Care service inspection report Follow-up inspection Riverview Lodge Care Home Care Home Service 111 Tay Street Newport-on-Tay Inspection completed on 09 March 2016
Service provided by: Thomas Dailey trading as Kennedy Care Group Service provider number: SP2003003646 Care service number: CS2006115975 Inspection Visit Type: Unannounced Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and set out improvements that must be made. We also investigate complaints about care services and take action when things aren't good enough. Please get in touch with us if you would like more information or have any concerns about a care service. Contact Us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com 0345 600 9527 www.careinspectorate.com @careinspect page 2 of 15
1 About the service we inspected Riverview Lodge Care Home is a private care home, provided by the Kennedy Care Group. The home has 18 rooms and is situated on the south bank of the River Tay. The home is registered to provide 24-hour nursing care and support for a maximum of 20 older people. At the time of this inspection visit there were 20 people living in the home. The accommodation is an extended Victorian mansion-house set within mature gardens with private off-street parking for visitors to the home. Accommodation is on three levels and can be accessed by means of a staircase or passenger lift. Office space and staff facilities are accommodated on the top floor of the home. The property has undergone a major refurbishment programme providing a pleasant place to live. There are 16 single rooms and two double rooms for residents who may choose to share. Of the bedrooms, 16 have an en suite toilet, wash hand basin and shower facility. This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April 2011. The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at www.careinspectorate.com. 2 How we inspected this service Two inspectors undertook an unannounced inspection visit to the service on 9 March 2016 between 11:00am and 4:30pm. Verbal feedback was given to the provider and manager at the end of the visit. We took account of the completed annual return and self assessment forms that we asked the provider to complete and submit to us. page 3 of 15
During this inspection process, we gathered evidence from various sources, including the following: We spoke with: - ten residents - members of the staff team - the provider - the manager. We looked at: - residents' care documentation - staff training records - quality assurance records - testing certificates for hoists/slings. We also observed staff practice and walked around the home. We used the Short Observational Framework for Inspection (SOFI 2) to directly observe the experience and outcomes for people who were unable to tell us their views. On this occasion we observed the interaction for three people for a period of eight minutes during their lunchtime meal. Outcomes experienced by people as a result of the observed level of engagement and staff interaction were discussed with the manager. 3 Taking the views of people using the service into account Residents told us: - "They are all lovely here." - "We are well looked after." - "Soup was great, they do a lovely salad." - "Lovely situation to be here, I am very contended. I don't have to do anything." page 4 of 15
4 Taking carers' views into account We did not have opportunity to speak with relatives during our visit. 5 What the service has done to meet any requirements we made at our last inspection Previous requirements 1. The provider must ensure that an appropriate wound care plan is put in place for each wound and that these are individually evaluated for clarity. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, (SSI 2011/210) Regulation 4(1)(a) - Welfare of Users. Timescale: to be commenced immediately on receipt of this report. This requirement was made on 05 January 2016 We undertook a review of three plans of care that were specific to the management of wound care. In doing so we saw that there had been development in the type of documentation used. This provided an opportunity to clearly demonstrate a process of assessment, plan and evaluation of care. However, areas identified for further improvement included: - There needed to be consistency in how wounds were described, for example the type, size and grade. - There needed to be consistency in ensuring the evaluation of care did not contain information that should have been reflected in the care plan. For example, when a choice of dressing had changed. page 5 of 15
- There needed to be greater consistency in the use of photographs to demonstrated effectiveness of care interventions. - There needed to be consistency in ensuring dates for evaluation of wound care interventions were undertaken as identified. As a result, this requirement remains in place. Not Met 6 What the service has done to meet any recommendations we made at our last inspection Previous recommendations 1. It is recommended that the manager ensures that staff are made aware of the need to have consistency in how assessment, risk assessment and care planning is undertaken. This is to ensure care is effective and based on best practice. National Care Standards, Care Homes for Older People - Standard 6: Support Arrangements. This recommendation was made on 05 January 2016 There had been a focus on the further development of documentation to support the delivery of individualised care. However, on review of care documentation we saw the following areas that needed further development: - We saw an example of a plan of care that set out palliative care needs, however this lacked some detail in respect of key elements of symptom control. We also saw page 6 of 15
