Isobel Fraser Care Home Service 4A Mayfield Road Inverness IV2 4AE Telephone: 01463 250178 Type of inspection: Unannounced Inspection completed on: 5 May 2017 Service provided by: Isobel Fraser Residential Home Service provider number: SP2003001704 Care service number: CS2003008481
About the service The Care Inspectorate regulates care services in Scotland. Prior to 1 April 2011, this function was carried out by the Care Commission. Information in relation to 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. Isobel Fraser provides a care service to a maximum of 28 older people. At the time of this inspection there were 28 residents living in the home. The trustees of Isobel Fraser are the providers. A full time manager is responsible for the day to day running of the service and overall care of residents. The home was well maintained and situated in attractive grounds, providing residents with a quiet, pleasant environment close to all amenities in the city of Inverness. All bedrooms, although small, were comfortable and of single occupancy with en-suite facilities. In spite of limited space, residents have personalised their rooms with small pieces of furniture and possessions. As stated in the home brochure:- 'Our philosophy of care aims at welcoming each resident as an individual into a non-institutional home, one that is safe, caring, relaxed and happy, with a homely atmosphere and one which respects the dignity and rights of privacy of each resident. We aim to encourage and enable residents to achieve their potential capacity physically, intellectually, emotionally and socially.' What people told us We spoke with some residents during our inspection and they were all very happy to be living in Isobel Fraser. They said that the staff were good and that they were well "looked after" with their care and support needs. They told us that the quality of the food that was offered was good and that they enjoyed getting together in the newly decorated dining room. They were happy with the environment and felt that it was well cared for, clean and comfortable. While there were meetings held on behalf of the people who used the service there was a small number of people who felt that these could be better promoted. Four residents had completed our questionnaires prior to the inspection and the responses within these were positive. They all agreed that overall they were happy with the quality of care that they received. Individual comments were: "Friendly and comfortable." "Good food and happy atmosphere." We spoke with two relatives during the inspection and they were very happy with the care that was offered. One felt that staff had "jumped on" issues straight away and as a result their relatives health had improved immeasurably. Another felt that the care home was very good and that staff were very supportive. They both felt that the home was very clean and maintained to a good standard. page 2 of 9
10 relatives had completed our questionnaires prior to the inspection and the responses within these were generally positive. Where issues were raised we discussed these with the manager and provider at the time of the feedback. We felt that there was a positive response to these and were taken seriously. Overall despite these the relatives agreed overall that they were either very happy or happy with the quality of care that their relative received. Individual comments included: "My mother has not been a resident for long, so she has a settling in phase. The staff are gaining a detailed understanding of her needs and personality etc. Overall I am very pleased with the quality of staff and all the support they provide to my mother. The manager's communicate regularly with me and my brother and keep us fully informed on how mum is settling in." "The garden is not secure so free access outside is not available because some other service users could 'wander', I am concerned about Vitamin D." - This relative did not supply their name or contact details so we could not speak with them about this. We walked around the garden and could see that it was secure with gates at either end. In addition there were plans in place to ensure that this space will have free access. "This home is the first one that I have been in that doesn't have the 'old folks home smell' which can take your breath away. My friend feels very safe and joins in anything she wants to be involved with." "My mother has only been at Isobel Fraser for three and a half months but has settled in very well and is much less agitated that when she was living at home. I believe this has a lot to do with the staff making her feel welcome from the start and creating a calm and happy atmosphere. I am delighted with the care she is receiving." A relative commented on "an unbalanced menu, especially in the evenings and felt that they were carbohydrate laden. They also felt that the alternatives were not always appropriate." - We discussed this during feedback and have also commented on how the choices of meals were promoted within the report. This relative also commented on choice/openness and voicing opinions. We have made reference as to how the service could promote working with residents and relatives within the report. The relative commented that a large number of staff had left since November 2015. In another questionnaire from a relative they also commented on the loss of long serving staff being replaced by younger members. However, and as part of the inspection process we did not identify any issues with the current staff team. One relative felt that the key worker system could be better promoted. We spoke with the service as to how staff were identified within the home and how this could be better promoted. "Considering that my relative can be very awkward and rude at times the staff are very patient and caring." Self assessment The service had not been asked to complete a self assessment in advance of the inspection. We looked at their own quality assurance paperwork. These demonstrated some priorities for development and how they were monitoring of the quality of the provision within the service. From this inspection we graded this service as: Quality of care and support page 3 of 9
Quality of environment Quality of staffing Quality of management and leadership not assessed not assessed What the service does well Isobel Fraser Care Home provided good care and support for the people who used the service and their families. The service was well managed and benefitted from a staff team who worked hard towards improving the quality of life and experiences for the people who live there. People who used the service had some opportunities to take part in some activities and events that were arranged by the service. The care plans in relation to social care needs had been further developed and there was some person centred information that would assist staff with their knowledge and then enable them to support people with their preferences and wishes. People, where able, were involved in developing their care by staff who knew them well. Relatives were also asked for their contribution when looking to plan the support that was needed. Overall we thought that the service worked very well to meet the health and wellbeing needs of the people they supported. Staff worked closely with healthcare professionals to ensure that people's health care needs were addressed. There were good relationships with community nurses who visited daily. Staff supported people sensitively, which helped to uphold dignity for those who needed some assistance and they encouraged people to use their existing skills to support independence. There was some positive work done to promote nutritional needs and the care plans reflected this. This had resulted in positive outcomes for those who were deemed at risk. Staff working in the kitchen