Bonnyton House - Busby Care Home Service Adults Oliphant Crescent Busby G76 8PU Telephone: 0141 577 4845 Inspected by: Annabell Nicolson Type of inspection: Unannounced Inspection completed on: 7 December 2011
Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 6 3 The inspection 11 4 Other information 20 5 Summary of grades 21 6 Inspection and grading history 21 Service provided by: East Renfrewshire Council Service provider number: SP2003003372 Care service number: CS2003045155 Contact details for the inspector who inspected this service: Annabell Nicolson Telephone 0141 843 4230 Email enquiries@scswis.com Bonnyton House - Busby, page 2 of 23
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 4 Good Quality of Environment 4 Good Quality of Staffing Quality of Management and Leadership N/A N/A What the service does well Staff continued to demonstrate a good knowledge and understanding of individual residents' care and support needs. Residents spoke positively about the care they received and there was good evidence that they had been involved in choosing colour schemes and furnishings for the refurbishment programme. The service had well established with different community health services. What the service could do better Care plans needed to be up to date and reflect residents' current care needs. The signing of care planning documentation by residents and relatives could be improved. This included review minutes and risk assessments. Staffing levels needed to be maintained on all shifts. To vary the staffing schedule, the provider needed to submit a relevant application with supporting evidence. What the service has done since the last inspection Communal areas and bedrooms had been refurbished and there was a new wet floor shower in the respite unit. Bonnyton House - Busby, page 3 of 23
The results of the last relatives' questionnaires had been collated and an action plan developed. Nearly all keyworkers had completed training on the care planning paperwork, and training in Adult Support and Protection and Falls Risk Assessment was ongoing. The menus had been revised in consultation with residents. Improvements were noted in the recording of residents' weights. Conclusion Two of the four recommendations made at the last inspection had been met. In questionnaires and interviews, residents and relatives confirmed that they were generally happy with the quality of care provided and enjoyed good relations with staff. Some concern was expressed about staff being less able to spend quality time with residents and about the frequency of outings. Who did this inspection Annabell Nicolson Lay assessor: N/A Bonnyton House - Busby, page 4 of 23
1 About the service we inspected Bonnyton House is registered to provide residential care to 34 older people. Six of the places are in a designated respite unit within the same building. The service is owned and managed by East Renfrewshire Council. The property is situated in a housing estate in Busby. The communal rooms and some bedrooms are on the ground floor. A lift provides access to the bedrooms on the upper floor. All bedrooms have en suite facilities. The respite unit is also situated on the ground floor. Off street parking is available. Before 1 April 2011 this service was registered with the Care Commission. On this date date, the new scrutiny body, Social Care and Social Work Improvement Scotland (SCSWIS), took over the work of the Care Commission including the registration of care services. This means that from 1 April 2011 this service continued its registration under the new body, SCSWIS. 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 this service has been awarded the following grades: Quality of Care and Support - Grade 4 - Good Quality of Environment - Grade 4 - Good Quality of Staffing - N/A Quality of Management and Leadership - N/A 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.scswis.com or by calling us on 0845 600 9527 or visiting one of our offices. Bonnyton House - Busby, page 5 of 23
2 How we inspected this service The level of inspection we carried out In this service we carried out a low intensity inspection. We carry out these inspections when we are satisfied that services are working hard to provide consistently high standards of care. What we did during the inspection This report was written following an unannounced inspection that took place on 29 November 2011 between 10.30am and 5.30pm and on 7 December 2011 between 10.15am and 4.45pm. Feedback was given to the Manager at the end of the inspection. During the inspection, evidence was gathered from various sources including the following: - evidence from the service's most recent self assessment - minutes of residents' and relatives' meetings - questionnaires from residents and relatives - staff training records - rotas - accident records - cleaning schedules - reports from Environmental Health and Health & Safety - three personal plans - discussions with the Manager and six staff - interviews with three residents and one relative - observation of staff practice. 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 Bonnyton House - Busby, page 6 of 23
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 Bonnyton House - Busby, page 7 of 23
