Henderson House. Care Home Service 2 Links Road Dalgety Bay Dunfermline KY11 9GW Telephone: 01383 821234 Type of inspection: Unannounced Inspection completed on: 11 January 2018 Service provided by: Roseguard Properties Limited, a Member of the Four Seasons Health Care Group Service provider number: SP2007009151 Care service number: CS2003010328
About the service Henderson House is situated in a residential area of Dalgety Bay. The care home is a three storey built by Four Seasons Health Care. The care home provides residential accommodation for older people offering long-term residential nursing care. Respite care may be provided when there are vacancies arising. It is registered to accommodate a maximum of 60 older people on a residential basis. There is a specialist unit for people with dementia. This facility is located on the ground floor. The accommodation provides single occupancy bedrooms, all with en-suite facilities. Service users' accommodation is located on the ground and upper floors which are served by a passenger lift. There are six lounges in total, consisting of a large lounge with a dining area, which has facilities for the making of simple snacks and a further two smaller lounges on each floor. The kitchen, laundry and staff facilities are located on the lower ground floor. A secure garden is located at the rear of the property and is accessed from the lower ground floor. There is an adequate number of bathrooms, a sufficient number of toilets and ancillary provision to meet the needs of the service users. The stated aim of Henderson House is to 'respect the rights, dignity, individuality and lifestyle of the service user'. What people told us The views of people living in Henderson House and their relatives were gathered throughout the visit. Their feedback is recorded here. This inspection also benefitted from support from our Inspection Volunteer Scheme which allowed us more opportunities to gather views about the service. People who spoke with our inspection volunteer and inspector were very positive, reflecting a high level of satisfaction with all aspects of the service. Staff were held in high regard. Comments included: "Staff treat you as one of their own." "My washing and ironing get done and my room is cleaned regularly." "I'm very content here." "I'm well looked after." "Care staff are terrific." "The food is good, plenty of choice and plenty to eat." "The management are always around and happy to deal with anything." "I've no complaints." "I'm happy and settled, I get on with my life and the staff are around to support and help me if I need them." "On the whole we are very happy, the staff have been extremely kind." page 2 of 14
Self assessment We did not request a self assessment this year. We discussed and considered the service's own development plan as part of this inspection. From this inspection we graded this service as: Quality of care and support Quality of environment Quality of staffing Quality of management and leadership not assessed not assessed Quality of care and support Findings from the inspection Staff were visible and communal areas were supervised. Staff were seen to be interacting positively with residents and we saw that staff approached residents in a caring, gentle manner. Residents appeared relaxed and comfortable in the company of staff. Discussion with the manager and review of duty rotas confirmed that staffing levels were directly related to the number and needs of people living in the home. We noted that staff were open and friendly in their manner and approach to residents. We found staff were aware of individual residents' and families' needs. This supported an appropriate and consistent level of care. We found that communication between care staff and the new manager was good. Relatives also spoke of being kept up to date on their relatives' health needs and felt confident that they would be informed of any changes in their relatives' care. We looked at a sample of medication administration records (MAR), nutrition and dietary information, skin care, care files and records of contact with health professionals to judge how the home met residents' general health and care needs. We also observed staff supporting residents at meal times. Staff approached residents in a supportive and considerate way. Residents had personal plans that had assessments to help staff measure specific risks to their health. We sampled fluid intake charts, wound care and position change charts and found these to be fully completed and the content evaluated to inform practice. This meant residents' health was being monitored. Residents we spoke with told us they had confidence in the staff and gave us examples of how well they had been cared for when they were unwell. A record of visits and communication with health professionals was maintained. We were told that there were good relationships with health professionals and good support was offered by them. Overall, we evidenced improvements in the standard of topical medication record keeping. However, we found a number of missing entries on the medication administration records. This had been subject to a requirement from the previous inspection and remains outstanding. See requirement 1. The manager introduced daily auditing of all medication records to address this issue. page 3 of 14
