Aaron House Care Home Care Home Service Adults Beeslack House Edinburgh Road Penicuik EH26 0QF Telephone: 01968 677 095 Type of inspection: Unannounced Inspection completed on: 11 March 2015
Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 16 4 Other information 33 5 Summary of grades 34 6 Inspection and grading history 34 Service provided by: Aaroncare Ltd Service provider number: SP2003002436 Care service number: CS2003010606 If you wish to contact the Care Inspectorate about this inspection report, please call us on 0345 600 9527 or email us at enquiries@careinspectorate.com Aaron House Care Home, page 2 of 36
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 3 Adequate Quality of Environment 3 Adequate Quality of Staffing 3 Adequate Quality of Management and Leadership 3 Adequate What the service does well We saw that staff were responding to residents' needs in a respectful way with a lot of humour being used which indicated close relationships between residents and staff. The home has a secure garden which can be easily accessed from the home by residents and relatives. Relatives felt they were kept informed of their family members' care and support needs and were contacted about any changes or issues. What the service could do better We have asked the Manager to ensure that there are clear records of the assessment of staffing levels needed in the home. We have asked the Manager to continue with the work already done to improve the care plans and the social activities for residents. When a resident remains in bed for long periods, we have asked that staff keep clearer records of the reasons and risks associated with this decision. We have made a number of recommendations about laundry systems and the labelling of topical treatments and foodstuffs. Aaron House Care Home, page 3 of 36
What the service has done since the last inspection A new Manager had been appointed and was only recently in post. We noted that he had identified a number of areas where improvements were needed and was actively working with staff to make changes. Conclusion We found that there had been some improvements since the last inspection and work was continuing to meet the remaining requirements and recommendations that are detailed in this report. Aaron House Care Home, page 4 of 36
1 About the service we inspected Aaron House is a care home for older people situated on the outskirts of Penicuik, approximately 10 miles from Edinburgh city centre. The home is situated off the main road within its' own grounds and has private parking. It is registered to provide residential and nursing care for up to 70 residents. The home is owned and managed by New Century Care. Accommodation for residents is provided within 'Beeslack' unit in the original Mansion House building and 'Errington' and 'Cowan' suites in the extension, built in 2009. Accommodation in 'Beeslack' is arranged over two floors. On the ground floor, there is a large lounge, dining room, bedrooms and communal bathrooms and toilets. The first floor accommodates further bedrooms, bathrooms and toilet facilities and can be accessed by a lift or stairs. 'Erringtonsuite toilet facilities, three lounges, a dining room and hairdressing room. There are also additional bathing and toilet facilities throughout the building. Aaron House aims to provide: "a quality service to meet our residents care needs - social, emotional, spiritual and physical. Therefore the care we offer will meet with residents changing needs". 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, 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. Recommendations are based on the National Care Standards, relevant codes of practice and recognised good practice. A requirement is a statement, which sets out what is required of a care service to comply with the Public Services Reform (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 Care Inspectorate. Aaron House Care Home, page 5 of 36
Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 3 - Adequate Quality of Environment - Grade 3 - Adequate Quality of Staffing - Grade 3 - Adequate Quality of Management and Leadership - Grade 3 - Adequate 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 0345 600 9527 or visiting one of our offices. Aaron House Care Home, page 6 of 36
2 How we inspected this service The level of inspection we carried out In this service we carried out a high intensity inspection. We carry out these inspections where we have assessed the service may need a more intense inspection. What we did during the inspection We wrote this report following an unannounced inspection. This was carried out by two inspectors. The inspection took place on 11 March 2015 between 8am and 4.30pm. We gave feedback to the manager and the area manager on the same day. As part of the inspection, we took account of the completed annual return and selfassessment forms that we asked the provider to complete and submit to us. During this inspection process, we gathered evidence from various sources, including the following: We spoke with a number of staff working in the home on the days of our inspection. This included the home manager, Peripatetic Manager, registered nurses and care assistants. We spoke with residents individually and in groups settings within lounges and other areas throughout the home. We also spoke with relatives, family and friends who visited the home during our inspection days. We looked at documents and records during our inspection, including: Staffing schedule. Registration certificate. Minutes of residents', relatives and staff meetings. Newsletters. Sample of care plans. Accident and incident records. Complaints log. Staff recruitment files. Quality assurance audits. Information displayed around the home. The environment and equipment. Aaron House Care Home, page 7 of 36
