview of each staff member's training needs. A detailed training programme should be developed and implemented within the service to ensure that all staff have the necessary skills and experience to meet the care and support needs of the residents and the skills required of their job description. (See requirement 2 and recommendations 2 and 3). The manager would need additional clinical support to implement this. Requirements Number of requirements: 2 1. The provider must ensure that staff have been recruited safely and in line with Scottish Social Services Council (SSSC) Codes of practice. In order to achieve this the provider must ensure that recruitment files evidence that the provider's safe recruitment procedures, which include obtaining a reference from candidates' present or last employer, have been completed and record any additional evidence gathered to support the application. This is in order to comply with Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011(SSI 2011/210) Regulation 9 (1) which is a requirement about fitness of employees. This also takes account of National Care Standards, Care homes for older people, Standard 5 Management and staffing arrangements and Scottish Social Services Council (SSSC) Code of Practice for employers of social service workers. Timescale: An action plan indicating how the service will meet this requirement should be submitted to us within three weeks of receiving this report. 2. The provider must ensure that a training programme is developed and implemented to ensure that all staff have the necessary skills to meet the care and support needs of the residents and the skills required of their job description. This is in order to comply with Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210) Regulation This also takes account of National Care Standards, Care homes for older people, Standard 5 Management and Timescale: An action plan indicating how the service will meet this requirement should be submitted to us within three weeks of receiving this report. Recommendations Number of recommendations: 4 1. The provider should ensure that a programme of formal staff supervision is in place and undertaken by all grades of staff. This takes into account the National Care Standards, Care homes for older people, Standard 5 Management and page 9 of 21

10 2. The provider should ensure that all care staff and nurses receive training in continence care. This takes into account the National Care Standards, Care homes for older people, Standard 5 Management and 3. When amended, the provider should ensure that all staff are made aware of the updated Adult Support and Protection Policy, and made aware of their role and responsibility in putting it into practice. This takes into account the National Care Standards, Care homes for older people, Standard 5 Management and 4. It is recommended that the service keep a copy of initial inductions in staff members' files to evidence that an appropriate induction has been completed. This takes account of National Care Standards, Care homes for older people, Standard 5 Management and Grade: 2 - weak Quality of management and leadership Findings from the inspection The new manager had only been in post since 19 August They had noted some of the issues we have reported on and had started to take action on their findings. Whilst we received some positive feedback about some of the changes they had started to make, we were concerned that the standards of service had dropped since the last inspection. None of the previous requirements and recommendations made at the last inspection or following the completion of complaint investigations had been met. This gave cause for concern and therefore we have graded this quality theme as 2 - weak. The service's complaints procedure and "comments, concerns, complaints" information sheet in the reception areas needed to be updated to reflect the correct contact details and management details for the service. The service should ensure that its policies and procedures are regularly updated to support staff and reflect current good practice. We were informed that meetings were planned for the service's administrators to meet with staff, residents and relatives. From the feedback we received people will find this helpful and will give them an opportunity to express their concerns. Staff who take charge of the home should be familiar with the Care Inspectorate's document 'Guidance on notification reporting' and aware of the correct reporting procedures under Adult Support and Protection legislation as well as local reporting arrangements. These procedures must be followed. (See requirements 1 and 2). page 10 of 21

