Badenscoth House Nursing Home Care Home Service Badenscoth House Badenscoth Rothienorman Inverurie AB51 8XR Telephone: 01651 821408 Type of inspection: Unannounced Inspection completed on: 7 July 2016 Service provided by: Alistair Munro and Judith Munro a Partnership Service provider number: SP2003002312 Care service number: CS2003010353
About the service The inspection focused on standards of care for people living with dementia. We are using a sample of 150 care home services to look in detail at the standards of care for people living with dementia and this service is one of those selected as part of the sample. The areas looked at were informed by the Scottish Government's 'Promoting Excellence: A framework for health and social care staff working with people with dementia and their carers' and the associated dementia standards. It is our intention to publish a national report on some of these standards during 2017. This service is privately owned and managed by Mrs. Munro to provide accommodation, support and nursing care to a maximum of 26 older people. It is also registered to provide an integrated support service to two people. This rural service operates from a traditionally-built house with a conservatory and other extensions in a rural setting. It is close to the village of Rothienorman and near the town of Inverurie. The home has been extended as part of an ongoing upgrade of the premises to provide single en suite accommodation. Badenscoth has a small well maintained garden which includes a sensory area. There are 26 bedrooms, all of which are single rooms. Sixteen of the bedrooms have en suite facilities. There are a variety of communal areas, including the lounge, conservatory and dining areas. The accommodation is provided on two levels. Some of the aims and objectives of the service include: - Residents will be cared for with dignity and respect, ensuring attention to private needs at all times. - Care given will be tailored to meet the individual needs and choice of residents in a homely and friendly atmosphere. - Practice will always be in the interest of the resident and be competent, safe and continually evaluated. - All care will be planned for the individual resident ensuring excellent communication, continuity and collaboration. - A homely, friendly atmosphere with provision of companionship should be maintained to enhance the residents' quality of life. The manager/owner told us that her ethos is that life should improve coming in to the home, where focus is on what residents are still able to do. What people told us We spoke with 16 residents, formally and informally, throughout our inspection. We also received back 13 out of 30 Care Standards Questionnaires (CSQs) we asked the home to randomly distribute to residents and families. Comments made in person and in the questionnaires were used to inform our report and included: - "I think this is an excellent care home. The staff are hardworking and dedicated and do their best within their resources." for Badenscoth House Nursing Home page 2 of 13
- "[Resident] is well cared for in a homely environment. Her communication is now very poor but I have no concerns about her wellbeing and care as the staff are considerate, kindly, understanding, and know her very well. During visits I feel welcome and always offered refreshment or meal." - "My relative is the third member of our family to be in the home. We see it as a home from home. The staff seem very loyal as I recognise they have been there a long time some of them. The younger members of staff are so cheery and deal very well with the residents." - "I did have experience of another care home and Badenscoth is far and above the other in all ways." - "So much is said negatively nowadays; Badenscoth could be used as an example of how it should be." - "It is very clear that the residents are involved as much as they are able in activities and expressing themselves." - "There are always a variety of activities going on and my mother is encouraged to take part in these as able, for example by playing table top games or with balloons. Often being simply included in the group is enough, but she is not left out. This is obvious whenever I visit which is not a fixed day or time and at any time of the day." - "I like a mixture of activities and TV, whatever's going on round about." - "Watches activities, they say he's now more inclined to be interested. Happy to sit in the garden. Played football with a soft ball last weekend and enjoyed it." - "I don't like going out; I'm very deaf. I have a TV with subtitles in my room. I do go to the church service. I like that." - "We are in constant contact about the care plan. We're told about medication." - "Choose bedtime and getting up; I ring the bell." - "I choose when I go to bed and get up." - "I brought my radio and phone though there is difficulty in getting it connected. I also have my Kindle and my own TV. I brought pots from my previous home to the garden." - "It's very comfortable. The heating is on all the time. I brought my own special bed." - "I have my own radiator if I want to put that on. I brought a wardrobe, chest of drawers and light as well as photos of the family and grandchildren." - "I would not change my room. The toilet is just outside, you can't ask for more than that." - "Staff find time to talk, most are cheery and they don't get many thanks." - "Staff listen. I say what I think, they know me." - "Staff are exceptionally nice. I forget names but they're getting badges." for Badenscoth House Nursing Home page 3 of 13
