Torry Nursing Home Care Home Service 36 Balnagask Road Torry Aberdeen AB11 8HR Telephone: 01224 890600 Type of inspection: Unannounced Inspection completed on: 13 December 2017 Service provided by: Renaissance Care (No3) Limited Service provider number: SP2013012055 Care service number: CS2013316789
About the service Torry Nursing Home service is provided by Renaissance Care (No3) Limited and was registered to provide a care service to a maximum of 81 older people. The service was registered with the Care Inspectorate on 4 October 2013. Torry Nursing Home is a purpose-built home, which is situated in the Torry area of Aberdeen. It is close to local amenities and bus routes. The service's written statement of aims states that 'Renaissance Care aims to enhance the quality of life and maximise the potential of each individual, ensuring that dignity and privacy are maintained.' There were 77 people resident in the home at the time of this inspection. The provider had recently opened a six bedded 'interim' unit on the recently refurbished top floor of the home. This unit is to prevent people from experiencing a delayed discharge from hospital whilst they wait for a permanent place to become available in their preferred home. What people told us We received completed Care Inspectorate questionnaires from 14 residents and relatives prior to the inspection and we spoke with 19 residents and relatives during the inspection visits. All of the residents and relatives who we spoke with told us that overall they were either satisfied or very satisfied with the service provided. Most of the people who we spoke with told us that they thought the staff were good and that they provided a good standard of care to residents. One relative told us that they were very happy that their relative had been effectively supported by staff to stabilise their weight. Residents and relatives told us that they felt the home was clean and free from any unpleasant odours. Some residents and relatives mentioned to us that they thought the parts of the home which had been refurbished looked much nicer. A number of residents and relatives told us that they felt the quality of food could be improved. The provider agreed to continue to involve residents and relatives in reviewing and further developing the food provision. Some residents and relatives told us that they would like to have more information about activities and would like to see a wider range of activities being provided including better supports for residents to remain physically and mentally active. page 2 of 11
Self assessment The service had not been asked to complete a self assessment in advance of this inspection. We looked at the provider's improvement plan and quality assurance documentation. These demonstrated the service's priorities for development and how the quality of the provision within the service was being monitored. From this inspection we graded this service as: Quality of care and support Quality of environment Quality of staffing Quality of management and leadership Quality of care and support Findings from the inspection We found that this was a well-managed service and that good standards of care and support were provided to the people who lived at Torry Nursing Home. We found that the staff knew the residents well and had continued to make good progress in providing a person-centred service to them. Each resident had in place a personal plan. The personal plans which we looked at were comprehensive and contained relevant and up-to-date information for each resident's care and support needs. Since the previous inspection, the service had been using an auditing process to support overall improvements in the quality of the personal plans. The provider had also developed useful overviews for each resident of relevant legal powers and any areas of significant risk to their health and wellbeing. We found that the service could improve its recording and care planning in relation to residents living with dementia who experienced stress and distress. Incident records should contain more detail which would help to analyse any patterns of behaviour and approaches which have proven to be helpful. Personal plans and records should contain more detail of the specific interventions that staff could try and have tried to reduce stress and distress. We have recommended the provider undertakes a focus on this area of practice using the guidance contained in module 4 of the Promoting Excellence Framework for dementia. A number of staff had recently completed this. (See recommendation 1.) Effective arrangements were in place to ensure that residents received a review of their personal plan at least every six months. Appropriate arrangements were in place to ensure that residents were able to access a range of external health services. We received some positive feedback about the programme of planned activities, entertainment and outings. This included some one-to-one work with residents who could not take part in the group activities and supports for some residents to be involved in their local community. However, many of the residents and relatives who we spoke with told us that more support was needed to help residents to spend their time meaningfully and to remain as active and independent as possible. (See recommendation 1.) The provider told us that they intended to increase the number of staff hours allocated to supporting activities and were planning to carry out page 3 of 11
