Strathallan House (Care Home) Care Home Service Golf Course Road Strathpeffer IV14 9AT Telephone: 01997 421670 Type of inspection: Unannounced Completed on: 26 October 2018 Service provided by: Mistral Care Homes Limited Service provider number: SP2003001712 Service no: CS2003008490
About the service The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at www.careinspectorate.com This service has been registered since 2002. The provider is Mistral Care Homes Ltd. The service is registered to provide a care service to a maximum of 32 older people. The care home is situated in a large, converted, victorian style house. The home is situated in a pleasant residential area of Strathpeffer. The two storey building has 32 bedrooms of which two have en suite (toilet and wash hand basins). There are two communal lounges, a dining room, as well as shower and bathrooms. The house is situated within its own grounds and a large section is enclosed. The first floor accommodation can be accessed via the stairwells or the chair lift on the main stair well/ passenger. The service's principal aims and objectives as stated, are designed to provide 24 hour supervision with a haven, which gives protection support and meets complex needs. There were 32 people using the service at the time of the inspection. What people told us As part of the inspection process we gathered people's views in a variety of ways. We sent care standard questionnaires to the service to pass to people and to their relatives and friends. People who used the service were invited to take part in the inspection by talking with the inspector and inspection volunteer. For this inspection, we receive four completed questionnaires back from people experiencing care and nine from their relatives. We spoke with eight people experiencing care and six relatives during the inspection. We received positive views and comments from both the people experiencing care and from relatives about the care people received, the staff and the food. People knew the new manager by name and people found the management and staff approachable. All the people who returned completed questionnaires agreed or strongly agreed that overall they were happy with the quality of care they or their relative/friend receives at this home. Comments from people included: About the staff and the care: 'The care staff are very good and are caring' 'I am mannerly to them and they are mannerly to me' 'It's like living in a family - we look after each other' 'Always made to feel welcome' 'Staff are excellent and very good at caring and making the place a proper home rather than a care home' 'Shower more often' 'Delighted with the standard of care my aunt receives - 1st class' 'We are very happy with the care my relative receives. Staff all very friendly and caring' 'Staff are friendly and responsive to my dad's needs' page 2 of 14
'The staff are respectful.' About things to do: 'A band comes to give us country and western music' 'It would be better if there were more activities for my mum' 'More activities to stimulate the brain would be good - scrabble, jigsaws, newspapers' (more)'opportunities for meaningful activity' (more)'opportunities for physical activity' 'Would prefer residents to have more access outdoors when they choose' 'It was good to sit outside in the better weather.' About the food: 'The food is nutritious and balanced' 'The food is very good' 'Mum enjoys the food.' About the management: 'They have a good way with everyone' 'I would speak with them if I had a problem; he's very accessible, so is [director] the owner.' 'I would go with them if I wanted advice, he would deal with any problem straight away' 'The manager and deputy manager are both good listeners and will do their best to address issues' 'The manager is a very nice man - you can speak to him anytime.' From this inspection we evaluated this service as: In evaluating quality, we use a six point scale where 1 is unsatisfactory and 6 is excellent How well do we support people's wellbeing? How good is our leadership? How good is our staffing? How good is our setting? How well is our care and support planned? 3 - Adequate 3 - Adequate Further details on the particular areas inspected are provided at the end of this report. How well do we support people's wellbeing? There were a number of important strengths which taken together, clearly outweighed areas for improvements. The strengths had a significant positive impact on people's experiences and outcomes. Improvements are page 3 of 14
needed to maximise wellbeing and ensure that people consistently have experience and outcomes which are as positive as possible. People told us they were happy with their care. People should be respected and treated with dignity as an individual and experience warm, compassionate and nurturing care and support. We saw staff support people well in a caring, respectful and compassionate way. This should have a significant positive impact on people's wellbeing. People told us their privacy was respected by staff and other residents. Relatives told us staff treated their relative politely at all times and respected their individuality. Staff who had worked some time in the service knew people well. They knew how best to support people in a way that worked best for the person. Staff shared this information with newer staff which helped them support people in a responsive way. This valuable information was not well documented in people's care plans. Please refer to Key question 5: How well is our care planned? We observed some good interactions where staff supported people well to reduce their distress using warmth, and inclusion. We saw that staff respected people's choices and people felt listened to. People were called by their preferred name which is important to help people maintain their identity and to be seen as an individual. Staff supported people with friendships and companionship which are important to people's wellbeing. Staff need to be mindful of those people who spend more time in their rooms to ensure they receive the right support for them. People were reassured by staff and felt safe. People should be protected from neglect, abuse or avoidable harm. We were reassured that staff had a clear understanding of their responsibilities to protect people from harm and how