The Village Nursing Home Care Home Service

The Village Nursing Home Care Home Service 1a The Auld Road Cumbernauld Glasgow G67 2RF Telephone: 01236 458587 Type of inspection: Unannounced Inspection completed on: 4 November 2016 Service provided by: HC-One Limited Service provider number: SP2011011682 Care service number: CS2011300789

About the service The inspection focused on standards of care for people living with dementia. We are using a sample of 150 care home services, to look in detail at the standards of care for people living with dementia and this service is one of those selected as part of the sample. The areas looked at were informed by the Scottish Government's Promoting Excellence: A framework for health and social care staff, working with people with dementia and their carers and the associated dementia standards. It is out intention to publish a national report on some of these standards during 2017. The Village Nursing Home is a service provided by HC One Limited and was registered with the Care Inspectorate in 2011, to provide care and support for forty-seven older people. The home provides long-term residential care as well as short-term respite breaks, to people with physical and cognitive impairment. The home is purpose-built over three levels with lounges and dining facilities in each of these. There is a passenger lift providing access to each floor. All bedrooms have en suite facilities and people are encouraged to bring in their own furnishings to personalise their rooms. There is a secure garden area with seated areas for people to enjoy in the better weather. What people told us Prior to this inspection we issued twenty Care Standard Questionnaires to people using the service as well as relatives and carers. We received one completed questionnaire from people using the service who strongly agreed that overall they were happy with the quality of service provided. We received three completed questionnaires from relatives/carers. Two people said they strongly agreed and one agreed that overall they were happy with the quality of service provided to their relative. Some of the comments included were as follows; "The team do a wonderful job with personal care and show great respect, humanity and kindness to my relative. I find the managerial side very efficient in every way. The home is always clean and tidy and meals very nutritious and appetising which I have sampled. Everyone is very welcoming and friendly ". We also looked at thank you cards with comments as follows; "My relative has been in this home for four years and has had exemplary care. In all that time every six months the care plan has been reviewed with myself. The improvements to this home in the last four years have been tremendous and things are still improving". "Since our relative moved in we have found staff very kind and attentive, staff are easy to talk to about the care and any concerns we have. I would like to see a little more activity as days can be very long for some residents. We visit regularly at different times of the day and at no time have we ever found we were intruding, we as a family feel we have made a good choice for our relative". page 2 of 15

"It's the perfect home for residents, from management to domestics everybody is so caring and helpful. The home is kept clean and tidy in all areas. Residents are well cared for and have plenty of activities. Food is well presented and there's plenty of variety. I cannot praise the home highly enough". Self assessment Every year we request all services registered to provide care and support submit a self assessment. This provides information on how the service is performing, we check this as part of the inspection process. The service submitted a self assessment to us prior to inspection and were satisfied with the way this had been completed. From this inspection we graded this service as: Quality of care and support Quality of environment Quality of staffing Quality of management and leadership Quality of care and support Findings from the inspection The service used a range of methods to engage with people using the service. Regular meetings, questionnaires and surveys were taking place with the introduction of Skype supporting residents to say in touch with friends and family. The consultation process could be improved by ensuring that any suggestions made provide evidence of actions taken and outcomes achieved as this was not always evident (see recommendation 1). There was a key worker system in place with information displayed in individual rooms, six monthly reviews were taking place and the service had recently introduced a new care plan format. There was some good information on individual preference/choices and some plans had information on Do Not Attempt CardioPulmonary Resuscitation (DNACPR) and who had the legal rights to make decisions on the person's behalf. There were lovely pictures of residents enjoying activities and we could see the positive effect of doll therapy used on a distressed resident. There were plans to develop and implement life histories. This will enable the service to determine individuals past interests to demonstrate how the activities offered are meaningful to each resident (see recommendation 2). The care plans lacked detail in relation to healthcare needs, where risk had been identified there was no followup to this. Where residents experienced distressed reactions there was lack of information on the management and outcome of this. Some of the monthly evaluations had not been completed for several months, lacked detail and where methods of restraint had been used to ensure individuals safety, it was unclear who had been consulted and provided consent. Daily notes lacked detail on how staff had supported the person to spend their day. page 3 of 15

