Abbeyside Nursing Home Care Home Service Adults Institution Road Elgin IV30 1QX Telephone: 01343 549468 Inspected by: Derek Priest Type of inspection: Unannounced Inspection completed on: 3 April 2013
Contents Page No Summary 3 1 About the service we inspected 4 2 How we inspected this service 6 3 The inspection 10 4 Other information 22 5 Summary of grades 23 6 Inspection and grading history 23 Service provided by: Abbeyside Nursing Homes Limited Service provider number: SP2003002308 Care service number: CS2003013732 Contact details for the inspector who inspected this service: Derek Priest Telephone 01343 541734 Email enquiries@careinspectorate.com Abbeyside Nursing Home, page 2 of 25
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 5 Very Good Quality of Environment 5 Very Good Quality of Staffing 5 Very Good Quality of Management and Leadership 5 Very Good What the service does well The service provided a homely environment for the residents. There was a good range of activities on offer to the residents, and it was good to see that outings continued even during colder periods of the year. What the service could do better The service should improve the recording of the dates for when the care plans are implemented What the service has done since the last inspection The service has continued to provide a very good level of care. A fire suppression system was in the process of being installed. Conclusion This service continues to perform at a very good level. There appeared to be good relationships and communication between the service, the residents and their families. Who did this inspection Derek Priest Abbeyside Nursing Home, page 3 of 25
1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at www.careinspectorate.com This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April 2011. Requirements and Recommendations If we are concerned about some aspect of a service, or think it could do more to improve, we may make a Recommendation or Requirement. - A Recommendation is a statement that sets out actions the care service provider should take to improve or develop the quality of the service, but where failure to do so will not directly result in enforcement. Recommendations are based on the National Care Standards, relevant codes of practice and recognised good practice. - A Requirement is a statement which sets out what is required of a care service to comply with the Public Services Reform (Scotland) Act 2010 and Regulations or Orders made under the Act or a condition of registration. Where there are breaches of Regulations, Orders or Conditions, a Requirement must be made. Requirements are legally enforceable at the discretion of the Care Inspectorate. Abbeyside Nursing Home is registered to provide a care home service to a maximum of 26 older people. The care home provides long term care as well as short breaks and respite placements. The service is operated by a private provider, Abbeyside Nursing Homes Limited, and is part of a group of four care homes situated in Elgin and Lossiemouth. The service operates from a large Victorian house situated in a quiet residential area, close to the amenities of the town centre of Elgin, in Morayshire. The care home provides single and double bedroom accommodation, some with ensuite facilities; there is an assisted bathroom and shower facilities. There is a bright and airy sitting room and dining room, and seating is also available around the fireplace at the entrance area. There is a dedicated hairdressing salon. The garden grounds are easily accessible to people using the service, and seating is available which can be enjoyed during good weather. Adequate car parking is available. Abbeyside aims and objectives include: 'We aim to provide the best possible care for all our residents in a comfortable, friendly environment with a kind and caring approach which extends beyond physical Abbeyside Nursing Home, page 4 of 25
well being to a philosophy of actively promoting a fulfilling lifestyle for each individual resident based on their needs.' Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 5 - Very Good Quality of Environment - Grade 5 - Very Good Quality of Staffing - Grade 5 - Very Good Quality of Management and Leadership - Grade 5 - Very Good Inspection report continued This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change following other regulatory activity. You can find the most up-to-date grades for this service by visiting our website www.careinspectorate.com or by calling us on 0845 600 9527 or visiting one of our offices. Abbeyside Nursing Home, page 5 of 25
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 We wrote this report after an unannounced inspection which started on Tuesday 2 April 2013 between 9.15 am and 4.15 pm approximately. A further visit took place on Wednesday 3 April 2013 between 9.15 am and 4 pm. The inspection was carried out by Derek Priest, an inspector with the Care Inspectorate. During the visit we gathered evidence from various sources, including written records: - current self assessment document - two Care Standards Questionnaires returned by or on behalf of residents - five Care Standards Questionnaires returned by relatives of residents - four staff questionnaires returned by staff members of the service - five service user care plans - various policies - maintenance records - training records. Discussions with various people, including: - five residents - the manager - three nurses - one care staff member - two relatives. 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 Abbeyside Nursing Home, page 6 of 25
Inspection Focus Areas (IFAs) Inspection report continued 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 Abbeyside Nursing Home, page 7 of 25
