St. Francis Nursing Home Care Home Service

St. Francis Nursing Home Care Home Service 54 Merryland Street Glasgow G51 2QD Telephone: 0141 445 1118 Type of inspection: Unannounced Inspection completed on: 11 October 2016 Service provided by: Franciscan Sisters Minoress Service provider number: SP2003002371 Care service number: CS2003010480

About the service This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April 2011. St. Francis Nursing Home is owned and run by the Order of Franciscan Sisters Minoress. The care home is registered to provide a care home service, including nursing, to a maximum of 40 older people. The care home is a purpose-built two storey building. All residents have a single room with en-suite bathroom facilities. There are a number of communal areas including a lounge and quiet room on each floor. There is a chapel at the front of the care home. St. Francis Nursing Home is managed within the context of the Roman Catholic faith which underpins the life of the home. The care home aims to: "Respond to the desires and aspirations of the residents in recognition of their dignity and their desire of being respected." What people told us We received a range of feedback about the service. We sent 15 Care Standards Questionnaires to the home to distribute to people who live in the home and we did not receive any completed forms back. We also sent 10 Standards Questionnaires to the home to distribute to relatives and carers of people who live in the home and we received two completed forms back. We spoke with people during our visits. Some people gave positive feedback. Some people indicated they were not satisfied with their experience of living in the care home. Self assessment It would be helpful if the self assessment could reflect more direct involvement of people living in the home and their carers/relatives. From this inspection we graded this service as: Quality of care and support Quality of environment Quality of staffing Quality of management and leadership page 2 of 13

Quality of care and support Findings from the inspection We found that the service provided an overall good level of care and support to residents. We received some positive feedback from people living in the care home and some relatives. "staff are great. Go out of their way to do stuff - make tea. Delighted where she is...really enjoys the food - offer to stay for meals - can come and go anytime. During our visit, we saw examples of good practice. We saw some very good practice when we observed mealtimes. Some people were being assisted in an unhurried, respectful way from staff who were sitting beside them. We saw some people enjoying their meal and they gave us some positive feedback. We were told that there were more activities taking place since our last visit. There was a new full time and part time activities co-ordinators in post and they worked flexible hours including weekends to meet people's needs. We saw information about a range of group activities such as musical entertainment on the whiteboard in the main hallway. There was also information about reminiscence and exercise classes which were coming soon. A newsletter contained further information about events and activities in the home. Regular church services and spiritual support was provided. There was a birthday party happening during one of our visits. We were also told that people were supported to attend events in the local community and that there was a focus on smaller groups of people going out together as it was more personal. Different ways of gathering people's opinions about the service were used. For example, we saw a general invitation to a tasting of the new autumn and winter menu. A recommendation was made at the last full inspection, this will be repeated. See recommendation 1. There was a wide range of relevant records in place which staff used to record different parts of the care they provided. Most records were kept on the computer and some were also kept on paper. We saw that a range of external healthcare professionals such as dieticians and speech and language therapists visited to provide support for people living in the care home and also to provide direct guidance for staff and carry out audits. We saw that a Caring for Smiles folder was in place. This is a national programme to support people with mouth and teeth care. www.nes.scot.nhs.uk There was a requirement at the last full inspection about nutrition. We were unable to see that all actions had been fully addressed. See requirement 1. We observed a mealtime and found that some people needed more help and support. Relevant records such as food and fluid charts were being completed, however, some of these were incomplete and lacking adequate detail. Fluid charts showed that some fluid balances were not totalled at the end of each day and the amounts recorded indicated that people had not reached their target. Entries on food charts saying "asleep" and no record of additional support offered at a later point or "refused main meal" and no record of alternatives offered. We therefore could not see that people's intake was monitored properly. We also could not see how the information in these charts and other records was used to make sure that people at risk of losing weight/ malnourishment had the right care and support. page 3 of 13