There was no overview of the DNACPR, Power of Attorney/Guardianship or Adult with incapacity documentation resulting in some being out of date (see requirement 1, recommendation 3). Anticipatory Care Plans were in place but had not been completed consistently with evidence of who had been involved in completing these (see recommendation 4). We looked at medication administration records and found these could be improved to include an explanation of medication regularly missed with evidence of consultation with the GP. As required medication should provide evidence of the outcome and handwritten instructions should provide a signature, date and reference to the prescriber (see recommendation 5). Requirements Number of requirements: 1 1. Record keeping must be improved to demonstrate that information recorded within the care plans are accurate, sufficiently detailed and reflect the care planned or provided. Staff require training to demonstrate they are aware of their responsibility to keep accurate records which reflect; - All the current healthcare and needs of individuals and how staff are expected to manage these appropriately. - Include accurate up to date information about care and support which is fully evaluated to provide an explanation on changing needs which are reflected within the relevant section of the care plan. - Have a full range of risk assessment tools in place to demonstrate the current level of risk and how staff are expected to manage this effectively for each individual with evidence of consultation and review of this process. - Have accurate up to date information with evidence of consultation in the DNACPR, POA, AWI and Guardianship documentation This is in order to comply with: SSI 2011/210 regulation 4(1)(a) - Welfare of users, Regulation 15(b)(i). Timescale for implementation; to be completed by 30 June 2017. Recommendations Number of recommendations: 5 1. The provider should ensure that where questionnaires are completed that the results are analysed and action is taken to address any issues raised and this is recorded. National Care Standards - Care Homes for Older People; Standard 5: Management and Arrangements 2. The provider should refer to best practice and review the provision of activities to ensure that activities are appropriate, engaging and relevant to people's preferences and abilities as detailed within their life history and care plans. National Care Standards - Care Homes for Older People Standard 5: Management and Arrangements, Standard 6 - Support Arrangements page 4 of 15

3. The provider should review and improve the quality and detail in care plan records to address the issues raised in this report. National Care Standards - Care Homes for Older People Standard 5: Management and Arrangements, Standard 6 - Support Arrangements. 4. The provider should ensure that where Anticipatory Care Plans (ACP) are in place that they have been fully completed. National Care Standards: Care Homes for Older People Standard 5: Management and staffing arrangements. 5. The recording of Medication Administration Charts should be improved to ensure they accurately reflect the reason and outcome of administering "as required" medications. Handwritten entries on the MARs should have appropriate signatures and be referenced to the prescriber. Medication which is regularly missed should be reviewed with the GP and outcome recorded within the care plan. National Care Standards: Care Homes for Older People, Standard 15 - Keeping Well - medication Grade: 4 - good Quality of environment Findings from the inspection There was a controlled door entry system with a visitors signing in book located at reception. Access into the units is via a secure door entry system to ensure residents safety. The home was clean and tidy, rooms were personalised demonstrating people had been consulted and involved in the quality of their environment. There was a designated smoking area, hairdresser and small pantry areas in each of the units with a café area at the front door for residents and visitors to use. The manager and staff carried out regular audits of the environment, including infection control and health and safety to ensure the home was safe and secure. We could see where issues had been identified these were followed up in an action plan to ensure a positive outcome. Maintenance checks had been completed monthly up until September 2016 when the maintenance person had left. A new maintenance person had been recruited and we were satisfied to see that actions had been taken meantime to address urgent repairs to maintain a safe environment. Satisfactory safety checks were in place for equipment such as hoists and stand aids, with additional checks including lift maintenance, gas safety and legionella available. There was secure garden area which residents could access with staff support. Further work is required on this to ensure it is free from trip hazards and provides a safe area to access and wander independently. Mealtimes were organised and staff supported people in a calm dignified manner. Tables were nicely set, menus displayed and specialist cutlery available to assist and promote independence ensuring a positive mealtime experience. page 5 of 15

