Drumry House Care Home Service

Drumry House Care Home Service 40 Kinfauns Drive Drumchapel G15 7TS Inspected by: (Care Commission Officer) Type of inspection: Tony Valbonesi Announced Inspection completed on: 20 June 2006 1/12

Service Number Service name CS2003001030 Drumry House Service address 40 Kinfauns Drive Drumchapel G15 7TS Provider Number dummy Provider Name SP2003003390 Glasgow City Council Inspected By dummy Inspection Type Tony Valbonesi Care Commission Officer Announced dummy Inspection Completed Period since last inspection 20 June 2006 5 months dummy Local Office Address 4th Floor 1 Smithhills Street Paisley PA1 1EB dummy 2/12

Introduction Drumry House is a care home which caters for older people. The service also houses a unit for people who have diagnosed dementia. The service is provided by Glasgow City Council and was registered by the Care Commission on 1st April 2002. The service provides care to a maximum of 41 frail older people and 11 older people with dementia, three of which are for respite places. The service aims, "to provide quality, personalised care in a warm homely, environment which promotes privacy, dignity, independence and choice". The accommodation is on two levels with a passenger lift or stairs to access the upper floor and is purpose built as a care home. Service users have access to a large dining room, two small lounges, a smoking room and a patio area. Smaller seating areas are located throughout the building. The dementia unit has a lounge with a small dining area situated just off the main lounge. Basis of Report This service was inspected after receiving a Regulation Support Assessment (RSA) to determine what level of support was necessary. The RSA is an assessment undertaken by Care Commission Officers which considers: complaints activity, changes in the provision of the service, nature of notifications made to the Care Commission by the service, action taken upon requirements,etc... This service was required to have a medium level of support that resulted in an inspection based on the national inspection themes, the core standards for the inspecting year and any recommendations and requirements from previous inspections, complaint or other regulatory activity. The Annual Return and Self-Evaluation form which provides information about the service were not completed or returned prior to the visit. The visit, which took place on 20 June 2006, was conducted by two Care Commission Officers. The Officers spoke with - The manager - The depute - Nine service users, - Three staff members. - District Nurse who was visiting on the day of the inspection. The Care Commission Officers also looked at a range of policies, procedures and records including the following: - Four Personal Plans - Kitchen Nutrition guidance - Policy and Procedure Manual - Welcome Pack of Information - Training records for care staff and kitchen staff - Menu planning - Significant Occurrence reports 3/12

- Draft Agency Induction Policy - Medication records - Fire Risk Assessment and Fire records Officers also had a walkround of the building with the manager and observed how staff interacted with service users. The Care Commission Officer took all of the above into account and reported on whether the service was meeting the following National Care Standards for Care Homes for Older People. Standard 4.10: Your Environment Standard 5: Management and Staffing arrangements Standard 13: Eating Well Standard 19: Support with Death and Dying Standard 20: Moving On Action taken on requirements in last Inspection Report There were three Requirements in the last inspection report. Progress with these is commented on under Standard 5: Management and Staffing Arrangements Comments on Self-Evaluation A Self Evaluation form was not received from the service prior or during the inspection. View of Service Users Service users continued to give a good impression of the service they received. Comments included: "Awfully well fed" "like the home" "Don't like the food. Could be better" "Staff are good company" "Home is always kept clean" "I go out often" "I am an early riser. My friend gets up later" "Not always enough staff - can be short staffed" "No concerns or complaints" View of Carers No carers were spoken with on this occasion. 4/12