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 Aaron House Care Home, page 8 of 36
What the service has done to meet any requirements we made at our last inspection The requirement Requirement 1 The provider must ensure that all residents' personal plans are reviewed at least once in every six month period, or when there is a significant change in a service user's health, welfare or safety needs. Consideration should be given on how reviews evidence: a) Residents and/or representatives involvement in reviews. b) If unable to attend, how residents and/or representative views were obtained and that they received a copy of the review. c) Changes required following the review and if/when these were actioned. What the service did to meet the requirement We have written about this under Quality Theme 1, Quality Statement 1 The requirement is: Met - Outwith Timescales The requirement Requirement 2 When planning and delivering support the provider must ensure that residents have opportunities to take part in appropriate social, recreational and stimulating activities to enable them to fulfil their potential and experience a good quality of life. In order to do this, the provider must: a) Ensure activities offered and provided are in line with residents' identified interests, needs choices and preferences. b) Consider how care staff can incorporate meaningful activities into residents' daily routines when the activity coordinator is not on duty. What the service did to meet the requirement We have written about this under Quality Theme 1, Quality Statement 2 The requirement is: Not Met Aaron House Care Home, page 9 of 36
The requirement Requirement 3 The provider must ensure that the nutritional needs of residents are met. In order to achieve this, the provider must: a) Ensure there are policies and procedures in place for staff to follow when there are concerns about a residents' intake b) Review staff practice and management of mealtimes to improve the dining experience of residents. This should include a record of actions required, by whom and in what timescale, and when these were completed, in order to evidence improvements in the service. c) Ensure residents weights and MUST's are recorded regularly (and at least monthly) and in accordance with any recommendations from the Dietician. d) Ensure that recommendations from the Dietician regarding special diets, supplements or food first approach should be clearly documented in care plans and implemented. e) Where there are concerns about a residents' intake, this should be competently recorded by staff. Food charts should be monitored and evaluated by senior staff on a daily basis and appropriate actions taken to help improve their intake. This requirement was combined with another requirement about nutrition and dining arising from a complaint investigation. The provider must ensure adequate care and support for residents with regard to nutrition. In order to achieve this the service should; (a) Introduce regular planned consultation with residents and their relatives/visitors about the meals served in the home. (b) Introduce robust systems to ensure that meals reflect those stated in the menu made available to residents. Consideration could also be given to introduce a visual choice to residents who may find it difficult to express an opinion. This means that residents will know what is available at mealtimes and can make choices. (c) Review the meals served in the home so that they reflect choice and include a good balance of fresh fruit and vegetables. (d) Introduce robust systems and guidance for staff to ensure the optimum temperature of hot food checked and maintained. (e) Appropriate protective clothing should be worn by all staff to ensure good food hygiene practice when handling foods. What the service did to meet the requirement We have written about this under Quality Theme 1, Quality Statement 3 The requirement is: Not Met Aaron House Care Home, page 10 of 36
The requirement Requirement 4 The provider must ensure there are adequate systems in place for monitoring service users' fluid intake when there are concerns. In order to achieve this, the provider must: a) Ensure there are policies and procedures in place for staff to follow when there are concerns about a residents' intake. b) Review their system of assessing if residents are at risk of not achieving a healthy fluid intake. c) Ensure residents assessed as at being risk of not drinking enough, have their fluid intake competently recorded. This should include a record of drinks offered and taken and be totalled in each 24 hour period. d) Fluid charts should be monitored and evaluated by senior staff on a daily basis. Where fluid intake is not sufficient, action to assist the resident to improve their intake is identified, recorded in the personal plan and carried out. e) Ensure that fluids should be thickened to the consistency recommended by other health professionals such as dieticians or speech and language therapists. What the service did to meet the requirement We have written about this under Quality Theme 1, Quality Statement 3 The requirement is: Met - Within Timescales The requirement Requirement 5 The provider must ensure they meet the needs of residents who are at risk of damage to the skin from pressure. In order to do this they must ensure that: a) Skin care risk assessments are complete on a regular basis and when here is a change of circumstances or residents' health. b) Care plans have information on the type of pressure reducing equipment to be used, the appropriate setting according to the residents' assessed clinical needs and the frequency of re-positioning the resident needs according to their assessed needs. c) Pressure relieving equipment is maintained at the appropriate setting. What the service did to meet the requirement We have written about this under Quality Theme 1, Quality Statement 3 The requirement is: Met - Within Timescales Aaron House Care Home, page 11 of 36
