Couthie Corner - Thurso Alzheimer Support Service Without Care at Home Bayview House Olrig Street Thurso KW14 7JZ Telephone:

Couthie Corner - Thurso Alzheimer Support Service Without Care at Home Bayview House Olrig Street Thurso KW14 7JZ Telephone: 01847 892152 Inspected by: Shona Smith Type of inspection: Unannounced Inspection completed on: 4 December 2013

Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 11 4 Other information 22 5 Summary of grades 23 6 Inspection and grading history 23 Service provided by: Alzheimer Scotland - Action on Dementia Service provider number: SP2003002734 Care service number: CS2003008496 Contact details for the inspector who inspected this service: Shona Smith Telephone Email enquiries@careinspectorate.com Couthie Corner - Thurso Alzheimer, page 2 of 25

Summary This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change after this inspection following other regulatory activity. For example, if we have to take enforcement action to make the service improve, or if we investigate and agree with a complaint someone makes about the service. We gave the service these grades Quality of Care and Support 5 Very Good Quality of Environment 5 Very Good Quality of Staffing 5 Very Good Quality of Management and Leadership 5 Very Good What the service does well Couthie Corner helped people with dementia to be as active, social and independent as possible within the day service. Staff supported people to go on outings and to take part in therapeutic activities; family carers got some respite while the service user was at the service. The people with dementia and their family carers who were supported by the service were very happy with the support that they received. Staff were very friendly and approachable. The staff had a wide range of training. The staff understood a great deal about dementia and supported service users to be calm and free from distress. Carers, service users and allied health and social work professionals were encouraged to give feedback about the service. What the service could do better Some care plans could be improved. Care plans should be reviewed 6 monthly The manager was reviewing the need for first aid training. Couthie Corner - Thurso Alzheimer, page 3 of 25

The conservatory should be able to be used daily. The annual return should be completed each year. What the service has done since the last inspection Staff have had further training including in relation to the Dementia Framework. The service has been involved in the local re-design services group. The manager has been trained in 'Talking Mats' which she will roll out to staff. Conclusion A highly valued service by professionals, service users and their carers. Staff understand about dementia and provide an interesting and courteous approach to service users to help them to live to their maximum. Who did this inspection Shona Smith Couthie Corner - Thurso Alzheimer, page 4 of 25

1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at www.careinspectorate.com This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April 2011. Requirements and recommendations: If we are concerned about some aspect of a service, or think it could do more to improve its service, we may make a recommendation or requirement. - A recommendation is a statement that sets out actions the care service provider should take to improve or develop the quality of the service but where failure to do so will not directly result in enforcement. - A requirement is a statement which sets out what is required of a care service to comply with the Public Services Reforms (Scotland) Act 2010 and Regulations or Orders made under the Act, or a condition of registration. Where there are breaches of the Regulations, Orders or conditions, a requirement must be made. Requirements are legally enforceable at the discretion of the Inspectorate. Couthie Corner is registered to provide a support service to a maximum of 10 people each day on Tuesdays, Wednesdays, Fridays and Saturdays between the hours of 9.30am and 4.30pm. The service is located in a care home provided by NHS Highland integrated with the local authority. The service has been there for some time. The accommodation consists of a sitting/dining area with access to a quiet room and a small conservatory. There is a small kitchen, 2 toilets and small office. The service has access to a garden area. Contained in the service aims are the statements: 'To maintain and restore the sense of self-esteem and dignity of the person with dementia and to have respect for both To respond to the individual needs and wishes of the person with dementia To provide opportunities for social contact for the person with dementia and where possible for, and desired by, the carer To provide stimulation through a range of appropriate activities To help maintain or regain skills To encourage user/carer choice and participation in decisions affecting the person with dementia.' Couthie Corner - Thurso Alzheimer, page 5 of 25

Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 5 - Very Good Quality of Environment - Grade 5 - Very Good Quality of Staffing - Grade 5 - Very Good Quality of Management and Leadership - Grade 5 - Very Good Inspection report continued This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change following other regulatory activity. You can find the most up-to-date grades for this service by visiting our website www.careinspectorate.com or by calling us on 0845 600 9527 or visiting one of our offices. Couthie Corner - Thurso Alzheimer, page 6 of 25

