Spiers Care Home Care Home Service 6 Janesfield Place Beith KA15 2BS Telephone: 01505 503324 Type of inspection: Unannounced Inspection completed on: 3 October 2017 Service provided by: Silverline Care Caledonia Limited Service provider number: SP2014012299 Care service number: CS2014326143
About the service This service has been registered with the Care Inspectorate since September 2014. Spiers Care Home is located in the centre of the small town of Beith, close to local amenities and transport links. The service is registered to support up to 45 older people, some of whom may have dementia. Residents' accommodation is located on the ground floor and is built around an attractive central courtyard, garden area. All of the bedrooms are single, with en suite facilities, 13 of which also have a shower. There are three units. Each has a lounge/dining area. There is an additional lounge for those who choose to smoke, a small therapy/relaxation room and a hairdressing salon. There is also a café room, used mainly for visitors. There is accommodation on the upper floor, used for staff training and administration. This inspection took place at various times between 25 September and 2 October 2017. What people told us We asked the service to distribute care standard questionnaires to residents, relatives and staff. We did not receive any completed questionnaires from residents. We did receive six from relatives/carers and five from members of staff. Overall, relatives who completed questionnaires were very satisfied with the quality of service received. However, one relative wrote to us expressing a number of concerns with the quality of service provided. We considered these issues during the inspection and, where we found areas for improvement, we reflected these in the body of the report. Other comments in questionnaires included: 'Staff are fantastic and make me feel welcome and treat my relative very well'. 'I and the family are very happy with the care provided'. 'My mum is very happy in the care home and also well cared for'. Staff reported that they felt residents received good care and that staff worked together to ensure the best care was provided. One staff member raised concerns about the difficulties staff faced, to find the time required to offer residents the opportunity to participate in meaningful activity. We also asked an inspector volunteer to assist us during the inspection. This is someone who uses, or has used services as an unpaid carer, who volunteers to take part in inspections. They talk to people who use the service, relatives and friends and make observations based on their own personal experience. This information is used by the inspector, to report on the service and award grades. The inspector volunteer spoke with five residents and two relatives. The comments made were generally positive. She found staff to be 'friendly, caring and helpful'. The care home was clean and odour free and rooms were nicely personalised. One resident told her 'its a great place, care is very good and staff are friendly'. We have included other comments from relatives and carers in the body of the report. page 2 of 15
Self assessment The service had not been asked to complete a self-assessment in advance of the inspection. The provider had an improvement plan which identified areas of improvement. From this inspection we graded this service as: Quality of care and support Quality of environment Quality of staffing Quality of management and leadership 3 - Adequate 5 - Very Good 3 - Adequate 3 - Adequate Quality of care and support Findings from the inspection The service had made improvements which meant that some of the recommendations made in the last inspection report had been met. Staff had established positive, friendly relationships with residents. Permanent staff knew residents and their specific care needs. A resident told us 'we are well looked after' and another said 'we have a nice wee chat when they come to help me in the morning'. Residents were offered some basic choices, regarding their daily routines. However, the level of consultation and participation was not as it had been in the past and improvements in this area was required. (See recommendation 1) Individuals' health and wellbeing was assessed and care plans compiled, to direct care delivery. The service had recently introduced an electronic care planning and records system. We found it difficult to form an overview of individuals' care needs and how these needs were met from the information available to us on the system. This was due to inconsistencies, in how and where information was recorded in the system. We were also made aware of visiting health professionals being unable to get the information they needed, to help with the assessment of individuals' health care needs. We have made a recommendation in theme 3, regarding staff training in this area. Records relating to food and fluid intake and the application of prescription creams and lotions remained poor. This meant we were unable to evidence that individuals received the support they required. The recommendation made in previous reports regarding this issue remained unmet. (See recommendation 2) Medication records were generally well maintained. Medication was stored in individuals' rooms. However, further work was required to ensure a more person led approach to supporting people with medication. (See recommendation 3) page 3 of 15