11 There should be a robust system in place for recording financial transactions and this should regularly be audited. (See requirement 3). When a resident did not have capacity to manage their own finances, we saw in the personal plans that it was sometimes documented who had legal authority to manage the resident's finances. The service had some copies of the certificates indicating that they had checked the person's authority to manage a resident's finances. The service was to complete a checklist to ensure that this check had been completed for all residents who did not have capacity to manage their own finances. Actioning the requirements, recommendations and areas for improvement detailed in this report will ensure improved outcomes for people using this service. In order to achieve this the manager will need additional clinical leadership support along with office support. The service's administrators agreed that these would be provided. Requirements Number of requirements: 3 1. The provider must ensure that where an allegation of abuse of a service user is made, this is reported without delay to the Local Authority in line with Adult Support and Protection legislation and local reporting arrangements. This is in order to comply with The Public Services Reform (Scotland) Act 2010 and The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011(SSI 2011/210). This also takes into account National Care Standards, Care homes for older people, Standard 5 Management and Timescale: within 24 hours of receipt of this report. 2. The provider must ensure that the Care Inspectorate are informed of all notifiable events in line with the Care Inspectorate's Guidance document 'Records that all registered care services (except child minding) must keep and guidance on notification reporting 2012'. This is in order to comply with The Public Services Reform (Scotland) Act 2010 and The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011(SSI 2011/210). This also takes into account National Care Standards, Care homes for older people, Standard 5 Management and Timescale: within 24 hours of receipt of this report. 3. The provider should ensure that there is a robust system in place for recording financial transactions and this is regularly audited to ensure compliance This is in order to comply with Social Care and Social Work Improvement Scotland, (Requirements for Care Services) Regulations 2011 (SSI 2011/210) Regulation 4(1) (a) proper provision for the health, welfare and safety of service users. page 11 of 21

12 This also takes into account National Care Standards, Care homes for older people, Standard 5 Management and Timescale: The service should send us details of how it is meeting this requirement within three weeks of receiving this report. Recommendations Number of recommendations: 1 1. The provider should ensure that their Adult Support and Protection Policy and Procedure are amended so that they are in line with Local Authority Adult Protection Guidelines and best practice. This takes into account the National Care Standards, Care homes for older people, Standard 5 Management and Grade: 2 - weak What the service has done to meet any requirements we made at or since the last inspection Previous requirements Requirement 1 The provider must ensure that suitable staff references are obtained for each employee. This is 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)(a) a Regulation regarding the welfare of service users and regulation 15(a) a regulation regarding staffing. In making this requirement account has been taken of the National Care Standards Care Homes for Older People Standard 5 Management and staffing. Timescale for achieving this requirement: By 31 January This requirement was made on 4 March page 12 of 21

13 Action taken on previous requirement We reviewed the recruitment records of five staff. We only found evidence that suitable references had been obtained for one member of staff. This requirement was not met. As a second requirement to improve recruitment practices was made following a complaint investigation, see requirement 2, and also found not to be met, we have made a new requirement that the provider must review all recruitment records to ensure that they evidence that the provider's safe recruitment procedures have been completed (see Quality Theme 3 requirement 1). Not met Requirement 2 The provider must ensure that robust recruitment checks are carried out on prospective staff prior to working in the care service including: taking up two references, one from the present or previous employer, obtaining a Protection of Vulnerable Groups (PVG) check, and checking relevant professional registers. This is to comply with The Public Service Reform (Scotland) Act 2010 (Requirements for Care Services) Order SSI 2011/210 Regulation 4 (1)(a) - welfare of service users and 15(a). Timescale: Within 24 hours of receipt of this report. This requirement was made on 3 June Action taken on previous requirement This requirement was made following the findings of a complaint investigation. The five recruitment records we reviewed failed to confirm that robust recruitment checks had been completed. The provider must review all recruitment records to ensure that they evidence that the provider's safe recruitment procedures have been completed (see Quality Theme 3 requirement 1). Not met Requirement 3 The provider must ensure that where an allegation of abuse of a service user is made, this is reported without delay to the Local Authority in line with Adult Support and Protection legislation and local reporting arrangements. This is to comply with The Public Service Reform (Scotland) Act 2010 (Requirements for Care Services) Order SSI 2011/210 Timescale: within 24 hours of receipt of this report. This requirement was made on 3 June Action taken on previous requirement This requirement was made following the findings of a complaint investigation. Information recorded within residents' personal plans indicated events had taken place that should have, at that time, been promptly reported to the Local Authority in line with Adult Support and Protection legislation and local reporting arrangements. page 13 of 21