were made aware of peoples needs and this was regularly reviewed to ensure that everyone was made aware of any changes. People told us staff respected their decisions and they could access support from staff when they needed and wanted this. Formal reviews of care and support were held and we could see that the outcomes from these were positive. Where issues had been raised the care plans and risk assessment process had been used to influence how staff supported people. This means that the service was flexible and could cope with changes to support personal choice and showed how people could influence how the support was delivered. There were various systems and processes that were used to influence the quality of the provision of the service. People who used the service were involved with some of these and their opinions were sought, which then influenced any change. This meant that there was some positive and inclusive approaches to improving the service, which was based on people's views and opinions. What the service could do better The quality of information in care plans varied. It is important for staff and families to have access to accurate information in personal plans about the individual care and support people need and are to receive. This was to include those care plans that were in relation to supporting people who lived with dementia. (See recommendation 1) While the care plans for social needs contained some good information they had not been used to influence the activities that were on offer. In addition the service had not effectively gained the views and opinions of people so that the activity programme could be further developed. The service was to review this with the people that used the service and include the staff so that a more interesting and varied programme was available. This was page 4 of 9
then to be positively promoted in the home so that people could look forward to and take part if they wished to do so. (See recommendation 2) Whilst people had the opportunity to make a choice about what they would like to take for their meals this was carried out a week in advance. This was not necessarily a practical way for those who may have memory problems. In addition the daily choice was not effectively promoted and some people we spoke to were unaware of what was on offer. There was the opportunity for people to share their views about the food but not necessarily how the dining experience was managed or the environment. We felt that this could be further improved. (See recommendation 3) The management of falls/accidents/incidents could be further developed. However it must be stated that the numbers of falls in the home were significantly low. There was some use of the "Managing falls and fractures in care homes" tool but this could be further developed. (See recommendation 4) We agreed with the provider and manager that the overall induction, appraisal and supervision of staff could be further developed. There was evidence that some of these were taking place but it was the case that this could be formalised and carried out with all staff that worked in the service. (See recommendation 5) We found that overall the systems and processes that were currently being used to assess and plan for improvement could be further developed. The service was to take into account all of the aspects of people living in the home and their experiences. Action plans were to be used to identify and plan for what needed to be achieved, by whom and by when. They were then to be revisited to ensure that the improvements planned for had been achieved. (See recommendation 6) Requirements Number of requirements: 0 Recommendations Number of recommendations: 6 1. It is a recommendation that the provider ensure that care plans are further developed. These should contain personal and unique information gathered by the service, which influences how they support people in their day to day life and makes a positive difference. There should also be guidance for staff in relation to appropriate strategies to use when supporting people in times of stress and distress. Care plans should be reviewed, evaluated and updated to ensure that the information is a current reflection of people's needs. Standard 6: Support arrangements. 2. It is a recommendation that the provider ensure they further develop the provision of activities and use life story work to help them with this. The service was to also take account of the views and opinions of people to assist with this so that the activities programme would then be in line with their preferences and wishes. Standard 6: Support arrangements Standard 8: Making choices page 5 of 9
Standard 11: Expressing your views Standard 12: Lifestyle - social, cultural and religious belief or faith Standard 17: Daily life. 3. It is a recommendation that the provider review the overall dining experience. As part of this they were to seek peoples views, act on their suggestions and then review the changes to ensure they were effective in bringing about a positive experience. In addition relatives and staffs view could also be taken so that everyone was involved and felt included. Standard 5: Management and staffing Standard 8: Making choices Standard 11: Expressing your views Standard 13: Eating well 4. It is a recommendation that the provider ensure that they put in place and implement a system whereby all incidents are formally documented and reviewed. The review was to include that of the manager and make reference to any patterns or triggers or other factors to that could minimise such incidents. Following the review where needed risk assessments and care plans were to reflect the changes that need to be made to peoples care and support and that these were reviewed on a regular basis. Standard 5: Management and staffing Standard 9: Feeling safe and secure 5. It is a recommendation that the provider ensure that they put in place and implement systems to provide staff with support, the opportunity to raise individual issues and as a means of monitoring staffs awareness of working practices, effectiveness of induction and training and to identify any further training needs. If issues are identified as part of supervision and/or appraisals there was to be clear written evidence of how these were being addressed and reviewed. Standard 5: Management and staffing. 6. It is a recommendation that the provider ensure that they put in place and implement effective and measurable systems by which they could assure themselves that they were assessing, reviewing and improving the overall provision of the service. Thereby ensuring that there were continued and positive outcomes for the residents and relatives. Standard 5: Management and staffing arrangements. Complaints Please see Care Inspectorate website (www.careinspectorate.com) for details of complaints about the service which have been upheld. page 6 of 9
Inspection and grading history Date Type Gradings 30 May 2016 Unannounced Care and support Management and leadership 20 Jul 2015 Unannounced Care and support Management and leadership 30 May 2014 Unannounced Care and support Management and leadership 25 Apr 2013 Unannounced Care and support Management and leadership 6 Jul 2012 Unannounced Care and support 5 - Very good 5 - Very good Management and leadership 2 Dec 2010 Unannounced Care and support 5 - Very good Management and leadership 14 Jun 2010 Announced Care and support Management and leadership 18 Jan 2010 Unannounced Care and support page 7 of 9
Date Type Gradings Management and leadership 30 Sep 2009 Announced Care and support 5 - Very good Management and leadership 8 Jan 2009 Unannounced Care and support Management and leadership 18 Sep 2008 Announced (short notice) Care and support Management and leadership page 8 of 9
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 9 of 9