- "She was a nice girl and cleaned my nails very particularly. I enjoyed it more than I thought. Nail polish made me feel better." - "They know who we are. I see the manager and the administrator quite often." - "There's a nice atmosphere around you. I'm very comfortable." - "The staff are always welcoming and helpful. There is a very homely atmosphere." - "This wallpaper is nice." - "I find the staff all very helpful, especially the older ones. Some of the younger ones are a bit flighty; some of the young ones are excellent." - "Would appreciate more staff on after tea." - "I asked for a toilet for the public. There could be cross infection of residents." We concluded that, overall, people were very happy with the quality of the care provided at Badenscoth House Nursing Home. Self assessment A comprehensively completed self assessment was submitted to us within the timescales given. The service had identified areas of strength as well as areas for developments. There was evidence that the service had consulted with residents, families and staff to inform the self assessment. From this inspection we graded this service as: Quality of care and support Quality of environment Quality of staffing Quality of management and leadership 5 - Very Good 5 - Very Good 5 - Very Good 5 - Very Good Quality of care and support Findings from the inspection We found that the service performed to a very good standard to ensure residents' rights to be treated as a unique individual and where dignity and respect were maintained. Staff provided very good support to residents following their diagnosis of dementia. The staff team had a very good knowledge about residents' and their families' likes and interests. Staff used this information to inform the day-to-day activities residents enjoyed. Staff recognised and properly responded to residents' changing care needs, including when they were showing signs of stress and distress. for Badenscoth House Nursing Home page 4 of 13
Residents were supported to a very good standard by staff to ensure their rights to access a range of treatment, care and support were met. Staff were very respectful when caring for people and when talking to each other about people's needs and wishes. Staff showed great patience and understanding when supporting residents at mealtimes to enjoy the meal as well as to have a good dietary intake. The service had well established links with a wide variety of the primary health team. The manager was a dementia champion. We would encourage the manager to consider having more dementia champions in the staff team to enhance the promotion of good dementia care. Residents' continence was promoted by staff who enabled and encouraged residents to use the toilets. Residents were supported by staff to maintain very good standards of oral care. Residents and/or their representatives were appropriately involved in all aspects of their care, including developing their care plans. One resident had written their own anticipatory care plan. Anticipatory care plans were properly considered for other residents. Residents were properly supported by staff to communicate. Good details about residents' preferred ways of communicating were recorded in the care plans. As well as keeping updated with changes, staff were further personalising care plans. We encouraged the management to ensure more information was recorded by staff about their knowledge of individual residents' likes and how this knowledge was being used to make a positive difference to the residents' lives. There was excellent evidence that residents were well supported with end of life care. Residents were supported to make decisions about their care, including whether or not to receive medical care. Care plans included individual details about legal documents, including Guardianship, Powers of Attorney (POA), Section 47 consent to treatment certificates under the Adults with Incapacity (Scotland) Act 2000, and DNACPR (do not attempt cardiopulmonary resuscitation medical documents). We recommend that the management develop a register of all legal documents (see recommendation 1). Requirements Number of requirements: 0 Recommendations Number of recommendations: 1 1. The management should develop a register of all legal documents. National Care Standards, Care Homes for Older People - Standard 5: Management and Arrangements Grade: 5 - very good for Badenscoth House Nursing Home page 5 of 13