What the service has done to meet any recommendations we made at our last inspection The previous Recommendation was addressed with consultation with the community pharmacist. 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 Care Inspectorate received a fully completed self assessment document from the provider. We were satisfied with the way the provider completed this, and with the relevant information included for each heading that we grade services under. The provider identified what it thought the service did well, some areas for development and any changes planned. Taking the views of people using the care service into account Care Standards Questionnaires were returned from two residents. Both either strongly agreed or agreed that they were satisfied with the overall quality of care that was provided. Information provided for other questions was similarly positive. Five residents were spoken with during the inspection. These residents reported that they received good care and good food. They stated that they got on well with the staff members. Taking carers' views into account Care Standards Questionnaires were returned from five relatives of residents at the care home. As with the residents, all five relatives responded with a strongly agree or Abbeyside Nursing Home, page 8 of 25
agree answer to the same question. One comment was received stating that "staff could not do enough for (their) relative." Two relatives were spoken with during the inspection visit. They reported that there was good communication from the staff at the care home. They also stated that the residents received a variety of activities and that their relative received good care and good food. Abbeyside Nursing Home, page 9 of 25
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: 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 At this inspection we found that the performance of the service was very good for this Statement. The service provided many opportunities for the residents and their relatives to be involved in various aspects of the care being provided. Residents and their families provided information about the residents' needs to help ensure that appropriate support was planned and implemented. One family member added information about the resident's interest in watching rugby. A note was added to the file to inform staff to put rugby on TV when possible. Families were invited to, and many attended, review meetings with or on behalf of the resident. This included six monthly and annual review processes. An advocate attended review meetings on behalf of one of the residents: this ensured that the resident's views were included. Where family members lived out of the area, reviews were planned to take place to suit their visiting pattern. The views of the residents and relatives were taken on a regular basis. Questionnaires were issued to a sample of residents and relatives every three months. These questionnaires provided suggestions for new activities and outings. The Care Standards Questionnaires also showed that the residents' and relatives' views were requested. The manager stated that there was to be a programme of refurbishment to the care home following the completion of the fire suppression system installation. Residents and their families would be asked about the decoration of communal areas and their rooms. Abbeyside Nursing Home, page 10 of 25
A regular newsletter was produced to update the residents and their families on any developments at the care home. This included the development of life stories and requesting families to assist staff with these, themed meals, results of questionnaires, and an update of work within the care home, planned entertainment and fundraising events. The most recent relatives' meetings discussed similar issues. Residents discussed the purchase of equipment for use during activities. The residents were involved in planning the entertainment to celebrate Burns Night. Residents were encouraged to continue their lifestyle as much as possible following admission to the care home, such as decorating their rooms with items from home, continuing to watch their favourite sports and attending their hairdresser in the community. Staff members supported them in continuing with these activities. The Abbeyside feedback policy included the situations which were currently being carried out at the care home, including involvement in reviews, relative/resident meetings and the availability of a suggestions box, which was infrequently used. Areas for improvement The service should continue to involve the residents and their families in making decisions about their individual care needs. They should also ensure that the views of the residents and relatives were taken into account when refurbishing the communal and personal areas of the care home. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths At this inspection we found that the performance of the service was very good for this Statement. The service provided a very good level of healthcare, including meals, to the residents. The staff at the service also provided a wide range of social care to the residents, with activities being held within the service and utilising local attractions. The care home continued to have good links with the local GP practices. Residents retained their family GP whenever possible, who continued to visit as necessary and were actively involved in supporting the care home staff with regards to the residents' healthcare needs. Other healthcare professionals were also involved in treating Abbeyside Nursing Home, page 11 of 25
