PERTH & KINROSS COUNCIL 4(i) 09/41 Housing & Health Executive Sub Committee 21 January 2009 CARE COMMISSION REPORT ON DALWEEM CARE HOME FOR OLDER PEOPLE Report by Executive Director (Housing & Community Care) ABSTRACT This report advises Committee of the key findings of the Care Commission Inspection of Dalweem Care Home for Older People in February 2008 and highlights the key strengths and the main points for action. 1 RECOMMENDATIONS Committee is asked to note the key findings of the Care Commission inspection, with reference to: The areas of strength Areas for development 2 BACKGROUND 2.1 The Care Commission reviewed it arrangements for inspections of care services. 2.2 This inspection was conducted as part of a small number of trial inspections the Care Commission undertook to develop and improve the inspection process. These developments form part of the Care Commission s Regulating for Improvement project and the Care Commission was grateful to the service for agreeing to take part in a trial inspection. 2.3 The inspection was reported in a trial report format. 3 FOCUS AND RESULTS OF THE INSPECTION 3.1 This report summarises the results of an annual inspection of Dalweem care home for older people in February 2008. 3.2 During the visit the Care Commission Officers spoke with the Manager of Dalweem, care staff and service users. No carers were available on the day. The Care Commission Officers also looked at a range of policies, procedures and records including the following: - Service users personal plans Accident and incident recording Policies and procedures including staff rotas 45
2 Audits undertaken by the service Staff files Minutes of service users, carers and staff meetings During the inspection, the Care Commission Officers observed staff practice which included how staff cared for and spoke with service users. The general condition of the premises was also observed as part of the inspection process. 3.3 The following Quality Themes were evaluated: - Quality of Care and Support Quality of Environment Quality of Staffing Quality of Management and Leadership 3.4 National Care Standard Number 2: Care Homes for Older People Quality of Environment Strengths Service users and carers participate in assessing and improving the quality of the environment within the service. The premises were kept very clean, tidy and free from malodour. A very good standard of décor and furnishing was observed throughout the care home. Very good evidence of service user and carer participation was noted in the minutes of the staff meeting, a residents meeting and in a carers group meeting. Information on local advocacy services was available and the Manager confirmed that advocacy support was provided to some residents. The environment is safe and service users are protected. Personal plans included care home contracts and risk assessments pertaining to identified need. An intensive programme of training was implemented to include adult protection, restraint and training, specific to the particular group. Areas for development The self assessment document completed by the Manager identified the need to involve service users in the recruitment of staff. 3.5 National Care Standard Number 4: Care Homes for Older People Quality of Management and Leadership Strengths Service users and staff described ready access to the Manager, if required and thought that the Manager was very approachable. 46
3 Staff had access to a continuous professional development programme and participated in a formal supervision and appraisal system. The Manager had been proactive in ascertaining the views of service users and carers about the service and was shortly to implement a participation strategy which would also inform staff. Action plans were being implemented which would evidence the outcomes for service users in terms of the development of the service. Areas for development The self assessment document completed by the Manager identified the view that service users and staff should be involved in the recruitment of staff. 3.6 National Care Standard Number 5: Care Homes for Older People Management and Staffing Arrangements Strengths Not all areas of this standard were inspected on this occasion. Instead the inspection focused on Protecting People this being one of the main themes for adult services for 2007/2008. Within this focus area the inspection considered child protection in adult services, restraint, adult protection, Scottish Social Codes of Practice and staff training. 3.7 National Care Standard Number 19: Care Homes for Older People Support and Care in Dying and Death Strengths Not all elements of this standard were inspected on this occasion. Instead the inspection focussed on Palliative Care this being one of the main themes for adult services for 2007/2008. The service adopted a palliative are approach to meet service users palliative care needs. A copy of Making good care Better, National practice statements for general palliative care was available within the service and accessible to staff. Staff had received training in relation to palliative care which included aspects of communication with service users and their relatives wished this. The Manager advised that there was also good links with the district nursing service, other ministers/priests in the area and form the local undertaker who were all willing to give help and advice when requested. Areas for development A proactive and caring approach in respect of end of life care was promoted by the service. 47