Quality of environment Findings from the inspection Residents chose from a very good range of lounges, rooms and spaces to spend time in. Ongoing refurbishment of the home continues in consultation with residents to improve residents' comfort. Residents were able to maintain very good links to the local community. Residents had very regular opportunities to go out in the home's minibus to local amenities, including the village hall, church and local shops. Residents benefitted from local groups regularly visiting the home, including a visiting library, church group, playgroups, and school children visits from the local school. Residents were very well supported to keep in touch with friends and families through being taken by staff to visit and using telephones, Skype and e-mails. We saw many people visiting throughout our inspection. Residents enjoyed taking part in a wide range of activities every day of the week, including going out for walks or sitting in the garden. Staff told us of plans to secure the garden to further enhance safety and independence. We saw that more door closers were bought and were to be fitted. This meant people could safely leave their doors open if they chose, yet be safer if the fire alarm activated because the doors would close automatically. A storage room was made safe during our inspection. Residents were enabled to maintain and further improve their independence as far as possible. We could see that new crockery and cutlery was being bought at the time of the inspection. This can help people to manage their meals and drinks well. Residents, who were able, were using the small, easy to use jugs and tea pots to choose and pour their own drinks. The management are to consider introducing a coffee/snack area with flask jugs for people to help themselves to tea and coffee, rather than accessing the non-domestic kitchen as they currently do. During the inspection staff improved some signage to make it clearer to people what the purpose of some rooms was. More directional signage will help people to find their way about the home, including where the toilets are. People would benefit from a hand rail in the main corridor. Not all of the toilet seats and grab rails contrasted with the walls and flooring to make it easier for people with sight problems or dementia. Staff and management were to make use of the Dementia Services information to further improve the environment. We have made two recommendations (see recommendations 1 and 2). Requirements Number of requirements: 0 Recommendations Number of recommendations: 2 1. The provider should further improve orientation and independence by providing more directional signs and contrasting toilet seats. National Care Standards, Care Homes for Older People - Standard 4: Your for Badenscoth House Nursing Home page 6 of 13
2. To promote safety, security and independence, the provider should secure the garden areas and add a handrail in the main corridor. National Care Standards, Care Homes for Older People - Standard 4: Your Grade: 5 - very good Quality of staffing Findings from the inspection Residents and families could be assured that their right to have staff who were well supported and educated about dementia was upheld. The manager/owner of the home was a dementia ambassador. She provided dementia training to every member of staff in the home, not only the carers. We would encourage the service to have more dementia ambassadors. Residents benefited from very good staffing ratios in the home with a very good skill mix of staff. The manager/ owner aimed to provide good staffing levels so residents could have their needs met promptly. Staff were employed following proper procedures and checks. All staff were properly registered with the appropriate professional regulatory body. Staff received a very good induction to the care home, usually over a period of three to four weeks. Staff undertook a wide range of training, refresher training and development according to their roles and responsibilities. Training was provided both in-house and externally as well as via e- learning. We observed staff providing very warm, personalised care to residents. Staff were enthusiastic and caring about the residents and each other. Staff worked hard to provide a good level of care and support to residents. Residents' needs and likes were very well known by most staff. Staff encouraged and enabled residents to do things for themselves and to retain the skills they had to be as independent as possible. Some very experienced members of staff were very good role models for less experienced staff. Staff demonstrated that they knew the proper action to take if they had any concerns about the safety and protection of residents or if they saw poor practice. Requirements Number of requirements: 0 Recommendations Number of recommendations: 0 Grade: 5 - very good for Badenscoth House Nursing Home page 7 of 13
Quality of management and leadership Findings from the inspection Residents benefitted from the management ethos that the home was the residents' home. Residents and families were very happy with the quality of the care provided at the home. Residents were offered choices by staff in all aspects of daily life in the home. Residents and families were kept well informed by staff about every day events. Management and staff could evidence more the discussions, education and support they provide to resident and families. The management team carried out very good quality assurance checks and audits to ensure good standards of care and support were provided to residents. Staff and some families were involved in the audits. People felt that the management had a very good presence in the home and the office door was always open. Not all checks and audits were formally recorded. The management could evidence more of the involvement of people in the audits (see recommendation 1). Resident and family meetings continued to be facilitated by the manager and staff. The meetings continued to have an independent spokesperson and note taker to help ensure the views of residents and