The Duchess Nina Nursing Home Care Home Service 13 Limekilnburn Road Quarter Hamilton ML3 7XA Telephone: 01698 427507 Type of inspection: Unannounced Inspection completed on: 25 January 2018 Service provided by: Bertinaley Care Limited Service provider number: SP2006008166 Care service number: CS2007141604
About the service we inspected The Duchess Nina care home is situated in the rural village of Quarter, on the outskirts of Hamilton. The care home is privately owned by Bertinaley Care. It provides care to a maximum of twenty older people. There were 17 service users at the time of the inspection visits. The home provides accommodation over two floors with a passenger lift between floors and has one main lounge, which includes a dining area. The service's aims are described as being the provision of the highest standards of care, the promotion of independence and respect for the rights of service users. How we inspected the service We carried out this unannounced inspection on 25 January 2018 between the hours of 11.25am and 4pm. Feedback was given to the Manager and Depute Manager at the end of the inspection. At this inspection we focused solely on the requirements and recommendations made at the previous inspection which was completed on 21 September 2017 and the progress made towards meeting these. During the inspection evidence was gathered from the following sources: - Medication Administration Records - Care Plans - Food and fluid intake charts - Wound records - Quality assurance records - Activity records - Staff recruitment files - Staff training records - Care review matrix. We spoke with the following people: - Five residents - The Manager. We also spent observed staff interaction and the general environment of the home. At the time of the inspection there were 17 service users. Taking the views of people using the service into account We spoke with five residents during this inspection who spoke positively about the service. Taking carers' views into account We did not speak with any carers during this inspection. page 2 of 13
What the service has done to meet any requirements we made at or since the last inspection Previous requirements Requirement 1 The provider must ensure that care plans clearly direct staff on the care and support to be provided to all those living in the service. In order to achieve this the provider shall: - Ensure that, where a care need is identified that an appropriate plan is put in place to support the individual to address this. - Where risk assessments are completed ensure that these are regularly reviewed and updated as needed. This is in order to comply with SSI 2011/210 Regulation 4 (1)(a) Health, welfare and safety of service users; Regulation 5: Personal Plans Timescale for implementation: To commence on receipt of this report and on-going. This requirement was made on 17 July 2015. We saw that where required, care plans had been developed and updated frequently and generally directed staff to a satisfactory level. Risk assessments had also been completed and updated frequently to reflect the most up to date information. Met - outwith timescales Requirement 2 The provider should ensure that all direct care staff receive training which is up to date with best practice guidance to inform and improve practice as detailed in this report. This should include training on the appropriate use of restraint, Adult Support and Protection legislation and Stress and Distress. This is in order to comply with SSI 2011/210 Regulation 15(b)(i) - The provider should ensure that the persons employed in the care service receive training appropriate to the work they are to perform. Timescale for implementation: Within five months of receipt of this report. This requirement was made on 17 September 2015. Given the information that was provided to us at the time of this inspection, we were satisfied with the progress which had been made in relation to this requirement. Met - outwith timescales page 3 of 13
Requirement 3 The provider must develop a detailed, structured training plan and training record. This must detail the following: - What is included in induction training with clear timescales for achieving this - What is included in mandatory training - Any specialised training - Who has received what training and when this was achieved - There must be a clear record for each staff member - There must be an annual training plan that includes future training for the next year. This is in order to comply with SSI 2011/210 Regulation 15(b) (i) - The provider should ensure that persons employed in the provision of the care service receive training appropriate to the work they are to perform. Timescale: Within four months of receipt of this report This requirement was made on 21 July 2017. We saw that every member of staff had their own file within the training folder and reflected all their training with certificates. A Training Matrix had been developed and showed that the training which staff had undertaken was generally up to date. We also saw evidence of specialised training which staff had undertaken