Bonnyton House - Busby Care Home Service

Bonnyton House - Busby Care Home Service Oliphant Crescent Busby G76 8PU Inspected by: (Care Commission Officer) Type of inspection: Annabell Nicolson Announced Inspection completed on: 31 October 28 1/15

Service Number Service name CS2345155 Bonnyton House - Busby Service address Oliphant Crescent Busby G76 8PU Provider Number dummy Provider Name SP233372 East Renfrewshire Council Inspected By dummy Inspection Type Annabell Nicolson Care Commission Officer Announced dummy Inspection Completed Period since last inspection 31 October 28 6 months dummy Local Office Address Central West Region 4th Floor 1 Smithhills Street Paisley PA1 1EB Tel: 141 843 423 Fax: 141 843 4289 dummy 2/15

Introduction Bonnyton House has been registered with the Care Commission since 1 April 22 and provides residential care to 34 older people. Six places are designated for respite care. The property which is on two floors is owned and managed by East Renfrewshire Council. It is situated in a housing estate in Busby, East Renfrewshire. Off street parking is available. The stated aims of the service are to provide residential care to older people affording them the opportunity to enhance their quality of life and to provide each with an individual care package tailored to meet their specific needs. Based on the findings of this inspection the service has been awarded the following grades: Quality of Care and Support - 4 - Good Quality of Environment - 4 - Good Quality of Staffing - 4 - Good Quality of Management and Leadership - 3 - Adequate This inspection report and grades represent the Care Commission s 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. Please refer to the care services register on the Care Commission s website (www.carecommission.com) for the most up-to-date grades for this service. Basis of Report This report was written following an announced inspection that took place between 1am and 5.15pm on 26 August 28 and between 9.45am and 4pm on 27 August 28. Before the Inspection The Annual Return The provider failed to submit an Annual Return as requested by the Care Commission. The Manager stated that due to other demands on time it had been omitted. The Self-Assessment Form The service submitted a self-assessment form as requested by the Care Commission Views of service users Seven residents completed Care Commission questionnaires. They indicated that they were happy with the quality of care. Regulation Support Assessment The inspection plan for this service was decided after a Regulation Support Assessment (RSA) was carried out to determine the intensity of inspection necessary. The RSA is an assessment undertaken by the Care Commission Officer (CCO) which considers complaints activity, changes in the provision of the service, nature of notifications made to the Care Commission by the service (such as absence of a manager) and action taken upon requirements. The CCO will also have considered how the service responded to situations and issues as part of the RSA. This assessment resulted in this service receiving a low RSA score and so a low intensity 3/15

inspection was required. The inspection was based on the relevant Inspection Focus Area and associated National Care Standards, recommendations and requirements from previous inspections and complaints or other regulatory activity. During the inspection process Staff at inspection The inspection involved one Care Commission Officer. Evidence During the inspection, evidence was gathered from a number of sources including: Supporting evidence from the up to date self assessment Information pack Responses to questionnaires Minutes of residents' meetings Protection of Vulnerable Adults procedure Health & Safety policy Accidents & Incidents policy Complaints policy Rotas Risk assessments for environment and equipment Staff training records Minutes of staff meetings Recruitment policy Training plan for SVQ Learning and Education Plan Disciplinary policy Three personal plans Discussions with the Manager, Depute and four staff Discussions with five residents and two relatives Observation of communal rooms and a few bedrooms Inspection Focus Areas and links to Quality Themes and Statements for 28/9 The inspection focus area for this inspection was notifications to the Scottish Social Services Council and the Care Commission. Details of the inspection focus and associated Quality Themes to be used in inspecting each type of care service in 28/9 and supporting inspection guidance, can be found at: http://www.carecommission.com/ Fire Safety Issues The Fire (Scotland) Act 25 introduced new regulatory arrangements in respect of fire safety, on 1 October 26. In terms of those arrangements, responsibility for enforcing the statutory provisions in relation to fire safety now lies with the Fire and Rescue service for the area in which a care service is located. Accordingly, the Care Commission will no longer report on matters of fire safety as part of its regulatory function, but, where significant fire safety issues become apparent, will alert the relevant Fire and Rescue service to their existence in order that it may act as it considers appropriate. Further advice on your 4/15