2 How we inspected this service The level of inspection we carried out In this service we carried out a low intensity inspection. We carry out these inspections when we are satisfied that services are working hard to provide consistently high standards of care. What we did during the inspection We wrote this report following an unannounced inspection which was carried out by Shona Smith, Care Inspector. The inspection took place on 4 December 2013, between the hours of 9.00am and 6.00pm. Feedback was given to the registered manager at the end of the inspection. The feedback included recommendation and areas of improvement made as a result of this visit. As part of the inspection, we took account of the self assessment form that we asked the provider to complete and submit to us. We sent ten Care Standards Questionnaires to the service, to be given to people who use the support service and five were returned completed. We also sent fifteen staff questionnaires and we received five completed questionnaires. During the inspection process we gathered evidence from various sources, including the following: We spoke with: * 6 of the people who use the service * day centre officer * 2 support workers * registered manager We looked at: * evidence from the service's most recent self assessment * the service's aims and objectives * personal plans of people who use the service * formal care reviews and records * participation information, including Care Standards Questionnaires * staff training records and certificates * staff and service user meeting minutes Couthie Corner - Thurso Alzheimer, page 7 of 25

* minutes of carers meetings * health and safety records * risk assessments * policies * notice boards * staff rotas * photos of activities in camera *Consideration of the National Care Standards: Support Services Grading the service against quality themes and statements We inspect and grade elements of care that we call 'quality themes'. For example, one of the quality themes we might look at is 'Quality of care and support'. Under each quality theme are 'quality statements' which describe what a service should be doing well for that theme. We grade how the service performs against the quality themes and statements. Details of what we found are in Section 3: The inspection Inspection Focus Areas (IFAs) In any year we may decide on specific aspects of care to focus on during our inspections. These are extra checks we make on top of all the normal ones we make during inspection. We do this to gather information about the quality of these aspects of care on a national basis. Where we have examined an inspection focus area we will clearly identify it under the relevant quality statement. Fire safety issues We do not regulate fire safety. Local fire and rescue services are responsible for checking services. However, where significant fire safety issues become apparent, we will alert the relevant fire and rescue services so they may consider what action to take. You can find out more about care services' responsibilities for fire safety at www.firelawscotland.org Couthie Corner - Thurso Alzheimer, page 8 of 25

The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: No Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. We received a completed self assessment document from the service provider. We were satisfied with the way the service provider had completed this and with the relevant information they had given us for each of the headings that we grade them under. The service provider identified what they thought they did well, some areas for development and any changes they planned. Taking the views of people using the care service into account We met with all the people who were attending the service on the day of the inspection. We joined in with an activity which was aimed at stimulating their recall and we joined them for lunch. Generally the people using the service seemed relaxed and happy to be there. Comments made included: "It passes the time." "I miss Dundee - I would like to go back." "I used to work at Dounreay." We received 5 completed care standard questionnaires. One agreed and four strongly agreed with the statement: 'Overall, I am happy with the quality of care this service gives me.' Couthie Corner - Thurso Alzheimer, page 9 of 25

Taking carers' views into account Inspection report continued We did not speak with any relatives during the visit. We received a carer/relative's comment from a completed care standard questionnaire: 'Couthie Corner is a place that my grandmother goes four times a week. She loves socialising with the other users and staff. I know when she is there she is being well looked after. They do lots of various activities - from what my gran says the food is great!! Anytime I have called, the staff are friendly and helpful. I do not attend the carer meetings that they hold although I am invited by letter to every one. Cathy always makes the time to discuss any matters that arise. I have complete confidence in the service and I trust all the staff with my gran's care.' Couthie Corner - Thurso Alzheimer, page 10 of 25

3 The inspection We looked at how the service performs against the following quality themes and statements. Here are the details of what we found. Quality Theme 1: Quality of Care and Support Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths We found that the service performance was excellent in relation to this statement. We decided this after we spoke with the manager, support staff and service users. We also looked at reviews of care plans, minutes of meetings, questionnaires and other relevant documents. Alzheimer Scotland were dedicated to full and effective participation and inclusion in society of people with dementia and their carers. The involvement policy stated: 'Alzheimer Scotland is committed to maximise the opportunities for involvement both within and outwith the organisation, of people with dementia, their carers and its members in order to make our legal structure work, to be the natural voice of people with dementia and their carers and to give credibility and authority to all our work.' The manager and her staff were fully aware of the ethos of participation and had training about how to involve service users and carers in the local service and nationally. The organisation had various guidelines to support staff in this area for example: about the use of visual prompts, interview schedules and guideline and focus group guideline. There was an obligation on local management by the national organisation to demonstrate how carers and service users' suggestions were improving the service. Some of the ways that carers and service users could participate included: Surveys Couthie Corner - Thurso Alzheimer, page 11 of 25

