Struan Lodge Nursing Home Care Home Service 54 Balgreen Avenue Edinburgh EH12 5SU Telephone: 0131 337 7477 Type of inspection: Unannounced Inspection completed on: 7 February 2018 Service provided by: Struan Lodge Ltd Service provider number: SP2003002474 Care service number: CS2003010671
About the service Struan Lodge Care Home is a purpose-built home and registered with the Care Inspectorate on 1 April 2011 to provide care for up to 32 older people. Care is provided over 24 hours by a team of registered nurses and carers led by the nursing manager. The home was sold in June 2017 and is now part of the Care Concern Group of care homes in Scotland. The current owners have been working with the new manager to develop and improve the home over the past eight months prior to the inspection. The home is situated at the end of a quiet cul-de-sac near Carrick Know golf course in the Murrayfield area of Edinburgh. There are pleasant open gardens to the front and off street parking is available. There are plans to develop the garden area to the rear of the home, which will make the gardens more accessible for residents to enjoy. Accommodation is provided over two floors with stairs and a lift to the first floor. All residents have their own rooms which have en suite facilities. Each floor has a lounge with a dining area, a small separate quieter sitting room and communal bathrooms and toilet facilities. All meals are provided by the kitchen team led by the chef and the home has its own laundry facilities. Daily activities are provided by the activities co-ordinator in addition to regular outings and special events. The home's aims and objectives includes the following philosophy: " to provide individuals with care in a safe environment, committed to excellence where personal dignity is maintained, personal privacy respected and personal needs are fully met", and " It's extremely important to us that our residents think of Struan Lodge as their home. We don't have set visiting hours - friends and family are always welcome to drop in for a chat, a coffee or a bite to eat". What people told us In November 2017 prior to the inspection we received responses to questionnaires from 10 residents and 10 relatives. People commented that things had deteriorated prior to the home being sold and raised various concerns about the quality of care and other aspects of the running of the home. Some of the comments were: "lack of support with washing, moving from my room to the dining room" (resident). "I would feel happier if there was always a carer in the lounge" (relative). "room for improvement in the staffing levels and nutrition" (relative). However there was also a feeling from others that the change of owner in June 2017 and the new manager was having a positive impact and that things were gradually improving. "The new owners are making various improvements which were long overdue" (relative). page 2 of 12
While these comments reflect the home prior to our inspection, comments from people we spoke with during our inspection showed improvement. People were generally happy with the care they experienced, with many complimentary comments about the staff. "Everyone is so kind to me...couldn't be better" (resident). "I think the home is lovely, it's perfect for me, the staff are excellent...don't think you can ask for more" (resident). "all staff are very friendly, it's the atmosphere - lovely and calm, staff keep me informed, I'm always offered tea, the room is lovely" (relative). Whilst the feeling was that things were improving there was still room for improvement. "I will say something if something is wrong, little things that the younger members are not picking up on, older staff are much more aware. If a resident needs the toilet "wait a wee minute", but this should be a priority" (relative). "staff presence in the lounge, there should be more of a presence" (relative). Self assessment We are not asking services to submit a self assessment for this inspection year. During the inspection we discussed ways in which the service could improve and develop. The manager and the area manager plan to use this discussion to inform their improvement plan for the coming year. From the 1st April 2018 the new "Health and Social Care Standards" will replace the existing care standards. The new standards seek to provide better outcomes for people who experience care and services and services should now be familiarising themselves with them. From this inspection we graded this service as: Quality of care and support Quality of environment Quality of staffing Quality of management and leadership 5 - Very Good Quality of care and support Findings from the inspection The home over the previous year had undergone some significant changes which had impacted negatively upon the home and this was reflected in the feedback from relatives and residents both from the questionnaires and what people told us during our inspection. There was a change of owner and manager in early June, followed by page 3 of 12
a further change of manager three months later. The new owners and the current manager quickly recognised areas that required immediate attention and have worked hard together with the all the staff to improve the care for the residents over the last eight months. Residents are experiencing on the whole good care and support. We saw staff treating residents in a caring manner with respect, warmth and patience. Those residents who were experiencing stress and distress were supported with a calm sensitive approach. During our inspection residents whose health and condition had deteriorated significantly were well cared for with close liaison with the resident's GP and other health professionals to ensure their comfort and support for their family. There were concerns about the nutritional quality of the food, cold food, lack of menu choices and weight loss of some residents. The home have made significant improvements introducing a hot trolley, full cream milk, butter, lots of cream and fortified food. The chef now feels the quality of the ingredients supplied is much better and he is able to offer a more varied menu. He also now has individual