Regulations / Principles Regulation : Strengths Areas for Development National Care Standards National Care Standard Number 4: Care Homes for Older People - Your Environment Strengths Service users spoke warmly about the environment within the home. They felt it was usually kept clean and tidy. They enjoyed their bedroom space which they could use as they chose. Residents were seen to be relaxed and comfortable in their environment. This inspection looked specifically at the capacity of the care home to provide single bedrooms for residents. In addition, a few other areas for development were highlighted during the inspection and are noted in this report. In terms of bedrooms, the care home provided single bedroom accommodation for all of its residents. Some of these rooms had ensuite shower and toilet facilities. Where residents were a couple or they wished to share, the manager confirmed this could also be accommodated within the home. Areas for Development Officers noted that staff from the adjoining day centre used the specialised Dementia Unit as a thoroughfare. The Manager confirmed that plans were in hand to provide alternative access to the day centre without the need to cut through the Dementia Unit. There was scope to provide more in the way of orientation aids within the specialised Dementia Unit. There were concerns raised about the adequacy of security arrangements at the main front door of the care home, particularly in relation to residents who may wander. In the interests of residents' safety this should be given urgent attention but without infringing the rights of able-bodied residents to come and go freely. (Recommendation 1) Residents' use of the garden area was also restricted by inadequate security measures and needed attention. Ripped decorative wall borders in corridors detracted from the overall pleasant and attractive 5/12

appearance of the home and would benefit from attention. National Care Standard Number 5: Care Homes for Older People - Management and Staffing Arrangements Strengths Service users were complimentary about the service they received and the conduct of staff. They knew who their keyworker was and good interactions were observed between staff and service users. Appropriate policies and procedures were provided by the managing organisation including: Training and Development Administration of Medication Health and Safety Whistleblowing Accidents and Incident reporting Complaints. Over half the staff team had undertaken SVQ 3 training and the manager had started SVQ 4 and the Registered Managers Award. At the time of inspection, staffing levels within the home had been alleviated to some extent as there were some service user vacancies. The service had a copy of the Royal Pharmaceutical Society guidelines on medication administration and the accompanying policy and procedure of the home was being revised in the light of these guidelines. The home has a policy on restraint and sampled records indicated that the previous requirement to record any instances of restraint had been met. Financial systems were not inspected on this occasion. Areas for Development The previous report made a Requirement for the home to review service users dependency levels as a basis for reviewing staffing levels in line with assessed needs. This was partially met. An Activities for Daily Living Assessment tool had been introduced to assess dependency levels, but this was limited as it did not encompass such areas as mental health needs, social needs or medication. A more holistic approach should be considered. The manager advised that a review of the Dementia Unit had recommended that one of the three respite beds be taken out of commission which would improve staffing levels in this area. However, there was no clear timescale for this to happen. The service needed to consider how it could clearly demonstrate to the Care Commission that staffing levels were based on the level of need and any other relevant factors such as the layout of the building. (See Recommendation 2) 6/12

The previous report made a Requirement for the Home to use the notification process for all notifiable incidents within the service to comply with SSI 114/2002, Regulation 21(2). All senior staff had been appraised of this requirement and the Care Commission had subsequently received relevant notifications. However, during the inspection, Officers noted that a serious incident involving the misconduct of a staff member had not been notified to Care Commission. It is understood this was due to a breakdown in communication and the manager agreed to ensure the Care Commission was now formally notified of this matter. Many of the staff spoken with were unfamiliar with the contents of the policy and procedure manual which guided their practice. The manual was disjointed and lacked guidance in key areas such as nutrition and general palliative care. Staff spoken with did not recall receiving a copy of the Scottish Social Services Council Code of Practice. This should be looked into and staff made aware of the employee and employer's responsibilities contained in this document. (See Recommendation 3) There were a number of staff vacancies which were being covered by agency staff. These vacancies need to be filled as soon as possible to ensure continuity of care. Not all staff were receiving regular one to one supervision and the manager was aware of the need to improve the standard of recording in this area. It was reported that a staff appraisal system had still to be introduced. (See Recommendation 4) A Training Programme for staff within the home needed to be devised. The previous recommendation that staff receive training on behaviour management and restraint still needed to be addressed. Staff needed training in a range of other areas beyond mandatory training and the manager recognised this as an important area for development. (See Recommendation 5) The previous inspection report recommended that an induction programme for agency staff was introduced. This is at the draft stage and this piece of work now needed to be completed and implemented. Personal plans sampled showed that instances of restraint were being recorded, but there was poor linkage between risk assessments, identified care plans and review, and written consent agreements were not in evidence. (See Recommendation 6) Officers noted some discrepancies in the management of medication by staff. These included, some medicines not properly labelled, the need to review the administration recording of controlled drugs in line with best practice and the inappropriate storage of some medicines awaiting to be returned to the pharmacist. The hot temperature of the medication room and the storage arrangements of medication in the Dementia Unit also needed attention. The medicine fridge needed defrosted. (See Recommendation 7) The elements of fire safety required to be inspected by the Care Commission as detailed in the Regulation of Care (Scotland) Act 2001, SSI 2002 No.114 and the National Care Standards were not at the time of the inspection found to be satisfactory. There was a lack of evidence of an Emergency Fire Action Plan in place specific to the home, staff receiving six monthly fire safety training, all staff participating in at least one of two fire drills per year and keeping fire records up to date in all areas. (See Requirement 1) An audit of the services safer recruitment policies and procedures has been carried out by the Care Commission resulting in two Recommendations. (See Recommendations 8 & 9). 7/12