The quality of care planning for individuals who experienced stress and distress remained variable. They continued to lack information on potential triggers and provide direction for staff regarding appropriate management strategies. The requirement made in the previous inspection report regarding this issue, remained unmet. (See requirement 1) From our observations, we saw that staff worked very hard and were motivated to deliver good care. However, we found there were issues with staffing levels and staff deployment, which had a negative impact on residents' care. We saw that staff had developed some routines, in order to manage their time, which resulted in poor practice and poor outcomes for residents. (See requirement 2) We also found there was an approach of incontinence management practiced in the service, rather than the promotion of continence (See recommendation 4). From the accident records and monthly audits, we noted that a significant number of falls were recorded, many of which were unwitnessed. Some Multifactorial Risk Assessments and Canard Risk Assessments were completed. We directed the manager to relevant guidance, to assist in developing good practice and strategies to reduce the number of falls experienced by residents. (See recommendation 5) We saw no opportunities for residents to participate in any activities during the inspection. We discussed this with staff who told us that they were unable to fill this role, due to the high dependency levels of residents and the need to deliver all other aspects of care. We were aware that the activity co-ordinator post had been vacant for some weeks and, although the recruitment process was underway, the provider had not made any interim arrangements, such as increasing staffing levels to fill this gap and provide residents with some meaningful engagement. One resident told us 'There haven't been any activities for two months. I need something to help pass the time'. (See recommendation 6) Residents told us that they enjoyed the food served. We were told 'food is excellent', 'if I don't like what they offer I can get something else' and 'there is always plenty of it'. However, we felt that the soup and sandwich option being served every day at lunchtime should be reviewed and that a more suitable 'soft option' menu should be available. We saw some poor practice during the meal service, which we discussed with managers who agreed to address this immediately with staff. (See recommendation 7) page 4 of 15
Requirements Number of requirements: 2 1. The provider must ensure that care plans relating to the support of service users with stressed and distressed behaviours, are improved. The provider should ensure that risk assessments are completed, which inform care plans showing potential triggers and management strategies to be used. This is in order to comply with The Social Care and Social Work Improvement Scotland ( Requirements for Care Services) regulations (SSI 2011/210). regulations 4 (1) (a) - Welfare of Users, 5(1) - personal plans. Timescales for implementation 30th November 2017 2. The provider must, having regard to the size and nature of the care service, the statement of aims and objectives and the number and needs of service users, ensure that, at all times, suitably qualified and competent persons are working in the care service in such numbers as are appropriate for the health, welfare and safety of service users. In this regard, they must conduct an assessment of the needs of residents, review this against current staffing levels and make this information available to residents and their relatives. This is in order to comply with SSI 2011/210, Regulation 15 (a), a requirement relating to staffing. Timescale for implementation: 2nd October 2017 Recommendations Number of recommendations: 7 1. The provider should re-establish the methods used to encourage the participation and involvement of residents and relatives, These should also include methods used to seek the views of people with dementia and other cognitive difficulties. National Care Standards, Care Homes for Older People, Standard 11 - Expressing Your Views. 2. Records used to monitor individuals * fluid and dietary intake * application of creams and lotions should be accurately completed and contain good detail. National Care Standards, Care Homes for Older People, Standard 13, Eating Well and Standard 15 Keeping Well - medication. 3. The provider should ensure that medication is administered in a person centred way, taking into account individuals' preferences and routines. National Care Standards, Care Homes for Older People, Standard 15 Keeping Well - medication. 4. The provider must ensure that practice relating to promoting continence is improved. The provider should take account of the best practice resource 'The promoting continence for people living with dementia and long-term conditions'. Care Inspectorate 2016. page 5 of 15