4 4 CONSULTATION The Executive Director of Corporate Services and the Chief Social Work Officer have been consulted in the preparation of this report. 5 RESOURCE IMPLICATIONS Any costs arising from implementation of actions from the Care Commission reports will be contained within the revenue budget for Community Care Services. 6 COUNCIL CORPORATE PLAN OBJECTIVES 2006-2010 This report relates in particular to the following objectives within the Council s Corporate Plan 2006-2010: (i) A Safe, Secure and Welcoming Environment (ii) Healthy, Caring Communities (v) Confident, Active and Inclusive Communities 7. EQUALITIES ASSESSMENT The Council s Corporate Equalities Assessment Framework requires an assessment of functions, policies, procedures or strategies in relation to race, gender and disability and other relevant equality categories. This supports the Council s legal requirement to comply with the duty to assess and consult on relevant new policies to ensure there is no adverse impact on any community group or employees. The findings of this report will have a positive impact on people s wellbeing as they demonstrate excellent care and support for some very vulnerable people. 8. STRATEGIC ENVIRONMENTAL ASSESSMENT Strategic Environmental Assessment (SEA) is a legal requirement under the Environmental Assessment (Scotland) Act 2005 that applies to all plans, programmes and strategies, including policies (PPS). The plan, programme or strategy presented in this report was considered under the Environmental Assessment (Scotland) Act 2005 and the determination was made that the items summarised in this report do not require further action as they do not qualify as a plan, programme or strategy as defined by the Act. 9. CONCLUSION 9.1 Inspections by Care Commission provide information on the standards and quality of the services and establishments provided by Community Care Services in Perth & Kinross. When considered alongside other Inspection Processes, such as the Social Work Inspection Agency, these reports set out 48
5 a clear agenda for continuous improvement in the standards and quality of these services/establishments. 9.2 The full Care Commission report is attached. DAVE ROBERTS Executive Director (Housing & Community Care) Contact Officer: Jim Dean, Head of Community Care Ext 76709, email: jimdean@pkc.gov.uk Address of Service: 5 Whitefriars Crescent, Perth, PH2 0PA Date of Report: 21 January 2009 Note: No background papers, as defined by Section 50D of the Local Government (Scotland) Act 1973 (other than any containing confidential or exempt information) were relied on to any material extent in preparing the above report. 49
6 50
Dalweem Care Home Service Dalweem Taybridge Road Aberfeldy PH15 2BH Inspected by: (Care Commission Officer) Lorna Scott Type of inspection: Inspection completed on: 26 February 2008 51 1/13
Service Number Service name CS2003009735 Dalweem Service address Dalweem Taybridge Road Aberfeldy PH15 2BH Provider Number dummy Provider Name SP2003003370 Perth & Kinross Council Inspected By dummy Inspection Type Lorna Scott Care Commission Officer dummy Inspection Completed Period since last inspection 26 February 2008 6 months dummy Local Office Address Perth and Kinross Team Central East Region Compass House 11 Riverside Drive Dundee DD1 4NY dummy 52 2/13
Introduction Dalweem is owned and managed by Perth and Kinross Council. It can accommodate up to 32 older people, which includes one room kept for respite care. There is also provision for a support service for up to four people per day. The Service has been registered with the Care Commission since April 2002 and the manager responsible for the day to day running of the Care Home and supervision of staff is Ms Margaret Quinn. The Home is purpose built. All bedrooms are single and there are a variety of lounge areas, including a family room and a library. The Home stands in its own grounds near the main street in the rural town of Aberfeldy. The Service's brochure states that Dalweem, " recognises the rights of all people to lead a valued life; it aims to be a provider of high standard care services, enabling all older people to remain as independent as possible." Basis of Report Before the Inspection The Annual Return The service submitted a completed Annual Return as requested by the Care Commission. The Self-Evaluation Form The service submitted a self-evaluation form as requested by the Care Commission and also a Quality Assessment Framework (QAF) self evaluation as part of a trial, in preparation for the new grading process commencing in April 2008. This service was inspected after a Regulatory Support Assessment (RSA) had been carried out to determine what level of support was necessary. The RSA is an assessment undertaken by the Care Commission Officer which considers: complaints activity, changes in the provision of the service, nature of notifications made to the Care Commission by the service (such as absence of Manager) and action taken