Eildon Housing Craw Wood Care Home Service 92/96 Craw Wood Tweedbank Galashiels TD1 3SU Inspected by: (Care Commission Officer) Type of inspection: Janette Bishop Announced Inspection completed on: 26 January 29 1/17
Service Number Service name CS239175 Eildon Housing Craw Wood Service address 92/96 Craw Wood Tweedbank Galashiels TD1 3SU Provider Number dummy Provider Name SP231963 Eildon Housing Association Ltd Inspected By dummy Inspection Type Janette Bishop Care Commission Officer Announced dummy Inspection Completed Period since last inspection 26 January 29 9 months dummy Local Office Address Unit 1a, Ground Floor Galabank Business Park Wilderhaugh Galashiels TD1 1PR dummy 2/17
Introduction 92-96 Craw Wood is a care home which provides residential care for a maximum of 24 older people who have a diagnosis of dementia. The service was registered with the Care Commission on the 1 April 22. The facility consists of three purpose built houses which are interlinked. The establishment is managed by Eildon Housing Association in partnership with Scottish Borders Council and Borders Health Board. Respite facilities are available. The service has developed a clear philosophy of care and statement of aims and objectives which emphasise the importance of the "individuality, privacy and dignity of the residents within a setting which the service considers to be their own home''. The service has a full time Manager based within the facility. A minimum of two members of staff are on duty in each house during the day and a minimum of three members of staff are on duty during the night. Based on the findings of this inspection the service has been awarded the following grades: Quality of Care and Support - 5 - Very Good Quality of Environment - 5 - Very Good Quality of Staffing - 5 - Very Good Quality of Management and Leadership - 4 - Good 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 The report was written following an announced inspection which took place over 2 days, with the final visit taking place on the 26 January 29. Before the Inspection The Annual Return The service submitted a completed Annual Return as requested by the Care Commission. The Self-Assessment Form The service submitted a self-assessment form as requested by the Care Commission Views of service users One service user was spoken with individually. Time was spent watching staff interaction with residents who were unable to verbally communicate their views of the service. 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 3/17
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 inspection was required. The inspection was based on the relevant Inspection Focus Areas and associated National Care Standards, recommendations and requirements from previous inspections and complaints or other regulatory activity. During the inspection process Staff at inspection Care Commission Officer, Janette Bishop, referred to in the body of the report as the Officer spoke with the following staff at the inspection. The project manager. Assistant project manager. Four care staff. The cook. The human resource assistant responsible for recruitment in the service. Evidence During the inspection evidence was gathered from a number of sources including: Discussion with one service user and three relatives. A review of a range of policies and procedures, records and other documentation relevant to the inspection including: Six service users personal plans, risk assessments and daily recording notes Minutes of meetings Activity records Information for new residents A recruitment file Staff training records Supervision notes Rotas Time was spent observing the interactions between staff and residents. A tour of the environment took place which included visiting a representative sample of bedrooms. Inspection Focus Areas and links to Quality Themes and Statements for 28/9 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 4/17
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 responsibilities is available at www.infoscotland.com/firelaw Action taken on requirements since last Inspection There were no requirements made at the last inspection. Comments on Self Assessment A detailed self- assessment was completed by the manager prior to inspection. This contained good information on the strengths of the service and areas for improvement for each statement. The information formed the basis of discussion at inspection. View of Service Users Due to the levels of mental frailty it was not possible to consult with the majority of residents at length, however the Officer spoke with one resident who gave their views of the service. Comments included "the staff here are good" and "I like my room". Time was spent observing staff interacting with residents. The interactions were age appropriate and enabling. Residents were relaxed and appeared to enjoy staff company. View of Carers Eight Care Commission Care Standards Questionnaires were sent out to relatives of service users prior to the inspection. All were returned. Feedback from responses to questions confirmed a high level of satisfaction with the quality of care and confidence in the staffs' knowledge and skill. Some relatives noted in their responses that they would like to be consulted more regularly on the content and review of the care plans. They would also like information on changes to medication, administration of as and when drugs and concerns about health to be shared with them at an earlier stage rather than having to ask about them. These points are discussed more fully in the body of the report and a recommendation made as a result. Three relatives were spoken with during the inspection. There feedback was very similar to that contained in the questionnaires. They were all very satisfied overall with the quality of the service. Comments included: "Staff are very good and patient". "I am extremely happy with the care" "Staff are always willing to answer questions". "Excellent care". 5/17
