Ach-an-Eas (Care Home) Care Home Service 21 Island Bank Road Inverness IV3 5NX Telephone: 01463 710890 Type of inspection: Unannounced Inspection completed on: 20 September 2017 Service provided by: NHS Highland Service provider number: SP2012011802 Care service number: CS2012307176
About the service The Care Inspectorate regulates care services in Scotland. Information in relation to all care services is available on our website at www.careinspectorate.com. This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April 2011. Ach-an-Eas is registered to provide a care service to a maximum of 24 older people. The building was formerly a large family house and has been adapted and extended for its present use. Accommodation is on two floors with lift access. The home is situated in large, pleasant grounds, convenient to the city centre. The home is comfortably appointed and very well maintained, both indoors and outdoors, with walkways and ramps for wheelchair access. All bedrooms are of single occupancy with en-suite facilities. The aims of the service recognised the home worked in accordance with the National Care Standards and hoped to provide safe, comfortable care in a stimulating environment by a well trained staff group and encouraging independence, recognising individuality and rights of all service users. What people told us The inspection volunteer spoke with seven people who used the service on the first day of the inspection. Whilst talking with people she received many positive comments about the quality of care people received at Ach-an- Eas. People told the inspection volunteer that the food was good and that there was always a choice. There were many positive comments made about the environment and how homely it was. People we spoke with told us that they would not hesitate to speak to the person in charge if they had any problem with their care. One person told us 'there are hardly any problems here'. We were also told that 'the staff are smashing'. We spoke with one relative/carer during the inspection. They were very complimentary about the quality of care their family member received. They told us that the communication was very good and that they were kept informed about any changes in their relative's health. We issued ten care standard questionnaires to people who used the service prior to the inspection. We received six completed questionnaires back. Responses to these indicated that four people strongly agreed and two people agreed that, overall, they were happy with the quality of care their relative received in the home. Four people strongly agreed and two agreed that the staff knew their dislikes and preferences and did what they could to meet them. We also issued ten care standard questionnaires to relatives/carers prior to the inspection and we received eight back. Comments from these indicated that eight people strongly agreed that, overall, they were happy with the quality of care their relative received in the home. page 2 of 11
Self assessment The service had not been asked to complete a self assessment in advance of the inspection. We looked at their own improvement plan and quality assurance paperwork. These demonstrated their priorities for development and how they were monitoring of the quality of the provision within the service. 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 not assessed not assessed Quality of care and support Findings from the inspection We found the quality of care and support to be very good at this inspection. People who used the service spoke very positively about the care they received from staff. We noted during observations that staff supported people in a very caring and kind manner. We looked at a sample of care plans and noted that there had been some improvements made. The care plans contained very person centred information in relation to people's health and wellbeing needs. The manager looked at care plans on a monthly basis. From this she wrote a short summary of people's general wellbeing over the previous month. Staff we spoke with told us that this had proved to very beneficial when speaking with doctors, or other health professionals and also to aid the twice yearly review process. Information in relation to supporting people in times if stress and distress had improved. The management told us that they were using the dementia standards and also the Kings fund tool to support the development of these specific care plans. As an area of development, staff need to ensure that they consistently use the update section of the care plan to record any changes to people's care needs. This will ensure that the care plans remain a current reflection of people's health and wellbeing needs. We looked at personal risk assessments and found that most had been well completed and were reviewed on a regular basis. Staff need to ensure that, if they complete a waterlow assessment for someone and the result is that they are at high risk, then a care plan should be developed to ensure that appropriate action has been taken, in relation each of the identified risks. When we looked further in to these we could see that the actions had been taken, for example special mattresses, positioning charts etc., however, they had not been recorded on the waterlow action plan. Senior staff/management should ensure that this is monitored through the care plan audit. We looked at reviews and found the in-house reviews to be of a good standard. We could see that, where any issues had been identified through the review process, actions were taken and care plans updated to reflect the changes to people's care. Management need to ensure that where reviews have been carried out externally, they have their own record of this. We noted that some of the external review records were missing and some were very limited in detail. page 3 of 11