There was an annual survey of carers' views. We could see that there had been very positive feedback. There had been questionnaires issued to associated health and social work professionals including Community Psychiatric Nurses and Social Work Care Managers. Some of the comments received included: "This resource is much valued and appreciated by clients, carers and myself" also "Alzheimer Scotland is an invaluable asset." Other comments related to the need for a waiting list and size of the resource as they wished to refer more people. Service users were also surveyed. Support staff recorded comments and preferences made by service users in relation to the activities and the routines of the day. These were used to influence planning of the service. Meetings Staff supported service users to meet together to discuss particular issues or themes. There had been a development day about transport. Carers were invited regularly to meetings to discuss the service and also wider issues that could be fed back to the national organisation. Amongst other issues they have discussed were the Carers Strategy, local resource guide and respite issues. There was a local group made up of representatives from Social Work, NHS and other bodies to look at the re-design of services for older people and people with dementia. Carers had been invited to contribute their ideas to this group. Each service user had a care plan that was reviewed regularly. This was an opportunity to suggest changes to the care provided and to give feedback about the service. Information Inspection report continued The service provided a great deal of information to carers and service users. They had a wide range of booklets and leaflets to help educate and enlighten about alzheimers and how individuals could be helped to live as well as possible. The service ran courses for carers to help them understand more about the condition and how they could help their relative. Within the service staff made use of photographs, calendars and visual prompts. Some photos of the groups' activities had been put through the television so all could see and comment. Service users and their carers could learn about the service before coming to assess whether it would be suitable for the individual. Staff were careful to provide information at a pace and in a way that service users could understand. Staff had received training in communication to help service users to get maximum enjoyment and stimulation from their day at the service. The service promoted information about the complaints procedure. Staff promoted awareness of dementia through local meetings and could also provide training. Couthie Corner - Thurso Alzheimer, page 12 of 25

The manager and staff were very approachable and friendly and encouraged service users and their carers to raise any concerns or issues to be discussed and to be sorted out. A newsletter was published which gave details of involvement opportunities. In the past there has been service user and carer involvement in recruitment. Areas for improvement The self assessment document indicated 'The service will continue to explore appropriate and accessible methods of involving service users and carers at all stages of the illness and including those in the later stages of the illness in conjunction with the Dementia Adviser for Caithness and Sutherland, Highland Regional Manager and Practice Development Team.' The manager had accessed training about talking mats. This technique may be used if thought suitable for the service users. I looked at a large number of photographs that were to be downloaded into photograph albums. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths We decided that the service grade for this statement was very good after we spoke with staff, manager and service users and looked at care plans, reviews and other documentation. Staff spoken with were very aware of service users' health needs and supported them when necessary to obtain help from allied health professionals, for example community nurse. Staff worked closely with health and social work professionals to benefit service users. Staff had a very good knowledge of how the service users' dementia had affected them and how best to communicate with them. Each service user had a care plan and we could see that there were some details of service users' health and well being needs. There were also risk assessments, for example about mobility and diabetes. There was a key worker system in operation which helped to ensure continuity of service. There were regular meetings of staff and Couthie Corner - Thurso Alzheimer, page 13 of 25

service users were discussed which helped all staff be up to date with information and assessment of each service user. Care plans were reviewed and evaluated. We could see in the records that there had been a recent review and that usually a relative/carer had been invited. Reviews offered an occasion for the service user and their relative if appropriate to suggest changes in the care routines or activities offered. Through the review the whole of the care plan should be looked at and assessed as to its suitability in guiding staff to the service user's current needs and health conditions. Staff promoted a healthy lifestyle through various ways including, encouraging nutritious meal choices, organising gentle exercises and therapeutic activities. Staff promoted social pastimes and trips out and about. Service users could take part in various activities of their choice. During the visit there was a motivating quiz which involved all staff and service users and later a Christmas collage was in the process of being constructed. In the afternoon there was a game of dominoes followed by a nature film. These were some of the activities of the day. Staff encouraged service users to maintain their independence and skills through encouraging and supporting them to do as much as they could for themselves. Staff helped some service users to take medication. When necessary staff accompanied service users to attend health appointments. Staff had the support of a range of policies and best practice guidance available on their website and in paper format. Areas for improvement Some care plans had few details about their health and situation. We found that some service users were not having full reviews six monthly. The regularity had improved since a senior care co-ordinator had been appointed for both Alzheimer day services in the Caithness area. Several care plans showed that the previous review had been a phone consultation with a relative with little details recorded of the discussion. See Recommendation. At present the manager and staff were re-visiting the medication policy to ensure all were up to date with its contents. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Inspection report continued Couthie Corner - Thurso Alzheimer, page 14 of 25