Quality Theme 1: Quality of Care and Support Overall CCO Theme Grading: 5 - Very 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 Crawwood specialises in the care of older adults with dementia. Due the constrictions caused by the service users' cognitive impairment, the Officer spent considerable time observing resident's body language as they went about their day and staff's interaction with them. The interaction at all times was observed to be warm and respectful. The Officer observed some very good examples of service users being enabled to make choices about where and how they spent their day. The cook was aware of residents' likes and dislikes and residents made their meal choice at the time of eating, with examples of the food on offer being taken to the table so a visual choice could be made. Family carers spoken with and responses to the Care Commission Questionnaires noted a high level of satisfaction with the quality of care and support provided. The majority of respondents felt that staff would ensure that they were kept well informed of changes to their relative's care and their views would be listened to. The manager and staff described a commitment to sharing information and encouraging feedback from service users and their families. At the time of inspection service user's views on the quality of care and support were obtained through: * Direct observation of behaviour using the Dementia Care Mapping tool which is a recognised tool for measuring the well-being of service users in a care setting. * Person centred planning, reviews and risk assessments. The personal plans and recording sheets contained very good examples whereby residents had been enabled to maintain links with their past lives. This included visits to hairdressers, shops and clubs in the local community. * Occasional relatives meetings. * 1.1 meetings with the representatives of service users. * The complaints procedure and informal discussion with service users. Relatives confirmed that they were involved in their care plans and the review process. External reviews carried out by the local social work department contained positive comments about the quality of care from the service users and their relatives. Action plans arising from these reviews were generally acted on promptly by the manager. The manager stated that various methods had been tried in the past to set up regular meeting with carers but these had resulted in a low uptake, however following the last meeting it was hoped that a "Friends of Crawwood" group which will be facilitated by relatives, would take off this year. The manager reported that independent advocacy was available for individual service users, when necessary. There was information displayed on local advocacy services and leaflets available at the entrance. Areas for Development 6/17
There was a generic participation strategy for tenants of Eildon Housing Association however, the provider should review this to ensure that it reflects the service provided within Crawwood. The strategy should also recognise that there may be barriers to participation as a result of services users' cognitive impairment which require different methods of engagement. There was no procedural guidance for staff on how to engage with service users and encourage their participation in assessing the quality of the service. Training in this would be beneficial to ensure that service users with cognitive impairment, sensory loss and communication difficulties have an opportunity to share their views on the quality of the service. (See recommendation 1) Discussion with relatives and responses to the Care Commission's Questionnaire highlighted that there were occasions when relatives did not feel fully informed about changes in care needs and prescribed medication. (See recommendation 2) The manager identified the need to continue o explore ways to engage with residents and their relatives as an area for development. Discussion took place about the development of meetings to include an agenda which reflects the quality statement. The recording of minutes, outcomes and sharing of information with relatives who were not able to attend meetings was also discussed. Progress with respect to this will be followed up at future inspections. CCO Grading 5 - Very Good Number of Requirements Number of Recommendations 2 Statement 3: We ensure that service user's health and wellbeing needs are met. Service Strengths Staff described a social model of care where health care needs were identified through knowledge of the individual and observation of changes in behaviour. Communication records in resident's personal plans and handover information ensured that key issues were noted and addressed. Staff had access to Best Practice guidance and there was good evidence that these had influenced practice. The use of the Abbey pain control tool was an example of this. There was very good evidence of multidisciplinary involvement in service user's care notes confirming that they had access to the relevant health care professionals especially in relation to mental health and well-being. It was noted that service users remained registered with their previous GP wherever possible. Residents that required aids to maintain their quality of life had these documented in their care plan. Robust records of maintenance were kept. 7/17
There was very good evidence to suggest that life histories and information from families informed the type of activities that service users engaged in. All the staff spoken with were knowledgeable about the needs of service users and gave very good examples of how they have cared for and supported residents to maintain links with their previous lives in the community. This was confirmed by observation of practice, written evidence documented in care notes and feedback from relatives. Staff training records confirmed that ongoing training relevant to residents needs was taking place. Through discussion, staff evidenced that they were very aware of their role in protecting vulnerable adults and had recently updated their knowledge by attendance at the relevant training course. The cook was very conscientious about monitoring resident's nutritional needs and demonstrated well how she monitored, recorded and responded to changing needs. She also gave a very good description of how staff encouraged choice at mealtimes and the values on which this was based. The service offers a plated choice at mealtimes rather than requesting residents to choose earlier in the day. The service had a comprehensive medication policy in place. Staff delegated responsibility for the administration of medication received training to establish competency. All the relevant policies and procedures relating to this statement were in place staff spoken with demonstrated that they were aware of how to access these. Areas for Development It was noted that some residents had experienced a steady weight loss however the actions taken to address this was not always fully documented in their care plan. The service had a comprehensive and easy to follow tool for monitoring weight loss with clear guidance on the steps to be taken should weight loss be identified. It was noted that the suggested increased frequency in weighing was not always adhered to. The service did not measure Body Mass Index in conjunction to weighing residents. (See recommendation 3) Discussion took place about the decision to introduce a private podiatry service in the unit. There was evidence that this decision had been taken in consultation with the families of service users and that they were free to opt out. The manager identified monitoring and reviewing the recently introduced service to ensure its suitability and effectiveness as an area for development. CCO Grading 5 - Very Good Number of Requirements Number of Recommendations 1 8/17