to respond if concerns were identified. People should be able to choose to have an active life and participate in a range of recreational creative, physical and learning activities everyday, both indoors and out. Staff recognised the importance of engaging people in activity and actively supported people to be included. People told us they had made good use of the outside area in the summer and it had been nice to sit outside in the fresh air with their visitors. Staff provided some kind of activity for people each day. People are experts in their own experiences, needs and wishes. There was some good information about people's life stories, preferences and wishes and staff knew people well. The service was planning to develop the range of activities for people further and their links with the wider community. The service should use the information to promote people's meaningful activity in their day to day life and further develop people's opportunities. Keeping active helps people to maintain independence for longer and have a better quality of life. People got time and support to move safely at their own pace. Some people told us they would like to do more and had discussed the activities they would like to do. The service should continue to build on opportunities for people to enable them to be more active, maintain existing abilities and interests and develop new ones. This should help people to get the most out of life. Mealtimes were sociable occasions and staff supported people well. Staff were aware of peoples' likes and dislikes and people were shown a plated choice of each option on offer during meal times. The service could look at ways they could create more opportunities to promote and maintain people's independence at mealtimes. People were happy with the meals and told us the food was good. There was a good choice of food, snack boxes and drinks. People were regularly offered drinks and snacks. The recent introduction of snack boxes had also made this easier for people to access them when they wanted. Some people had recently been involved in a review of the menus and their suggestions had been listened to. An evening menu night was also held to enable residents and families to sample and review the new dishes together. The feedback sheets helped form the revised menus and the service planned to make this a 6 monthly event. People benefited from the involvement of other health and social care professionals. Staff sought prompt advice from them and followed their advice and treatment to support people's wellbeing. page 4 of 14
Any treatment or intervention people experience should be safe and effective. The arrangements to support people with their medication was satisfactory with the exception of topical creams and applications. The topical creams administration records were poorly completed and did not support the people who were receiving their prescribed topical preparations and creams as and when they should. The new management team discussed the plans they were implementing to ensure that people received their prescribed topical preparations and that staff maintained accurate records. Arrangements should be in place to ensure that staff practice is good so that people receive the right care at the right time for their skin. Information about how protecting people's skin where they are at risk from pressure damage needs to be better. Please refer to Key question 5: How well is our care planned? How good is our leadership? 3 - Adequate There were some strengths but these just outweigh weaknesses. Improvements must be made by building on strengths while addressing those elements that are not contributing to positive outcomes for people. People should expect to use a service that is well led and managed. There had been a change to the management team. A new manager and deputy manager had taken up post since the last inspection visit. People found the management approachable and felt listened to. The manager had a good awareness of where the service needed to improve. The manager, deputy and team leader roles and responsibilities were more clearly defined and communication had improved. Key working had been introduced and the manager was working with the staff to develop the team, supervision, support and development arrangements and to improve the service. People should benefit from a culture of continuous improvement, with the organisation having robust and transparent quality assurance processes. Although the service carried out an annual audit and internal audits there were not robust quality assurance processes in place. There was poor follow up after audits and they need to ensure that planned improvement had been achieved. Some audits, for example the care plan audit, identified what was missing but did not follow up effectively on this or look at the quality of information and how it was being used to promote people's health and wellbeing. Since taking up post the manager had identified areas for improvement and put plans in place to move the service forward on their improvement journey. Using these arrangements alongside the Health and Social care standards and the involvement of people should enable the service to carry out self-evaluation to ensure people receive the care and support that is right for them at the right time. The service should use the information to develop their service improvement plan further so it is more proactive and focused on assessing the quality of people's wellbeing and experience. How good is our staff team? There were a number of important strengths which taken together, clearly outweighed areas for improvement. The strengths had a significant positive impact on people's experiences and outcomes. Improvements are needed to maximise wellbeing and ensure that people consistently have experience and outcomes which are as positive as possible. People's needs should be met by the right number of staff at the right time. The service took account of assessment of people's needs and observations to determine the numbers of staff. They had recently identified that they needed additional staff at breakfast time to support people and had addressed this. There were occasions when the service had to use agency staff to cover vacancies and absences to ensure they had sufficient staff on duty and they were actively recruiting staff. page 5 of 14