The requirement Requirement 6 The provider must make proper provision for the health and welfare of service users. In order to do so, the Provider must maintain residents' safety in all areas of the home. In order to do this the provider must: a) Ensure a falls risk assessment is completed for each resident. This must be reviewed and updated at regular intervals, and after each fall or change of circumstance. This must be done in accordance with the organisations 'Prevention of falls' policy and effectively implemented. b) Ensure residents individual care plans have sufficient detail on the actions required by staff to help reduce the likelihood of a resident falling. This information must be made available to all staff members to ensure they have knowledge of what support is required to be provided in order to minimise falls. c) Consider the location of call bells and residents' ability to recognise the need for help and use call bells. Where residents cannot access or use call bells, the service should put equipment or a system in place to ensure residents are able to summon and receive assistance promptly. d) Ensure that staff are deployed appropriately in order to supervise residents in all areas of the home including shared lounges, dining rooms and bedrooms. What the service did to meet the requirement We have written about this under Quality Theme 2, Quality Statement 2 The requirement is: Met - Outwith Timescales The requirement Requirement 7 The provider must ensure that the environment is safe and service users are protected. In order to do this, the provider must ensure: a) That all areas of the home are kept clean and free from odours. b) A system is in place to clean all equipment, including commodes, moving and handling equipment and wheelchairs. c) A system is in place for regular cleaning of all areas of the home and equipment and that this is recorded, monitored and evaluated on a regular basis. What the service did to meet the requirement We have written about this under Quality Theme 2, Quality Statement 2 The requirement is: Met - Within Timescales Aaron House Care Home, page 12 of 36
The requirement Requirement 8 The provider must review the management and procedure for serving food and ensure food is served at a safe temperature and in line with good food hygiene practices. What the service did to meet the requirement We have written about this under Quality Theme 2, Quality Statement 2 The requirement is: Met - Within Timescales The requirement Requirement 9 1. The service provider must ensure medication is managed in a manner that protects the health, welfare and safety of service users. In order to achieve this, the provider must ensure; a) Administration of medication or reason for omission must be recorded on the MAR, TMAR and controlled drug sheet at the time of administration. b) Creams and ointments are labelled with the resident's details and date of opening. c) Ensure that staff are aware of, and follow good practice, in applying and recording creams and ointments. What the service did to meet the requirement We have written about this under Quality Theme 3, Quality Statement 3 The requirement is: Not Met The requirement Requirement 10 The provider must ensure that all staff receive training appropriate to their role. In order to do this, the provider must: a) Review staff training needs for all staff working in the care home and provide the training that it has identified that staff require. b) Ensure there is a system in place to assess that this is reviewed on an on-going basis. c) Review the induction programme for new staff to ensure there is initial training, observation/shadow opportunities and competency checks in place relevant to their role. d) A staff training plan must be in place which details when training will be provided. Training should consider current good practice guidance and must include, but not be Aaron House Care Home, page 13 of 36
restricted to: - moving and handling. - nutrition/hydration for older people. - Falls prevention management. - person-centred care planning. - management of stress and distress (behaviours that challenge). e) Provide the Care Inspectorate with a copy of the training plan. What the service did to meet the requirement We have written about this under Quality Theme 3, Quality Statement 3 The requirement is: Met Requirement 11 The provider must ensure that there is sufficient staff working in the care home to meet the needs and requests of all service users. The provider must ensure they are meeting at least the minimal staffing levels detailed in Condition 2 on their Registration Certificate and must increase staffing levels as per the increase in the dependency needs of the residents. What the service did to meet the requirement We have written about this under Quality Theme 4, Quality Statement 4 The requirement is: Not Met What the service has done to meet any recommendations we made at our last inspection We made a total of 20 recommendations after the last inspection. We have detailed these under the Quality Themes and Statements in this report. Of the 20 recommendations, 14 had been met. 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: Yes - Electronic Comments on Self Assessment Aaron House Care Home, page 14 of 36