Quality Theme 2: Quality of Environment Overall CCO Theme Grading: 5 - Very 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 accommodation is representative of the information contained in the service's brochure. There are three interlinked houses each with its own sitting, dining and kitchen area. Residents are accommodated in single bedrooms with en-suite toilet and shower room. There is an easily accessible and secure garden. The manager and staff gave very good examples of how service users were involved in improvements to the environment. Residents and their relatives had been involved the choice of decorative finishes and carpets in the newly refurbished unit. Residents and family visitors confirmed that they were encouraged to personalise their rooms. Responses to the Care Commission Satisfaction Questionnaires confirmed that relatives were, on the whole, very satisfied with the quality of the environment. Many of the areas identified as strengths under Statement 1.1 of the report also apply to this statement. Areas for Development The manager plans to build on this very good practice by increasing the involvement of residents and visitors to the home in the future refurbishment of other areas of the home. Areas for improvement and discussed under statement 1.1 are also applicable to this statement. CCO Grading 5 - Very Good Number of Requirements Number of Recommendations Statement 2: We make sure that the environment is safe and service users are protected Service Strengths There were very good systems in place for ensuring that the environment was safe and 9/17
secure for the residents. Crawwood is a purpose built unit for older adults with dementia; therefore the building has been designed with discrete security and risk reducing measures in place. The service continually reviews the safety of the environment and makes use of SMART technology such as infra red sensors where appropriate. The service's maintenance records were seen to be well organised and evidenced that safety checks were conducted within the appropriate timescales. The Officer conducted a tour of the building which included resident's accommodation and communal areas. The home was well maintained and was observed to be clean, there were no unpleasant smells. The service had all relevant policies and procedures for this statement including adult and child protection, safer recruitment and health and safety policies. Staff were aware of how to access these policies and procedures and confirmed that they were discussed during induction and at supervision. The home kept records of regular risk assessments. Some of these were externally audited by environmental health and the fire officer. Areas for Development Continual review of safety measures as new technologies become available and replacement of the call system to improve reliability and functionality were identified by the manager as areas for improvement. CCO Grading 5 - Very Good Number of Requirements Number of Recommendations 1/17
Quality Theme 3: Quality of Staffing Overall CCO Theme Grading: 5 - Very Good Statement 1: We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service Strengths The manager and the human resource (HR) assistant provided very good evidence that the residents participated in the recruitment and selection process. The recruitment process was adapted to take account of the resident's cognitive impairment and the special skills required of staff working in this area. An open social evening was held for prospective candidates where they could meet and socialise with residents and their families. Their interactions with the residents were observed and the manager and HR assistant were available to answer questions about working in the unit. Regular Dementia Care Mapping takes place which monitors the effectiveness of staffs' interactions with the residents. How residents respond to staff during this process is reviewed in supervision and staff meetings and shapes future practice. Service users were not directly involved in the development of staff training plans however there was good evidence that the manager had responded to their changing needs by accessing places for staff on relevant training courses. Areas for Development The manager and HR assistant discussed how they would like to continue to develop the involvement of residents and families in their recruitment and selection process following on from the success of this initiative. How this is progressed will be reviewed at future inspections. Discussion also took place with the manager about utilising relatives meetings as a forum to get regular feedback about the quality of staff. CCO Grading 5 - Very Good Number of Requirements Number of Recommendations Statement 3: We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service Strengths 11/17
The manager described a robust recruitment process which followed best practice, 'safer recruitment guidance'. This was undertaken with the corporate support of a human resource department. The Association had the necessary policies and procedures to support this statement. Staff spoken with evidenced that they were aware of these policies and knew how to access them. There has been a low staff turnover and staff spoken with appeared motivated and to enjoy their work. The induction process, supervision and appraisal records indicated that good account was taken of the needs of the service users. One to one supervision and staff meetings were taking place on a regular basis. This was confirmed through discussion with staff. There was very good evidence that the service promoted the attainment of a recognised qualification to register with the Scottish Social Services Councils for both manager and staff. Staff indicated that they had no outstanding training needs and were keen to continue with their ongoing professional development. Throughout the inspection staff were observed to be respectful and professional in their interactions with residents and visitors to the home. Visitors who were interviewed spoke highly of the staff. Areas for Development A member of the senior staff has been allocated responsibility for training in the unit. The manager identified familiarisation with this role as an areas of improvement. CCO Grading 5 - Very Good Number of Requirements Number of Recommendations 12/17