upon requirements. The CCO will also have considered how the service responded to situations and issues as part of the RSA. This assessment resulted in this service receiving a low RSA score and so a low intensity inspection was required as a result. The inspection was then based upon specific statements within the four quality themes, the relevant inspection focus areas for the inspecting year 2007/2008 and follow up on any recommendations and requirements from previous inspections, complaints or other regulatory activity. During the inspection process The report was written following an announced inspection on Tuesday 26 February 2008 by Lorna Scott and Patsy McDermott, Care Commission Officers. Feedback was given to the Manager at the end of the inspection and during a further meeting with the Care Home Manager on 18 March 2008. This inspection was conducted as part of a small number of trial inspections. The Care Commission is using these trial inspections to develop and improve the inspection process. The inspection will be reported in a trial report format. These developments form part of the Care Commission's Regulating for Improvement project and the Care Commission is grateful 53 3/13
to this service for agreeing to take part in a trial inspection. During the visit the Care Commission Officers spoke with: The Manager of the Care Home Care Staff Service Users The Care Commission Officers also looked at a range of policies, procedures and records including the following: Service users' personal plans Accident and incident recording Policies and procedures including staff rotas Audits undertaken by the service Staff files Minutes of Service user, Carer and Staff Meetings During the inspection, the Care Commission Officers observed staff practice which included how staff cared for and spoke with service users. The general condition of the premises was observed as part of the inspection process. The Care Commission Officers took all of the above into account and reported on whether the service was meeting a range of relevant National Care Standards for Care Homes for Older People associated with the Inspection Focus Areas for 2007/2008 and specific aspects of the following Quality Themes: Quality of Care and Support Quality of Environment Quality of Staffing Quality of Management and Leadership The main inspection focus areas for this Care Home service were:- 1. Protecting People, including Adult Protection, Restraint, Child Protection (for visiting children) and Staff training/training plans. Aspects of all associated National Care Standards were taken into account during this inspection. 2. Palliative Care. The following standards from care homes for older people were also taken into account during this inspection to support the inspection focus areas and follow up on the service actions in relation to recommendations and requirements made in all regulatory activity since the last inspection:- Standard 5: Management and Staffing Arrangements Standard 19: Support and care in dying and death The inspection also took into account the Regulation of Care Act (Scotland) 2001 and the Regulation of Care (Requirements as to Care Services) (Scotland) Regulations, 2002, Scottish Statutory Instrument 1124, referred to below as SSI 22002/114) The Fire (Scotland) Act 2005 introduced new regulatory arrangements in respect of fire safety, on 1 October 2006. In terms of those arrangements, responsibility for enforcing the 54 4/13
statutory provisions in relation to fire safety now lies with the Fire and Rescue service for the area in which a care service is located. Accordingly, the Care Commission will no longer report on matters of fire safety as part of its regulatory function, but, where significant fire safety issues become apparent, will alert the relevant Fire and Rescue service to their existence in order that it may act as it considers appropriate. Further advice on your responsibilities is available at www.infoscotland.com/firelaw Action taken on requirements in last Inspection Report There were no requirements made during the previous inspection. Comments on Self-Evaluation A comprehensive self-assessment was carried out by the service manager which identified the strengths of the service and areas for development. View of Service Users This part of the report has been compiled by the lay assessor who participated in the inspection process. A lay assessor is a volunteer, who has experience of being a user of care services or as an informal carer. 