There was a reminiscence area with a washing machine and kitchen facilities. This had been developed to encourage residents to participate in domestic activities, reduce distressed reactions and promote independence. This room was locked and could only be accessed under staff supervision. The manager discussed plans to risk assess this and review access for residents to use independently. There were well-developed memory boxes outside some of the rooms containing a range of personal memorabilia. These provided a point of interest and assisted residents in locating their own room. Although there was some signage visible to orientate residents and visitors this could be improved (see recommendation 1). Requirements Number of requirements: 0 Recommendations Number of recommendations: 1 1. The provider should continue to implement dementia friendly signage for communal facilities and to peoples' rooms. This will help to promote independence, aid orientation and improve people's quality of life. National Care Standards: Care Homes for Older People, Standard 4 - Your, Standard 5: Management and staffing arrangements Grade: 4 - good Quality of staffing Findings from the inspection We looked at files of recently recruited staff and were satisfied that safe recruitment practices had been followed. There was evidence of satisfactory safety checks, references and checks of current registration status with the relevant regulatory body. We found this process could be improved by ensuring where staff have conditions applied to their registration that the manager has an overview of these conditions with timescales for completion. All the recruitment files should contain the same information with all sections fully completed consistently throughout. In some instances the manager was conducting interviews alone which was not in-line with company policy and should be reviewed. Similar to the previous inspection we found some of the documentation referred to English legislation (see recommendation 1). We found the atmosphere in the home relaxed and friendly, staff were approachable and helpful. From our observations and discussion with staff we could see positive relationships and good interaction with residents who they appeared to know well. Staff received a wide and varied range of training. This was achieved through regular e-learning and face to face training. All staff from the administrator to domestic staff had received 'Open hearts and Minds' training which page 6 of 15

focused on a person-centred approach and management of behaviour that challenges in dementia. This training was followed by reflective learning which several staff had completed with the majority still to do. This assessed how the training had positively influenced their practice, skills and knowledge. The service were promoting a new nursing assistant post. This encouraged senior care staff to undertake further training providing them with the skills and knowledge to carry out more clinical checks and observations in order to assist the qualified nursing staff in their role. Some staff (champions) had attended further training in areas of particular interest and used this additional knowledge to support their colleagues, to improve their knowledge and skills. Staff meetings and supervision sessions took place and staff said they felt listened to, supported and involved in the running of the service. The service had developed a new supervision/appraisal system which included assessing staff competencies. As this was not yet been fully implemented we will review this at the next inspection (see recommendation 2). Requirements Number of requirements: 0 Recommendations Number of recommendations: 2 1. The provider should review the recruitment terminology used to ensure it reflects relevant Scottish agencies. National Care Standards - Care Homes for Older People; Standard 5 - Management and Arrangements. 2. The provider should review the system of supervision and appraisal to ensure it is line with best practice and fit for purpose going forward. National Care Standards - Care Homes for Older People Standard 5: Management and Arrangements. Grade: 4 - good Quality of management and leadership Findings from the inspection Regular meetings and fundraising events took place with the manager and staff together with residents and relatives to improve outcomes for people. There was a complaints policy displayed and the manager kept a log of any complaints/concerns. We could see that positive actions were taken to improve outcomes and prevent escalation. People we spoke to spoke with high regard for the manager and staff team. Residents and relatives were encouraged to nominate staff for a 'kindness' award in recognition of the care and support provided. The manager promoted an open door policy and was seen regularly within the units speaking to staff and residents. As well as regular meetings and surveys the service were about to implement a new portal system as an additional method of obtaining feedback from residents, relatives and visiting professionals on the quality of staff performance and management within the service. page 7 of 15