Quality Theme 4: Quality of Management and Leadership Overall CCO Theme Grading: 4 - Good 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 There was an Eildon wide participation strategy in place which reflects the way the provider engages with service users. The Association has a Tenant Participation Officer whose role is developing different methods to encourage participation. Bulletins containing relevant information were supplied to service users and other stakeholders on current developments within the Association. Opportunities to join service user forums were provided. The manager expressed a commitment to providing an open door policy and visitors to the home were clear as to who the manager was and confirmed they were made welcome. Observation of the relaxed manner in which residents sought out and conversed with the manager it was obvious that she was accessible and familiar to them. Staff spoken with expressed their confidence in the leadership of the service and felt that they worked well as a team. Areas for Development It is acknowledged that there are difficulties due to cognitive impairment which restricts the engagement of service users in discussion about future development of the service and feedback on the quality of management and leadership of the service. Further development of relatives meetings and quality assurance systems which invites feedback from relatives and other stakeholders on the quality of the service may facilitate this. Areas for development identified in Quality Statement 1.1 would further facilitate service user and other stakeholders' involvement in the self assessment process. CCO Grading 4 - Good Number of Requirements Number of Recommendations 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. 13/17
Service Strengths The service recognised the importance of good leadership and accountability. The management ensured that the appropriate action plans were submitted to the Care Commission for the purpose of regulatory activity. The manager displayed a good level of knowledge with regards to her role and responsibilities to report to the Scottish Social Services Council and the Care Commission incidents involving staff misconduct and any resulting dismissals. All the satisfaction questionnaires issued by the Care Commission noted that service users and their families who were consulted were aware of the complaints procedure and would be comfortable raising concerns. The relevant notifications to the Care Commission were completed and submitted. The verbal responses and information contained in satisfaction questionnaires demonstrated that the providers and manager were held in high regard and stake holders had confidence in their management and leadership. Areas for Development Discussion took place about extending and formalising the auditing systems in the home to ensure that regular audits were carried out on all recording systems and the outcomes documented as part of the quality assurance process. Extending the role of relatives and other stakeholders in the completion of the self assessment form and subsequent grading of the service should be considered. Progress with regards to the above will be reviewed at the next inspection. The areas for development identified under statement 1.1 also apply. CCO Grading 4 - Good Number of Requirements Number of Recommendations 14/17
Regulations / Principles National Care Standards 15/17
Enforcement There has been no enforcement action against this service since the last inspection. Other Information Three recommendations were made at the last inspection. 1. The provider should continue to explore methods of seeking resident's representative's views including re-instating carers' meetings. This could include a meeting to inform them of the changes to inspection and their role in influencing gradings. National Care Standards, Care Homes for Older People: Standard 11 - Expressing your views This recommendation has been met. 2. A procedure which ensures consistency in the delivery of information during the introductory visits to the care service should be developed. National Care Standards, Care Homes for Older People: Standard 2 - Trial visits Progress - The introductory information sheets for new residents had been reviewed and a new question and answer format adopted which addresses the most commonly asked questions from prospective residents and their families. This recommendation has been met. 3. Consideration should be given to developing a staff satisfaction survey which is relevant to the provision of a care services. National Care Standards, Care Homes for Older People: Standard 5 - Management and Staffing arrangements. This recommendation has been met. Requirements There were no requirements made at this inspection. Recommendations 1. The provider should review the service's participation strategy to ensure it is representative of the service provided at Crawwood. Following this training should be provided for staff in participatory and engagement methods. To ensure that service users with cognitive impairment can share their views and maximise their contribution to the development of the quality of the service. National Care Standards, Care Homes for Older People: Standard 5 - Management and staffing arrangements. 2. As part of the care planning process the manager should explore with the service users' representatives the extent of their involvement in care planning and review and their satisfaction with the current arrangements. This discussion should take account of the circumstances when they would like informed of changes to health care needs, visits from health professionals and any issues they may have with regards to the administration of medication. National Care Standards, Care Homes for Older People: Standard 11 - Expressing your views and Standard 6- Support arrangements. 3. The manager should review, in consultation with a qualified dietician, the robustness of their current nutritional assessment tool to ensure that it is an effective and validated method for identifying the risk of under nutrition. National Care Standards, Care Homes for Older People: Standard 13 - Eating Well 16/17
Janette Bishop Care Commission Officer 17/17