information for each resident regarding their weight and food preferences. The chef chatted with residents during mealtimes ensuring that alternatives to the daily menu were offered. Residents had benefited from the improved meals. "the kitchen staff are fabulous, the food has been enhanced ten fold, she lost weight before she came in, now she's eating, they do try very hard"(relative). We observed some staff assisting residents to move in ways that were not always helpful and some techniques used that could potentially lead to injury. This was discussed with the manager and we were assured that this would be addressed as a priority. Staff training over a number of key areas had not occurred and moving and handling training was one of these. Some new moving and handling equipment had been bought but it appeared that staff did not have the skills to assess the suitability of the equipment for some less mobile residents. (Recommendation 1). The way residents are supported with their medications has been reviewed. A traditional hospital type system where medication is given at a set time from a trolley has been replaced with resident's own medication now being kept in the residents' rooms in small cabinets. This means that residents are supported with their medication in a more personal way as part of their care, as if they were in their own homes. This also means that those residents who wish to and are able to continue to manage their own medications, can do so. The home has been addressing the lack of stimulation, activities and having meaningful things to do. "I think more needs to be done to provide entertainment/stimulation/activities relevant to the residents' needs... she sleeps because there is nothing to do" (relative). A programme of activities is now in place, developed by the recently appointed activities co-ordinator. We observed that if residents chose not to take part in communal entertainment then one to one time was spent with them where possible. Links with the local community are being developed. Local nursery visits are taking place and trips out are being planned. The home should continue to develop more individualised and small group activities especially for those residents who are unable or do not wish to take part in larger events such as visiting entertainers. The home was introducing new mini care plans kept in the residents' rooms. These reflected the person's needs, wishes and how they liked to spend their time. Staff felt they were readily accessible and that visiting family also liked them as they could see how their relative had been. When looking at care plans and discussing residents' care needs with staff, staff knew the resident's needs and described in detail how to support them. However this information was not reflected in the residents' care plans. For example we observed staff caring well for page 4 of 12
resident's who experience pain and it was evident that the staff knew how to support them. However this information was not detailed within their plans. Likewise residents whose medical conditions were being managed well by the nursing and care staff had no corresponding care plan in place. (Recommendation 2). There was a problem with the laundering and care of residents' clothing: "her clothing is clearly marked but others use them" "sometimes my father is wearing clothes that are not his" The home is taking steps to label all resident's clothing and improve the care and support for residents to wear their own clothes. Requirements Number of requirements: 0 Recommendations Number of recommendations: 2 1. To ensure that residents are supported to move in a safe and comfortable manner the home should: (i) Ensure that residents' needs and abilities are assessed regularly and detailed support plans are in place. (ii) Staff should receive training and updates in moving and handling techniques in line with best and safe practice. (iii) Staff should undergo training to develop the necessary skills to assess the suitability of moving and handling equipment for less mobile residents, this includes the use of stand aid hoists. (iv) The impact training has upon staffs' practice and skills should be evaluated which should include feedback from people experiencing care. This takes account of: National Care Standards, Care homes for older people - Standard 5: Management and Arrangements and Standard 6: Support Arrangements. The Nursing and Midwifery Council - The Code. 2. So that residents can experience high quality safe care from staff that know their care needs the manager should ensure that there is detailed up to date information contained within care plans that meet identified individual support and care needs. This takes into account of: The National Care Standards, Care Homes for Older People - Standard 6: Support Arrangements and Standard 14: Keeping Well- healthcare. The Nursing and Midwifery Council - The Code. Grade: 4 - good page 5 of 12
Quality of environment Findings from the inspection Feedback from relatives and residents prior to our inspection suggested that standards had suffered recently. "Wheel chairs not always clean" During our visit we saw that the home was pleasant and maintained to a high standard of cleanliness. The domestic team was dedicated and took pride in maintaining standards. The home have taken steps to put in place a programme of improvements. The new maintenance member of staff had taken immediate steps to rectify some safety issues with the temperature controls for hot water. They had also implemented regular checks and servicing for all equipment, the fabric of the building and the grounds. This ensured that the environment was safe and residents and staff were protected. Staff reported that they raised any maintenance issues which were being dealt with promptly. The manager noted that the towels had been of very poor quality and residents also noted that there were "often no towels and old towels" and "lack of towels when I want to wash". In residents en suite bathrooms old towels had been replaced with new ones and they had been individually labelled. There were very pleasant well maintained gardens to the front of the home but relatives noted