residents and supporting care staff to meet the needs of the residents. The personal plans provided very good information about the residents' personal information, healthcare and social needs, and how these were being supported through the development of individual care plans. The care plans provided information on the residents' level of independence and detailed the support that was required to maintain that level. All appropriate assessments had been carried out and were regularly updated, and care plans were amended as necessary. Annual reviews with the care manager and six-monthly reviews with the care home staff continued to take place, with the involvement of the resident and their families as appropriate. More frequent reviews took place as necessary. Daily records continued to be recorded. Safe medication procedures were observed during lunchtime. Medications were administered safely and appropriate records were made, including where medications were being withheld. Regular auditing of the medication procedures was carried out by the local pharmacist and by the NHS pharmacist. A very high quality level of meals was provided. Mealtimes and "fly cups" were well presented, with the residents being offered a choice of where they took meals and tea breaks. Many chose to have their tea breaks and meals in the dining room, but some had these in their rooms. Meals were well presented, with the tables being well laid out with appropriate crockery and cutlery, including specialised utensils. A single choice was offered, but alternatives were available for each course. Meals were well presented and were of a very good portion size. Staff members supported the residents during mealtimes and were observed to encourage residents with their meal; this was in an unhurried way to allow the residents to enjoy their meal. It was observed that appropriate dietary arrangements were also available, and on one occasion a resident was offered an alternative kind of soup when they did not appear to like the one on the menu. On speaking with a relative they explained that their relative, the resident, required encouragement to eat her meals. During mealtimes a plentiful supply of drinks was offered to the residents. Jugs of juices and water were refreshed as necessary. Thickened drinks were also provided, as recommended by speech and language therapists, for specific residents. Residents had requested that tea was provided after lunch and this was done. Staff members appeared well organised during the mealtime, with each staff member being aware of their role and area of responsibility. Some staff attended to the residents in the dining room, with other staff members ensuring that the other residents were also attended to. It was also noted that the staff members were well organised at other times Abbeyside Nursing Home, page 12 of 25
throughout the day, ensuring that there was always a staff member present in the day room to provide activities and support to the residents there. It was observed that safe moving and handling procedures were being used, with good communication between the staff and residents regarding an explanation of the procedure. Residents returning from the dining room following tea break or lunch were transferred from their wheelchair to a chair of their choice in the sitting room. Appropriate equipment was being used. In addition to the staff supporting the healthcare needs of the residents, an active activity plan was in operation. This included regular outings, attending church, musical entertainment and regular in-house activities. It was very good to view that outings took place throughout the year unless the weather made it unsafe to be out. A photographic record of the type of activities was kept. It was very good to see that residents continued to go on outings throughout the year. The photos demonstrated that staff had considered the weather and that the residents were appropriately dressed for them to go to the park during February. Other activities included an exotic foods tasting, Burns Supper and visits from pet therapy groups. Areas for improvement Despite the personal plans having a very good level of detail about the person and their preferences, and care plans explaining the support that they needed, it was noted that some care plans had not been dated as to when these were commenced. It was also noted that some care plans could include further detail, such as: * more detail about sleeping routine, including the resident's usual wakening time * reference to detailed guidance such as diabetic and nutritional guidance * information explaining when "as required" medications should be recorded. The care plans should be reviewed to ensure that these examples and any others are updated to provide more detailed information. (See Recommendation 1) Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. It is recommended that all care plans are dated to record their commencement and when they are reviewed, and provide detailed information to enable staff to provide appropriate support. National Care Standards, Care Homes for Older People, Standard 6, Support Arrangements. Abbeyside Nursing Home, page 13 of 25