that a large number of care plans had not been reviewed and discontinued as no longer appropriate. This had the potential to impact on the delivery of consistent care based on good practice. - We were aware of an example where supplementary documentation used to demonstrate the frequency of when a person was being moved had not been completed. This made it difficult to demonstrate an appropriate level of care intervention to promote an individual's wellbeing. - Care plans needed to be more measurable with clear dates for evaluation of interventions. - Care was needed to ensure that review documentation reflected the outcome of interventions and that any actions proposed were clearly recorded as being achieved. - We saw that in two instances evaluation of care was undertaken but there were no plans in place. Staff we spoke with were able to demonstrate an understanding of people's needs. However, the deficits identified above had the potential to impact on consistency in how care was being delivered. As a result, this recommendation remains in place. 2. It is recommended that the management and maintenance team carry out a full audit of all lifting equipment (including slings) in the home and take actions to ensure that records are available to confirm that the required checks are carried out prior to these being used to help move around. National Care Standards, Care Homes for Older People - Standard 4: Your. (1) Your environment will enhance your quality of life and be a pleasant place to live. (2) You can expect that the home is run in a way that protects you from any avoidable risk or harm, including physical harm and infection. The nature of its design, facilities and equipment also protect you. page 7 of 15
This recommendation was made on 05 January 2016 People's safety was being promoted through the regular service and inspection of hoists and slings. This was demonstrated when we viewed the testing certificates and saw that appropriate checks had been completed. We discussed the importance of having the information readily accessible to staff so that they could check the safety record of each piece of equipment/sling as and when it was being used. The manager agreed to facilitate this. As a result, this recommendation has been achieved. 3. It is recommended that the management team fully implement the planned training programme for all staff. This should include training in palliative care and wound care and measures should be in place to assess staff competencies following training. National Care Standards, Care Homes for Older People - Standard 5: Management and Arrangements. (1) You experience good quality support and care. This is provided by management and staff whose professional training and expertise allows them to meet your needs. The service operates in line with all necessary legal requirements and best practice guidelines. (2) You are confident that staff know how to put policies and procedures into practice. They have regular training to review this and to learn about new guidance. (3) You are confident that the staff providing your support and care have the knowledge and skills gained from the experience of working with people whose needs are similar to yours. If they are new staff, they are being helped to get this experience as part of a planned training programme. (4) You are confident that all the staff use methods that reflect up-to-date knowledge and best practice guidance and that the management are continuously striving to improve practice. page 8 of 15
(9) You know that the service has a staff development strategy and an effective yearly training plan for all its staff. This recommendation was made on 05 January 2016 The development of the staff knowledge and skills continued to be a focus area. A training matrix was being developed and we saw that this reflected the dates of training completed since the beginning of the year. However, the matrix did not contain information about training that had been completed in previous years or when refresher training would be expected to be undertaken. This made it difficult to determine if staff had the appropriate level of knowledge needed to maintain people's health and welfare. On review of the matrix we also saw that there continued to be a focus on mandatory training, such as fire safety, moving and handling and infection control. However, there was a lack of focus on key training to support the care being delivered. For example, wound care, palliative care, diabetic care, and adult support and protection (ASP). There was a lack of ability to demonstrate how increased knowledge and skill had been put into practice. This was because supervision sessions had been commenced but had not focused on the inclusion of observed practice. We saw that quality assurance systems implemented did not formally reflect how residents had benefitted from staff training. We discussed with the manager the importance of ensuring systems, such as staff supervision, appraisals and quality assurance monitoring, form the basis of staff's continued development and performance management. This would ensure positive outcomes for people through the delivery of care based on best practice. In determining the outcome of this recommendation we took into account other findings referenced throughout this report. As a result, this recommendation remains in place. page 9 of 15