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 did not request an updated self-assessment for this inspection. Taking the views of people using the care service into account During our inspection we spent time speaking with residents in lounge and dining areas and in their own bedrooms. Some residents had dementia or other communication difficulties and were not able to tell us what they thought about the home but we were able to judge their wellbeing by watching how they responded to staff. Residents responded positively to the care offered by staff. Taking carers' views into account We spoke with two relatives visiting the home. The relatives we spoke with, overall, were happy with the care and support given to their relative. We have included some relatives' views in the body of the report. Aaron House Care Home, page 15 of 36
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: 3 - Adequate 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 This inspection was focussed on following up requirements and recommendations made previously. We did not look at all aspects of this Quality Statement. As at previous inspections, we saw that the service had a range of ways that residents and relatives could give their views on the quality of the service or the care and support they received. Separate meetings were held for residents and relatives. Minutes of meetings showed that people were able to raise issues or concerns and were asked for suggestions and views on changes to aspects of the service, such as options for a new activity programme. We saw that the agenda for forthcoming relatives' meetings was available and displayed near the entrance to the home. We saw that the service had made attempts to keep people updated regarding the recent changes. The relatives we spoke with said they felt that they were kept informed of their relatives' care and support needs and were contacted about any changes or issues. Information was displayed in the home to keep people up-to-date on forthcoming events and activities, such as We made one requirement after the last inspection: Aaron House Care Home, page 16 of 36
"The provider must ensure that all residents' personal plans are reviewed at least once in every six month period, or when there is a significant change in a service user's health, welfare or safety needs. Consideration should be given on how reviews evidence: a) Residents and/or representatives involvement in reviews. b) If unable to attend, how residents and/or representative views were obtained and that they received a copy of the review. c) Changes required following the review and if/when these were actioned. We saw that most care plans had been reviewed recently and the remainder were planned.. Care reviews ensure that residents and relatives/carers have an opportunity to contribute and express individual preferences in their planned care. The service had put a planner in place to ensure that all future care reviews were completed within the expected timescales. We were satisfied that the requirement was met and we will monitor the review process at future inspections to ensure this is maintained. Areas for improvement A new Manager had been appointed and was going through induction within the home, supported by the peripatetic Manager who had been managing the home while the post was vacant. We agreed that some time was needed for the Manager to settle in and establish his own links with residents and relatives. We made two recommendations after the last inspection. One was related to the minutes of meetings and had been met. The other was about communication within the home. The Managers advised us that this was a 'work in progress' while the new Manager settled into the home. We have left the recommendation in place and will follow it up at the next inspection. Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The service should review the current communication systems which are in place to ensure they are effective and relatives and/or chosen representatives are being informed of key information. This should be discussed with relatives to confirm when and in what circumstances they want to be contacted. This takes account of the National Care Standards, Care Homes for Older People, standard 6 - support arrangements. Aaron House Care Home, page 17 of 36
Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths This inspection was focussed on following up requirements and recommendations made previously. We did not look at all aspects of this Quality Statement. Care Planning After the last inspection we made a requirement: The Provider must ensure all residents have a personal care and support plan which identifies all their needs and how those needs are to be met. Healthcare risk assessment must be undertaken and completed and risk reduction measures recorded to provide guidance to care staff on how these measures are to be implemented and risks reduced. Care and support plans must be reviewed frequently to ensure they are effective and providing positive outcomes for residents. We also made two recommendations: 1. It is recommended that the service should develop the residents' personal plans to contain detailed, personalised information that would guide staff in providing care and support in a person centred way. This should include details about individual likes and preferences and an assessment of resident's social and recreational needs and how this should be met. 2. The service should be developing and implementing advanced care planning for each resident to determine their wishes and choices in such circumstances. Consultation must be done with those who are important to them. All residents had an appropriate care plan in place which included family involvement, physical care needs and social needs as well as advanced planning for the future. The requirement and recommendations were met. We will continue to monitor care plans at future inspections to ensure these are consistently maintained. Hydration After the last inspection we made a requirement: The provider must ensure there are adequate systems in place for monitoring service users' fluid intake when there are concerns. In order to achieve this, the provider must: a) Ensure there are policies and procedures in place for staff to follow when there are concerns about a residents' intake. b) Review their system of assessing if residents are at risk of not achieving a healthy fluid intake. c) Ensure residents assessed as at being risk of not drinking enough, have their fluid Aaron House Care Home, page 18 of 36