National Care Standard Number 13: Care Homes for Older People - Eating well Strengths The Catering Manager had worked in the care home for a number of years and was very familiar with resident's food likes and dislikes. There were opportunities for her to meet with residents and discuss menus. The general view of residents spoken with and observed was that they found the meals satisfactory although a few did not. Catering staff had undertaken elementary food hygiene training and the Catering Manager had an Intermediate certificate in this area. During the inspection, staff were observed to be generally attentive and helpful to residents during mealtimes. Tables were attractively set with napkins for residents' use. Residents had free access to fluids during the day. Residents had the choice of at least five portions of fruit and vegetables during the day and fruit was made available in communal areas. Staff confirmed that fruit was prepared in line with residents' eating requirements and cut up if need be. Areas for Development The Catering Manager and kitchen staff did not have policies and procedures on eating, drinking, food and nutrition geared towards the needs of older people. Likewise, staff did not follow clear management guidelines on these areas. (See Recommendation 10) The catering and care staff should receive training in fortified diets, textured diets and nutrition. (See Recommendation 11 ) During the inspection, one resident was observed to have difficulty eating because of her oral condition and as a result left most of her meal without any assistance or intervention by care staff. On enquiry, the Officer was advised an alternative meal could not be provided as the resident had chosen this one. This highlighted the need for staff to develop their understanding of good practice in relation to nutrition and review this person's nutritional and oral care needs via appropriate care planning. Care staff should not dispense medication during the meal. They should also ensure that they witness the resident taking their mealtime medication before marking up administration records. Paperwork in relation to BMI and under-nutrition screening was available but had not yet been put into use. This needs to be implemented with written guidance provided and care staff given suitable training in this area. (See Recommendation 12) National Care Standard Number 19: Care Homes for Older People - Support and Care in Dying and Death Strengths 8/12

Management assured that appropriate and sensitive attention was given to residents in the area of death and dying. Personal plans included sections to record residents' post death wishes and spiritual beliefs. Areas for Development Staff training should be provided on loss and bereavement, general palliative care and care staffs' role in pain management. (See Recommendation 5) The service needed to obtain a copy of the new National Practice Statements for General Palliative Care in Adult Care Homes in Scotland and develop its associated policies and procedures, personal planning approach and staff training in the light of these standards. (See Recommendation 13) National Care Standard Number 20: Care Homes for Older People - Moving On Strengths Service user and family involvement was encouraged in planning and discussing the best way forward for service users. This standard was not inspected in detail, but the manager was able to describe the elements of the moving on process which the service promoted and which were in line with a good discharge policy. Areas for Development The manager had identified the need to improve senior staff's adherence to good recording practices in relation to the moving on process. 9/12