Recommendations Inspection report continued 1. It is recommended that care plans contain all necessary information in order to guide staff about each service users' health and well being needs. Care plans should be reviewed six monthly with minutes recorded of the discussion, who attended and any actions identified. This takes account of the National care standards - Support services - Standard 4 - Support arrangements Couthie Corner - Thurso Alzheimer, page 15 of 25

Quality Theme 2: Quality of Environment Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the environment within the service. Service strengths We found that the service performance was excellent in relation to this statement. The evidence in statement 1.1 is valid here. Areas for improvement See statement 1.1. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Statement 2 We make sure that the environment is safe and service users are protected. Service strengths We found that the service performance was very good in relation to this statement. We decided this after we looked round the accommodation, resources and examined relevant records and policies. The day service was held in a part of Bayview House care home provided by NHS and the local authority. Couthie Corner had the use of a large room that was used for activities and for lunch. Service users had the use of a quiet room and a small conservatory accessed from the main room. Risk assessment of the premises and fire risk assessment had been recently reviewed and updated. We found that the manager and staff took health and safety issues seriously and all were encouraged to continually assess the premises and when out and about for any Couthie Corner - Thurso Alzheimer, page 16 of 25

hazards. Health and safety was a permanent item on the staff meeting standing agenda. Accidents were documented appropriately and the manager would review any record and put in place necessary action to prevent re-occurrence. The service had appropriate policies to guide staff. The restraint policy was underpinned by the Mental Welfare Commission guidance 'Rights, Risks and Limits to Freedom.' Staff had training about how to deal with service users who might be distressed and confused and display difficult behaviours. The ratio of staff to service users was good and allowed staff to spend quality time with service users. The service benefited from having volunteers. Recruitment of volunteers followed a similar safe recruitment procedure as to staff. The kitchen area had been 'passed' by the local environmental health team. The premises though somewhat cluttered due to Christmas activities and decorations, had a high standard of cleanliness. Areas for improvement We found that service users could not use the conservatory area that day as it was very cold and full of activity related items on the chairs. It is acknowledged that service users also had a quiet room they could access. All lounge chairs had extra decorative pads on them in case of incontinence accidents. The service should review this practice as it stigmatises all service users. I note that staff do not want to highlight an individual's problem though hope staff may find a solution that benefits all. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Couthie Corner - Thurso Alzheimer, page 17 of 25

Quality Theme 3: Quality of Staffing Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service strengths We decided that the service grade for this statement should be excellent. The evidence in statement 1.1 is valid here. Areas for improvement See statement 1.1. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths We decided that the service grade for this statement was very good after we spoke with staff and looked at training and supervision records. There was good staff retention with most having worked in the service for several years. Staff impressed with their enthusiasm and commitment to the service users to helping them to have a better quality of life. We could see from a recently employed member of staff's personnel file that she had been recruited using safe procedures. This included: an application form was completed showing skills and previous experience a competency interview was carried out by more than one person Couthie Corner - Thurso Alzheimer, page 18 of 25

