Hollybank Care Home, Living Ambitions Limited Care Home Service Wallacestone Brae Reddingmuirhead Polmont Falkirk FK2 0DQ Telephone: 01324 719130 Type of inspection: Unannounced Completed on: 14 August 2018 Service provided by: Living Ambitions Ltd Service provider number: SP2003000276 Service no: CS2011300798
About the service This service registered with the Care Inspectorate on 31 October 2011. Hollybank is a care home for adults who have a learning disability. The provider of the service is a national organisation, Living Ambitions Ltd. Living Ambitions Ltd. is part of the Lifeways Group, a UK wide provider of support services for people with complex needs in community settings. The stated aims and objectives of the service are: "We specialise in providing opportunities for people to gain the life skills they require to live in the community, either independently or through supported living. By offering a full timetable of activities including daily living skills, socialising and outdoor activities, we work with the individual to promote confidence and build selfesteem. Once people have gained the life skills they require to live in their own homes, they move on whether this be with the aid of supported living or to be totally independent". At the time of inspection 12 people were being supported by the service. What people told us Overall, the people who we met and spoke with told us that they were not happy with the service and that it needed to improve. People said: "The place needs a 'shake up' urgently". "Service users don't always get their 1:1 support as there is more than often staffing issues". "The number of changes in management over the years has resulted in a real lack of consistency of support for people who live at Hollybank". "Never seen any real meaningful or structured activities taking place when I have visited". "Very short staffed lately, staff resigning, off-sick". "Some staff seem able and caring but real lack of support from management". "There aren't always enough staff". "Very disappointed with Hollybank". (My relative) "has gone backwards in terms of abilities, life skills, since living at Hollybank". "Mix of people living there doesn't really work". page 2 of 12
Self assessment We did not request a self-assessment but did discuss the service's development and improvement plans as part of our inspection. 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 Quality of care and support Findings from the inspection Our last inspection raised concerns about the way people were supported with their medication; errors had still been happening regularly and during our inspection we saw incomplete recording, unclear or contradictory protocols and a lack of medication auditing. As a result of medication errors, the risks of people experiencing discomfort and pain was increased significantly. A requirement had been made at our previous two inspections but has not been met and needs urgent action to improve it. (See outstanding requirement 1). In terms of supporting people with dignity and respect we found a mixed picture and whilst, overall, we found that staff were treating people with dignity and respect, there were some observations that gave us some cause for concern. We discussed those issues with the manager during our inspection and expect such issues to be addressed as learning for staff. We saw, and spoke with, staff who clearly appeared to have people's best interests at heart and were sensitive to their needs. However, it was not clear that they always understood how to best support and engage people with more complex needs. In any case, there was often not enough staff available to support people to do any meaningful activities. People told us about the lack of things to do and we saw that there was very little stimulation or structure to their day. This meant that people were not being encouraged to achieve their full potential. We heard about support strategies and plans not being adhered to and of how people's abilities had declined. Again this will need to be a high priority action for the service to make improvements on. (See recommendation 1). We had difficulty establishing whether or not people were having their needs assessed and reviewed regularly and, therefore, getting the support that was right for them. We did eventually find some review notes written in a note book but these were full of actions that had not been done or not been completed. Personal plans were not easy to follow and did not give enough detail on a person's needs and wishes. (See requirement 1). In addition we did not see any substantial evidence to assure us that people living at Hollybank: receive the right information, at the right time and in a way that they can understand are supported to make informed choices, so that they can control their care and support page 3 of 12
are included in wider decisions about the way the service is provided, and their suggestions, feedback and concerns are considered are being supported to participate fully and actively in my community. Overall, the service needs to make substantial improvements in the quality of care and support it provides for each of the people who live there. Requirements Number of requirements: 1 1. The service is required to ensure that people have their needs reviewed at least every six months, where formal notes are taken and actions and outcomes clearly identified. SSI 2011/210 5 Personal Plans - Review the personal plan at least once in every six month period whilst the service user is in receipt of the service. The Health and Social Care Standards state: "My personal plan is right for me because it sets out how my needs will be met, as well as my wishes and choices". (HSCS 1.15) Timescale: To be completed by 31 December 2018 Recommendations Number of recommendations: 1 1. The service should support people to make the most of their day and provide many more opportunities for them to enjoy life and achieve their potential. The Health and Social Care Standards state - "I get the most out of life because the people and organisation who support and care for me have an enabling attitude and believe in my potential". (HSCS 1.6) Grade: 2 - weak Quality of environment Findings from the inspection We saw that improvements had been made to the general décor of the home, for example, replacement flooring in the living areas and the installation of hand washing facilities in the laundry room. The home had a cleaner and a part-time maintenance worker and there was evidence of regular safety checks to ensure that the home was safe and secure. However, we felt that the home still lacked a 'homely feel' to it and the experience of living there did not always appear to be relaxed and peaceful. During our inspection we saw a fairly large hole on a wall in the living room page 4 of 12