People benefited from a calm and caring atmosphere. Staff worked within day to day routines with a person centred approach. This included the catering staff that, although they did not provide direct care, provided support to people. Staff worked well together as a team in a more organised and structured way. We observed that staff had time support people and speak with them. We observed staff being attentive to people in the communal areas and supported them well throughout the day. People should have confidence that the people who support them are suitably trained and competent to meet their needs. The right staff skill mix to meet people's needs was taken in to account in the day to day running of the service. The manager was working with staff to develop their roles through supervision and training. Additional training and support had been put in place to continue to develop the shift leader roles. The service should continue to monitor and review the staffing skill mix, numbers and deployment of staff to ensure these are right to meet people's needs. This should include both the direct care staff and the ancillary staff. How good is our setting? There were a number of important strengths which taken together, clearly outweighed areas for improvements. The strengths had a significant positive impact on people's experiences and outcomes. Improvements are needed to maximise wellbeing and ensure that people consistently have experience and outcomes which are as positive as possible. Premises should be adapted, equipped and furnished to meet people's needs and people should be empowered and enable to be as independent and in control of their life as they want and can be. The environment was relaxed, welcoming and free from intrusive noise and smells which is important for people's wellbeing. People's rooms were personalised with their own belongings which is important as personal objects are reassuring and can help to promote self-care. Several positive improvements had been made to enhance the environment and to make it easier for people to find their way around. These improvements, for example better lighting, more suitable flooring and hand rails help support people to be more independent, move around more and to reduce the risks of falling. Areas of the home had been decorated. Some changes had been made to the lounges and dining room to improve people's choice of where to sit. We observed that people were using these spaces more and moving freely between them. People had access to televisions, radio, newspapers and could have a phone installed in their room. It is important for people to be connected. The manager was looking at ways wireless internet could be made available throughout the home to make it easier for some people to keep in touch with friends and family. The premises did not have facilities to enable people to make their own snacks and drinks although snack boxes were available for people to help themselves. The service should explore ways people could be supported and be as involved as they would like to be with making their own drinks and snacks. The provider and manager had plans to make further improvements to the environment. These should look at further ways the environment can be enhanced for people and include ways to help people have more control and retain their independence where they can. People should be able to use a private garden and have access to the outdoors throughout the year as it is important for people's wellbeing. There was good access to the outside decking area which had been well used in the warmer weather. There was a large enclosed garden which people could access with support. Staff should explore ways they could continue to support people to make use of the enclosed outdoor spaces. page 6 of 14
How well is our care and support planned? 3 - Adequate There were some strengths but these just outweigh weaknesses. Strengths may still have a positive impact but the likelihood of achieving positive experiences and outcomes for people is reduced significantly because the key areas of performance need to improve. People should be fully involved in assessing their emotional, psychologically, social and physical needs at an early stage, regularly and when their needs change. Although there was some good assessment information, the frequency that this was reviewed was inconsistent and some information was not up to date. It was difficult to see how assessment information was used to inform the care plan and the way people were to be supported to meet their needs. Within the staff team there was good knowledge about people's needs and how best to support them however this was not reflected well in people's care plans therefore not shared in a consistent way. The service sought advice and support from other professionals when people's conditions changed. There service needs to ensure that any relevant information is included in people's care plans to enable all staff know how to support people based on their needs and preferences. We could see where there had been some involvement of people and their relatives in reviews and their views were sought. The service should improve the way they record evaluations of care plans and outcomes of reviews. This is to ensure the information is shared with the relevant people and actions that have been identified are addressed so people receive the care and support that is right for them. People's care plan should be right for them because it sets out how their needs will be met, as well as their wishes and choices. The care plans were not in a format that was easy for people to use on a day to day basis. Although some staff had received training on the care planning system that was used, there was a lack of guidance for staff to refer to. People should be recognised as experts in their own experiences, needs and wishes. Staff should develop people's care plans, with their involvement, in a way that empowers and enables people to be as independent and as in control of their life as they can be. It was identified that further training was needed for staff to ensure that assessment and care planning reflects people's needs. The management confirmed that this would be arranged. This should improve the way people's care and support is informed and the care people experience. What the service has done to meet any requirements we made at or since the last inspection Requirements Requirement 1 The provider must ensure they have effective systems in place to keep people safe and to meet their wellbeing needs. To do this they must ensure a robust risk assessment is carried out of the premises and health and safety arrangements and appropriate action is taken, to address areas of risk identified, within reasonable timescales. This should include the areas of risk identified during the inspection. a) ensure the laundry facilities have appropriate infection prevention and control arrangements including suitable hand washing facilities b) ensure suitable infection prevention and control arrangements are in place page 7 of 14
