Abbotsford Care, Kinglassie Care Home Service Mina Crescent Kinglassie Lochgelly KY5 0XT Telephone: 01592 882950 Type of inspection: Unannounced Inspection completed on: 18 August 2016 Service provided by: Abbotsford Care (Glenrothes) Limited Service provider number: SP2010010867 Care service number: CS2010248945
About the service Abbotsford Care, Kinglassie (known as Mina Lodge) is registered with the Care Inspectorate to provide care and support to people with a range of needs and ages. This includes people living with dementia, people who are physically frail and people with learning disabilities. Mina Lodge has two units within the care home, each offering accommodation for a maximum of 12 people. Both units have kitchen, dining and lounge areas and a communal bathroom and shower room. The home is on one level. People are not restricted to one unit and some people choose to spend time across the home. At the time of the inspection, one unit offered accommodation and care to people with learning difficulties (Jura) and the other unit to older people (Islay). When we visited, 19 people were living in the home. The garden space is easily accessed from both units and there has been a focus on improving the gardens. We saw the garden used and enjoyed. The care home is situated in a residential area and has a strong base in the community of Kinglassie. People are well placed to access facilities and events within the local community. This service was previous registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April 2011. What people told us There were no visiting relatives in the home during our inspection visit. We sent out 15 questionnaires to relatives /carers who visit Mina Lodge and had 2 returned to us. Overall, people said that they were satisfied with the home. Comments included: "We are very grateful to the staff at Abbotsford." "Occasionally clothes can be worn by my mother that are not hers." "There have been occasions when there have been shortages of trained staff, which puts pressure on the existing staff available." "I used to receive a monthly programme sheet giving details of activities taking place everyday in the forthcoming month. This no longer happens and may be due to staff shortages, it means I do not know what activities the residents are engaging in on a daily basis." The views and feedback from people living in the home are included in the body of the report. All comments were shared with the management and provider and they told us that these comments would be responded to. for Abbotsford Care, Kinglassie page 2 of 14
Self assessment The provider submitted a self assessment to the Care Inspectorate but this did not provide strong evidence of the use of quality assurance systems or improvement plans to develop the service in a systematic way. The provider's assessment of the service reflected upon policies and procedures and not the outcomes for people. There was limited indications of the provider involving people using the service or the staff team in undertaking 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 3 - Adequate Quality of care and support Findings from the inspection People had key workers to support them, their photo was on display and their names were recorded in care plans. Staff understood their key working responsibilities. People's care needs were reviewed in a more meaningful and planned way and relatives were invited to these meetings. The social work department were completing reviews of people's care and, overall, relatives and people involved in reviews were positive about life in Mina Lodge. We concluded a recommendation from the previous inspection about review meetings was met. The service had improved links with health professionals; for example, staff including the cook had met with the speech and language therapist (SALT) and learned about how someone's swallowing was impaired and how they now needed support to eat and drink. The cook had also met with the dietician and, as a result, had more knowledge about preparing textured meals. This meant that meal choices for people were more appropriate. One person with a diagnosis of dementia could become distressed and needed a lot of reassurance and support. The staff were working alongside relevant professionals to monitor and assess this individual's behaviours so that they could have an effective personal support plan in place. This was a positive development. We observed some very positive interactions with staff who showed warmth and compassion. People were treated as individuals and we saw some good examples of people being supported, whilst being encouraged to remain independent. We found the overall care of people had improved, whilst recognising there were areas for improvement. for Abbotsford Care, Kinglassie page 3 of 14
We found that care plans still need to be further developed by the service to reflect the support people require. Care plans were often not updated and it could be difficult to find information. There was little evaluation of care plans. For example, if someone had lost weight, care plans did not describe what would be done to help that person gain weight and sometimes the information about how often someone would be weighed was not consistent. The recommendation made at the previous inspection remains. (Recommendation 1). There were examples where people or staff had identified things that could improve or things that they would like - but it was difficult to know what had happened as a result of these suggestions. We spoke with the management and provider about following through on ideas or action plans and the importance of this. Requirements Number of requirements: 0 Recommendations Number of recommendations: 1 1. Recommendation with reference to Theme 1, Statement 3: Care planning should be improved to evidence: (a) - The support of residents who demonstrate stressed and distressed