'The care home has four wings, each with a resident s sitting room, toilets and bathrooms, and a library or crafts/hobbies room. There is also a quiet sitting room which can be adapted into a visitor s bedroom. There is a large communal dining room and a smaller dining room which seats eight people and is used for residents to eat with their visitors. The hairdressing salon is made to look exactly like a real salon, which I feel gives residents the feeling that they are out at the hairdressers. There is also a small shop which is manned by a volunteer one day a week or on request by staff. A large enclosed garden is under construction. Staff/resident interaction was observed to be good. During the morning, staff provided tea and biscuits and lingered to chat to residents. I observed residents making their way from their rooms to the dining room. Residents were using zimmers, walking sticks and wheelchairs. Staff were standing by ready to assist but were not required. Staff were also observed knocking on resident s door before being invited to enter. The local GP surgery is next to the care home and a weekly surgery is held in the home with the district nurse also attending once a week. There is a residents' meeting once a month when residents can air their views. There is a choice of food at all meal times and residents can choose to eat in the dining rooms or their own room if they wish. Due to staff changes some residents were concerned that the standard of food was not so good but this was being addressed by the service. Residents seemed happy with the care they received. Comments included the following:- The food is good and plenty of it. We get a choice of food and lots of cuppas. I wouldn t want to be anywhere else. The laundry is good. Nothing gets lost. The food is good and well presented. 55 5/13
I feel the staff listen to me. The staff are very helpful. The staff are wonderful. This place is second to none. We have dominoes and quizzes in the afternoon. We go bus trips in the summer. My own hairdresser comes here to do my hair. I can go in the Jacuzzi if I want. View of Carers There were no relatives available for discussion with the Care Commission Officers, during this inspection. 56 6/13
Regulations / Principles National Care Standards National Care Standard Number 1: QAF Care Homes for older people - Quality of Care and Support Strengths The findings in this section are based on the undernoted Quality Statements: 1.1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. The participation of service users and carers was evidenced in the minutes of meetings. Opportunities were provided for residents to voice their views in respect of entertainment, menu planning and any other issues arising. Issues in respect of laundry had been raised by residents and appropriate action was taken by the service. During a staff meeting, a concern raised by a relative was discussed. As a result it was decided that an early review meeting would take place. These were good examples of how service user and relative/carer participation could lead to service improvements. Carers meetings had commenced on 11February 2008 when the new grading system was discussed. Staff meetings were held regularly and minuted. Issues relating to health and safety, risk assessments, training, laundry arrangements for service users and the need for new equipment for the hairdressing room to promote comfort and safety for residents, were all addressed. 1.3 We ensure that service users' health and wellbeing needs are met. A policy had been formulated relating to food, fluid and nutrition Training in respect of nutritional issues was due to commence in April 2008. Whilst there were good examples of assessment of the mental health issues for some residents, the emotional needs of all service users should be assessed and recorded. As previously stated in Standard 19 of this report, policies and procedures relating to the care of the dying, death and bereavement were implemented by the service. Close links had been developed with local GP practices and district nursing services. An open door policy for relatives and visitors to the home was in place and this was particularly relevant where end of life care was being provided. An attractively furnished room was available for relatives or carers wishing to stay overnight in the care home to be near and support their relative. Areas for Development Six monthly reviews of personal plans were being undertaken for the majority of the residents and the Manager intended to ensure that these were conducted for all service users and that service user and relative/carer participation within these meetings, is clearly evidenced. Where relatives did not attend review meetings, the Manager intended to endeavour to obtain their views in relation to the quality of the service provided to their relative. The Manager also intended providing service users and significant others with a copy of the minutes of each meeting. 57 7/13
A participation strategy highlighting the process of promoting service user and carer/relative involvement in the development of the service and arrangements for staff training in this respect, was discussed with the Manager who intended to formulate a plan to take this forward. The self-assessment document completed by the Manager identified areas for development, including: > Further development of the Carers' Group and the implementation of an action plan. > A residents' action plan and development plan in respect of resident views. > The promotion of relative/carer participation in the development of care plans. National Care Standard Number 2: QAF Care Homes for older people - Quality of Environment Strengths The findings in this section are based on the undernoted Quality Statements: 2.1- We ensure that service users and carers participate in assessing and improving the quality of the environment within the service. The premises were kept very clean, tidy and free from malodour. A very good standard