c) ensure there is sufficient hot water at all times d) ensure suitable handrails are installed in corridors to support people with their mobility e) ensure all areas of the home are suitably lit. This is in order to comply with: Regulation 4(1)(a), (d), 10(1), (2)(b), (d) 14(d) of The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (Scottish Statutory Instrument 2011/210). National Care Standards Care Homes for Older People, Standard 4: Your environment. Timescale: An action plan detailing work in progress, work completed and planned action to be taken to address risks within reasonable and planned timescales must be submitted by 20 February 2018 This requirement was made on 14 February 2018. Action taken on previous requirement Appropriate action had been taken to address the areas of risk identified. The provider should continue to ensure that risk assessments are regularly reviewed and appropriate action is taken where risks are identified. Met - within timescales Requirement 2 The provider must ensure they maintain an inventory of personal possessions for people who are admitted to the home, with a procedure for identifying missing items. This procedure should be audited to ensure it is effective in protecting people's valuables. This is in order to comply with: SSI no. 210 The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (4) (1) (b) provide services in a manner which respects the privacy and dignity of service users. National Care Standards Care Homes for Older People, Standard 16: Private life - 8, 10. Timescale: To be completed by 31 January 2018. This requirement was made on 14 February 2018. Action taken on previous requirement Suitable arrangements had been put in place for identifying missing items and protecting valuables. These had been found to be effective. The arrangements should continue to be regularly reviewed to ensure that the desired outcomes are being achieved and amended/updated when applicable. Met - within timescales page 8 of 14
What the service has done to meet any areas for improvement we made at or since the last inspection Areas for improvement Previous area for improvement 1 The provider should ensure that staff continue to develop care plans in a person-centred way to ensure people's wellbeing needs can be met in a consistent and planned way. Each person should have an up-to-date, accurate and easy to read care plan, which reflects their wishes, preferences and the support they need to meet their needs. This should include information about people's wishes on the event of death that had been agreed with them and/or people who have authority to act on their behalf. National Care Standards Care Homes for Older People, Standard 6: Support arrangements; Standard 8: Making choices; Standard 12: Lifestyle - social, cultural and religious belief or faith; Standard 14: Keeping well - healthcare: and Standard 19: Support and care in dying and death. Please refer to Key Question 5, How well is our care and support planned. Previous area for improvement 2 The provider should ensure that staff review people's care plans with them and their representative at least once every six months and more often, where needed. This is to ensure the information is current, agreed and takes account of the person's wishes, preferences and care needs. Accurate records of the review meetings should be maintained including the outcome and action to be taken where applicable. National Care Standards Care Homes for Older People, Standard 5: Management and staffing arrangements; and Standard 6: Support arrangements. Please refer to Key Question 5, How well is our care and support planned. Previous area for improvement 3 Where people are prescribed medication in the form of transdermal patches, staff should follow the administration guidance relating to the specific medication. Staff need to maintain accurate records including the site used, time of administration/removal, rotation and frequency of use of different sites. The person's care plan should contain clear, specific guidance for staff relating to the application and removal of the patch and frequency of checks that might be needed in the interim. National Care Standards Care Homes for Older People, Standard 5: Management and staffing arrangements; Standard 6: Support arrangements; and Standard 15; Keeping well medication. page 9 of 14
Administration and recording records practices had been improved and were being followed. Improvements were needed to the way information was recorded in people's care plans. Please refer to Key question 5, How well is our care and support planned. Previous area for improvement 4 The provider should ensure that when people are prescribed topical preparations and creams as part of their planned care, these are administered as prescribed. Staff should ensure their administration and recording follows good practice guidance. National Care Standards Care Homes for Older People, Standard 5: Management and staffing arrangements; Standard 6: Support arrangements; and Standard 15: Keeping well - medication. The administration records were poorly completed and did not support that people were receiving their prescribed topical preparations and creams as and when they should. The new management team discussed the plans they were implementing to ensure that people received their prescribed topical preparations and that staff maintained accurate records. Please refer to Key Question 1, How well do we support people's well being. Previous area for