a trial with an external specialist provider to support the development of meaningful activity in the home including physical activities. Whilst a number of residents and relatives told us that they were happy with the food, a significant number told us they thought that there was room for improvement. The provider agreed to continue to review the provision of food in the home to ensure that this meets the needs and expectations of residents and their relatives. Since the previous inspection the provider had continued to make progress in involving residents and relatives in the continuous improvement of the service. This included recent residents' and relatives' surveys and regular relatives' meetings which had been better attended. The provider should consider collating the results of the surveys and sharing these, including any actions planned as a result of the surveys, with residents, relatives and staff. Requirements Number of requirements: 0 Recommendations Number of recommendations: 1 1. To support continuous improvements in the service, the provider should undertake a series of practice development focus areas. These should include supports; - for residents to spend their time meaningfully and to remain active - for residents who experience stress and distress. In doing so, account should be taken of the best practice guidance documents; 'Make Every Moment Count', 'Make Every Movement Count', 'Care About Physical Activity' and module 4 of the Promoting Excellent Framework for Dementia - 'Meeting the needs of the person with dementia who is distressed'. Reference: National Care Standards Care Homes for Older People - Standard 6: Support arrangements. Grade: 4 - good Quality of environment Findings from the inspection We found that good standards of cleanliness were maintained throughout the home and effective arrangements were in place for maintaining a safe environment. The areas of the home which had been refurbished were homely and welcoming. The home generally appeared to be well maintained, however, in some areas the décor was showing signs of wear. A programme of redecoration was on-going to ensure that good standards of décor are maintained throughout the home. Since the previous inspection external wood-work had been repainted which had improved the overall appearance of the home. There was evidence that in-house repairs were promptly carried page 4 of 11
out. We observed that supplies of personal protective equipment (PPE) were available throughout the premises at the point of use. There was evidence of a range of safety checks which had been completed by external contractors such as testing of portable electrical appliances. The provider had in place a schedule of equipment which required routine inspection and testing. Records indicated that all equipment used to assist residents to mobilise had been recently inspected and serviced. Staff told us that they had access to the equipment that they required to enable them to carry out their work safely. The home had a secure entry system to manage people coming in and out of the building. The provider had completed an audit of the premises to identify how it could be made more dementia friendly. The manager advised that they planned to review signage and other features to support improved orientation for people living with cognitive impairments and to identify ways to create a more enriched environment. A plan to create easier access to the enclosed central courtyard area was also being progressed to enable residents to get outdoors more often. The provider advised that they would continue to explore ideas for creating a more homely feel in the large Brimmond unit lounge. (See recommendation 1.) Requirements Number of requirements: 0 Recommendations Number of recommendations: 1 1. In order to ensure that all areas of the premises are appealing and welcoming for residents and their visitors, and is well suited to the needs of people living with dementia, the provider should continue with its ongoing refurbishment and development programme. This should include; - continuation of the internal re-decoration programme - replacement of remaining worn and stained floor coverings - implementation of areas for improvement identified from the dementia review of the environment - implementation of plans to create easy access to the secure outdoor area. National Care Standards Care Homes for Older People - Standard 4: Your. Grade: 3 - adequate Quality of staffing Findings from the inspection Since the previous inspection the rate of staff turnover had continued to reduce and the number of staff vacancies remained low. The provider continued to cover a small number of nurse shifts with agency staff, otherwise all carer and nurse shifts were covered by either the provider's permanent or bank staff. This helped to improve the continuity of care for residents. Good progress had been made on the completion of essential training and there was good evidence that staff page 5 of 11
had been supported to undertake relevant developmental training. The provider had established a number of practice leads and staff had been supported to complete additional training to develop further knowledge in these areas. The provider was making good progress in supporting all staff to complete the level of dementia training relevant to their role. The deputy manager was undertaking mentoring training, which was due to be completed in January 2018, to enable the service to provide work based placements for student nurses. All staff had received recent one to one supervisions to support their professional development. Overall, we found that the provider had given a strong commitment to supporting staff professional development and to developing a learning culture in the home. Effective arrangements were in place for checking that staff were registered with an appropriate professional body (Scottish Social Services Council (SSSC) or Nursing Midwifery Council (NMC)) and that their registrations were maintained. Over 50% of current care staff had achieved the conditions which are a condition of their registration with the SSSC. The manager advised that plans were being progressed to ensure that all care staff were supported to achieve relevant qualifications within the required timescales. We looked at a small sample of recent recruitment records. We found that safer recruitment guidance had been fully implemented in the recruitment of new staff and that appropriate and clear records of this were maintained. Requirements Number of requirements: 0 Recommendations Number of recommendations: 0 Grade: 4 - good Quality of management and leadership Findings from the inspection We found that