of decor and furnishing was observed throughout the care home. Very good evidence of service user and carer participation was noted in the minutes of a staff meeting, a residents' meeting and in a carers' group meeting. There were details of areas to be improved and those which had already been addressed for the benefit of service users. These related to laundry provision, car parking arrangements and salting and gritting during inclement weather. Information on local advocacy services was available and the Manager confirmed that advocacy support was provided to some residents. The Manager intended to ensure that records would be updated to reflect the offer of advocacy services for individual service users and evidence of the support provided to individual service users from this independent agency. 2.2 - We make sure that the environment is safe and service users are protected A service management audit report which included a risk assessment of the environment was concluded in November 2007. Personal plans included care home contracts and risk assessments pertaining to identified need. An intensive programme of training was implemented to include adult protection, restraint and training, specific to the particular client group. A child protection policy to ensure clear lines of responsibility when children visited the service and action to be taken by staff where there was an incident or allegation of abuse, was in place. Areas for Development As previously stated within this report it is the intention of the Manager to introduce a 58 8/13
participation strategy to guide staff on the promotion of service user and carer involvement in the development of the service. The self-assessment completed by the Manager identified areas for development, including: Assessment of service user dependency levels which will inform staffing levels within the care home. The development of a secure garden area. The reviewing and updating of equipment on a monthly basis. Ongoing decoration and upgrading of facilities, including, replacement of furnishings and floor coverings. National Care Standard Number 3: QAF Care Homes for older people - Quality of Staffing Strengths The findings in this section are based on the undernoted Quality Statements: 3.1 - We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. The staff recruitment processes of the Service Provider had been the subject of audit by the Care Commission and found to be satisfactory. The service had in place the appropriate policies and procedures to meet legal requirements such as Health and Safety, Complaints Policy and Procedure, Medication Policy, Visiting Policy and Adult Protection. A staff training plan was in place and training appropriate to the service user group and service provision was provided. Questionnaires were used to evaluate the effectiveness of staff training in addition to observation by the Manager of the daily practice of staff. 3.4 - We ensure that everyone working in the service has an ethos of respect towards service users and each other. Staff had been provided with a copy of the National Care Standards, Care Homes for Older People and ongoing training was provided which addressed the meeting of those standards. Staff were observed caring for residents and showed patience and respect for them. This was supported by the findings of the lay assessor detailed in the first section of this report. During the interviewing of staff the Care Commission Officers also noted an attitude of caring, commitment and respect for residents, demonstrated in the way individual staff members spoke about their contact with residents. Areas for Development The self-assessment document completed by the Manager identified the need to involve service users in the recruitment of staff. The Manager intended to implement action plans which will demonstrate the service's commitment to act on information collated from service users, carers/relatives and staff in 59 9/13
addressing issues raised, the areas for development and the outcomes for service users. National Care Standard Number 4: QAF Care Homes for older people - Quality of Management and Leadership Strengths The findings in this section are based on the undernoted Quality Statements: 4.l - We ensure that service users and carers participate in assessing and improving the quality of management and leadership of the service. Service users and staff described ready access to the Manager, if required and thought that the Manager was very approachable. Staff had access to a continuous professional development programme and participated in a formal supervision and appraisal system. 