Having their own record would ensure that they have a full record of the review with details of any issues that require action to be taken. They would also have the necessary information to make any required changes to people's care plans. See recommendation 1. We looked at the medication system and found that generally this was in good order. Staff need to ensure that they continue to work on evaluating 'as required' medications. This will ensure that people's medication continues to be effective. Staff should also ensure that they correctly complete the records for topical creams. Progress will be monitored on this at the next inspection. There was a requirement made at the last inspection in relation to medication. This has now been met. The activity provision in the home had improved since the last inspection. There was more evidence of group and one to one activities taking place. We could see that consideration had been given to people's interests and hobbies when planning some of the activities. Comments from conversations with the people who used the service confirmed that they enjoyed the activities in the home. The inspection volunteer was told:- 'I can go our for walks round the grounds'. 'we have a sing song, I like a wee song'. We looked at the finance systems in the home. This was well organised. We could see that there had been a period of time where monthly audits of any money held in the home had not been carried out. This was now rectified and there was a good system in place. Accidents and incidents were well recorded and there was a monthly audit in place. Requirements Number of requirements: 0 Recommendations Number of recommendations: 1 1. The provider should ensure that where an external care review is carried out with people who use the service, the home keep their own written minute of this. Having their own review notes would ensure that they have a full record of the review, with details of any issues that require action to be taken. They would also have the necessary information to make any required changes to people's care plans. National Care Standards Care Homes for Older People. Standard 6: Support arrangements. Grade: 5 - very good Quality of environment This quality theme was not assessed. Quality of staffing page 4 of 11
Findings from the inspection We found the quality of staffing to be good at this inspection. We carried out several observations of staff practice during the inspection. We found that staff treated people who use the service in a kind and respectful manner. People who use the service told the inspection volunteer that:- 'the staff are very good to everybody'. 'I get on alright with the staff. If you need help they come quickly". Practice in relation to the administering of medications had improved since the last inspection. Staff now followed their own policy and best practice guidance in relation to this. Training had been given to staff who have responsibility for management of people's medication and there had been observed practice carried out with staff, to ensure that practice had improved in this area. There was a training and development policy in place. We were able to see that the service had a training plan in place. The manager and deputy had worked hard to make improvements to the individual training records for each staff member. Moving and handling training was provided for each member of staff and there were regular competencies carried out with staff, by the moving and handling key worker. Staff had access to learn pro for some aspects of their training. Each staff member has a training passport and this identifies the training required for their role. Some training for example, caring for smiles, dementia and adult support and protection had been identified for some staff. See recommendation 1. There was a system for supervision and appraisal and both the manager and deputy were making efforts to move this forward. Further work was required to ensure that each member of staff received regular supervision and an annual appraisal. We could see that a planner for appraisals had been developed and work in relation to implementing this was now underway. See recommendation 2. Questionnaires had been issued to staff in March 2017. At the time of the inspection the manager had started to carry out an evaluation of these, in order to give feedback to all the staff involved. Progress will be monitored on this at the next inspection. The programme of meetings for all levels of staff had been re-established. There was a good written minute of these. We could see that any issues were taken forward through an action plan. Staff we spoke with confirmed that they attended the meetings and found them both interesting and beneficial. All staff we spoke with confirmed that they thought things were good at Ach-an-Eas. Staff told us that they enjoyed their job and felt that things had really settled down now in the home. They told us that they found the manager and deputy both approachable and supportive. Requirements Number of requirements: 0 page 5 of 11
Recommendations Number of recommendations: 2 1. The manager should ensure they continue to work on the programme of training for staff. As part of this programme, staff who require this should receive training in the following areas:- caring for smiles, dementia and adult support and protection. National Care Standards Care Homes for Older People. Standard 5: Management and staffing arrangements. 2. The manager should ensure they continue to work on the programme of supervision and appraisal for all levels of staff. This is to ensure that it becomes established practice and is an effective tool to support all levels of staff. The manager should ensure that, where the responsibility to provide supervision is delegated to other staff, they have appropriate training in how to deliver good quality supervision. The systems for supervision and appraisal should be linked to the training plan and supervised practice. National Care Standards Care Homes for Older People. Standard 5: Management and staffing arrangements. Grade: 4 - good Quality of management and leadership This quality theme was not assessed. What the service has done to meet any requirements we made at or since the last inspection Previous requirements There are no outstanding requirements. page 6 of 11