Quality Theme 2: Quality of Environment Grade awarded for this theme: 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 This Quality Statement has been reported as part of Quality Theme 1, Quality Statement 1. Areas for improvement Any Recommendations or Requirements have been reported as part of Quality Theme 1, Quality Statement 1. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Statement 2 We make sure that the environment is safe and service users are protected. Service strengths At this inspection, we found the performance of the service to be very good in relation to this Statement. The environment was safe and was appropriate for the service operating from the building. The care home was clean and tidy and was reasonably decorated. The service provider was in the process of installing a fire suppression system. The manager, staff and tradesmen installing the equipment were working closely together to ensure that the works did not cause any risk to the staff and residents. The care home provided a secure and safe environment for the people who lived there. Risk assessments had been completed for the building to ensure that any risks to residents were minimised and actions taken were made to reduce any potential risk. Risk assessments were developed for the kitchen area, stair climbers, infection control, food hygiene and other relevant areas. This document was reviewed annually or whenever any changes were made to the premises. Abbeyside Nursing Home, page 14 of 25
Individual risk assessments were also made for each resident, which included moving and handling and other issues which may affect the resident. The items of equipment used at the service was serviced and maintained regularly to ensure that they were in a working condition, in order to be used to assist staff in the care of the residents. Portable appliance testing was carried out on all small electrical appliances used by the service or the residents. The service had an appropriate health and safety policy which was reviewed by external consultants. External consultants also carried out health and safety inspections of the service. Action plans were developed and implemented. The manager and nurses carried out additional quarterly health and safety inspections following a detailed checklist. Issues identified were reported for maintenance or implemented as necessary. A programme of daily checks was completed for wheelchairs, bed rails and sensor mats to ensure that they were in proper working order. Any issues were reported to the handyman for repair. Other maintenance issues were also reported in a maintenance record, and completion of the repair was also recorded. During the inspection visit an engineer was called to repair the "hot water boiler" in the kitchen. This was repaired later the same day. Thermostatically controlled valves were fitted to hot water outlets. Regular checks were made to these. Environmental Health inspectors visited the service periodically and had recorded a satisfactory report. Areas for improvement The service carried out appropriate checks to the hot water outlets. However, from the records it was noted that some of the recordings exceeded the guidance in relation to the maximum temperature for hot water outlets. The manager called the following day to advise that arrangements had been made to address these issues. (See Recommendation 1) The manager advised that following the completion of the installation of the fire suppression system a programme of refurbishment would take place to communal areas, followed by individual rooms. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Abbeyside Nursing Home, page 15 of 25
Recommendations Inspection report continued 1. The manager should ensure that when the hot water temperature exceeds the recommended level appropriate action is taken to reduce the water temperature at the hot water outlet to a safe level. National Care Standards, Care Homes for Older People, Standard 4, Your Environment. Health and Safety in Care Homes, Health & Safety Executive, page 29 - ISBN 0 7176 2082 4. Abbeyside Nursing Home, page 16 of 25
Quality Theme 3: Quality of Staffing Grade awarded for this theme: 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 This Quality Statement has been reported as part of Quality Theme 1, Quality Statement 1. Areas for improvement Any Recommendations or Requirements have been reported as part of Quality Theme 1, Quality Statement 1. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths At this inspectio, we found the performance of the service to be of a very good level for this Statement. Staff members appeared motivated and provided a very good level of support to the residents. Staff members were recruited in accordance with the service's recruitment policy and safe recruitment guidance. References and PVG (disclosure) reports were obtained prior to staff members commencing work at the service. A wide range of training was available through the company's training manager. This included mandatory training for new staff members, annual training and training related to specific needs. All staff received Moving and Handling, Fire, Infection Control, Food Hygiene and Adult Support and Protection training before they commenced work. The Adult Support and Abbeyside Nursing Home, page 17 of 25
Protection training was completed as part of e-learning. Moving and handling and Fire training were completed by all staff on an annual basis. Specific training was provided to nursing staff as part of their Continued Professional Development. This included Anaphylaxis, Catheterisation, Venepuncture and Pain Management training. Nursing staff also attended other training and took lead responsibilities for link nurse roles, such as continence and wound care. Another nurse had attended and completed a Cleanliness Champions course. Part of this role was to link staff with information that they could access online. Additional training was also available for Dementia using online resources such as the Social Care Institute for Excellence (SCIE) and other DVD resources. Training was also provided in relation to Nutrition, Challenging Behaviours, Continence, Safe Handling of Medicines, Palliative Care, Oral Care, Foot Care, Caring for Smiles and wound care. These training events were provided in-house or by local healthcare professionals. From discussion