Overall outcomes for residents appeared to be good and we received positive feedback from residents and relatives. However, we found the quality of record keeping needs to improve. Two requirements were made as a result of upheld complaints regarding care planning and clinical oversight of residents' wellbeing. The service have introduced an improvement plan and are working with staff to improve the standards of record keeping to support practice. These requirements remain outstanding and will be followed up at next inspection. See requirements 2 and 3. Requirements Number of requirements: 3 1. The service provider must ensure medication is managed in a manner that protects the health, welfare and safety of service users. In order to achieve this the provider must ensure; - administration of medication or reason for omission must be recorded on the MAR sheet at the time of administration This is in order to comply with: SSI 2011/210 Regulation 4 (1)(a) - a requirement to make proper provision for the health and welfare of people, SSI 2002/114 Regulation 19(3)(j) - a requirement to keep a record of medicines kept on the premises for residents. Timescale: To be completed by 19 January 2018. 2. The provider must ensure that the health, wellbeing and safety needs of people using the care home are met. In order to do this, the provider must: a) ensure that suitable and appropriate care plans are in place to meet service users' needs in relation to tissue viability, hydration and nutritional care needs b) ensure that assessment tools which are used to inform care planning, are completed accurately and revisited when service users' needs change c) ensure that there is effective clinical oversight of service users' health care needs and changing presentations, to meets the provider's own expected standards as well as those set by the National Care Standards. This is in order to comply with The Regulation of Care (Requirements as to Care Services) (Scotland) Regulations 2002 (SSI 2002/114). Regulation 4(1)(a) - a regulation regarding the welfare of service users Timescale: To be completed by 12 February 2018 3. The provider must put in place and implement a system and be able to demonstrate that the skin care needs of service users are regularly assessed and adequately met. In particular the provider must: - ensure that the assessment and monitoring of skin care issues are appropriate and up to date - demonstrate that adequate care planning and interventions are in place to care and support those service users at risk - ensure that appropriate equipment to minimise the risk of service users is always available and used appropriately - ensure accurate recording of the details of care interventions. page 4 of 14
This is in order to comply with The Social Care and Social Work Improvement Scotland(Requirements for Care Services) Regulations, SSI 2011/210 regulation 4(1)(a (1) A provider must - make proper provision for the health, welfare and safety of residents Timescale: To be completed by 12 February 2018 Recommendations Number of recommendations: 0 Grade: 3 - adequate Quality of environment This quality theme was not assessed. Quality of staffing This quality theme was not assessed. Quality of management and leadership Findings from the inspection There is evidence that quality assurance systems support services in improving their practice, which can result in improved outcomes for people using the services, relatives and the staff team. A number of audits were carried out in the home. The aim of the audits was to make sure standards were maintained and any areas for improvement identified and acted upon. We looked at some of the regular quality assurance audits completed, including medication management (alongside an independent pharmacy audit), personal care plans and an environmental audit. Action plans were developed and introduced when required. We saw some improvements since our last inspection, however, the care plan and medication audits had not highlighted all areas for improvements (please refer to quality theme 1). A new manager has been recently appointed. She is supported by a deputy manager who has a very good knowledge of the service. Since coming into post, the new manager has introduced an improvement plan which includes details and timescales on how the service plans to address the standards of record keeping and general day to day running of the home. Daily briefings with all heads of departments now take place to ensure all staff are aware of what is happening in the home. A clinical overview of residents has been introduced; this covers residents who may have skin integrity issues, who may be nutritionally compromised and anyone who may be presenting with stress/distress as well as all other all other residents' wellbeing. This is supported by a weekly clinical meeting with key staff to discuss all residents and their wellbeing. Feedback from staff was that they now feel better supported and they have a greater awareness of everything that is happening within the home. page 5 of 14