What the service has done to meet any recommendations we made at our last inspection 1. All personal plans should be updated following reviews and when there are changes to residents' care and support needs. National Care Standards - Care Homes for Older People, Standard 6, Support arrangements. Progress is reported in Quality Statement 1.3. The recommendation was not met 2. The service should ensure that the agreed staffing schedule is being maintained on all shifts. National Care Standards - Care Homes for Older People, Standard 6, Management and staffing arrangements. Progress is reported in Quality Statement 2.2. The recommendation was not met 3. To ensure consistency in practice, records relating to visits made by GPs and other health professionals should be in place for every resident. National Care Standards - Care Homes for Older People, Standard 6, Support arrangements. Progress is reported in Quality Statement 1.3. The recommendation was met 2. Weight monitoring records should be available in personal plans and should be fully completed. National Care Standards - Care Homes for Older People, Standard 14.6, Keeping well - healthcare Progress is reported in Quality Statement 1.3. The recommendation was met Bonnyton House - Busby, page 8 of 23
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 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. The service submitted a fully completed self assessment before the inspection. It identified what the service thought it did well and some areas for improvement. Taking the views of people using the care service into account Seven of the ten questionnaires received from residents had been completed on their behalf by relatives. Any comments from those questionnaires are noted in the section 'Views of Carers'. Three residents were interviewed during the inspection. Some of their comments were: "everyone is very nice in here" "I think we are very well cared for" "staff couldn't do more for us" "the food is very good - I cannot complain about it" "my bedroom is a very nice room - it is cleaned every morning" "I can still play dominoes and friends take me to church" "my bedroom is lovely" Taking carers' views into account Questionnaires were received from nine relatives and one relative was interviewed during the inspection. "the care my mother is given is excellent and her quality of life has been excellent since she went to Bonnyton" "there is very little daily mental and physical stimulation" "outings are organised periodically which seem to be very popular but activities are very repetitive - seemingly due to lack of staff" "staff do their best at all times however since the change to number of seniors and other staff I think there is less quality time available to residents" "I am very happy with mum's treatment and care and staff are always helpful and cheery" Bonnyton House - Busby, page 9 of 23
"my relative has found herself cared for personally in very high quality relations with staff" "the quality of care my relative receives at Bonnyton is very good and her keyworker is particularly caring" "although activities do regularly take place in the home, care could be even better if more links with community activities could be encouraged" "I think staff are very stretched since the recent rationalisation exercise" "my concerns would be around the dilution of this excellent service through the use of agency staff due to financial restraints" "I have been at some care reviews" "I couldn't fault it - I am very happy and have no concerns" "staff are approachable if I have any issues" Bonnyton House - Busby, page 10 of 23
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: 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. Service strengths Copies of the participation strategy and the complaints procedure were displayed at the main entrance. The service was divided into three units with specific staff teams. Care staff were identified as having key worker or co worker responsibilities for a number of residents. Meetings were arranged for residents within units. Minutes seen showed discussion on different topics including redecoration, the garden, activities and menus. Information about SCSWIS, inspection grading, the complaints procedure and key worker duties had been shared with some residents. Suggestions for questions for forthcoming staff interviews were discussed at one meeting. Examples of responses by the service to residents' requests were the purchase of garden plants, additional lounge lighting, new DVDs and the provision of more fresh fruit throughout the day. Having consulted with carers, the service arranged meetings that included those linked to both Bonnyton House and the adjoining Resource Centre. The last meeting took place in March 2011 when the refurbishment of the residential accommodation, the use of the smoke room and the review of menus were discussed. Two subsequent meetings had to be cancelled. The responses to the last questionnaires sent to relatives had been collated, and an action plan developed to address issues raised. The Manager planned to inform relatives about the outcome at their next meeting. The service's latest newsletter was being finalised at the time of the inspection. Most of the staff had completed the training on the care planning paperwork. In care Bonnyton House - Busby, page 11 of 23