with nursing and care staff they advised that the service provided many opportunities for staff to access additional training. A number of staff members held appropriate qualifications for working at the service. These qualifications include a nursing qualification or an SVQ in care. Staff members also reported that they received regular supervision sessions and that staff meetings were held every three months. Areas for improvement The service should further develop the role of cleanliness champion and any similar positions to provide training to staff, carry out audits and implement changes to recommended practices. The service should ensure that care staff are provided with the opportunity to complete an SVQ in care. Current guidance is that all support workers for this type of service must submit their applications to register with the Scottish Social Services Council (SSSC) by 30 September 2014. (See Recommendation 1) Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. The service provider should ensure that all care staff become registered with the SSSC and are provided with the opportunity to complete an SVQ in care within the Abbeyside Nursing Home, page 18 of 25
timescales provided by the SSSC. National Care Standards, Care Homes for Older People, Standard 5, Management and Staffing Arrangements. Abbeyside Nursing Home, page 19 of 25
Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 5 - Very 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 This Quality Statement has been reported as part of Quality Theme 1, Quality Statement 1. Areas for improvement Any Recommendations or Requirements have been reported as part of Quality Theme 1, Quality Statement 1. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Statement 4 We use quality assurance systems and processes which involve service users, carers, staff and stakeholders to assess the quality of service we provide. Service strengths At this inspection we found that the performance of the service was very good for this Statement. The service had a system in place to ensure that the safety checks identified in Quality Theme 2, Statement 2 were carried out at the appropriate time. The resident reviews took place every six months, with the dates being recorded in advance to ensure that these took place at the appropriate time. The manager was required to submit information to the local authority on a regular basis for accidents, incidents complaints and admission/discharges. In an Annual Quality Assurance Assessment Self Audi,. 25% of residents were audited each quarter in relation to care, environment, entertainment, personal care, choice, outings and other issues. Abbeyside Nursing Home, page 20 of 25
There was evidence that the NHS and the local pharmacy carried out regular audits of the medication systems such as storage, returns and recordings. Other audits carried out at the service included weight audits, care plan audits and training needs audit. Examples of these were viewed. Areas for improvement The manager had started to complete a regular dependency scale. She advised that she had started to complete this but had been unable to access the system to complete this. The manager should begin to complete this on a monthly basis. (See Recommendation 1) Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. It is recommended that the manager completes four-weekly assessments of the residents' physical, social, psychological and recreational needs and choices as to how the service will deliver their care. This is to lead to identifying the number of care hours required for each resident, and therefore lead to develop a minimum staffing level. National Care Standards, Care Homes for Older People, Standard 5, Management and Staffing Arrangements. Records Registered Care Services Must Keep, SCSWIS (Care Inspectorate), 2011. Abbeyside Nursing Home, page 21 of 25
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 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). Abbeyside Nursing Home, page 22 of 25
5 Summary of grades Quality of Care and Support - 5 - Very Good Statement 1 Statement 3 5 - Very Good 5 - Very Good Quality of Environment - 5 - Very Good Statement 1 Statement 2 5 - Very Good 5 - Very Good Quality of Staffing - 5 - Very Good Statement 1 Statement 3 5 - Very Good 5 - Very Good Quality of Management and Leadership - 5 - Very Good Statement 1 Statement 4 5 - Very Good 5 - Very Good 6 Inspection and grading history Date Type Gradings 4 Apr 2012 Unannounced Care and support 5 - Very Good Environment 4 - Good Staffing 5 - Very Good Management and Leadership 4 - Good 13 Jan 2011 Announced Care and support 4 - Good Environment Not Assessed Staffing Not Assessed Management and Leadership Not Assessed 3 Nov 2010 Unannounced Care and support 5 - Very Good Environment 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good Abbeyside Nursing Home, page 23 of 25
1 Mar 2010 Unannounced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 3 - Adequate 31 Jul 2009 Announced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 3 - Adequate 19 Feb 2009 Unannounced Care and support 3 - Adequate Environment Not Assessed Staffing 3 - Adequate Management and Leadership 3 - Adequate 22 Jul 2008 Announced Care and support 3 - Adequate Environment 4 - Good Staffing 3 - Adequate 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. Abbeyside Nursing Home, page 24 of 25
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 the Care Inspectorate. You can get more copies of this report and others by downloading it from our website: www.careinspectorate.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@careinspectorate.com Web: www.careinspectorate.com Abbeyside Nursing Home, page 25 of 25