responsibilities is available at www.infoscotland.com/firelaw Action taken on requirements since last Inspection The two requirements made following the last inspection had been met. 1. The service had developed a Vulnerable Adults procedure that detailed types of abuse, indicators and staff responsibilities. The risk assessment documentation had been amended to take account of challenging behaviour issues. The two assessments sampled had related support plans. 2. A Learning and Education plan had been produced by the provider. Comments on Self Assessment The self assessment had been fully completed by the service and identified strengths and areas for improvement in relation to all the statements. View of Service Users The residents spoken with said they were happy with the care provided by staff and, if they did have concerns, they knew what staff they would speak to. Three of the residents were receiving respite care. Their comments included I can t really complain about the care it s good, I m quite satisfied with the care, staff are very pleasant and the food is okay, the day is a bit monotonous, I can t think about anything that I would like to be different, I have no complaints about the meals although sometimes they could be hotter and the food is okay I enjoy it. In the completed questionnaires, two residents indicated that they did not know about the home s complaints procedure and five did not know that they could complain to the Care Commission. View of Carers The carers who were interviewed were frequent visitors to the home. They expressed no concerns about the care provided and were of the opinion that it could not be better. They described the care as excellent and the staff as very kind, always offering tea or coffee. They also commented on the cleanliness of the accommodation and the fact that their relative was always well presented. Of the ten questionnaires sent to carers, nine were returned completed. They were generally happy about the care and stated that my mother is treated well very reassuring for the family, extremely happy with the care and attention, staff are courteous and considerate excellent at entertainment and fundraising. 5/15

Quality Theme 1: Quality of Care and Support Overall CCO Theme Grading: 4 - Good Statement 1: We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. The stated aims of the service were "to ensure clients are consulted about all service provision, and are able to exercise choice" and "to ensure carers/relatives are actively involved in the service provision". Monthly residents' meetings had been introduced earlier in the year. Minutes evidenced discussion on different topics including menu suggestions, activities and the environment. Three lunch outings were arranged during the summer following a request from residents at an earlier meeting. Other suggestions made about supper choices and the provision of cake stands had also been responded to positively by management. An initial meeting with carers was being planned and questionnaires had been sent to ask for their suggestions about the format of meetings. There was a key worker system in place. Care reviews with resident and relative involvement were evident in care files sampled. Copies of the most recent inspection report and the complaints procedure were displayed at the main entrance to the home and in the respite unit. Information leaflets about a local independent advocacy service were also provided. In the questionnaires completed for the Care Commission, relatives indicated that they were happy with the quality of the care provided. The service's intention to develop a participation strategy in conjunction with residents and carers was highlighted in the self assessment. Training for staff in promoting the strategy was also noted. A questionnaire for residents was to be developed. The minutes of residents' meetings lacked detail about the actual discussion that took place and provided limited information for residents who were not present. 5 - Very Good Statement 5: We respond to service users' care and support needs using person centered values. 6/15

One of the service's stated aims was "to provide each client with an individual care package tailored to meet their specific needs." Staff had been consulted about the new care planning format that was in the process of being implemented for all residents. Management also advised that additional time had been given to enable staff to discuss the care plans with residents and their families. The new documentation took account of residents' preferences in relation to their personal care, mealtimes and other support needs. Key workers had specified time allocated every month on the rota to enable them to review and update care plans. A policy and guidance on food, fluid and nutritional care had recently been introduced. While the need for care assistants to undertake training in record keeping was identified by the Manager, sampling of care files indicated that other staff may also benefit from further guidance in relation to the completion of the new paperwork. The quality of recording varied with some documents blank or incomplete, the information in the daily reports that linked to care plans did not always reflect what was recorded in the care plan. In one care file, the strategies for managing challenging behaviour were recorded in daily notes but were not detailed in the relevant support plan. (see Recommendation 1) Individual risk assessments were not signed by the resident or their representative. (see Recommendation 2) A similar issue was noted in review minutes. While all personal plans had been reviewed during 28, there were significant gaps between reviews for a few residents. (see Recommendation 3) 3 - Adequate 3 7/15

Quality Theme 2: Quality of Environment Overall CCO Theme Grading: 4 - Good Statement 1: We ensure that service users and carers participate in assessing and improving the quality of the environment within the service. Evidence noted in Statement 1.1 in relation to consultation and participation is relevant to this Statement. Residents were encouraged to personalise their bedrooms as they wished with items of furniture, photographs and ornaments. In the questionnaires completed for the Care Commission, residents indicated that they were happy with the environment and the standards of housekeeping. While there was information about the service available for prospective residents, the content and layout could be improved. A description of the facilities provided would also be a useful addition. 4 - Good Statement 2: We make sure that the environment is safe and service users are protected Residents were given a copy of the Agreement of Care which detailed what was covered by the cost of care and the items which were not included in the fee. The service had policies and procedures relating to Health & Safety and accident/incident reporting. Risk assessments had been completed in relation to the environment, activities and equipment. Housekeeping standards were good and there was a weekly cleaning schedule for kitchen equipment. Since the last inspection, the flooring in the designated smoking room had been replaced. As detailed in the recruitment policy, relevant checks were undertaken when recruiting new staff. The majority of staff had completed CALM training, and a restraint policy had been developed. 8/15