Through on-going training, support and supervision staff were being supported to develop their roles further with additional responsibility in their areas of interest and competency. The manager promoted staffs leadership skills by encouraging a more active role in the quality assurance processes within the home. A range of in-house audits were taking place some of which included accidents/incidents, dependencies and weight management. This provided the manager with a full overview of what was happening in each unit to ensure that any concerns were being actioned appropriately. One of the areas identified for improvement through the auditing process was the environment within the ground floor unit, used for residents with more advanced dementia. This provided a good example of how the manager and staff were working together to improve outcomes for residents. In addition to these in-house audits the manager completed a more comprehensive Key Performance Indicator audit for senior management. This covered the quality of care, medication, nutrition, infection control, health/ safety, environment and management. We could see where issues were identified these were included in an action plan. We concluded that these audits were having a positive impact on the standards within this service who continue to perform at a good level over all Quality Themes. Requirements Number of requirements: 0 Recommendations Number of recommendations: 0 Grade: 4 - good What the service has done to meet any requirements we made at or since the last inspection Previous requirements Requirement 1 The provider should ensure that reviews take place within the legal minimum of six months. National Care Standards - Care Homes for Older People; Standard 5: Management and Arrangements, Standard 8: Making Choices, Standard 10: Exercising Your Rights, Standard 11: Expressing Your Views, Standard 16: Private life, Standard 17: Daily Life This requirement was made on 5 May 2016. page 8 of 15

Action taken on previous requirement From the evidence we were presented with we were satisfied that reviews were taking place six-monthly in order to meet this legal requirement. Met - within timescales Requirement 2 Record keeping must be improved to demonstrate that documents are accurate, sufficiently detailed and reflect the care planned or provided. Staff require training to demonstrate they are aware of their responsibility to keep accurate records. This is in order to comply with: SSI 2011/210 regulation 4(1)(a) - requirement for the health and welfare of service users. And regulation 15(b)(i) requirement about training. Timescale for implementation: to start within twenty-four hours and be completed within twelve weeks of receipt of this report. This requirement was made on 5 May 2016. Action taken on previous requirement Please refer to Quality Theme 1 Care and Support for further information on 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 provider should ensure that where questionnaires are completed that the results are analysed and action is taken to address any issues raised and this is recorded. National Care Standards - Care Homes for Older People; Standard 5: Management and Arrangements Please refer to Quality Theme 1 Care and Support for further information on this recommendation which has Not Been Met at this inspection. Recommendation 2 The provider should ensure that the ways in which it seeks the views of service users and relatives is planned, consistent and happens regularly. page 9 of 15

National Care Standards - Care Homes for Older People; Standard 5: Management and Arrangements, Standard 8: Making Choices, Standard 10: Exercising Your Rights, Standard 11: Expressing Your Views, Standard 16: Private life, Standard 17: Daily Life From the evidence we were presented with we concluded that there were regular meetings taking place, questionnaires and surveys were issued regularly. This recommendation has been MET. Recommendation 3 The key worker system should be fully implemented in-line with the provider's own policies and procedures. This recommendation has been made specifically in relation to helping service users identify who their key worker is. National Care Standards: Care Homes for Older People, Standard 5 - Management and staffing arrangements. There was a key worker system in place with information with each bedroom. Staff we spoke to were familiar with this and were aware of their responsibilities. This recommendation has been MET. Recommendation 4 The provider should review and improve the quality and detail in care plan records to address the issues raised in this report. National Care Standards - Care Homes for Older People Standard 5: Management and Arrangements, Standard 6 - Support Arrangements. Please refer to Quality Theme 1 Care and Support for further information on this recommendation which has Not Been Met at this inspection. Recommendation 5 The provider should refer to best practice and review the provision of activities to ensure that activities are appropriate, engaging and relevant to people's preferences and abilities. National Care Standards - Care Homes for Older People Standard 5: Management and Arrangements, Standard 6 - Support Arrangements. page 10 of 15