and it was unclear how long it had been there, or when it was going to be mended. We spoke with the service about this and made it clear that this work should take place as soon as possible. There also seemed to be very limited opportunities for people to take part in daily routines, such as setting up activities and mealtimes. The service should do much more to support people to maintain, or indeed improve, their independent living skills and to be more involved in day to day life in their own home. By doing these daily routine tasks around their home people would develop their independent living skills. This could be helpful for people's general sense of wellbeing and purpose and for future goals and wishes they may have The home had a good sized outside space but it did not seem to be getting used to any great degree. The raised beds were over grown; and there were lots of weeds in the pathways and so on. There was little to encourage people to spend some time outdoors and we would encourage the service to address this and involve service users in developing the outside space. Overall, the environment at Hollybank could promote a more active life and participation in a range of recreational, social, creative, physical and learning activities every day, both indoors and outdoors but it was not being used to anything like its full potential. Requirements Number of requirements: 0 Recommendations Number of recommendations: 0 Grade: 3 - adequate Quality of staffing Findings from the inspection Support staff did appear to care about the people they supported and had some good relationships with them. However, repeated changes in management and the uncertainty associated with this had clearly impacted on the staff team and morale was very low. Staff appeared to be lacking in confidence, particularly when we asked them about supporting people with their medication. There had been training provided for them but they told us that they did not feel that it had equipped them to best support people with their medication needs. There was a real lack of clarity as to what workers' roles and responsibilities were and the management team needed to communicate much more with the staff team and make it far clearer what their roles and responsibilities were. This would provide more consistency of support for people and make staff feel more valued in their job. There had been training and development opportunities but more thought needed to be put into what people's specific needs were. An example of this was where we saw that 'intensive interaction' was a recommended page 5 of 12
support strategy for a particular person but nobody appeared to have accessed training for this and the need remained unmet. (See recommendation 1). Staff told us that staffing shortages were an on-going problem and we saw ourselves that covering shifts was proving to be a challenge and there were a number of staff absences while we were there. This did not give us confidence that people supported had the right staff there when they wanted or needed them. (See recommendation 2). We also had some concerns about shift patterns and length of shifts, which could be up to 14 hours. Although staff change who they are supporting mid-way through a shift we would question whether or not people are receiving the level and consistency of support they require when staff have been working long hours without a proper break. In terms of formal supervision, people who had been in post for a significant period of time told us that they had never had supervision. This meant that they had little opportunity to discuss their training and development needs or to reflect on their working practice. The support staff did appear to care about the people they supported and had some good relationships with them. Requirements Number of requirements: 0 Recommendations Number of recommendations: 2 1. The service should further develop their training and development plan to include training for staff in supporting people with their individual needs. The Health and Social Care Standards state: "I experience high quality care and support because people have the necessary information and resources". (HSCS 4.27) 2. The service should ensure that staffing levels truly reflect the needs of the people they support and carry out more accurate dependency needs assessments to achieve this. The Health and Social Care Standards state: "My needs are met by the right number of people". (HSCS 3.15) "People have time to support and care for me and speak with me". (HSCS 3.16) Grade: 3 - adequate Quality of management and leadership page 6 of 12