two references were taken up, one of which was from the most recent employment a 'Protection of Vulnerable Adults check was completed. This helped to ensure that only suitable people were recruited to look after very vulnerable individuals. There was a comprehensive training and development strategy demonstrating the service's commitment to having a highly trained staff group. Staff had regular core training including: moving and handling, food hygiene, medication, adult support and protection and palliative care. There were opportunities to access a wide range of training to help staff understand about the service users' situation and improve their skills. Subjects included personalisation, communication, life story work and meaningful activities. Training related to the Dementia Framework was being actioned and all staff would be trained to the skilled or enhanced level. There was a system for staff to be appraised and to have supervision. Records and staff confirmed that these staff procedures happened and this helped to ensure that staff practice remained at a high standard. Most staff had relevant qualifications which enabled them to be registered with the Scottish Social Services Council (SSSC). All staff had received a copy of the SSSC codes of practice. There were staff meetings to which all staff could contribute. It was a forum for debate and to consider how to improve the service. Day Centre Organisers and Manager met frequently. There were suitable policies and procedures in place that covered recruitment, training, supervision and appraisal. Areas for improvement We found that some staff were not receiving supervision as regularly as the service policy indicated. The manager was reviewing staff need for first aid training which had not happened for a while. Given that staff take service users out and about and may be some distance from medical help it would be beneficial to service users for staff to have first aid training. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Couthie Corner - Thurso Alzheimer, page 19 of 25

Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the management and leadership of the service. Service strengths We found that the service performance was excellent in relation to this statement. The evidence in statement 1.1 should be read. Areas for improvement See statement 1.1. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Statement 4 We use quality assurance systems and processes which involve service users, carers, staff and stakeholders to assess the quality of service we provide Service strengths We decided that the service grade for this statement was very good after we spoke with manager, staff, service users and looked at appropriate documents. The quality of the service was monitored in a number of ways. Alzheimer Scotland had developed a strategic plan of which all staff had a copy. This was discussed at staff meetings. The regional manager had conducted an audit which was done every 2 years. Any actions identified would be completed within one year. The service looked for feedback from service users, carers and partner health and social work agencies. Suggestions for improvement were actioned if appropriate. Couthie Corner - Thurso Alzheimer, page 20 of 25

The organisation was a member of Quality Scotland's voluntary sector network and they benchmarked their performance against other voluntary providers using the European Framework for Quality Management. The organisation had also achieved the European Foundation for Quality Management's 'Committed to Excellence' award. The manager monitored staff practice through observation, through supervision and appraisal and at staff meetings. The manager made notifications as necessary to the Care Inspectorate and other regulatory bodies. Areas for improvement The Care Inspectorate did not receive a completed annual return this year. This is required every year and the service usually complies. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Couthie Corner - Thurso Alzheimer, page 21 of 25

4 Other information Complaints No complaints have been upheld, or partially upheld, since the last inspection. Enforcements We have taken no enforcement action against this care service since the last inspection. Additional Information Action Plan Failure to submit an appropriate action plan within the required timescale, including any agreed extension, where requirements and recommendations have been made, will result in the Care Inspectorate re-grading a Quality Statement within the Quality of Management and Leadership Theme (or for childminders, Quality of Staffing Theme) as unsatisfactory (1). This will result in the Quality Theme being re-graded as unsatisfactory (1). Couthie Corner - Thurso Alzheimer, page 22 of 25

5 Summary of grades Quality of Care and Support - 5 - Very Good Statement 1 Statement 3 6 - Excellent 5 - Very Good Quality of Environment - 5 - Very Good Statement 1 Statement 2 6 - Excellent 5 - Very Good Quality of Staffing - 5 - Very Good Statement 1 Statement 3 6 - Excellent 5 - Very Good Quality of Management and Leadership - 5 - Very Good Statement 1 Statement 4 6 - Excellent 5 - Very Good 6 Inspection and grading history Date Type Gradings 1 Oct 2010 Announced Care and support 6 - Excellent Environment Not Assessed Staffing Not Assessed Management and Leadership Not Assessed 8 Dec 2009 Announced Care and support 5 - Very Good Environment Not Assessed Staffing 5 - Very Good Management and Leadership Not Assessed 17 Feb 2009 Announced Care and support 5 - Very Good Environment 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good Couthie Corner - Thurso Alzheimer, page 23 of 25

All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Couthie Corner - Thurso Alzheimer, page 24 of 25

To find out more about our inspections and inspection reports Read our leaflet 'How we inspect'. You can download it from our website or ask us to send you a copy by telephoning us on 0845 600 9527. This inspection report is published by the Care Inspectorate. You can get more copies of this report and others by downloading it from our website: www.careinspectorate.com or by telephoning 0845 600 9527. Translations and alternative formats This inspection report is available in other languages and formats on request. Telephone: 0845 600 9527 Email: enquiries@careinspectorate.com Web: www.careinspectorate.com Couthie Corner - Thurso Alzheimer, page 25 of 25