files sampled, there was evidence of residents and residents being involved in reviewing care plans and contributing to personal histories. Areas for improvement As noted at previous inspections, review documentation was not being consistently signed by residents or their representatives. 'Contract of Care' agreements in care files were also not signed. (See Recommendation 1). There were no residents' meeting minutes available for one unit. The frequency of meetings was unclear and there was no indication of meetings having taken place in the recent months. The action taken by the service in response to comments and requests from residents could be more clearly evidenced. The annual questionnaires for relatives were due to be sent out in early 2012. The service should ensure that the inspection reports available on notice boards were the most recent ones. The current location of the suggestions box at the main entrance should be reviewed as residents could not readily access it without staff assistance. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The service should ensure that care planning documentation and contracts of care are appropriately signed. National Care Standards - Care Homes for Older People, Standard 6, Support arrangements. Bonnyton House - Busby, page 12 of 23
Statement 3 We ensure that service user's health and wellbeing needs are met. Service strengths Residents could choose to retain their own GP and other health contacts if there were no geographical limitations. Staff also supported them to access a range of other health services that included district nurses, chiropodist, optician and dentist. The service had well established links with local community health services that provided support and specialist equipment when required. A community psycho geriatrician visited on a monthly basis and, if needed, arranged follow up visits by the community psychiatric nurse. The four week menu had recently been revised after catering staff met with individual residents. Choice of main course continued to be offered at lunch and evening meal. If required, residents who had special dietary needs could have their own individual menu, and there was evidence of catering staff being proactive in identifying alternative desserts and bakery items for residents with special diets. Fresh fruit and vegetables were provided daily. A recommendation made at the last inspection about weight monitoring records being available in care files had been met. There was evidence in care files of residents' weights being monitored and recorded on at least a monthly basis. If they wished, residents could take part in the activity programme that was arranged in one of the units as well as participating in unit based activities. There was a social evening for all residents every Saturday. In meeting minutes, positive comments were made about a few group outings enjoyed by residents. Areas for improvement The care plans seen for two residents had not been updated to take account of changes in their nutritional needs. The monthly reviews of care plans were not completed in one of the three files sampled. The need to update care plans was a previous recommendation and will be repeated. (See Recommendation 1). As recommended at the last inspection, separate records of visits from health personnel were available in the personal plans. Attention was however needed to ensure that all visits were recorded on the paperwork. A number of staff had yet to complete training in Adult Support and Protection. As noted at the last inspection, palliative care training for staff was again identified in the self assessment as an area for improvement. The Manager was due to attend a two day course in palliative care that it was planned would be delivered to staff. Bonnyton House - Busby, page 13 of 23
When interviewed, staff identified that training in dementia would be beneficial. Some staff felt that they had few opportunities for spending one to one time with key residents. They also felt there could be more outings. Similar views were expressed in some questionnaires received before the inspection. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. Care plans should be reviewed and updated to reflect changes in residents' care and support needs. National Care Standards - Care Homes for Older People, Standard 6 Support arrangements. Bonnyton House - Busby, page 14 of 23
Quality Theme 2: Quality of Environment Grade awarded for this theme: 4 - Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the environment within the service. Service strengths The evidence in Statement 1.1 in relation to participation and consultation is relevant to this Statement. Residents were encouraged to personalise their bedrooms with pictures, furniture and other personal items. All the bedrooms, communal areas and some corridors had recently been redecorated and fitted with new carpets. Residents and relatives were consulted about the colour schemes, carpets and furniture, for example, lounge chairs and dining room furniture. A wet floor shower was fitted in a bathroom in the respite unit and a number of profile beds were bought. Areas for improvement The service planned to redecorate and replace carpets in the remaining corridors during the next few months. The replacement of the stained, lounge carpet in Kintyre unit should also be considered. The service's new information leaflet which gave details of the accommodation had yet to be published in its final format. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Bonnyton House - Busby, page 15 of 23