National Care Standards, Care Homes for Older People, Standard 14 keeping Well - healthcare and Standard 6 Support Arrangements 5. The provider must ensure that residents have the opportunity to participate in meaningful engagement and activity, based on individuals' needs, interests and aspirations. The following best practice guidance should be considered; CAPA (Care about Physical Activity), A Moment in Time (Pocket ideas) NHS Ayrshire and Arran. Tips for good quality for meaningful engagement and conversation. Making every Moment Count. Care Inspectorate and BHF National Centre. National Care Standards, Care Homes for Older People, Standard 6 Support Arrangements and Standard 14.7 Keeping Well - Healthcare 6. The provider should ensure that the approach to the prevention of falls and fractures is improved. To assist in improving practice in this area the service should: * use the Managing falls and fractures in Care Homes for Older People. Good practice Resource 2016 Care Inspectorate and NHS Education in Scotland * ensure staff undertake updated training National Care Standards, Care Homes for Older People, Standard 6 Support Arrangements 7. In order to improve residents' dining experience the provider should; * review the current lunch time menu * provide an appropriate soft option menu * ensure that each course of the meal is served in the proper sequence the service should consult with best practice guidance; Care Homes for Older People Best Practice Standards and Guidance on Food Fluid and Nutrition 2014 Care Inspectorate Promoting Nutrition in care Homes for Older People 2009 Care Commission National Care Standards, Care Homes for Older People, Standard 13 Eating Well Grade: 3 - adequate Quality of environment Findings from the inspection The care home provided residents with a pleasant and well equipped environment. There were three separate units, each offering residents a comfortable lounge/dining area, decorated and furnished to a good standard. Residents had single, en suite rooms, which they were encouraged to personalise with their own furniture, photographs and decorative items. One resident told us 'I have a lovely room with all my own things around me' another said 'I have a lovely room and all I need'. Although the care home was clean and odour free, there were areas which were cluttered and untidy. There were electrical cables from various appliances which were not secured, resulting in potential tripping hazards. We also spoke with the manager about how incontinence products were being stored, which did not take account of individuals' dignity and privacy. page 6 of 15
(See recommendation 1) Residents' private information was not always securely held. We saw residents' files in lounge areas and information displayed on the wall, relating to individuals dietary needs and weights. (See recommendation 2) There were appropriate health and safety systems in place, to ensure residents lived in a safe and secure environment. Essential equipment and utilities had been serviced as required. However, the systems used to inform when servicing was due should be improved. The service had a policy of storing residents' medication in their own rooms. However, many of the storage units used were too small to accommodate all the medication prescribed for individuals. A programme of replacement of storage units, where required, should be established. (See recommendation 3). Requirements Number of requirements: 0 Recommendations Number of recommendations: 3 1. The provider should ensure that medication storage arrangements in individuals' rooms are sufficient to ensure that all prescribed medication is stored securely. National Care Standards, Care Homes for Older People, Standard 15 Keeping Well - Medication and Standard 4 Your Environment 2. The provider should ensure that residents' personal information is securely held and cannot be accessed by unauthorised people. National Care Standards, Care Homes for Older People, Standard 10 Exercising your Rights and Standard 16 Private life. 3. The provider should ensure that the environment is clutter free, safe from tripping hazards and the storage of incontinence products takes account of individuals' privacy and dignity. National Care Standards, Care Homes for Older People, Standard 4 Your Environment. Grade: 5 - very good Quality of staffing page 7 of 15
Findings from the inspection There were adequate communication methods used in the form of shift handovers, 'flash meetings and written diary entries, to inform staff of residents' changing needs and presentation. The new manager was aware that the programme of staff meetings required to be re-established. Residents were cared for by staff who had access to training relevant to their role. Staff were supported to achieve a qualification, to meet conditions of registration with the Scottish Social Services Council. The majority of the training was designated as 'mandatory', delivered in an e-learning format and repeated annually. Training for nursing staff outwith the mandatory programme was limited. The provider should carry out a training needs analysis for all staff, to inform individual and service level training and development plans. (See recommendation 1) To enhance the care provided to residents, the provider should consider developing the role of 'champions' within the service. This is where specific staff are identified to lead learning and best practice and share with the staff team in specific areas of care, such as infection control, nutrition, continence promotion and palliative care. There were issues with staffing levels, staff deployment and rota management. The provider had difficulty achieving a consistent staff team, due to high levels of staff absence and vacant nursing hours. This resulted in a reliance on bank staff and agency use, which meant that staff did not always know residents well. (See requirement 2 Theme 1) The issues highlighted in Theme 1 regarding inconsistencies in the way that staff accessed and used the new electronic care planning system, demonstrated a need for further training and instruction on the system. (See recommendation 2) The recommendations made in the last inspection report relating to induction training and Dementia Training had not been met. (See recommendations 3 and 4) We observed a number of staff practice issues during the inspection, which we raised with management. Requirements Number of requirements: 0 Recommendations Number of recommendations: 4 1. The provided should carry out a training needs analysis for all staff to inform individual and service level training and development plans. National Care Standards Care Homes for Older People. Standard 5 Management and Staffing Arrangements. page 8 of 15