14 The new manager had since, having found this information, reported this to the appropriate authorities. This requirement remains so that we can follow up at the next inspection visit. Not met Requirement 4 The provider must ensure that the Care Inspectorate are informed of all notifiable events in line with the Care Inspectorate's Guidance document 'Records that all registered care services (except child minding) must keep and guidance on notification reporting 2012'. This is in order to comply with The Public Services Reform (Scotland) Act Timescale: within 24 hours of receipt of this report. This requirement was made on 3 June Action taken on previous requirement This requirement was made following the findings of a complaint investigation. Information recorded within residents' personal plans indicated events had taken place that should have at that time, been promptly reported to the Care Inspectorate. The new manager had since, having found this information, reported this to the appropriate authorities. We were not informed of the previous manager's absences. Some of the staff who took charge of the home were not familiar with our notification guidance. This requirement remains so that we can follow up at the next inspection visit. Not met Requirement 5 The approach to skin care and tissue viability requires to be improved. In order to do this the provider must: - Ensure that staff assess and manage skin care in line with best practice; - Ensure a pain assessment tool is fully used to demonstrate that staff assess and manage all symptoms; - Improve care plan documentation to ensure that a clear complete and accurate record of skin care is kept. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations, Scottish Statutory Instruments 2011 No 210: Welfare of users 4(1)(a) A provider must - make proper provision for the health, welfare and safety of users; regulation 5(1) - requirement for personal plans. Timescale: Immediately and eight weeks upon receipt of this report. This requirement was made on 27 June Action taken on previous requirement This requirement was made following the findings of a complaint investigation. page 14 of 21

15 Examination of personal plans and care records at this inspection identified that residents' tissue viability was assessed regularly but the assessments were not always updated following change, for example, on returning from hospital. Where residents were identified as at risk from tissue damage we would expect a care plan to be written to direct and support staff and to evidence the actions that staff were taking to manage these risks. We did not see that the corresponding care plans contained this level of information.they did not detail the use of other care records that were or should be completed, for example, pain assessment tools, position change charts and fluid charts. The new manager was planning to introduce new care planning documentation which would be easier for staff to follow and would prompt staff to record key aspects of care. We directed the manager to the Care Inspectorate's resource centre The Hub, in order to access good practice guidance that can support staff with their record keeping. This requirement remains so that we can follow up on fully compliance at the next inspection visit. Not met What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 In order to sustain improvement in the quality and consistency of care planning and record keeping the service should: - Identify the essential information including risk assessments that must be included in service users' personal plans and specific care plans. - Put in place regular monitoring procedures to identify areas of care planning, risk assessment and record keeping that have not been undertaken correctly and take action to improve procedures and staff practice. National Care Standards, Care homes for older people, Standard 5 Management and Arrangements and Standard 14 Keeping Well - healthcare. This recommendation was made on 4 March Action taken on previous recommendation Examination of personal plans and care records at this inspection identified that key risk assessments were in place but not always updated following change, for example, on returning from hospital. The corresponding care plans to address these risks did not contain sufficient detail to direct and support staff or to evidence the actions page 15 of 21

16 that staff were taking to manage these risks. They did not detail the use of other care records that were or should be completed, for example, position change charts and fluid charts. We were informed that new care planning documentation was to be introduced which would be easier for staff to follow and would prompt staff to record key aspects of care. This recommendation will remain so that we can follow up at our next inspection. Recommendation 2 It is recommended that risk assessments are undertaken in respect of the wardrobe provision and any necessary action as a result of the risk assessments is carried out. National Care Standards, Care homes for older people, Standard 4 Your Standard. This recommendation was made on 4 March Action taken on previous recommendation There was no evidence found that indicated that risk assessments had been completed. Securing wardrobes to the wall would prevent them tipping over, which is more likely when items are placed on the top of wardrobes but would be dependent on other factors such as the design of the furniture. This recommendation therefore remains so that appropriate action can be taken to reduce any risk where identified. Recommendation 3 The provider should ensure that a programme of formal staff supervision is in place and undertaken by all grades of staff. This takes into account the National Care Standards, Care homes for older people, Standard 5 Management and This recommendation was made on 4 March Action taken on previous recommendation We did not see evidence of recent formal supervision and/or a programme to indicate a system of formal staff supervision was in place. Supervision is important in giving staff support and developing their professional practice. This recommendation remains. Recommendation 4 The provider should ensure that all care staff and nurses receive training in continence care. This takes into account the National Care Standards, Care homes for older people, Standard 5 Management and This recommendation was made on 3 June Action taken on previous recommendation This recommendation was made following the findings of a complaint investigation. page 16 of 21