Statement 2 We make sure that the environment is safe and service users are protected. Service strengths There was a secure entry system with CCTV at the main entrance to the home and all visitors were expected to sign the visitors' book. The new accident recording system was established and included an overview by the Manager and external management. Individual monthly logs giving detailed information about the falls sustained by residents and falls prevention monitoring forms were also in use in care files. It was noted that, for some residents, the number of accidents had reduced in recent months. A similar system was in place for recording and monitoring incidents. Falls risk assessments were completed for every resident and the related training for staff was ongoing. Reviews had recently been carried out for the generic falls risk assessments that were in place for the three units. Satisfactory audits had recently been carried out by the Environmental Health and Health and Safety departments within the local authority. Responsibility for ensuring that action was taken to address any issues had recently been transferred to the Manager. Daily and weekly cleaning schedules were in place for catering and domestic staff. Senior staff were in the process of registering with the Scottish Social Services Council (SSSC). Areas for improvement In care files sampled, risk assessments for challenging behaviour and the use of sensor mats were not signed by the residents or their next of kin. (See Recommendation 1). Falls risk assessments will be completed for individuals receiving respite after the relevant staff in the Resource Centre complete the related training. The need to ensure that the staffing schedule was maintained on all shifts was a recommendation at the last inspection. As observed and confirmed by rotas, this had continued to be an issue on day shifts. It was also noted that there were occasions when the Manager was not supernumerary. An application submitted in 2010 by the service to vary the number and skill mix of staff on these shifts was not progressed as additional information requested in Bonnyton House - Busby, page 16 of 23
relation to residents' dependency needs was outstanding. The Manager also advised that the post of depute had been removed from the staffing complement and the hours had not been replaced. (See Requirement 1). Grade awarded for this statement: 3 - Adequate Number of requirements: 1 Number of recommendations: 1 Requirements 1. The provider must ensure that the agreed staffing levels are maintained on all shifts. In order to vary the current staffing schedule, an application with supporting evidence must be submitted to SCSWIS. This is in order to comply with SSI 2011/210, Regulation 4(1)(a) Welfare of service users and Regulation 15(a) Staffing Timescale: Within 2 months of this report being published. Recommendations 1. Individual risk assessments should be discussed with relatives and their representatives, and appropriately signed. National Care Standards - Care Homes for Older People, Standard 6.1, Support arrangements. Bonnyton House - Busby, page 17 of 23
Quality Theme 3: Quality of Staffing - NOT ASSESSED Bonnyton House - Busby, page 18 of 23
Quality Theme 4: Quality of Management and Leadership - NOT ASSESSED Bonnyton House - Busby, page 19 of 23
4 Other information Complaints No complaints have been upheld or partially upheld since the last inspection. Enforcements We have taken no enforcement action against this care service since the last inspection. Additional Information None. Action Plan Failure to submit an appropriate action plan within the required timescale, including any agreed extension, where requirements and recommendations have been made, will result in SCSWIS re-grading the Quality Statement within the Management and Leadership Theme as unsatisfactory (1). This will result in the Quality Theme for Management and Leadership being re-graded as Unsatisfactory (1). Bonnyton House - Busby, page 20 of 23
5 Summary of grades Quality of Care and Support - 4 - Good Statement 1 Statement 3 4 - Good 5 - Very Good Quality of Environment - 4 - Good Statement 1 Statement 2 5 - Very Good 3 - Adequate Quality of Staffing - Not Assessed Quality of Management and Leadership - Not Assessed 6 Inspection and grading history Date Type Gradings 31 Jan 2011 Unannounced Care and support 4 - Good Environment Not Assessed Staffing Not Assessed Management and Leadership Not Assessed 30 Sep 2010 Announced Care and support 4 - Good Environment Not Assessed Staffing Not Assessed Management and Leadership 4 - Good 16 Mar 2010 Unannounced Care and support 3 - Adequate Environment Not Assessed Staffing Not Assessed Management and Leadership 3 - Adequate 15 Sep 2009 Announced Care and support 3 - Adequate Environment 4 - Good Staffing 4 - Good Management and Leadership 3 - Adequate Bonnyton House - Busby, page 21 of 23
26 Mar 2009 Unannounced Care and support 3 - Adequate Environment Not Assessed Staffing Not Assessed Management and Leadership 3 - Adequate 31 Oct 2008 Announced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 3 - Adequate All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Bonnyton House - Busby, page 22 of 23
To find out more about our inspections and inspection reports Read our leaflet 'How we inspect'. You can download it from our website or ask us to send you a copy by telephoning us on 0845 600 9527. This inspection report is published by SCSWIS. You can get more copies of this report and others by downloading it from our website: www.scswis.com or by telephoning 0845 600 9527. Translations and alternative formats This inspection report is available in other languages and formats on request. Telephone: 0845 600 9527 Email: enquiries@scswis.com Web: www.scswis.com Bonnyton House - Busby, page 23 of 23