the day-to-day management of the service was good. The manager and deputy manager had a good understanding of any issues affecting residents and understood what the service was doing well and those areas which were the priorities for improvement. Residents and relatives told us that they felt confident about how the service was being managed and that any concerns or problems they had with the service would be resolved by staff or management. There was good evidence of internal formal quality assurance processes being implemented. These included; monitoring of residents' nutritional status, risk of skin breakdown, regular medication administration record checks, health and safety audits and personal plans audits. A comprehensive audit of the service had also recently been completed by the provider's operations manager. The provider should make further use of quality assurance processes to support continuous improvements in practice areas, for example in relation to; food provision and the dining experience, preventing stress and distress, meaningful activity and care about physical activity. Given the large size of the home the provider should page 6 of 11
consider whether the current supernumerary management hours are sufficient to support ongoing continuous improvements in the service. In order to support continuous improvement in the home and to be able to share information about the improvement agenda, the provider should consider pulling all the different identified areas for improvement together into a service development action plan. Requirements Number of requirements: 0 Recommendations Number of recommendations: 0 Grade: 4 - good What the service has done to meet any requirements we made at or since the last inspection Previous requirements There are no outstanding requirements. What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 In order to ensure that all areas of the premises are appealing and welcoming for residents and their visitors, the provider should continue with its ongoing refurbishment programme. This should include; - internal re-decoration - re-painting of external woodwork - replacement of worn and stained floor coverings - implementation of areas for improvement identified from the dementia review of the environment. National Care Standards Care Homes for Older People - Standard 4: Your. page 7 of 11
This recommendation was made on 9 December 2016. Action taken on previous recommendation Since the previous inspection in March 2017 the provider had continued to make improvements to the environment. This included the following; - all of the internal light fittings in communal areas, bedrooms and en-suites had been upgraded - we observed that this had significantly improved the light levels throughout the premises - new outside lighting had been installed which made it easier and safer for residents and relatives to enter and leave the building after dark. The car park surface had been fully repaired to make this area safer to navigate. - all elements of the refurbishment of the Grampian ground floor unit had been completed, including new floor coverings in some areas, re-decorating, new furniture, curtains and pictures, which had significantly improved the overall impression of this part of the home - a bathroom in Tullos unit had been upgraded with a replacement bath and a new floor covering - the provider had employed its own decorator who was carrying out a programme of re-decoration of bedrooms which was progressing well - a number of worn floor coverings had been replaced including the carpet at the entrance of the hall which made this area more appealing - a downstairs bathroom which was surplice to requirements had been re-fitted to create a purpose-built hairdressing room - plan for improving access to and refurbishing the outside courtyard area had been progressed and it was hoped that work on this would commence in the spring of 2018. There remained a number of areas which the provider intended to improve as part of the ongoing refurbishment of the premises. These included; - continuation of the programme of internal re-decoration - replacement of further floor coverings - implementation of areas for improvement identified from the dementia review of the environment including signage and orientating features. The provider had made significant progress in meeting this area for improvement. A number of matters remained outstanding so we have continued this recommendation to be followed up at the next inspection. Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at www.careinspectorate.com. page 8 of 11
Enforcement No enforcement action has been taken against this care service since the last inspection. Inspection and grading history Date Type Gradings 23 Mar 2017 Unannounced Care and support Not assessed Not assessed Not assessed Management and leadership Not assessed 8 Dec 2016 Unannounced Care and support Management and leadership 30 Mar 2016 Unannounced Care and support Not assessed Not assessed Not assessed Management and leadership Not assessed 24 Nov 2015 Unannounced Care and support Management and leadership 11 Dec 2014 Unannounced Care and support Management and leadership 12 Aug 2014 Re-grade Care and support Not assessed Not assessed Management and leadership Not assessed 28 May 2014 Unannounced Care and support 2 - Weak page 9 of 11
Date Type Gradings Management and leadership 28 Nov 2013 Unannounced Care and support Management and leadership page 10 of 11
To find out more This inspection report is published by the Care Inspectorate. You can download this report and others from our website. Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and help services to improve. We also investigate complaints about care services and can 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. You can also read more about our work online at www.careinspectorate.com Contact us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com 0345 600 9527 Find us on Facebook Twitter: @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 cànain eile ma nithear iarrtas. page 11 of 11