4. It is recommended that there is a greater focus on development of staff leadership skills to ensure greater consistency in care delivery, staff practices and ongoing development and improvement of the service being provided. National Care Standards, Care Homes for Older People - Standard 5: Management and Arrangements. This recommendation was made on 05 January 2016 We were aware that this remained a key focus area for further development. The manager informed us that they had accessed additional learning opportunities for staff. However, this had yet to be undertaken. In determining the outcome of this recommendation we also took into account the findings of other sections of this report. As a result, this recommendation remains in place. 5. It is recommended that management need to monitor/evaluate quality assurance systems to ensure that they are effective. Findings and actions plans need to be followed up to bring about improvements. National Care Standards, Care Homes for Older People - Standard 5: Management and Arrangements; and Standard 11: Expressing Your Views. This recommendation was made on 05 January 2016 We saw that quality assurance monitoring had continued with a number of audits being undertaken at regular intervals. The manager confirmed that audits had been delegated to members of the staff team. This had resulted in a different perspective being achieved. Documentation viewed demonstrated the identification of actions but did not consistently indicate whether they had been completed. We saw that there needed to be a greater focus on using a risk-based approach to ensure actions were demonstrated as being achieved in a timely manner. page 10 of 15
When viewing the documentation we were unable to clearly identify the outcomes achieved for people who lived in the home. We discussed with the provider and manager how the service would benefit from a development plan that clearly set out key aims and objectives. The setting of measurable actions would result in a more focused, targeted approach being taken to the development of the service. In determining whether this recommendation had been achieved we took into account the findings as referenced throughout this report. As a result, this recommendation remains in place. 7 Complaints No complaints have been upheld, or partially upheld, since the last inspection. 8 Enforcements We have taken no enforcement action against this care service since the last inspection. 9 Additional Information People were being supported to maintain their interests and hobbies through a programme of social activities and events. Through discussions with residents and by looking at photographs around the home, we were able to see that there was a variety and choice available to people. Staff demonstrated an understanding of people's needs and interactions were seen to be warm and friendly. Residents were being supported in a way that maintained their dignity and choice. page 11 of 15
We had opportunity to observe a mealtime. We saw that there was good staff support and interaction for residents who needed assistance. People were assisted in a timely manner. The tables were nicely set and most residents appeared to be sitting with others they got on with. Choices and preferences were seen to be met. This included choice of drinks and visual choices of meals at point of serving. We also observed where residents changed their mind during meals that alternatives were offered. We noted that there was a nice atmosphere that encouraged a social event. Signage throughout the home had improved and since the last inspection the kitchen had undergone a refurbishment with new flooring, wall coverings, units and equipment. We saw that the entrance and lounge carpets both needed cleaning/ replacement and in discussion with the provider we were assured that this would be arranged. This will be followed up at the next full inspection. During this inspection it came to our attention that not all staff who were required to were registered with the Scottish Social Services Council (SSSC). The provider took immediate action in relation to this therefore no requirement was made. 10 Inspection and grading history Date Type Gradings 11 Nov 2015 Unannounced Care and support Management and Leadership 3 Mar 2015 Unannounced Care and support Management and Leadership 23 Oct 2014 Unannounced Care and support Management and Leadership page 12 of 15
16 Dec 2013 Unannounced Care and support 5 - Very Good 5 - Very Good 5 - Very Good Management and Leadership 5 - Very Good 18 Jan 2013 Unannounced Care and support Management and Leadership 19 Nov 2012 Re-grade Care and support 2 - Weak Management and Leadership 19 Apr 2012 Unannounced Care and support Management and Leadership 10 Nov 2011 Unannounced Care and support Management and Leadership 24 Jun 2011 Unannounced Care and support Management and Leadership 30 Nov 2010 Unannounced Care and support Management and Leadership 17 Sep 2010 Unannounced Care and support Management and Leadership page 13 of 15
28 Apr 2010 Announced Care and support Management and Leadership 5 Nov 2009 Announced Care and support Management and Leadership 24 Jun 2009 Unannounced Care and support Management and Leadership 29 Jan 2009 Announced (short notice) Care and support Management and Leadership 2 - Weak 30 Oct 2008 Unannounced Care and support Management and Leadership 2 - Weak 18 Sep 2008 Unannounced Care and support 2 - Weak 2 - Weak 2 - Weak Management and Leadership 2 - Weak 16 Jul 2008 Announced Care and support Management and Leadership 2 - Weak page 14 of 15
To find out more This inspection report is published by the Care Inspectorate. You can download this report and others from our website. You can also read more about our work online. Contact Us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com 0345 600 9527 www.careinspectorate.com @careinspect Other languages and formats This report is available in other languages and formats on request. Tha am foillseachadh seo ri fhaighinn ann an cruthannan is c?nain eile ma nithear iarrtas. page 15 of 15