intake competently recorded. This should include a record of drinks offered and taken and be totalled in each 24 hour period. d) Fluid charts should be monitored and evaluated by senior staff on a daily basis. Where fluid intake is not sufficient, action to assist the resident to improve their intake is identified, recorded in the personal plan and carried out. e) Ensure that fluids should be thickened to the consistency recommended by other health professionals such as dieticians or speech and language therapists. We also made a recommendation: It is recommended that staff implement best practice guidance to ensure appropriate support and monitoring practices to maintain adequate hydration. We found that staff had a good level of awareness about fluids and the hydration needs of residents. There were detailed records kept where there was a concern about an individual resident and nursing staff had oversight of these. Staff were following guidance from the dietician or speech and language therapist about the consistency of fluids. The requirement and recommendation were met. Skin Care After the last inspection we made a requirement: The provider must ensure they meet the needs of residents who are at risk of damage to the skin from pressure. In order to do this they must ensure that: a) Skin care risk assessments are complete on a regular basis and when here is a change of circumstances or residents' health. b) Care plans have information on the type of pressure reducing equipment to be used, the appropriate setting according to the residents' assessed clinical needs and the frequency of re-positioning the resident needs according to their assessed needs. c) Pressure relieving equipment is maintained at the appropriate setting. We found that the staff were using appropriate documentation to record the risks for each resident and these were updated regularly. We checked equipment that was in use and found it was set correctly and in line with the assessment that was recorded in the care plan. The requirement was met. Falls risk assessments After the last inspection we made a recommendation: Residents, families and chosen representatives should be fully involved in developing and evaluating fall risk assessments and action plans. Aaron House Care Home, page 19 of 36
We examined care plans and saw that family members and carers were involved in the planning process and were signing documentation to say they had seen and agreed with the content. The recommendation was met. Areas for improvement Activities We made a requirement after the last inspection: When planning and delivering support the provider must ensure that residents have opportunities to take part in appropriate social, recreational and stimulating activities to enable them to fulfil their potential and experience a good quality of life. In order to do this, the provider must: a) Ensure activities offered and provided are in line with residents' identified interests, needs choices and preferences. b) Consider how care staff can incorporate meaningful activities into residents' daily routines when the activity coordinator is not on duty. The activity co-ordinator was recently in post and was beginning to develop activity plans for each resident. We noted that there was still some development to be done with what happened during the times the activity co-ordinator was not on duty. We discussed the issue with the Manager, who was aware of this and was planning training for care staff. We have left the requirement in place to allow the development to continue (requirement 1) Nutrition After the last inspection we made three requirements about nutrition, the way meals were served and the way staff recorded food intake. We found that considerable work had been carried out to meet these requirements and the majority of them had been met, with only a few issues remaining. We found that care plans included relevant information about nutrition including regular assessments using the Malnutrition Universal Screening Tool (MUST). If a resident was not eating well, staff were recording what they ate and drank on charts and the charts we looked at had been completed fully. Staff were checking the food being served to ensure it was served at the correct temperature. Staff were following good practice with food hygiene and were wearing the correct protective clothing. However, we saw that the staffing arrangements for serving meals were disorganised and there were not enough staff available to assist all the residents who needed help to eat. This meant they had to wait for long periods before having their meal and staff helping more than one person at the same time. Aaron House Care Home, page 20 of 36