We discussed with the manager the importance of ensuring the service improvement plan is adhered to and all required actions are taken to improve the service for residents and their families. In order to further improve quality outcomes for residents and ongoing development of the service, the manager and staff team must improve the standard of record keeping and take forward the requirements identified in this report. Requirements Number of requirements: 0 Recommendations Number of recommendations: 0 Grade: 3 - adequate What the service has done to meet any requirements we made at or since the last inspection Previous requirements Requirement 1 The service provider must ensure medication is managed in a manner that protects the health, welfare and safety of service users. In order to achieve this the provider must ensure; - administration of medication or reason for omission must be recorded on the MAR sheet at the time of administration - they maintain accurate, detailed records on how much and where to apply particular topical creams/ ointments. This is in order to comply with: SSI 2011/210 Regulation 4 (1)(a) - a requirement to make proper provision for the health and welfare of people, SSI 2002/114 Regulation 19(3)(j) - a requirement to keep a record of medicines kept on the premises for residents. This requirement was made on 18 May 2017. Action taken on previous requirement We found an improvement in the standard of record keeping for the safe administration of creams/topical ointments. This part of the requirement has been met. page 6 of 14
We continued to find a number of missing entries on the MAR sheets. The manager has agreed to introduce daily audits of these to ensure the standards of record keeping improves. This part of the requirement will be carried forward to the next inspection. Not met Requirement 2 The provider must make proper provision for the health, welfare and safety of service users. In order to achieve this the provider must ensure; The use of sensor mats is a form of restraint. Their use must be supported by evidence of discussion and agreement with the service user and/or their representative. This is in order to comply with: SSI 2011/210 Regulation 4(1)(a) - a requirement to make proper provision for the health and welfare of people This requirement was made on 18 May 2017. Action taken on previous requirement Consent was seen to be in place for all sensor mats and other forms of restraint. Met - within timescales Requirement 3 The following complaint arose as a result of an upheld complaint: The provider must ensure that the health, wellbeing and safety needs of people using the care home are met. In order to do this, the provider must: a) ensure that suitable and appropriate care plans are in place to meet service users' needs in relation to tissue viability, hydration and nutritional care needs b) ensure that assessment tools which are used to inform care planning, are completed accurately and revisited when service users' needs change c) ensure that there is effective clinical oversight of service users' health care needs and changing presentations, to meets the provider's own expected standards as well as those set by the National Care Standards. This is in order to comply with The Regulation of Care (Requirements as to Care Services) (Scotland) Regulations 2002 (SSI 2002/114). Regulation 4(1)(a) - a regulation regarding the welfare of service users This requirement was made on 2 November 2017. Action taken on previous requirement Overall, the standard of record keeping was seen to have improved, however, there were still a number of care plans in need of updating. The management team have introduced an improvement plan and are working in conjunction with the staff to address the shortfalls in care planning. This requirement will remain outstanding and will be followed up at the next inspection. Not met page 7 of 14
Requirement 4 The following complaint arose as a result of an upheld complaint: The provider must put in place and implement a system and be able to demonstrate that the skin care needs of service users are regularly assessed and adequately met. In particular the provider must: - ensure that the assessment and monitoring of skin care issues are appropriate and up to date - demonstrate that adequate care planning and interventions are in place to care and support those service users at risk - ensure that appropriate equipment to minimise the risk of service users is always available and used appropriately - ensure accurate recording of the details of care interventions. This is in order to comply with The Social Care and Social Work Improvement Scotland(Requirements for Care Services) Regulations, SSI 2011/210 regulation 4(1)(a (1) A provider must - make proper provision for the health, welfare and safety of residents This