Enforcement There has been no enforcement action taken against this service. Other Information There was a significant task to improve the quality of personal plan recording and for these to become working tools for staff, residents and their representatives. This has been a recurring theme for this service. For instance Officers noted from records sampled that there was poor linkage between assessments, careplans and day to day recordings. There was little evidence that service users and/or their representatives had been involved in the design of the personal plans. Paperwork was sometimes incomplete, not signed by all stakeholders or dated. Detail in care plans was often limited as was the assessment of the service users' healthcare needs. In one example seen, there was inadequate detail on the action to be taken when a resident, who had an inclination to wander, was trying to leave the building. Individual's specific type of diagnosed dementia was not recorded. The Manager recognised that personal plans were an area needing improvement and ongoing monitoring. He assured Officers this was one of his key management objectives. (See Recommendation 12) The Aims and Objectives statement for the service did not fully detail who the service was for, how it would be provided, by whom and on what basis. (See Recommendation 13) Requirements 1. Fire safety must be managed in a manner that protects the lives and welfare of service users. In order to achieve this the manager must: - put an Emergency Fire Action Plan in place, - ensure and evidence that staff receive six monthly fire safety training, - ensure all staff participating in at least one of two fire drills per year and - keep fire records up to date in all areas. This is in order to comply with: SSI 2002/114 Regulation 4.1(a) - a requirement to make proper provision for the welfare of service users SSI 2002/114 Regulation 19.3(b) and Regulation 19.3(c) - requirements to keep proper records in relation to fire safety In making this Requirement the following National Care Standards have been taken into account: National Care Standards Care Homes for Older People, Standard 4 - Your Environment Recommendations 1. Action should be taken as necessary to improve the security of the main front door without infringing upon the rights of able-bodied residents to come and go freely. (Standard 4, Your Environment) 2. A more holistic approach to assessing residents' dependency levels should be developed and the service should provide evidence to clearly demonstrate to the Care Commission that staffing levels were based on the level of need and any other relevant factors. (Standard 5, 10/12

Management and Staffing Arrangements) 3. The Home should ensure it has easy access to all relevant policies and procedures and that a system is introduced to confirm staff's understanding of their contents and the Scottish Social Services Council Code of Practice which they should each have a copy of. (Standard 5, Management and Staffing Arrangements) 4. All staff should receive regular individual supervision and a staff appraisal system should be introduced. (Standard 5, Management and Staffing Arrangements) 5. Staff's training opportunities should be increased in a range of relevant care practice areas, for instance, behavioural management, the use of restraint, infection control, general palliative care, loss and bereavement and care staff's role in pain management. (Standard 5, Staffing and Management Arrangements and Standard 19, Support with Death and Dying) 6. Recording and practice in relation to restraint should be improved with better linkage between risk assessments, identified care plans and review, and written consent agreements evidenced. (Standard 5, Management and Staffing Arrangements) 7. The management of medication within the home should be reviewed in the light of associated comments made in this report. (Standard 5, Management and Staffing Arrangements) 8. A system for re-checking Enhanced Disclosures for staff should be given further consideration.(standard 5, Management and Staffing Arrangements 9. All staff appointments should be made following receipt of two references on candidates whether or not they have been internally recruited. (Standard 5, Management and Staffing) 10. The home should put in place written guidelines, policy and procedures for food, fluid and nutrition to ensure service users' food, fluid and nutritional care are supported by clear management guidelines. (Standards 13 and 5.4 of the National Care Standards for Older People.) 11. All catering and care staff should receive training in fortified diets, textured diets and nutrition. (Standards 13 and 5.4 of the National Care Standards for Older People.) 12. The service should implement the BMI and under-nutritional risk screening for all service users within one month of admission and regularly thereafter to ensure appropriate care needs in this area are identified, met and monitored. Associated guidelines and staff training should also be implemented to support this area of care practice. (Standard 13.1 and 14.6 of the National Care Standards for Care Homes for Older People) 13. The service needed to obtain a copy of the new National Practice Statements for General Palliative Care in Adult Care Homes in Scotland and develop its associated policies and procedures, personal planning approach and staff training in line with these standards. (Standard 19, Support in Dying and Death) 14. Staff should receive ongoing training and guidance on the implementation of personal plans which are person centred, detailed, can be measured for success and are working tools in identifying and meeting all of the service users personal, social and health care needs. (Standard 6: Support Arrangements) 11/12

15. The Aims and Objectives statement for the service should be revised to fully detail who the service is for, how it will be provided, by whom and on what basis. (SSI 114/2002, Regulation 3, Statement of Aims and Objectives) Tony Valbonesi Care Commission Officer 12/12