reactions, including any known causes or triggers, detail early signs or indicators of agitation and outline a range of interventions to be used. This could include: the person's symptoms of disturbance, what is likely to cause/trigger this behaviour, how this is best managed for that person. The Care Plans should reflect: (b) - A staged approach to the administration of 'as required' medication prescribed to manage stress, distress and anxiety, the medication and dose prescribed, and the circumstances under which the medication should be administered of interventions to be used. Reference is made to: National Care Standards Care Homes for Older People - Lifestyle - Keeping Well - Healthcare Standard 5 - Management and staffing arrangements Standard 14 - Care Homes for Older People - Lifestyle - Keeping Well - Healthcare Grade: 4 - good for Abbotsford Care, Kinglassie page 4 of 14
Quality of environment Findings from the inspection We walked around all communal areas and looked at people's bedrooms when they invited us to. We found that the home was comfortable and communal lounge and dining areas were clean and well maintained. The 'quiet room' had been re-arranged and was more inviting. Some people living in the home were now able to use the computer in this room, which meant that they had easier access to their interests and information. The kitchen in Islay unit had new flooring which improved the room significantly. The general cleanliness of communal bathrooms and toilets could be much improved and this was addressed by management during our visit. An audit had been carried out using the "How dementia friendly is your care home?" Kings Fund assessment. An action plan was in place with points identified for improvement and we will measure the progress made at our next inspection. The garden was being used more by people. Staff had bought a bird feeder with a donation made to the home and people both indoors and outdoors were enjoying watching the birds that visited to feed. A strawberry patch was being cared for by those in the home and people were delighted to be eating the strawberries that they had grown. A few people in particular were spending much more time outdoors and really benefiting from it. Mina Lodge has links in the local community and people had recently attended the tea dance and told us how much they enjoyed it. During our visit, an individual went with staff to the shop and, afterwards, was more settled and relaxed in their home. At care reviews, people spoke of wanting to spend more time out and about, and this was recognised by staff as being really important. We identified ways that activity planning could be more personalised and meaningful. For example, some weekly activity planners in people's care plans were very general and did not relate well to their interests. Staff also spent time recording activities in care plans such as 'watched TV, listened to radio'. These are daily activities for most of us and we advised that staff use their time more effectively finding out about people's lives, interests and how they now want to spend their day. The service needs to develop a system to make sure that maintenance requests are followed through; for example, a bath seat had been reported as broken for several weeks but no one had followed this up and questioned the time taken for the repair. In another situation, a call buzzer had been faulty for months - this was not impacting upon people's safety - but should have been identified as still requiring repair. A recommendation was made. See Recommendation 1. Requirements Number of requirements: 0 Recommendations Number of recommendations: 1 1. It is recommended that the service review and improve current environmental checks to ensure the safety and wellbeing of people who use the service. for Abbotsford Care, Kinglassie page 5 of 14
The provider must ensure that a robust programme of maintenance is in place to identify and rectify concerns timeously. The provider must ensure that documentation in relation to environment checks, maintenance and repairs evidences the reporting structure and the outcomes. This must include work carried out by external tradesmen and contactors. Reference is made to: National Care Standards - Care Homes for Older People Standard 4 - Standard 5 - Management and Arrangements Standard 9 - Feeling Safe and Secure Grade: 4 - good Quality of staffing Findings from the inspection The manager had focused on developing the staff teams. Staff motivation and morale had increased as a result of improved support, communication and involvement. Formal and informal meetings happened regularly and staff told us that they could make suggestions and were listened to. Staff respected the fact that the management knew people's needs and regularly worked alongside the staff team to provide people's care and support. There was a stable staff group at Mina Lodge. numbers were in keeping with the dependencies and number of people in the home and staff told us that, mostly, an extra staff member was available between the two units and that this was really essential. There were increased training opportunities. An electronic on-line learning system was used to cover important topics such as adult protection, duty of care and infection control. Staff also attended 'core' training as required; this included moving and handling techniques. Importantly, staff had attended learning sessions specific to people's needs. For example, the cook and charge nurse had met with the dietician and discussed people who required a reducing diet. These training opportunities resulted in better care and improved outcomes for people. There was no clear overview of staff training that could identify training completed and when training updates were due. The senior manager and records we examined informed us that a new IT system for recording training and highlighting training needs was being planned. This is a positive development. Systems for recording, monitoring and evaluating staff's supervision need to be further developed to ensure that regular dates are set and that areas for professional development are followed through. We previously advised that the service expand on the formal methods used to assess staff's overall competency. This recommendation has been amended to reflect some development but remains (Recommendation 1). for Abbotsford Care, Kinglassie page 6 of 14