that the garden used to be well used but it now no longer was. There are plans to develop the garden to the rear. This should enable easier and freer access for residents to enjoy the health and well being benefits of being outside. Requirements Number of requirements: 0 Recommendations Number of recommendations: 0 Grade: 5 - very good Quality of staffing Findings from the inspection Feedback in November 2017 from the questionnaires raised concerns that the staff did not have the necessary skills to care for their relative and that staff would benefit from more training. We found that staff training had lapsed but that the new manager and deputy manager had commenced a training programme to address key areas of staff skills, knowledge and practice. We discussed and identified the priority areas that staff required training in; movement and handling, preventing harm and dementia care. We saw that plans were already in place to progress training in these areas. page 6 of 12
We also highlighted the importance of ensuring that staff are developing the necessary skills and putting into practice what they have learned from training. Having well trained and skilled staff will help make sure people feel confident in all the staff caring and supporting them. We found a committed team of staff who felt that the recent improvements had had a positive effect and they were very keen to undertake training and develop their skills. We observed some lovely interactions between staff and residents. Staff were on the whole kind, attentive, caring and well meaning. "I think it's better now, just the atmosphere. You can go to the manager with anything and you get very good support. I just love my job"(staff). "Before it was tense, now allowed to sit and chat with residents which is what it is all about"(staff). Staff support and supervision dates were in place in the coming months. This should help support staff in their development and make them feel valued. Staff we spoke to felt well supported by their colleagues and their manager. There was the perception by relatives that the staff were already feeling more valued and this has had a positive impact upon morale. "It's more settled, the staff are more settled, think they feel more loved and valued, change for the better"( relative). There were some concerns that there was not always a nurse or carer present in the sitting room with the result that other residents or visitors would then be approached for assistance. "I would feel happier if there was always a carer in the residents' lounge" (relative). We observed that there were periods where there were no carers in the sitting room leaving very frail residents at times unattended. We discussed this and the above comment from a relative with the manager during our inspection and were assured that this would be addressed. Requirements Number of requirements: 0 Recommendations Number of recommendations: 0 Grade: 4 - good page 7 of 12
Quality of management and leadership Findings from the inspection The new manager came into post in October 2017 and quickly recognised the areas within the home that required improvement. There were many examples of where improvements had already been made under her leadership, such as nutrition and essential maintenance work. She has been involving residents, relatives and staff in ways to make things better. We saw that the senior management team and the deputy manager were supporting her with improvements and were reassured that the manager was able to request and get support for developments. She is also currently undergoing training to develop her leadership and management skills. The manager was developing systems to monitor and prevent risks to residents in areas such as falls, infection control, nutrition, medication errors and pressure ulcers. A staff training and supervision programme was being developed and we were able to suggest areas that needed to be prioritised. There was positive feedback from staff that the recent changes were making a difference. "It's been a challenging time but many positives, family and residents have more of a say. I have great support; I feel they (management) listen to my ideas". "They (manager) are good at letting me expand my role, lots of support and encouragement. I am able to address any concerns... the manager has an open door". During our inspection there was positive engagement during all our discussions with the manager, deputy manager and area manager. It was evident that they and the whole staff team had been working hard to improve the lives of the residents. They were very open to the feedback comments from residents and relatives we were able to provide to them. They had made significant improvements over a relatively short period of time but also recognised that there was much more work to be done. There is in place detailed service development plans for the coming year and this along with a continued stable management team should ensure that the home continues to improve. Requirements Number of requirements: 0 Recommendations Number of recommendations: 0 Grade: 4 - good page 8 of 12
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 There are no outstanding recommendations. 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. Inspection and grading history Date Type Gradings 22 Feb 2017 Unannounced Care and support Management and leadership page 9 of 12
Date Type Gradings 24 Feb 2016 Unannounced Care and support Management and leadership 9 Jan 2015 Unannounced Care and support Management and leadership 22 Nov 2013 Unannounced Care and support Management and leadership 15 Aug 2012 Unannounced Care and support Management and leadership 28 Oct 2010 Unannounced Care and support Management and leadership 8 Jun 2010 Announced Care and support Management and leadership 19 Mar 2010 Unannounced Care and support Management and leadership 10 Nov 2009 Unannounced Care and support Management and leadership page 10 of 12
Date Type Gradings 10 Feb 2009 Unannounced Care and support Management and leadership 19 Nov 2008 Announced Care and support Management and leadership page 11 of 12
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 12 of 12