We saw that some residents were not always aware of the menus choices that were available to them. This included residents who told us that they did not know that they could have a cooked breakfast if they wished. We have made a requirement about these issues (requirement 2). Appearance After the last inspection we made a recommendation: The provider should ensure that all residents are given the time and support they need to maintain their appearance. The majority of residents appeared well groomed and were clearly being helped to dress the way they wished. However we saw a few residents who had spilled food on their clothing at mealtimes and staff had not noticed this. We have made a recommendation about this (recommendation 1) We also found some residents who had not been helped with cleaning their teeth. We have made a requirement about this. (requirement 3) After the last inspection we made a recommendation: We recommend that the provider reviews the support needs for residents being cared for in bed to ensure that, if appropriate, they have been assessed for specialist equipment that would assist them to spend time out of bed. Care plans should have clear information on the rationale for residents being fully cared for in bed. We found that appropriate assessments for equipment were in place. However the documentation of the rationale for residents spending most or all of their time in bed was not always clear. We have left the recommendation in place to allow staff time to fully record these details.(recommendation 2) Grade awarded for this statement: 3 - Adequate Number of requirements: 3 Number of recommendations: 2 Requirements 1. When planning and delivering support the provider must ensure that residents have opportunities to take part in appropriate social, recreational and stimulating activities to enable them to fulfil their potential and experience a good quality of life. In order to do this, the provider must: a) Ensure activities offered and provided are in line with residents' identified interests, needs choices and preferences. b) Consider how care staff can incorporate meaningful activities into residents' daily routines when the activity coordinator is not on duty. This is to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210) Principles and Aaron House Care Home, page 21 of 36
Regulation 3 Timescale: Before 31 August 2015 2. The service provider must ensure that the nutritional needs of residents are met at all times. In order to achieve this they must: a/ Review the mealtime arrangements to ensure that there are sufficient staff available to assist residents who need help to eat. b/ Ensure that residents are aware of the menu choices that are available to them, including the option to have a cooked breakfast if they wish. This is to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210) Regulation 3 Timescale: This was required from the date of the inspection and on a continuing basis 3. The provider must ensure that residents receive adequate help to maintain their oral hygiene. Accurate records must be maintained of the help given. This is to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210) Regulation 3 Timescale: This was required from the date of the inspection and on a continuing basis Recommendations 1. Staff should ensure that residents are assisted to change their clothing when necessary. This takes account of National Care Standards, Care Homes for Older People, Standard 5 - Management and staffing arrangements and Standard 16.10 2. We recommend that the provider reviews the support needs for residents being cared for in bed to ensure that, if appropriate, they have been assessed for specialist equipment that would assist them to spend time out of bed. Care plans should have clear information on the rationale for residents being fully cared for in bed. This takes account of National Care Standards, Care Homes for Older People,Standard 5 - Management and staffing arrangements Aaron House Care Home, page 22 of 36
Quality Theme 2: Quality of Environment Grade awarded for this theme: 3 - Adequate Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the environment within the service. Service strengths The strengths identified under Quality Theme 1, Statement 1 also apply to this statement and support residents and relatives/carers to participate in assessing and improving the quality of the environment within the service. Areas for improvement The areas for development described in Quality Theme 1, Statement 1 are also relevant to this statement. Grade awarded for this statement: 3 - Adequate 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 This inspection was focussed on following up requirements and recommendations made previously. We did not look at all aspects of this Quality Statement. Falls management After the last inspection we made a requirement: 1. The provider must make proper provision for the health and welfare of service users. In order to do so, the Provider must maintain residents' safety in all areas of the home. In order to do this the provider must: a) Ensure a falls risk assessment is completed for each resident. This must be reviewed and updated at regular intervals, and after each fall or change of circumstance. This must be done in accordance with the organisations 'Prevention of falls' policy and effectively implemented. Aaron House Care Home, page 23 of 36
b) Ensure residents individual care plans have sufficient detail on the actions required by staff to help reduce the likelihood of a resident falling. This information must be made available to all staff members to ensure they have knowledge of what support is required to be provided in order to minimise falls. c) Consider the location of call bells and residents' ability to recognise the need for help and use call bells. Where residents cannot access or use call bells, the service should put equipment or a system in place to ensure residents are able to summon and receive assistance promptly. d) Ensure that staff are deployed appropriately in order to supervise residents in all areas of the home including shared lounges, dining rooms and bedrooms. We found that there had been considerable improvement in the recording of falls and the risk assessment processes. The staff on duty were deployed as efficiently as possible to supervise residents. This requirement was met. However we found residents in lounges were sometimes left unsupervised while staff were occupied with other responsibilities. We had made a requirement about staffing levels after the last inspection and this will be carried forward.