families were objectively represented. Residents and families held parts of the meetings without staff and management present to help them to express their views without the staff presence. Staff felt very empowered and encouraged to make decisions and take leadership roles. Staff analysed what was happening on a shift to determine what worked well for residents and staff and what and how things could be improved. Staff felt they had very good communications and teamworking. This contributed to residents receiving very good standards of care in the home. Requirements and recommendations we made at the previous inspection were all seen to be met. These included ensuring the environment was safe, bathrooms all had working locks, photos be added to care plans, and mentoring and quality assurance monitoring to include observation of staff practice. Requirements Number of requirements: 0 Recommendations Number of recommendations: 1 1. The provider should make development plans visible and show how they are being progressed, such as anticipated and achieved completion dates. National Care Standards, Care Homes for Older People - Standard 5: Management and Arrangements Grade: 5 - very good for Badenscoth House Nursing Home page 8 of 13
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 the environment is safe and service users are protected. In order to achieve this, the provider must: (a) Ensure the supplies of personal protective equipment (PPE) available at the point of use are properly stored. (b) Ensure paper hand towel dispensers are fitted at points of use, including in the communal toilets, bathrooms and shower rooms. (c) Ensure the smoking area is kept free from hazards, including preventing flammable waste collecting in the sand buckets and the buckets from obstructing escape routes. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, (SSI 2011/210) Regulation 4(1)(a) and (d) - Welfare of Users. In making this requirement, the following was also taken into consideration: National Care Standards, Care Homes for Older People - Standard 4: Your ; and Standard 5: Management and Arrangements. Timescale: by 31 May 2015. This requirement was made on 12 May 2015. Action taken on previous requirement The provider had put in place protective equipment and paper hand towels at point of use. A cigarette disposal unit had been fitted and the exit doorway cleared of trip hazards, freeing up the escape route. Met - within timescales Requirement 2 The provider must ensure all bathrooms, shower rooms and toilets have working locks which can be opened from the outside, if required. This is in order to comply with: for Badenscoth House Nursing Home page 9 of 13
The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, (SSI 2011/210) Regulation 4(1)(a) and (d) - Welfare of Users. In making this requirement, the following was also taken into consideration: National Care Standards, Care Homes for Older People - Standard 4: Your ; and Standard 5: Management and Arrangements. Timescale: by 31 May 2015. This requirement was made on 12 May 2015. Action taken on previous requirement Working locks were fitted on all bathrooms, shower rooms and toilets. Met - within timescales What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 Clear and current photos of individual residents be added to care plans and medication administrations records (MARs). National Care Standards, Care Homes for Older People - Standard 5: Management and Arrangements This recommendation was made on 12 May 2015. Action taken on previous recommendation Clear photos had been added to care plans and medication recording sheets. Recommendation 2 Mentoring and ongoing quality assurance monitoring of staff practices should include observation of how staff support residents to move around the home, including safe moving and handling techniques and safe use of wheelchairs. National Care Standards, Care Homes for Older People - Standard 5: Management and Arrangements This recommendation was made on 12 May 2015. Action taken on previous recommendation Senior staff and nurses carried out observations of practice as part of ongoing mentoring and quality assurance of staff practice to ensure proper care practices were carried out by staff. for Badenscoth House Nursing Home page 10 of 13
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 16 Apr 2015 Unannounced Care and support Management and leadership 22 Apr 2014 Unannounced Care and support Management and leadership 24 Apr 2013 Unannounced Care and support Management and leadership 26 Apr 2012 Unannounced Care and support Management and leadership 14 Dec 2010 Unannounced Care and support 6 - Excellent Not assessed Not assessed Management and leadership Not assessed for Badenscoth House Nursing Home page 11 of 13
Date Type Gradings 11 Aug 2010 Announced Care and support 6 - Excellent Not assessed Management and leadership Not assessed 12 Mar 2010 Unannounced Care and support Not assessed Management and leadership Not assessed 14 Aug 2009 Announced Care and support Management and leadership 27 Feb 2009 Unannounced Care and support Not assessed Not assessed Management and leadership 22 Oct 2008 Announced Care and support Management and leadership 4 - Good for Badenscoth House Nursing Home page 12 of 13
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. for Badenscoth House Nursing Home page 13 of 13