Findings from the inspection The registered manager of the service had left their post just before our inspection, and this was the fourth manager to leave in the past two years. An interim manager, who had been in post for about two weeks, was managing the service. The area manager, who was also new to the organisation, was providing additional support to them on a regular basis. They both recognised that urgent action was needed and had already started to address some of the issues the service had. The recruitment process for another registered manager had begun. However, the management of the service in the period since our last inspection in February 2018, and going forward, gave us significant cause for concern. (See requirement 1). Fundamentally, the service had not been well led and people told us they did not have trust and confidence in the way the service had been managed. For example, in the management of significant events, people raised concerns with us about a lack of communication and clarity regarding incidents that had taken place. Indeed, during our inspection, we saw evidence of a serious incident that had not been brought to our attention when it should have been immediately. Staff members had not been receiving formal supervision and, when discussing this with them, a number did not appear to be clear as to what the purpose of supervision was. In terms of quality assurance; there was no evidence of personal plan audits taking place at all, no audits of people finances had taken place since April 2018 and no medication audits since April 2018. The lack of any medication audits being completed was a particular cause for alarm given the issues with medication that were on going. (See recommendation 1). The service could consider introducing workplace 'champions' to take the lead on specific areas, such as; medication, healthy eating, active lifestyles, developing the outside space, more use of community resources and opportunities, quality assurance, health & safety checks and so on. A new permanent manager will hopefully be appointed in the near future. We would urge the provider to consider how they support the new manager, when appointed, to try and avoid a repeat of the continual changes of registered manager. A clear support structure for any newly appointed manager would promote a more positive staff retention strategy. Requirements Number of requirements: 1 1. The service must ensure that a robust recruitment process is followed when recruiting a new registered manager in order that the person appointed has the necessary skills and experience to lead the improvement work that is required. SSI 2011/2107 Fitness of managers 7. (2) The following persons are unfit to act as a manager in relation to a care service: (c) a person who does not have the skills, knowledge and experience necessary for managing the care service. Timescale: To be completed by 31 December 2018 page 7 of 12
Recommendations Number of recommendations: 1 1. The service should ensure that its quality assurance system is up and running again as soon as possible and is carried out in a regular and comprehensive manner. The Health and Social Care Standards state: "I benefit from a culture of continuous improvement, with the organisation having robust and transparent quality assurance processes". (HSCS 4.19) 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 all staff follow policy and procedures with regard to the administration of medication and that there are systems in place to support the medication policy. This includes: (i) All relevant staff having competency checks in the administration and recording of medication. (ii) Accurate audits of medication records and systems to ensure staff competency in administration. (iii)all staff receive appropriate training which is updated as per Living Ambitions policy on the administration of medication. This is in order to comply with Scottish Statutory Instrument 2011 - No 210 Regulation 15(b)(i) a Regulation relating to staff training. Timescale: to commence on receipt of this report and be fully completed by 1 December 2017. This requirement was made on 8 November 2017. Action taken on previous requirement Training and competency checks had taken place, however, errors were still happening. Medication audits had been taking place but none since April 2018. The service recognised that they need to do further work to bring medication practices up to an acceptable standard. Therefore, the requirement will remain in place and will be followed up at the next inspection. Not met Requirement 2 The provider must evidence how improvements identified will be put in place, sustained and monitored to agreed timescales. A comprehensive improvement plan should be written detailing responsibilities and action to be taken to oversee the improvements. page 8 of 12
This is in order to comply with SSI 2011/210 Regulation 4 - Welfare of users Timescale for implementation: to commence on receipt of this report and be completed within four weeks. This requirement was made on 8 November 2017. Action taken on previous requirement An initial improvement plan was submitted to the Care Inspectorate and updated in February 2018. However, at the August 2018 inspection of the service it was clear that improvement work had not progressed sufficiently and we require a new improvement plan that reflects the current issues that need to be addressed. Not met What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations There are no outstanding recommendations. Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at www.careinspectorate.com. Enforcement No enforcement action has been taken against this care service since the last inspection. Inspection and grading history Date Type Gradings 19 Feb 2018 Unannounced Care and support page 9 of 12
Date Type Gradings 10 Oct 2017 Unannounced Care and support 28 Mar 2017 Unannounced Care and support 21 Apr 2017 Re-grade Care and support 24 Nov 2016 Unannounced Care and support 2 - Weak 2 - Weak 25 Nov 2015 Unannounced Care and support 4 - Good 4 - Good 4 - Good 4 - Good 16 Mar 2015 Unannounced Care and support 30 Oct 2014 Unannounced Care and support 25 Mar 2014 Unannounced Care and support 4 - Good page 10 of 12
Date Type Gradings 31 Jul 2013 Unannounced Care and support 10 Dec 2012 Unannounced Care and support 4 - Good 2 - Weak 16 Mar 2012 Unannounced Care and support 4 - Good 4 - Good page 11 of 12
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 12 of 12