A number of staff had not completed training in adult abuse and adult protection. (see Recommendation 4 ) A further day's training in de-escalation techniques had yet to be arranged for all staff. Refresher training in Moving and Handling was due to take place. Accidents were not always being recorded on the relevant documentation. (see Recommendation 5) Attention was needed to the carpet and some armchairs in the conservatory that were stained, and to areas of torn wallpaper in the lounge and adjoining corridor. The need for similar remedial work was also observed in two bedrooms. 4 - Good 2 9/15

Quality Theme 3: Quality of Staffing Overall CCO Theme Grading: 4 - Good Statement 1: We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Evidence noted in Statement 1.1 in relation to consultation and participation is relevant to this Statement. Residents who completed Care Commission questionnaires indicated that they were satisfied that staff treated them politely and respected their privacy. When interviewed, they described staff as "very pleasant", "absolutely wonderful" and "they are all nice". In questionnaires, relatives commented that "the staff are kind and caring and we are made very welcome no matter when we turn up", "the staff are very courteous and considerate" and "my relative has been treated very well". The service needed to consider ways in which residents and carers could be involved in the recruitment and selection process. 4 - Good Statement 3: We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. As a result of a restructuring of the services, the Manager of the Resource Centre had recently been appointed as Manager with overall responsibility for both the day care and residential provision. A new post for a Depute Manager had also been created and recently filled. Induction training was provided for new staff, and they were given copies of the Scottish Social Services Council (SSSC) Codes of Practice and the relevant National Care Standards. A significant number of staff had a relevant qualification. The service had a training plan specifically for SVQ. Three staff had recently completed HNC and one had finished SVQ3. Four staff were due to start either SVQ or HNC and the depute manager was undertaking a degree course in management. Annual Personal Development plans were in the process of being completed for all staff. 1/15

A training plan for the service was to be developed once the annual appraisals were complete. Food hygiene training was being arranged for any care and kitchen staff who had not yet completed it. The need for dementia awareness training was highlighted in the self assessment. Individual records needed to be updated to reflect the training that staff had attended this year. Staff responses in relation to supervision indicated that it was not as frequent as it should be. There were mixed views from staff about how well they felt the team worked together. 4 - Good 11/15

Quality Theme 4: Quality of Management and Leadership Overall CCO Theme Grading: 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. The service's aims were detailed in the information available for prospective residents. The manager operated an open door policy for residents and relatives. In the Care Commission questionnaires, residents indicated that they felt able to give their views about the management of the service. A similar response was received from relatives. The service should progress the development of questionnaires for both carers and residents, and consider how best to consult them in assessing and improving the management and leadership of the service. 3 - Adequate 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. Some of the staff interviewed felt that they were able to contribute at meetings and put forward any suggestions for improvement. As part of their annual appraisal, staff were asked to comment on what skills and abilities they utilised in order to deliver a quality service. In addition, senior staff had to consider how they encouraged and contributed to improvements in the service. Action plans were submitted by the service in response to requirements and recommendations from inspections. The Manager was aware of the responsibilities in relation to reporting staff dismissals to the SSSC. The requirement to report incidents of staff misconduct, including theft, to the Care Commission was also understood. The manager had not had any reason to dismiss a member of staff and there had been no incidents of staff misconduct since the last inspection. 12/15

Minutes seen did not reflect the stated frequency of the various staff meetings. The Manager however advised that the format and frequency of meetings was being reviewed. Staff interviewed demonstrated limited, if any, understanding of the grading process. Although some staff had expressed an initial interest in being involved in completing the self assessment, they had not followed it through. The disciplinary policy did not refer to the provider's responsibilities in relation to notifications to the SSSC and the Care Commission. (see Recommendation 6) The development of a quality assurance system that involved service users, carers and key stakeholders in assessing the quality of the service should be progressed. The Care Commission had not been notified of three accidents when residents had sustained injuries. (see Requirement 1) 3 - Adequate 1 1 13/15

Regulations / Principles National Care Standards 14/15

Enforcement There has been no enforcement action against this service since the last inspection. Other Information None identified. Requirements 1. Notifications must be sent to the Care Commission of all incidents involving residents that result in medical treatment being sought. SSI 22/114 Regulation 21(2) (b) Timescale for implementation: Within 24 hours of the issuing of this report Recommendations 1. Further training and guidance should be provided for staff to ensure that the care planning documentation for all residents is fully completed. (Standard 5.4) 2. Risk assessments should be signed by the resident or their representative. (Standard 9.2) 3. The service should ensure that all personal plans are reviewed at least once every six months. (Standard 6) 4. All staff should attend training in adult abuse and adult protection. (Standard 5.2) 5. All accidents should be recorded on relevant documentation. (Standard 5.1) 6. The disciplinary policy should be amended to include reference to notifications to the SSSC and the Care Commission. (Standard 2.1) Annabell Nicolson Care Commission Officer 15/15