to meet specific needs of residents. The staff induction programme booklet had been developed to show what training was minimally required of new staff. A training plan for staff had also been developed which helped staff to maintain and developed their skills. Met - within timescales Requirement 4 The Provider must be able to demonstrate that there is provision of meaningful activities for service users to engage in based on their personal choices and abilities. This is in order to comply with: SSI 2011/210 Regulation 4(1) (a) - a requirement to make proper provision for the health welfare and safety of services users. Timescale for Implementation: The provider must do this within 12 weeks of receipt of this report. This requirement was made on 21 July 2017. We acknowledged that there had been some group and individual activities undertaken. Activity records however, continued to show a lack of meaningful activities for many consecutive days. We therefore continued to be concerned about the lack of day to day activities for people and opportunities to go outdoors for social or community events or trips. Not met Requirement 5 The service must ensure that staff follow specific guidance from professional clinician assessments or a reason recorded and action taken if they have been unable to do so. Staff must also follow best practice moving and handling practices at all times when assisting and supporting people. page 4 of 13
This is in order to comply with SSI 2011/210 Regulation 15(b) (i) - The provider should ensure that the persons employed in the care service receive training appropriate to the work they are to perform. Timescale for implementation: To be commenced of receipt of this report. This requirement was made on 21 July 2017. We looked at a sample of care plans which showed examples of how staff had followed specific instructions from healthcare clinicians. Relevant information had been transferred into care plans and we saw how this had led to improved outcomes for residents. Met - within timescales Requirement 6 The provider must ensure staff undertake appropriate clinical checks, assessments and first aid procedures where residents have sustained any form of head injury. Subsequent effective monitoring must also be carried out at suitable intervals. In doing so, records of any such interventions must be clearly recorded. This is in order to comply with: SSI 2011/210 Regulation 4 (1) (a) - a requirement to make proper provision for the health and welfare of people and Regulation 9 - Fitness of employees Timescale for implementation: To be commenced on receipt of this report. This requirement was made on 21 July 2017. This requirement had been made following a specific incident which came to light at the last inspection. Accident and incident records looked at this inspection showed how staff had carried out regular observations on a resident who had fallen, even though no head injury had been sustained. The Manager advised how this protocol would be followed in the event of someone having a head injury. Met - within timescales Requirement 7 The provider must ensure that appropriate recruitment and induction procedures are followed in order to ensure the safety of service users. This is in order to comply with: SSI 2002/114 Regulation 9 - Fitness of employees. Timescale for implementation: To be commenced on receipt of this report. This requirement was made on 21 July 2017. page 5 of 13
We looked at 2 new staff files and were satisfied that safe recruitment procedures had been followed. Met - within timescales Requirement 8 The Provider must ensure that there is a suitably qualified and competent person allocated to manage the home in the absence of the manager who is 100% supernumerary. This is in order to comply with: SSI 2011/210 Regulation 4(1) (a) - a requirement to make proper provision for the health welfare and safety of services users. Timescale for implementation: To be commenced on receipt of this report. This requirement was made on 21 July 2017. There was a structure in place which made sure a suitable person was in place to manage the home in the absence of the manager. Met - within timescales What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 The dining experience should be improved to include menus with alternative meals available and better access to drinks for people. National Care Standards - Care Homes for Older People Standard 5: Management and Arrangements, Standard 6 - Support Arrangements. Residents we spoke with told us that they had plenty choice at mealtimes and there were always alternatives. They also told us there were plenty hot and cold drinks they could have throughout the day. This recommendation has been met. page 6 of 13