The need for more in depth Adult Support and Protection training had been identified and was being arranged with the local authority. Requirements Number of requirements: 0 Recommendations Number of recommendations: 1 1. Recommendation with reference to Theme 3, Statement 3: The service is recommended to formalise and improve the existing competency assessment framework to satisfy themselves that training which has been delivered to staff is being applied in practice and resulting in consistently positive outcomes for people. This should incorporate observational monitoring of practice and could for example, be included as part of the supervision process. Reference is made to: National Care Standards, Care Homes for Older People - Standard 5 Management and Grade: 4 - good Quality of management and leadership Findings from the inspection Staff we met told us that there was strong leadership and management in the home. The manager and registered nurses were clearly respected and we could evidence progress made since the change of manager. The manager was responsive and committed to ensuring that people were comfortable and happy in their home, supported by a skilled and caring staff team. A new medication audit tool was very thorough and we asked that this was implemented for all people. There was more evidence of involvement from staff and people in Mina Lodge around the home's future plans; the general atmosphere in the home was more relaxed and encouraged this participation. This participation should now be further developed and evaluated; for example, positive links have been made with visiting professionals, their formal views on the service could be sought. The outcomes from participation and service development plans should be shared and on display. A recent service audit identified similar areas that are included in this inspection report. This means that the service should be well placed to progress the areas for development required. for Abbotsford Care, Kinglassie page 7 of 14
We noted a number of areas of work which had not been carried forward to full completion. The lack of structure around quality assurance systems was having an impact in the home. Some audits are more lists as opposed to focusing on content. Quality assurance systems need developed to ensure that action plans are in place and are followed through to evidence that the desired outcome is achieved. A recommendation is made. (Recommendation 1). There has been discussion around the importance of reporting incidents to relevant authorities. The Care Inspectorate and provider have confirmed arrangements and we will continue to work along with the provider and other agencies to ensure appropriate outcomes. Requirements Number of requirements: 0 Recommendations Number of recommendations: 1 1. It is recommended that the service: - review and develop current monitoring systems across the home in order for the quality of the service provided to be accurately assessed - ensure that current auditing systems are being used effectively in order to drive up standards and improve service quality - formally monitor the quality of the care and support provided by care staff - ensure issues of concern identified are appropriately recorded and followed up with outcomes and improvements clearly identified. Reference is made to: National Care Standards - Care Homes for Older People Standard 5 - Management and staffing arrangements Grade: 3 - adequate What the service has done to meet any requirements we made at or since the last inspection Previous requirements There are no outstanding requirements. for Abbotsford Care, Kinglassie page 8 of 14
What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 Recommendation 1 with reference to Theme 1, Statement 1: The service must fully review an individual's healthcare and support needs at least six monthly. All assessments and reviews should be recorded and this document should allow for the individual and their relative/carer to sign that they have participated in the review and agreed with the outcome. Reference is made to: National Care Standards - Care Homes for Older People - Standard 14 - Keeping Well, Standard 11 - Expressing your view. This recommendation was made on 21 August 2015. Action taken on previous recommendation We concluded that this recommendation had been met. In the care files that we sampled, we could see evidence of monthly key worker review meetings and the person receiving the care and their relatives had been involved. These reviews were more detailed than we saw at previous inspection visits and were more person centred. We did share with the management some examples of key information that was not discussed at these meetings and would expect this to be improved upon. We confirmed that relatives had been invited to attend formal six monthly reviews of their relatives' care needs. Some reviews had taken place and others were being arranged. We discussed how the service could further improve the review meetings. The Social Work Department were completing formal reviews of people's care and the reviewing officer told us that, overall, relatives' feedback was positive and that there were good personal outcomes for people at Mina Lodge. Recommendation 2 Recommendation with reference to Theme 1, Statement 3: Care planning should be improved to evidence: (a) - The support of residents who demonstrate stressed and distressed reactions,including any known causes or triggers, detail early signs or indicators of agitation and outline a range of interventions to be used. This could include: the person's symptoms of disturbance, what is likely to cause/trigger this behaviour, how this is best managed for that person. The Care Plans should reflect: (b) - A staged approach to the administration of 'as required' medication prescribed to manage stress, distress and anxiety. -The medication and dose prescribed, and the circumstances under which themedication should be administered of interventions to be used. for Abbotsford Care, Kinglassie page 9 of 14