Records of people's weights were kept in different places and we saw that some weekly weight records were blank. Staff we spoke with were not clear about who had low weights. There was also a lack of information in some care plans. These were not always updated or evaluated so we could not see if the planned care and support was resulting in improved outcomes for each person or that it was reviewed when necessary. When we looked at paper records and records on the computer, we found them quite confusing and it was hard to track clear information and to see how this was managed overall. We have repeated this requirement. See requirement 1. We found that several people spent a lot of time in their room and/or their bed and we were unable to clearly see how their needs were met throughout the day. We discussed the need to explore more ways of supporting people to be engaged in purposeful meaningful activities each day. We saw that sometimes there was a delay when someone was calling for help. It is important that a consistent staff approach is promoted in relation to this. Some language in some records indicated that staff needed more training and supervision in relation to supporting people who have dementia and who may become distressed. Use of language such as "rude towards staff", " agitated and rude". We also found that some people were receiving medication when they became distressed. This should be a last resort when other ways of supporting the person have been tried. In some cases, there was no care plans in place about how to provide person centred care and support when someone became distressed. We were also unable to see that there was a detailed up to date protocol for each person who was receiving PRN medication. ABC charts did not provide clear information about what support was given when someone was distressed and what effect medication had on the person when it was administered. Overall, we were unable to see that the right care and support was in place and this needed to be addressed. We were told that the CPN was involved and had recently given staff new ABC charts and that more staff training was being provided. We were told that staff were undertaking training in dementia and we would expect that adequate monitoring would take place to make sure that this resulted in improved practice. We had also signposted the manager to guidelines on delirium and they advised that they would revisit this. We will look at progress on this on our next inspection visit. Overall more focus was needed on how care and support was being delivered to each person throughout the day to make sure that outcomes were improved and that record keeping reflected this. Requirements Number of requirements: 1 1. The provider must ensure that all residents receive the right care and support in relation to nutrition. In order to do this, they must demonstrate that: - managers and staff are knowledgeable and competent in their role - the right assessment, care planning and delivery of care is carried out for all residents who are at risk of malnourishment, weight loss and choking and that this is appropriately reviewed page 4 of 13

- the approach to record keeping is improved to ensure that a clear, complete, up to date and accurate record of all care and outcomes is in place - there is an effective, accountable and robust way of monitoring and auditing staff competency, staff practice and outcomes for people at risk. This is in order to comply with: SSI 2002/2014 regulation 4(1) (a) - requirement for the health and welfare of service users. Timescale - to start immediately and be completed by four weeks from receipt of this report. Recommendations Number of recommendations: 1 1. The service provider should ensure that methods of gaining feedback from residents with dementia are developed and implemented. National Care Standards for Care Homes for Older People: Standard 11 - Expressing Your Views. Grade: 4 - good Quality of environment Findings from the inspection The environment in the care home was clean and tidy overall. We received positive feedback from people that they were satisfied about this also. The manager and staff had a copy of a King's Fund document which was designed to support services to make their care homes more dementia friendly. The manager had started to use this in looking at ways to improve the environment. We saw that pictures of actors and actresses were on some walls and we were told that these were talking points for some people who lived in the care home. We were told about the provider's plans to develop and extend the layout of the home and for example to have more space for activities. There were also plans to develop the outdoor spaces around the home to enable people to get outside more. We saw that maintenance log records were kept in a clear format with several records showing that repairs were carried out promptly. There was a fire alarm during the inspection visit which was managed well. The provider needed to make sure that there were clear up to date records of all aids and equipment in use in the home including records of maintenance and checks of these. Some information and dates in the maintenance log were unclear and it was hard to track when a repair had been carried out and what was done. When we looked at records in personal plans, we found some gaps in information such as falls risk assessments not being updated and we also saw that someone had bedrails in place when this was not noted in their care plan. page 5 of 13