Each care plan contained information on individuals likes and dislikes as well as an activity plan. This recorded what kind of activity the resident enjoyed. We saw morning exercises taking place which people chose to attend, participated in and enjoyed. There was a weekly coffee morning which was well attended by residents and visitors who commented how much they enjoyed the coffee and cakes. There was a wide arrange of activities offered in-house in addition to trips to various places of interest. This recommendation has been met. Recommendation 6 The recording of MARs should be improved upon to make sure they more accurately reflect the reason and outcome of administering "as required" medications. Handwritten entries on the MARs should have appropriate signatures and indicate prescribers and all medications administered recorded as such with appropriate signatures. National Care Standards: Care Homes for Older People, Standard 15 - Keeping Well - medication. Please refer to Quality Theme 1 Care and Support for further information on this recommendation which has Not Been Met at this inspection. Recommendation 7 The provider should ensure that where Anticipatory Care Plans (ACP) are in place that they have been fully completed. National Care Standards: Care Homes for Older People Standard 5:Management and staffing arrangements. Please refer to Quality Theme 1 Care and Support for further information on this recommendation which has Not Been Met at this inspection. Recommendation 8 Any substances which could be hazardous to service users if ingested should be stored appropriately. National Care Standards: Care Homes for Older People, Standard 4 - your environment. From our observations throughout the inspection we were satisfied that any cleaning/hazardous substances were being stored safely and appropriately. This recommendation has been MET. Recommendation 9 The service management should ensure that there is a regular duty in place of cleaning hoists and that this is adhered to. page 11 of 15

National Care Standards - Care Homes for Older People Standard 4, 3 - Your. The moving and handling equipment we saw was clean demonstrating it had been cleaned regularly, this recommendation has been MET. Recommendation 10 The provider should continue to implement dementia friendly signage for communal facilities and to peoples' rooms. This will help to promote independence, aid orientation and improve people's quality of life. National Care Standards: Care Homes for Older People, Standard 4 - Your, Standard 5: Management and staffing arrangements. Please refer to Quality Theme 2 Quality of for further information on this recommendation which has Not Been Met at this inspection. Recommendation 11 The provider should review the recruitment terminology used to ensure it reflects relevant Scottish agencies. National Care Standards - Care Homes for Older People; Standard 5 - Management and Arrangements. This recommendation was made on 5 May 2016. Please refer to Quality Theme 3 Quality of for further information on this recommendation which has Not Been Met at this inspection. Recommendation 12 The provider should review the system of supervision and appraisal to ensure it is line with best practice and fit for purpose going forward. National Care Standards - Care Homes for Older People Standard 5: Management and Arrangements. This recommendation was made on 5 May 2016. Please refer to Quality Theme 3 Quality of for further information on this recommendation which has Not Been Met at this inspection. Recommendation 13 The service should ensure that it carries out audits within the frequency identified by the provider. In doing so, audits should be fully completed, signed and dated. A copy of the corresponding action plan should be kept next to the audit or cross referenced if stored elsewhere. page 12 of 15

National Care Standards - Care Homes for Older People; Standard 4 - Your. This recommendation was made on 5 May 2016. From the evidence we were presented with we concluded that the manager had a range of audits in place as part of the quality assurance system. These audits were completed with action plans and evidence of actions taken where issues had been identified. This recommendation has been MET. 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 18 Mar 2016 Unannounced Care and support Management and leadership 13 Nov 2014 Unannounced Care and support Management and leadership 11 Feb 2014 Unannounced Care and support Not assessed Not assessed Management and leadership page 13 of 15

Date Type Gradings 9 Aug 2013 Unannounced Care and support Not assessed Management and leadership Not assessed 26 Nov 2012 Unannounced Care and support 3 - Adequate 3 - Adequate Not assessed Management and leadership 29 Aug 2012 Re-grade Care and support 2 - Weak Not assessed Not assessed Management and leadership Not assessed 20 Jun 2012 Unannounced Care and support 3 - Adequate Not assessed 3 - Adequate Management and leadership Not assessed 1 Mar 2012 Unannounced Care and support Not assessed 3 - Adequate Not assessed Management and leadership Not assessed 6 Dec 2011 Unannounced Care and support 3 - Adequate 1 - Unsatisfactory 3 - Adequate Management and leadership Not assessed 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