2. Staff must have further training and instruction on the use of the electronic care planning system. Individual staff competency on the effective operation of the system should be monitored through the staff supervision process and further training provided where required. National Care Standards Care Homes for Older People. Standard 5 Management and Staffing Arrangements. 3. The provider must ensure that staff complete the Dementia Training outlined in the Promoting Excellence Framework developed by Scottish Social Services Council and NHS Scotland as part of the Scottish Governments Dementia Strategy. National Care Standards Care Homes for Older People. Standard 5 Management and Staffing Arrangements. 4. The provider should develop the induction training programme to include evidence of competency for each element of training completed, which should include observed practice. National Care Standards Older People. Standard 5: Management and Staffing Arrangements. Grade: 3 - adequate Quality of management and leadership Findings from the inspection The provider used a comprehensive range of quality assurance audits, some of which took the views and experiences of service users and relatives into account. However, we have repeated the requirement in the last inspection report relating to quality assurance. (See requirement 1). At the time of this inspection, a new manager had just been appointed and had commenced induction training. We found the new manager to be co-operative and receptive to our observations and recognise where improvements were needed. The manager was receiving support from the external manager and personnel from other departments within the organisation. There was a need for the organisation to support the development of the leadership role of nurses and senior care assistants. This will enable more effective deployment of staff and decision-making on a day-to-day basis, which will result in better outcomes for residents. (See recommendation 1) A development plan was in place. However, this should be extended, taking into account the findings of this inspection and include an action plan giving timescales for identified areas of improvement to be achieved. (See recommendation 2) page 9 of 15
Requirements Number of requirements: 1 1. The provider must improve quality assurance systems to ensure that deficits within the service are identified and evidence is available to show the action taken to effect improvements. This is in order to comply with; SSI 2011/210 Regulation 4 (1) (a) Welfare of service users. Timescale for implementation: 30th November 2017 Recommendations Number of recommendations: 2 1. The organisation should have methods in place, including training and supervision, to support the development of the leadership role of nurses and senior care assistants. National Care Standards Care Homes for Older People. Standard 5 Management and Staffing Arrangements. 2. The service development plan should be extended to take into account the findings of this inspection and include an action plan giving timescales for identified areas of improvement to be achieved. National Care Standards Care Homes for Older People. Standard 5 Management and Staffing Arrangements. 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 provider must ensure that the admission process is followed robustly, to ensure that service users' care needs are assessed and the required interventions take place to ensure these needs are met. Quality assurance processes should include an audit within 12 hours of admission to ensure all required interventions have been identified and included in care plans. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services), Regulations (SSI 2011/210), regulations 4 (1) (a) - Welfare of users and 5(1) - Personal plans. This requirement was made on 14 April 2016. page 10 of 15
Action taken on previous requirement The service had made improvements in how the admission process was undertaken. Information from the written assessment was entered into the electronic care planning system. We saw that there was adequate information collated from the resident and their relatives/carers, to ensure that immediate care needs were met. Assessments were carried out timeously and more detailed care plans compiled within acceptable timescales. Met - outwith timescales Requirement 2 The provider must ensure that care plans relating to the support of service users with stressed and distressed behaviours are improved. The provider should ensure that risk assessments are completed which inform care plans showing potential triggers and management strategies to be used. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services), Regulations (SSI 2011/210), regulations 4 (1) (a) - Welfare of users and 5(1) - Personal plans. This requirement was made on 14 April 2016. Action taken on previous requirement We found that the standard of care planning for individuals with stress and distressed behaviours remained variable. There were a small number of good examples of care plans which referred to potential triggers and contained details of strategies to direct staff on how best to care for individuals' when stressed or distressed. However, other care plans still lacked details and adequate direction for staff. Not met Requirement 3 The provider must ensure there is evidence that all staff who are involved in moving and handling service users are doing so safely using up to date approved techniques and appropriate equipment. This could be evidenced through recorded assessments of observed practice. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services), Regulations (SSI 2011/210), regulations 4 (1) (a) - Welfare of users and 15 (a) (b)(i) - Suitably qualified and trained staff and ensure persons employed in the provision of the service receive training appropriate to the work they are to perform. This requirement was made on 14 April 2016. Action taken on previous requirement From our discussions with staff and the records we saw there was evidence that staff had competed appropriate assessments of their moving and handling skills, which included observed practice. Met - outwith timescales Requirement 4 The provider must improve quality assurance systems, to ensure that deficits within the service are identified and evidence is available, to show the action taken to effect improvements. page 11 of 15
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) - Welfare of service users. This requirement was made on 14 April 2016. Action taken on previous requirement Although the service had a comprehensive range of quality assurance audits across all aspects of service provision we found that these audits did not identify the areas for improvement highlighted in this report. The provider should review the current quality assurance audits and make any changes required to ensure that any deficits are addressed. Not met What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 The provider should review how accidents/incidents are recorded, to ensure that all the relevant information is provided to support other processes such as care planning, risk assessments, distressed behaviour strategies and quality assurance audits. National Care Standards, Care Homes for Older People - Standard 5: Management and staffing and Standard 6: Support planning. This recommendation was made on 14 April 2016. Action taken on previous recommendation Additional information had been added to accident incident records and information was included when a review of risk assessments or care plans had been carried out. Overall, we saw that this recommendation had been met. However, the provider should consider reviewing the current layout of the accident form used to provide better direction to staff on the type of information to include and any further action required. Recommendation 2 The provider should assess individuals' needs for monitoring/supervision and ensure this is clearly documented in care plans and recorded accurately, to reflect instructions in care plans. National Care Standards, Care Homes for Older People - Standard 6: Support planning. This recommendation was made on 14 April 2016. page 12 of 15
Action taken on previous recommendation A the time of this inspection, one resident required additional monitoring/supervision. The individuals' care plan clearly stated the reason for this monitoring and how this should be carried out. Records were available showing that the care plan had been followed. This recommendation was met. Recommendation 3 The provider should consider developing the induction training programme to include evidence of competency for each element of training completed, which should include observed practice. National Care Standards, Care Homes for Older People - Standard 5: Management and staffing arrangements. This recommendation was made on 14 April 2016. Action taken on previous recommendation The provider had not sustained the improvements that we saw in the last inspection. The provider should have an induction training programme specific to each staff role. This should include an assessment of competencies and observed practice. This recommendation was not met. Recommendation 4 The provider must ensure that staff complete the dementia training outlined in the Promoting Excellence Framework developed by the Scottish Social Services Council and NHS Scotland as part of the Scottish Government's Dementia Strategy. National Care Standards, Care Homes for Older People - Standard 5: Management and staffing arrangements. This recommendation was made on 14 April 2016. Action taken on previous recommendation The majority of staff had completed a short e-learning course in dementia awareness. A small number of staff had completed training to at least Skilled Level as outlined in the Promoting Excellence Framework. However, we were unable to evidence that the learning outcomes included in the short e-learning course could be mapped across to the Skilled Level as outlined in the Promoting Excellence Framework. This recommendation was not met. Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at www.careinspectorate.com. page 13 of 15
Enforcement No enforcement action has been taken against this care service since the last inspection. Inspection and grading history Date Type Gradings 8 Dec 2016 Unannounced Care and support Not assessed Environment Not assessed Staffing Not assessed Management and leadership Not assessed 14 Apr 2016 Unannounced Care and support 4 - Good Environment 4 - Good Staffing 3 - Adequate Management and leadership 3 - Adequate 16 Apr 2015 Unannounced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and leadership 4 - Good 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. 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 15 of 15