Reference is made to: National Care Standards Care Homes for Older People - Lifestyle - Keeping Well - Healthcare. Standard 5 - Management and staffing arrangements Standard 14 - Care Homes for Older People - Lifestyle - Keeping Well - Healthcare. This recommendation was made on 21 August 2015. Action taken on previous recommendation We concluded that this recommendation had not been met. Management and staff continued to focus on the care plans and staff had attended training on record keeping and documentation. An audit process was established and on each day of the month an individual had their plan of care reviewed. Staff were becoming more confident in recording as a result of the training they attended. We saw care plans where the level of information about people was good but it was often difficult to find. When there had been a change in people's needs, care plans were not always updated and there was little evaluation of each care plan. We shared with the management and provider several examples. Staff could give positive examples of how to support people who become distressed but care plans and records did not always record outcomes from actions taken, so it was difficult to know what worked well for people. Some staff were unsure when to record incidents. We discussed this fully with the provider and they agreed that staff would benefit from additional support and training to increase their understanding. The manager confirmed this would continue to be a focused area of staff development. When we looked at people's medication records and needs, staff had a good understanding that medication should not always be the first option for reducing a person's anxiety. When medication was given, the effect from this was mostly recorded on medication records. However, in some of the plans of care, this was not recorded or could be improved upon. Potentially, poor recording and evaluation of people's healthcare needs can affect their health and wellbeing. It is strongly recommended that care planning and evaluation remains a focus for the service. Recommendation 3 Recommendation with reference to Theme 3, Statement 3: It is recommended that the service introduce a competency assessment framework to satisfy themselves that training, which has been delivered to staff, is being applied in practice and resulting in positive outcomes for residents. This should incorporate observational monitoring of practice and could, for example, be included as part of the supervision process. Reference is made to: National Care Standards - Care Home for Older People - Standard 5 - Management and. This recommendation was made on 21 August 2015. Action taken on previous recommendation We concluded that this recommendation had not been met. There was not a formal structure in place for assessing staff's competency. for Abbotsford Care, Kinglassie page 10 of 14
The way that staff's moving and handling practice was assessed and observed was formally recorded, but did not include enough detail. We shared with the management ways that this could be developed. Some staff did reflect formally on training they attended and how this had a positive affect on the care they provided - but this was not across the staff team. Information and training records in staff files was inconsistent and must improve. 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. for Abbotsford Care, Kinglassie page 11 of 14
Inspection and grading history Date Type Gradings 2 Mar 2016 Unannounced Care and support Not assessed Not assessed Not assessed Management and leadership Not assessed 21 Aug 2015 Unannounced Care and support 3 - Adequate Management and leadership 3 - Adequate 29 Apr 2015 Unannounced Care and support Management and leadership 14 May 2014 Unannounced Care and support 5 - Very good Management and leadership 5 - Very good 22 May 2013 Unannounced Care and support 5 - Very good 5 - Very good Management and leadership 5 - Very good 24 Jul 2012 Unannounced Care and support 5 - Very good 5 - Very good Management and leadership 16 Feb 2012 Unannounced Care and support 5 - Very good Not assessed Not assessed Management and leadership 5 - Very good for Abbotsford Care, Kinglassie page 12 of 14
Date Type Gradings 1 Jun 2011 Unannounced Care and support 5 - Very good Not assessed 5 - Very good Management and leadership 5 - Very good for Abbotsford Care, Kinglassie page 13 of 14
To find out more This inspection report is published by the Care Inspectorate. You can download this report and others from our website. Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and help services to improve. We also investigate complaints about care services and can take action when things aren't good enough. Please get in touch with us if you would like more information or have any concerns about a care service. You can also read more about our work online at www.careinspectorate.com Contact us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com 0345 600 9527 Find us on Facebook Twitter: @careinspect Other languages and formats This report is available in other languages and formats on request. Tha am foillseachadh seo ri fhaighinn ann an cruthannan is cànain eile ma nithear iarrtas. for Abbotsford Care, Kinglassie page 14 of 14