Recommendation 2 Food intake should be monitored where people have had unplanned weight loss and this gives cause for concern. National Care Standards - Care Homes for Older People Standard 5: Management and Arrangements, Standard 6 - Support Arrangements. We were satisfied with the completion of the food intake records which had been completed for those residents requiring additional monitoring. This recommendation has been met. Recommendation 3 Medication Administration Records (MARs) should be improved to ensure service users receive their medications at prescribed time and is in keeping with their routines. Where a medication is not administered there should be a clear reason for this recorded. Where someone constantly refuses their medication, there should be a clear record of any subsequent actions taken. The recording of MARs should be improved upon to make sure they more accurately reflect the reason and outcome of administering "as required" medications. Each MAR should contain an up to date resident photograph. National Care Standards: Care Homes for Older People, Standard 15 - Keeping Well - medication. National Care standards 10 Care Homes for Older People - Exercising Your Rights. We were satisfied with the improvements made in relation to the overall completion of the MARs. This recommendation has been met. Recommendation 4 Information within formal records should be clearly recorded in a professional way without the use of jargon and colloquialisms. National Care Standards Care Homes for Older People - Standard 5: Management and staffing arrangements. We were satisfied with the improvement made in relation to recording within formal documents. page 7 of 13
Recommendation 5 The service should follow a planned, systematic and structured approach to how and when supervision is carried out. National Care Standards - Care Homes for Older People Standard 5: Management and Arrangements. The Manager continued to work towards improving staff supervision. A staff supervision planner had been developed however some staff supervision continued to be out of date. We will review this at the next inspection. This recommendation has not been met. Recommendation 6 The provider should improve the analysis of any returned questionnaires from relatives and feedback from participation meetings by having a breakdown of responses to each question rather than having a percentage total. The provider should make clear from the analysis what issues have been raised by relatives and what action the care home had taken to address any concerns. National Care Standards; Care Homes for Older People; Standard 5: Management and Arrangements, Standard 11: Expressing Your Views. We saw evidence which showed how responses from residents had been collated and actioned where appropriate. This recommendation has been met. Recommendation 7 Any actions which required to be taken to address shortfalls identified through audits undertaken should be recorded. Timescales for any such actions to be completed should also be clearly recorded. National Care Standards; Care Homes for Older People; Standard 5: Management and Arrangements, Standard 11: Expressing Your Views. The Manager had made significant progress in improving the completion of audits in a range of areas within the service. We were satisfied that actions had been taken to address any shortfalls. This recommendation has been met. page 8 of 13
Recommendation 8 The overall audit collated by the manager should accurately reflect and correspond with information within individual audits. National Care Standards - Care Homes for Older People Standard 5: Management and Arrangements, Standard 6 - Support Arrangements. We were satisfied that the overall audit collated by the manager accurately reflected and corresponded with information within individual audits. 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 30 Jan 2018 Re-grade Care and support Not assessed Not assessed Management and leadership Not assessed 28 Jul 2017 Unannounced Care and support Management and leadership page 9 of 13
Date Type Gradings 13 Jun 2016 Unannounced Care and support Management and leadership 11 Jan 2016 Unannounced Care and support Not assessed Not assessed Not assessed Management and leadership Not assessed 17 Jul 2015 Unannounced Care and support Management and leadership 20 Jan 2015 Unannounced Care and support 4 - Good 4 - Good Management and leadership 15 Jul 2014 Unannounced Care and support Management and leadership 28 Feb 2014 Unannounced Care and support 1 - Unsatisfactory Management and leadership 1 - Unsatisfactory 10 Jul 2013 Unannounced Care and support Management and leadership 6 Nov 2012 Unannounced Care and support Management and leadership page 10 of 13
Date Type Gradings 4 Apr 2012 Unannounced Care and support Management and leadership 15 Nov 2011 Unannounced Care and support Not assessed Management and leadership Not assessed 27 Jun 2011 Unannounced Care and support Not assessed Management and leadership Not assessed 16 Nov 2010 Unannounced Care and support Not assessed Management and leadership 22 Jul 2010 Announced Care and support Management and leadership 17 Mar 2010 Unannounced Care and support Management and leadership 17 Aug 2009 Announced Care and support Management and leadership 17 Feb 2009 Unannounced Care and support Management and leadership page 11 of 13
Date Type Gradings 20 Aug 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