4.4 - We use quality assurance systems and processes which involve service users, carers, staff and stakeholders to assess the quality of service we provide. The Manager had been proactive in ascertaining the views of service users and carers about the service and was shortly to implement a participation strategy which would also inform staff. Action plans were being implemented which would evidence the outcomes for service users in terms of the development of the service. Areas for Development The self-assessment document completed by the Manager identified the view that service users and staff should be involved in the recruitment of staff. National Care Standard Number 5: Care Homes for Older People - Management and Staffing Arrangements Strengths Not all areas of this standard were inspected on this occasion. Instead the inspection focused on Protecting People this being one of the main themes for adult services for 2007/2008. Within this focus area the inspection considered child protection in adult services, restraint, adult protection, Scottish Social Services Codes of practice and staff training. Child Protection in Adult Services Visitors, which included children, were welcomed within the service. Accordingly the service had a child protection/visitors policy which detailed responsibilities for the protection and safeguarding of children including the staff role in reporting any Child protection concerns. Staff were aware of the policy and their responsibilities in relation to it. Restraint 60 10/13
The service had a policy and procedure in relation to restraint which was currently being reviewed. This detailed different types of restraint, conditions under which restraint may occur and appropriate recording details for any instances of restraint. Each service user had a risk assessment, which detailed their abilities and needs in relation to rights, risks and limits to freedom as advised by the Mental Welfare Commission s good practice guidance. The Manager advised that to date, restraint had not been used within the care home. However, staff had received training in relation to restraint issues including appropriate training in safe techniques used in direct physical restraint. Adult Protection The service had a policy in relation to adult protection. This detailed the roles and responsibilities of the manager and staff, the recording of any concerns and appropriate supports available for service users. The service had a copy of the Area Inter-Agency Adult protection procedures and staff were aware of its content. All staff had received training in adult abuse and adult protection. SSSC codes of Practice and staff training The service had developed a learning and development policy. A training needs assessment had been carried out for each staff group and a staff training programme was in place which covered mandatory training such as fire safety, first aid and food hygiene as well as training to meet the needs of specific service users or groups. The service maintained records of all staff training and used questionnaires to evaluate the effectiveness of training. Staff indicated that they felt training was accessible and relevant. The service was addressing the issue of training in relation to SSSC registration and an SVQ programme was well underway. Nineteen care staff out of a total of twenty five had either achieved or were undertaking appropriate training and the Manager had achieved the Registered Manager's award. Areas for Development There were no areas identified for development within this standard. National Care Standard Number 19: Care Homes for Older People - Support and Care in Dying and Death Strengths Not all elements of this standard were inspected on this occasion. Instead the inspection focused on Palliative Care this being one of the main themes for adult services for 2007/2008. The service adopted a palliative care approach to meet service users palliative care needs. A copy of Making good care Better, National practice statements for general palliative care was available within the service and accessible to staff. Staff had received training in relation to palliative care which included aspects of 61 11/13
communication with service users and their relatives about their palliative care needs. The service had a policy in relation to accessing specialist advice and staff described occasions where they had developed close links with healthcare specialists, sharing information about symptoms and the need for more pain relief. A comfortable room was available for relatives who wished to stay overnight. There was an agreement with a local minister to provide support if residents or relatives wished this. The Manager advised that there were also good links with the district nursing service, other ministers/priests in the area and from the local undertaker who were all willing to give help and advice when requested. Areas for Development A proactive and caring approach in respect of end of life care was promoted by the service. 62 12/13
Enforcement There has been no enforcement action against this service since the last inspection Other Information The Care Commission Officers discussed with the Manager, the 'Regulating for Improvement' project - a development which will significantly change how the Care Commission will regulate services from April 2008. It will mean better information, more involvement with people who use care services and their carers and the introduction of clear gradings which will help people make more informed choices about the care services they want to use. The Manager had already familiarised herself with the information and briefings that have been made available at www.carecommission.com /Care Services/Regulating for Improvement/Information for Service Providers.' Requirements Recommendations Lorna Scott Care Commission Officer 63 13/13
64