requirement was made on 9 January 2018. Action taken on previous requirement Overall, the standard of record keeping was seen to have improved, however, there were still a number of care plans in need of updating. The management team have introduced an improvement plan and are working in conjunction with the staff to address the shortfalls in care planning. This requirement will remain outstanding and will be followed up at the next inspection Not met What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 Regular cleaning and, when necessary, replacement of the sealant around the shower areas should be carried out routinely. This should be monitored by senior staff to ensure an improvement in standards is maintained. Reference: National Care Standards; Care Homes for Older People Standard 4 Your This recommendation was made on 18 May 2017. Action taken on previous recommendation Refurbishment work has been undertaken in the shower rooms. Both rooms were seen to be well maiantained and clean. Management routinely check these areas to ensure standards are maintained. page 8 of 14
This recommendation has been met. Recommendation 2 The following recommendation arose as a result of an upheld complaint: People who use the care service should expect staff to take care of their personal items and belongings. Any missing items should be identified quickly and records should demonstrate the steps which have been taken to locate these. National Care Standards - Care at Home, Standard 4.6; Management and staffing. This recommendation was made on 2 November 2017. Action taken on previous recommendation The manager has introduced a lost property rail of clothing for families to identify any unmarked clothing that may belong to their relative. Notices have been put up to remind everyone about ensuring all clothing/ belongings are labelled and recorded on clothing/belongings inventories. The manager plans to discuss the laundry and labelling of clothing/belongings at the next relatives' meeting. This recommendation has been met. Recommendation 3 The following recommendation arose as a result of an upheld complaint: The provider should ensure notifications are made to the Care Inspectorate as required in the guidance document, Records that all registered care services (except childminding) must keep and guidance on notification reporting. National Care Standards - Care at Home, Standard 4.6; Management and staffing. This recommendation was made on 2 November 2017. Action taken on previous recommendation The service now routinely carry out all notifications as detailed in the guidance documentation. This receommendation has been met. Complaints There have been two upheld complaints since the previous inspection. Please see Care Inspectorate website (www.careinspectorate.com) for details of complaints about the service which have been upheld. page 9 of 14
Enforcement No enforcement action has been taken against this care service since the last inspection. Inspection and grading history Date Type Gradings 12 May 2017 Unannounced Care and support Management and leadership 12 Jan 2017 Unannounced Care and support Management and leadership 28 Apr 2016 Unannounced Care and support Management and leadership 7 Mar 2016 Re-grade Care and support Management and leadership 10 Feb 2016 Unannounced Care and support Management and leadership 15 Oct 2015 Re-grade Care and support 2 - Weak 2 - Weak 2 - Weak Management and leadership 2 - Weak page 10 of 14
Date Type Gradings 30 Apr 2015 Unannounced Care and support 5 - Very good Management and leadership 5 Jan 2015 Unannounced Care and support Management and leadership 16 Jun 2014 Unannounced Care and support Management and leadership 12 Mar 2014 Unannounced Care and support Management and leadership 21 Oct 2013 Unannounced Care and support Management and leadership 1 May 2013 Unannounced Care and support Management and leadership 30 Jan 2013 Unannounced Care and support 2 - Weak Management and leadership 2 - Weak 18 Oct 2012 Unannounced Care and support 2 - Weak Management and leadership page 11 of 14
Date Type Gradings 23 May 2012 Unannounced Care and support Management and leadership 10 Nov 2011 Unannounced Care and support Management and leadership 31 May 2011 Unannounced Care and support Management and leadership 7 Apr 2011 Unannounced Care and support 2 - Weak 2 - Weak 2 - Weak Management and leadership 2 - Weak 10 Mar 2011 Re-grade Care and support Management and leadership 2 - Weak 22 Nov 2010 Unannounced Care and support Management and leadership 21 Sep 2010 Unannounced Care and support Management and leadership 14 May 2010 Announced Care and support Management and leadership page 12 of 14
Date Type Gradings 5 Mar 2010 Unannounced Care and support 2 - Weak 2 - Weak Management and leadership 2 - Weak 29 Sep 2009 Announced Care and support 2 - Weak 2 - Weak Management and leadership 2 - Weak 15 Jan 2009 Unannounced Care and support Management and leadership 1 Oct 2008 Announced Care and support Management and leadership page 13 of 14
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 14 of 14