We found that there were delays for some people who were calling out for help. A review was needed to make sure that the staff numbers and deployment was meeting the needs of everyone living in the home. We also found that there was noise disruption from buzzers sounding and at times sounding for an extended period of time. A review was needed to see if staff were able to have pagers and if the upstairs and downstairs buzzers could be separated. We will look at the progress on the above on our next inspection visit. Requirements Number of requirements: 0 Recommendations Number of recommendations: 0 Grade: 4 - good Quality of staffing Findings from the inspection We received some positive feedback from staff who said they enjoyed working in the home and they appreciated the feedback they got from families. We also received some positive feedback about staff. We saw records which showed that there had been training in venepuncture, bed making, first aid, moving and assisting, adult support and protection and person centred care training. We attended a morning meeting which is held every morning to allow the staff member in charge of catering, laundry, activities, administration and nursing to share information, a working plan for the day and agree any actions which need to be taken. This meeting was also used to discuss any issues such as, how people could be supported to go out shopping when they need new clothes and also complaints which had been raised, for example, about a lack of activities upstairs. We were shown a copy of the first staff newsletter which provided a range of information to the staff team. It was not clear from the training records we saw which staff had actually attended the session. It would be helpful to review the way this was recorded. page 6 of 13

Whilst we acknowledged that a range of training had been carried out, we were unable to clearly see the impact on this on improved and consistent staff practice and improved outcomes for people living in the care home. From our findings including observation we found that there needed to be more consistency across the staff team in terms of person-centred practice. For example, we observed some situations where someone was calling out for help and there was no response from staff or no staff available to hear and respond. We intervened at points to ask staff if they were able to respond. We felt that more focus was needed to make sure that staff were deployed to meet people's needs more consistently. We also found that the use of some language indicated that more work was needed in relation to personcentred care and in particular the approach that some staff had when supporting people with dementia. For example, we have noted earlier in the report about the use of language to describe distressed behaviour. We had some feedback about the atmosphere being "a bit serious" and also that there was some feeling within the home that staff were not encouraged to spend time talking to people. This reflected a task orientated approach which was reflected in some of the observations we made. We will look at the progress on the above on our next inspection visit. Requirements Number of requirements: 0 Recommendations Number of recommendations: 0 Grade: 4 - good Quality of management and leadership Findings from the inspection In discussion the manager demonstrated a very positive commitment to their role and a clear focus on improving the service. They were very knowledgeable about the needs and wishes of people living in the care home. We saw that they spent a lot of time around the home speaking with people. There was a depute manager who had been in post for 10 months. We were told they had a range of duties including audits, monitoring and training. We saw records of some audits that were carried out for example, in relation to activities and observational audits of the environment. We felt that the information in these could be expanded from to reflect the manager's engagement with people they spoke with. page 7 of 13

We saw that some gaps in outcomes were identified during some of the audits, for example, people sitting too long in their wheelchair. However, there were no action plans or other information available about what action was taken to address this and prevent it happening again. We were unable to clearly see that six monthly reviews were taking place. When we looked at review records, a number of them had no date or clear information about who was involved in the review. They were not always signed. We would have expected the areas for improvement which we identified to have been picked up through effective quality assurance processes. Overall, we were unable to see that there were clear and accountable quality assurance processes in place. We also were unable to see that there was a good level of monitoring of staff practice and outcomes for people living in the service. A recommendation was made at the last full inspection, this will be repeated. See recommendation 1. We also found that there needed to be clearer processes in place with regards to support and monitoring of service provision. Although we were told about informal visits being carried out by the managers and by relevant members of the Board, we were unable to gather any clear information about these and how they helped to support improvements in the home. There were no processes in place to record who was involved, when these were carried out and what actions resulted towards improvements. We also felt that there needed to be more attention to providing care in line with best practice for example, delirium guidance and paperwork had been shared by the CI, however we could not find evidence of this being implemented. We will look at the progress on the above on our next inspection visit. Requirements Number of requirements: 0 Recommendations Number of recommendations: 1 1. The provider should ensure that work continues to develop adequate, robust and accountable monitoring and auditing in relation to staff practice and outcomes for residents. National Care Standards for Care Homes for Older People: Standard 5 - Management and Arrangements. Grade: 4 - good page 8 of 13