17 Some of the care staff we spoke with told us that they had received update training on continence care. The training records were incomplete so we were unable to confirm that all care staff and nurses had received training in continence care. This recommendation will remain so that we can follow up at the next inspection. Recommendation 5 The provider should ensure that their Adult Support and Protection Policy and Procedure are amended so that they are in line with Local Authority Adult Protection Guidelines and best practice. This takes into account the National Care Standards, Care homes for older people, Standard 5 Management and This recommendation was made on 3 June Action taken on previous recommendation This recommendation was made following the findings of a complaint investigation. The service's Adult Support and Protection Policy and Procedure had not been updated and did not provide staff with details of Local Authority Adult Protection Guidelines and best practice. This recommendation remains. Recommendation 6 When amended, the provider should ensure that all staff are made aware of the updated Adult Support and Protection Policy, and made aware of their role and responsibility in putting it into practice. This takes into account the National Care Standards, Care homes for older people, Standard 5 Management and This recommendation was made on 3 June Action taken on previous recommendation This recommendation was made following the findings of a complaint investigation. The service's Adult Support and Protection Policy and Procedure had not been updated. Training records were incomplete so we were unable to confirm that all staff had received recent training on Adult Support and Protection procedures. We found a number examples where staff had failed to promptly report incidents and events to the Local Authority in line with Adult Support and Protection legislation and local reporting arrangements. This recommendation remains. Recommendation 7 In order to sustain improvement in the quality and consistency of care planning and record keeping the service should: - Identify the essential information including risk assessments that must be included in service users' personal plans and specific care plans. page 17 of 21

18 -Put in place regular monitoring procedures to identify areas of care planning, risk assessment and record keeping that have not been undertaken correctly and take action to improve procedures and staff practice. This takes into account the National Care Standards, Care homes for older people, Standard 5 Management and staffing arrangements and Standard 14 Keeping well - healthcare. This recommendation was made on 27 June Action taken on previous recommendation This recommendation was made following the findings of a complaint investigation, where improvements were seen needed in the quality and consistency of care planning and record keeping. As detailed under actions taken on previous recommendation 1 this recommendation was not fully met and will remain. Complaints Please see Care Inspectorate website ( for details of complaints about the service which have been upheld. Enforcement No enforcement action has been taken against this care service since the last inspection. Inspection and grading history Date Type Gradings 16 Dec 2015 Unannounced Care and support Management and leadership 3 Mar 2015 Unannounced Care and support Management and leadership 29 Aug 2014 Unannounced Care and support page 18 of 21

19 Date Type Gradings Management and leadership 8 Jan 2014 Unannounced Care and support Management and leadership 16 Sep 2013 Unannounced Care and support Management and leadership 16 Jan 2013 Unannounced Care and support Management and leadership 28 Aug 2012 Unannounced Care and support 2 - Weak 2 - Weak Not assessed Management and leadership Not assessed 23 Jan 2012 Unannounced Care and support Not assessed Management and leadership Not assessed 21 Jul 2011 Unannounced Care and support Not assessed Management and leadership Not assessed 7 Jan 2011 Unannounced Care and support Not assessed Not assessed Management and leadership Not assessed 12 Oct 2010 Unannounced Care and support 2 - Weak page 19 of 21

20 Date Type Gradings Management and leadership Not assessed 14 May 2010 Announced Care and support 2 - Weak Management and leadership 30 Dec 2009 Unannounced Care and support Management and leadership Not assessed 29 May 2009 Announced Care and support Management and leadership 9 Jan 2009 Care and support 2 - Weak 2 - Weak Management and leadership 18 Sep 2008 Unannounced Care and support 2 - Weak Management and leadership page 20 of 21

21 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 21 of 21