improvement 5 The provider and management should ensure they make appropriate arrangements: a) to ensure people's care plans includes detailed information about their choices and should draw on information from life histories and family members. The section for planning and delivery of meaningful activity for each person should be completed b) to support people with activities that are meaningful to them c) to provide activities that people can take part in if they choose d) to support people with choices on how they spend their day National Care Standards Care Homes for Older People, Standard 6: Support arrangements; Standard 12: Lifestyle - social, cultural and religious belief or faith: and Standard 17: Daily life. Please refer to Key Question 1, How well do we support people's well being; and Key question 5, How well is our care and support planned. Previous area for improvement 6 The management and staff should ensure they re-assess the environment and include in the service improvement plan ways to enhance the environment for people using the service with dementia or cognitive or visual impairment. National Care Standards Care Homes for Older People, Standard 4: Your environment. Is Your Care Home dementia friendly? Enhancing Healing Environments (EHE) Environmental Assessment Tool page 10 of 14
There had been several improvements made that had enhanced the environment for people and should make it easier for people to move around more safely. These included improvements to the lighting, flooring and fitting of hand rails. Further improvements were planned and a re-assessment of the environment was also planned. Previous area for improvement 7 The provider should ensure that suitable maintenance arrangements are in place for day-to-day repairs, routine checks, maintenance and servicing of equipment. This should take account of good practice guidance and current legislation. Appropriate records should be maintained and notifications made to the relevant organisations where applicable. National Care Standards Care Homes for Older People, Standard 4: Your environment; and Standard 5: Management and staffing A maintenance person had been employed and carried out day-to-day repairs, routine checks and maintenance. The systems for reporting and recording the action was much better, Suitable arrangements were in place for servicing and repairs out with this. Previous area for improvement 8 The provider should ensure that staff are supported to complete their induction in line with the service's policy. National Care Standards Care Homes for Older People, Standard 5: Management and staffing arrangements. The manager had reviewed the staffing arrangements. A lot of work had been carried out to implement improvements to the way people worked together as a team and to the way staff were supported with their development. The induction pack was under review and improvements were being made to streamline information and link in to staff roles and responsibilities, accountability and practice and the supervision structure. Previous area for improvement 9 Recommendation 9. The provider should ensure they review and put a plan in place to fully implement the learning and development policies. National Care Standards Care Homes for Older People, Standard 5: Management and staffing arrangements. Please refer to the action taken for area of improvement 9. Previous area for improvement 10 The provider should ensure they review and further develop the way they monitor the quality of the service and how they plan for improvements. National Care Standards Care Homes for Older People Standard 5: Management and staffing arrangements. page 11 of 14
Please refer to Key question 2, How good is our leadership Previous area for improvement 11 The provider should ensure they put plans in place to review and update their policies and procedures in order of priority. These should be shared with staff for their guidance and supported with appropriate training where applicable. National Care Standards Care Homes for Older People, Standard 5: Management and staffing arrangements. The service had recently obtained and adopted polices and procedures externally from an organisation who would review and keep theses up to date. This guidance was could be accessed online. All staff and access to a computer to be able to do this. The system had recently been implemented and arrangements should be made to ensure that all staff know how and where to access the relevant information staff. Previous area for improvement 12 Recommendation 12 The provider should ensure they review the current management arrangements and ensure the registered manager, service care manager and deputy manager's roles and responsibilities are clearly defined and that the current arrangements are suitable to meet the needs of the service. There had been a change in the management team since the last inspection. A new service care manager had been employed in April 2018 and taken up the post of Registered manager in July. A new deputy manager had only recently taken up post and had not yet completed a full induction to her post. There was a clearer definition of people's roles and responsibilities. The manager was developing the whole staff team and team leaders roles were better defined. Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at www.careinspectorate.com. Detailed evaluations How well do we support people's wellbeing? page 12 of 14
1.1 People experience compassion, dignity and respect 5 - Very Good 1.2 People get the most out of life 1.3 People's health benefits from their care and support How good is our leadership? 3 - Adequate 2.2 Quality assurance and improvement is led well 3 - Adequate How good is our staff team? 3.3 Staffing levels and mix meet people's needs, with staff working well together How good is our setting? 4.2 The setting promotes and enables people's independence How well is our care and support planned? 5.1 Assessment and care planning reflects people's planning needs and wishes 3 - Adequate 3 - Adequate page 13 of 14
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 www.careinspectorate.com Contact us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com 0345 600 9527 Find us on Facebook Twitter: @careinspect 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 14 of 14