(requirement 2) After the last inspection we made a requirement: The provider must ensure that the environment is safe and service users are protected. In order to do this, the provider must ensure: a) That all areas of the home are kept clean and free from odours. b) A system is in place to clean all equipment, including commodes, moving and handling equipment and wheelchairs. c) A system is in place for regular cleaning of all areas of the home and equipment and that this is recorded, monitored and evaluated on a regular basis. We visited all public areas in the home and a sample of bedrooms. We found the home was clean and there were no unpleasant smells. The equipment was cleaned regularly. The requirement was met. After the last inspection we made a requirement: The provider must review the management and procedure for serving food and ensure food is served at a safe temperature and in line with good food hygiene practices. We watched staff working and found that they had a good understanding of food hygiene and were using protective clothing appropriately The food temperatures were being checked and recorded. The requirement was met. After the last inspection we made a recommendation: The provider should review all linen, pillows and duvets to ensure they are in good condition and there are sufficient stocks for all areas of the home. Aaron House Care Home, page 24 of 36
We found that the pillows and duvets were in good condition and we noted that new items had been purchased. The recommendation was met. Areas for improvement After the last inspection we made a requirement: The provider must ensure that there is sufficient staff working in the care home to meet the needs and requests of all service users. The provider must ensure they are meeting at least the minimal staffing levels detailed in Condition 2 on their Registration Certificate and must increase staffing levels as per the increase in the dependency needs of the residents. We found that there was no up to date dependency assessment for the current residents in the home. This would allow the Manager to ensure that staffing levels were appropriate to the needs of the residents. We have made a requirement about this. (requirement 1) The provider was unable to evidence that this requirement was met, in particular in relation to the observation of residents in lounges. (requirement 2) After the last inspection we made a recommendation: It is recommended that topical creams and ointments are labelled with the resident's details and date of opening. This would help staff judge when to dispose of or replace topical medicines and to ensure they are applied within the manufacturers guidelines. We found a number of items which had not been labelled appropriately. The Manager told us that he was carrying out a full medication audit.the recommendation was not met and is carried forward. (recommendation 1) After the last inspection we made a recommendation: The service should review the laundry system to ensure resident's clothing is being labelled and returned to the correct resident. We noted that there were still reports of items not being returned to residents in good time. This recommendation had not been met and is carried forward.(recommendation 2) After the last inspection we made a recommendation: It is recommended that all opened foodstuffs are labelled with a date of opening to assist staff in ensuring that these are stored and served in line with the manufacturers' guidelines and best practice in food hygiene. Aaron House Care Home, page 25 of 36
We found a number of items in cupboards and fridges in the home that had not been labelled. The recommendation was not met and is carried forward.(recommendation 3) Grade awarded for this statement: 3 - Adequate Number of requirements: 2 Number of recommendations: 3 Requirements 1. The service provider must carry out an assessment of dependency levels using a recognised assessment tool and update the assessment regularly. This is to comply with Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210), Regulation 4 (1) (a). This also takes account of the National Care Standards, Care Homes for Older People, Standard 5 - Management and staffing Timescale: This was to commence at the time of the inspection and on a continuing basis. 2. The provider must ensure that there is sufficient staff working in the care home to meet the needs and requests of all service users. The provider must ensure they are meeting at least the minimal staffing levels detailed in Condition 2 on their Registration Certificate and must increase staffing levels as per the increase in the dependency needs of the residents. This is to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210) Regulation 15 (a) Staffing and 4 (1)(a) Welfare of Users. This takes account of National Care Standards, Care homes for older people, Standard 5 - Management and staffing arrangements. Timescale: for completion within 24 hours on receipt of this report. Recommendations 1. It is recommended that topical creams and ointments are labelled with the resident's details and date of opening. This would help staff judge when to dispose of or replace topical medicines and to ensure they are applied within the manufacturers guidelines. This takes account of National Care Standards, Care Homes for Older People, Standard 15, Keeping well - medication. 2. The service should review the laundry system to ensure resident's clothing is being labelled and returned to the correct resident. This takes account of National Care Standards, Care Homes for Older People, Standard 16 - Private Life. 3. It is recommended that all opened foodstuffs are labelled with a date of opening to assist staff in ensuring that these are stored and served in line with the Aaron House Care Home, page 26 of 36