What the service has done to meet any requirements we made at or since the last inspection Previous requirements Requirement 1 Requirement with reference to Quality Theme 1, Statement 3: The provider must ensure that all residents receive the right care and support in relation to nutrition. In order to do this, they must demonstrate that: - managers and staff are knowledgeable and competent in their role - the right assessment, care planning and delivery of care is carried out for all residents who are at risk of malnourishment, weight loss and choking and that this is appropriately reviewed - the approach to record keeping is improved to ensure that a clear, complete, up to date and accurate record of all care and outcomes is in place - there is an effective, accountable and robust way of monitoring and auditing staff competency, staff practice and outcomes for people at risk. This is in order to comply with: SSI 2002/2014 regulation 4(1) (a) - requirement for the health and welfare of service users. Timescale - to start immediately and be completed by four weeks from receipt of this report. This requirement was made on 14 January 2016. Action taken on previous requirement We were told that a range of work had been carried out to address this. However, from our findings we were unable to clearly see that this requirement had been met. We have recorded our findings in quality theme 1. We have repeated this requirement. Not met What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 The service provider should ensure that methods of gaining feedback from residents with dementia are developed and implemented. National Care Standards for Care Homes for Older People: Standard 11 - Expressing Your Views. This recommendation was made on 14 January 2016. page 9 of 13

Action taken on previous recommendation We acknowledged that work was on going and that the manager continued to express their commitment to exploring different ways of gathering feedback as part of the overall improvement work. However, we were unable to clearly see that improvements had been made since the last inspection. Given our findings, we have repeated this recommendation. Recommendation 2 The provider should ensure that work continues to develop adequate, robust and accountable monitoring and auditing in relation to staff practice and outcomes for residents. National Care Standards for Care Homes for Older People: Standard 5 - Management and Arrangements. This recommendation was made on 14 January 2016. Action taken on previous recommendation We saw some audits however, we found that the range and quality of these needed to be improved. We have repeated this recommendation. Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at www.careinspectorate.com. Enforcement No enforcement action has been taken against this care service since the last inspection. page 10 of 13

Inspection and grading history Date Type Gradings 11 Feb 2016 Unannounced Care and support Management and leadership 1 Oct 2015 Unannounced Care and support Management and leadership 3 - Adequate 6 Feb 2015 Unannounced Care and support Management and leadership 3 - Adequate 29 Sep 2014 Unannounced Care and support Management and leadership 3 - Adequate 31 Mar 2014 Unannounced Care and support 3 - Adequate 3 - Adequate 3 - Adequate Management and leadership 3 - Adequate 17 May 2013 Unannounced Care and support 3 - Adequate 3 - Adequate 3 - Adequate Management and leadership 3 - Adequate 19 Dec 2012 Unannounced Care and support 2 - Weak 2 - Weak 2 - Weak Management and leadership 2 - Weak page 11 of 13

Date Type Gradings 30 Aug 2012 Unannounced Care and support 2 - Weak 2 - Weak 2 - Weak Management and leadership 2 - Weak 13 Dec 2010 Unannounced Care and support 5 - Very good Management and leadership 5 Jul 2010 Announced Care and support 5 - Very good 5 - Very good Management and leadership 28 Jan 2010 Unannounced Care and support 5 - Very good 5 - Very good Management and leadership 9 Sep 2009 Announced Care and support 5 - Very good 5 - Very good 5 - Very good Management and leadership 5 - Very good 16 Jan 2009 Unannounced Care and support Management and leadership 29 Jun 2008 Announced Care and support Management and leadership page 12 of 13

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 13 of 13