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 specific care plans are developed for people who live with dementia or have cognitive impairment. These should contain personal and unique information gathered by the service, which influences how they support people in their day to day life and makes a positive difference. There should also be guidance for staff in relation to appropriate strategies to use when supporting people in times of stress and distress. Care plans should be evaluated and updated as necessary to ensure that the information is a current reflection of people's needs. National Care Standards Care Homes for Older People. Standard 6: Support arrangements. The service was making good progress with their care plans. They contained good person centred information in relation to people's health and wellbeing needs. Care plans for people who experience times of stress and distress contained some good strategies for staff to use when supporting people through these difficult times. There was good information in relation to people's past histories and also their interests and hobbies, both past and present. There was an update section to each care plan and staff could use this to record any changes to people's care needs. The manager carried out a monthly summary of each person's care plan and staff used this to inform care reviews and for discussions with health professionals. Staff need to ensure that they use the update facility as it is intended to ensure that each care plan remains a current reflection of people's care needs. Progress in relation to this will be looked at as part of the next inspection. Recommendation 2 The provider should ensure they provide activities that take account of each person's ability, needs and preferences to ensure that there is activity provision suitable for all who use the service. Individual life story, preferences, needs and abilities should be taken account of to inform person centred activities, support, and improve the provision of activity that is meaningful for all people using the service. The service should also look in to different ways they could support people who use the service to maintain good links with their local community. National Care Standards Care Homes for Older People. Standard 6: Support arrangements; and Standard 12: Lifestyle - social, cultural and religious belief or faith. We could see that progress had been made in relation to this recommendation since the last inspection. Staff were making efforts to develop life histories with the support of people who used the service and their families. Activities were more person centred. There was more evidence of one to one activities being provided to those people who were not able, or chose not to take part in the group sessions. Staff were recording in people's page 7 of 11
activity profiles and an audit was being carried out to ensure that activities remained appropriate for people's preferences. This recommendation has now been met. Recommendation 3 The provider should give consideration as to how people who use the service could have independent access to the secure garden areas of the home. National Care Standards Care Homes for Older People. Standard 4: Your environment. There had been no further progress in this area at the time of this inspection. Staff continued to support people to access the outside grounds of the home. Progress will be monitored on this at the next inspection. Recommendation 4 The provider should ensure they develop and implement a system of staff appraisal for all levels of staff who work in the service. National Care Standards Care Homes for Older People. Standard 5: Management and staffing arrangements. The service had made some progress in this area. We could see that the manager had a supervision planner and that efforts had been made to start implementing the system of regular supervision, for all levels of staff. We could see that for some people supervision had been planned, however, had not taken place. The manager had made a start on implementing the programme of annual appraisals to all levels of staff. Work will need to continue in this area, to ensure that the system of supervision and appraisal is rolled out across all levels of staff and becomes established practice. Progress will continue to be monitored at the next inspection. Recommendation 5 The provider should ensure they give consideration to developing some information to give to potential residents and their relatives/carers, to ensure that they have all the necessary information about the service provided, to support them to make an informed decision about their preferred place to stay. National Care Standards Care Homes for Older People. Standard 1: Informing and deciding. The service was making good progress in relation to this recommendation. We were able to see two different brochures. One was more detailed than the other. One, in particular, was very informative and would give prospective service users a good overview of the service to be provided. Progress will be monitored on this at the next inspection. page 8 of 11
Recommendation 6 The management and staff should ensure they continue to work on the quality assurance systems and processes. This is to ensure that they effectively assess the quality of the service they provide. Where audits have been carried out, action should be taken and the audit cycle completed. This is to ensure that the audit process has been effective in bringing about improvements and has had a positive impact on outcomes for all those people living in the care home. National Care Standards Care Homes for Older People. Standard 5: Management and staffing arrangements. The manager and deputy continued to make good progress in this area. They were developing a system of audits and there was evidence to support that these were carried out on a regular basis. Through discussion at the inspection we noted that some of the audits could improve in quality, this would support a more effective audit process. Management need to ensure that they complete the audit cycle by following up on the issues raised through the audit process. This will ensure that the audit process has been effective in bringing about improvements and has had a positive impact on outcomes for all those people living in the care home. Progress will continue to be monitored in this area at the next inspection. 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 15 Feb 2017 Unannounced Care and support Not assessed Not assessed Not assessed Management and leadership Not assessed 8 Jul 2016 Unannounced Care and support 3 - Adequate page 9 of 11
Date Type Gradings Management and leadership 5 - Very good 3 - Adequate 24 Sep 2015 Unannounced Care and support 3 - Adequate 3 - Adequate 3 - Adequate Management and leadership 3 - Adequate 10 Mar 2015 Unannounced Care and support Management and leadership 11 Jun 2014 Unannounced Care and support Management and leadership 18 Jul 2013 Unannounced Care and support Management and leadership 11 Jul 2012 Unannounced Care and support Management and leadership page 10 of 11
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 11 of 11