manufacturers' guidelines and best practice in food hygiene. This also takes account of National Care Standards - Care Homes for Older People, Standard 4 - your environment. Aaron House Care Home, page 27 of 36
Quality Theme 3: Quality of Staffing Grade awarded for this theme: 3 - Adequate Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service Strengths The strengths identified under Quality Theme 1, Statement 1 also apply to this statement and support residents and relatives/carers to participate in assessing and improving the quality of the staffing within the service. Areas for improvement The areas for development described in Quality Theme 1, Statement 1 are also relevant to this statement. Grade awarded for this statement: 3 - Adequate 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 This inspection was focussed on following up requirements and recommendations made previously. We did not look at all aspects of this Quality Statement. After the last inspection we made two requirements and two recommendations about training: 1. The provider must ensure that all staff receive training appropriate to their role. In order to do this, the provider must: a) Review staff training needs for all staff working in the care home and provide the training that it has identified that staff require. b) Ensure there is a system in place to assess that this is reviewed on an on-going basis. c) Review the induction programme for new staff to ensure there is initial training, observation/shadow opportunities and competency checks in place relevant to their Aaron House Care Home, page 28 of 36
role. d) A staff training plan must be in place which details when training will be provided. Training should consider current good practice guidance and must include, but not be restricted to: - moving and handling. - nutrition/hydration for older people. - Falls prevention management. - person-centred care planning. - management of stress and distress (behaviours that challenge). e) Provide the Care Inspectorate with a copy of the training plan. 2. The provider must ensure that staff employed are adequately trained appropriate to the work they are to perform. The staff must be assessed by the provider as competent in their practice and suitably qualified to recognise changes in resident's health and wellbeing. 3.The service should review how staff competencies are being monitored and assessed to ensure staff are meeting the requirements of their role and job descriptions. 4. It is recommended that the service review their system for providing staff supervision to ensure that all staff receive regular planned supervision to allow for discussion on staff practice, training needs and future development. Records should be kept of supervision meetings. There was an appropriate and comprehensive training plan in place. The staff we spoke with told us that they had received a lot of training recently and were enthusiastic about the future training that was planned. There was evidence that staff competencies were being assessed regularly and there were records of supervision taking place. The requirements and recommendations were met and we will continue to monitor training and supervision in the home to ensure the progress is maintained. After the last inspection we made a recommendation: It is recommended that the all safe recruitment procedures are followed so that the provider is able to demonstrate that all prospective employees are fit to be employed in the service. This should include: a) That where additional checks are needed, such as checking gaps in application forms, this is clearly documented and carried out. b) Completed PVG scheme membership or updates are complete and in place prior to staff starting work in the service. Aaron House Care Home, page 29 of 36
We examined a sample of recruitment records and found that appropriate checks were being carried out. The recommendation was met. Areas for improvement The Manager and staff should continue to take forward the improvements that have been made. Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0 Aaron House Care Home, page 30 of 36
Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 3 - Adequate 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 The strengths identified under Quality Theme 1, Statement 1 also apply to this statement and support residents and relatives/carers to participate in assessing and improving the quality of the management and leadership within the service. Areas for improvement The areas for development described in Quality Theme 1, Statement 1 are also relevant to this statement. Grade awarded for this statement: 3 - Adequate 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 This inspection was focussed on following up requirements and recommendations made previously. We did not look at all aspects of this Quality Statement. A new Manager was in post and was having an induction period alongside the previous temporary Manager to ensure continuity. He had identified a number of priority areas which he wanted to develop and these were also in line with the findings of this inspection. After the last inspection we made a recommendation: The service should ensure that audits have clear information on what has been audited and have an action plan to evidence actions taken. This should include actions required, by whom, in what timescale and when they were completed. Aaron House Care Home, page 31 of 36