Abbey Gardens Nursing Home Care Home Service Lincluden Road Dumfries DG2 0QB Telephone: 01387 255322 Type of inspection: Unannounced Inspection completed on: 23 October 2017 Service provided by: Voyage 1 Limited Service provider number: SP2004005660 Care service number: CS2003010806
About the service Abbey Gardens is a purpose-built care home situated in Lincluden on the outskirts of Dumfries. The service provider is Millbury Care Services Ltd trading as Voyage. The home provides 24 hour nursing care and accommodation for up to 32 older people with mental health needs and associated sensory and physical disabilities. These disabilities may be complex and include enduring health conditions and behavioural support. The home consists of four units, each providing accommodation and support for eight residents. All bedrooms are single with en-suite facilities, fully accessible and designed for people with mental and physical health needs. Each unit has communal rooms including lounge, kitchen, dining area and shower/bathroom. There is also a large reception area, an activity room, central kitchen and laundry. There are large gardens with enclosed patio areas and a greenhouse. The service aims are "to provide a safe environment for those who have enduring mental health problems and require a high level of support, whilst still recognising that these individuals have the right to a life style that is happy, dignified and reflects the concept of normalisation so that the residents are seen as valued individuals within the community". What people told us Prior to the inspection we sent out questionnaires to help us gauge views on the quality of the service. We received four completed questionnaires from people using the service. Of these one "strongly agreed" and two "agreed" they were happy with the quality of care received. Positive comments were made about the service. People liked the relaxed atmosphere and friendly staff. However, one "disagreed" they were happy with the care and support. This was due to other residents coming into their room uninvited. This led to a lack of privacy and feeling of safety. We asked the manager to increase the availability of bed-room keys and ensure privacy and safety is more fully considered. We received five completed questionnaires from relatives of people using the service. Of these one "strongly agreed" and four "agreed" they were happy with the quality of care and support provided. Relatives commented that it was a good home and they were pleased with the service. One relative felt the care of clothing should be better as their relative had been found with the wrong clothing on. This relative had raised issues and found they were not always listened and responded to. We noted clothing was not always labelled clearly enough and the manager agreed to improve this. During the inspection we spoke with three relatives who were all very complimentary about the service and felt a high level of trust in the staff to care for their relative's often very complex needs. page 2 of 8
Self assessment The service was not requested to submit a self assessment prior to this inspection. 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 What the service does well We heard very positive feedback from residents and relatives on the care and support provided. People said they felt luck to have found Abbey Gardens. We observed very kind, personal approaches by staff. This indicated a person centred approach to care where people's individual preferences were recognised and respected. The service caters for a mixed client group of older and some younger adults with mental health and dementia care needs. This appeared to be working well but can stretch the staff group in being able to care for an increasingly diverse set of needs. There were good links with psychiatry and other health care professionals to help people stay well and ensure symptoms are managed as far as possible. We observed residents were supported to get out to local shops and meet people. This helps people to stay connected and feel part of the community. We checked medication management and finances and these were mostly satisfactory. The service benefits from a small group living layout of four units for eight residents. This helps to provide a homely atmosphere. We found all areas to be clean and no hazards were seen. There was a choice of places to sit both indoors and outdoors. Health and safety checks were carried out around the building. This meant it was kept safe and well looked after. Systems were in place to monitor falls and action was taken to try to prevent these from occurring. Further improvement was planned to ensure individual falls prevention plans were put in place in keeping with best practice. What the service could do better The personal plans in use were hard to follow and did not support current care needs well. There were lots of areas of duplication and some important areas were missed out. A detailed discussion took place with page 3 of 8
management highlighting how this could be improved to ensure records were up to date and used as a meaningful working tool to support care. See recommendation 1. We observed that closer monitoring of care outcomes was needed. For example a resident was in bed for several days without good reason and records of positioning/ equipment, oral care and weights were not up to date and accurate. We discussed staff roles and how freeing up some of the nurses time could be used to better effect. Although staff had specialist healthcare support the personal plan of a resident with stress/ distress reactions was not detailed and monitoring charts to record how behaviours were displayed had not been used. This would be good practice and further work should be done to develop this area of support. See recommendation 2. The system for residents finances could be developed to ensure legal status is clearer and an individual support plan is in place to support residents to spend their money on things they like to do. See recommendation 3. The medication audit trail should be reviewed to ensure quantities of medications are recorded on arrival at the service and depending on risks balance counts could be done on a "spot-check" basis rather than for all medications. This would help to ensure medications are accounted for but balanced with the risks and pressures of staff time. See recommendation 4. We heard from two residents they were unhappy about other residents going into their rooms. A more proactive approach to providing bedroom keys should be encouraged to ensure privacy. See recommendation 5. A relative also highlighted that clothing was sometimes not well labelled. This could result in clothing going missing or being worn by the wrong person. We checked and confirmed that labels could be made clearer. The manager agreed to pursue this. The environment could be further improved to be more dementia friendly. For example, bedroom doors could be more personal to support a sense of belonging. More memorable pictures could be used to support orientation. The layout of the small kitchens and dining areas may also benefit from review. They are located at opposite ends of the corridor and this means staff have to transport meals from one area to another. There were no stay warm facilities such as a hot trolley or plate covers. Consideration could also be given to adapting one of the small kitchens to enable safer use by residents who are able to make drinks and snacks. For example, by lowering a work top or providing a kettle tipper. Some of the safety checks carried out by staff may be done too frequently and this means things are not checked properly. For example a profile bed was not working correctly despite regular checks indicating otherwise. Automatic closing devises on bedroom doors were also seen to be faulty. The manager agreed to rectify these immediately but checking systems may need to be overseen more robustly to ensure they are carried out correctly. Requirements Number of requirements: 0 page 4 of 8
Recommendations Number of recommendations: 5 1. 1. The service provider should ensure all personal plans reflect the health and welfare support needs of service users. This will be demonstrated by: - a revised format which can be used effectively by staff to support day-to-day care - inclusion of clear records to support and guide care decisions. i.e. legal status/ Adults with Incapacity forms/ resuscitation decisions/ anticipatory care plans - clear record of long-term medical conditions and how these are to be monitored - outcomes of risk assessments to have a clear link to the support plan - 6 monthly review records that support review of support plans, checks to ensure consents, changes to care have been discussed and agreed. (i.e. medication changes, equipment use, finances etc.), agreement with individual or their agreed representative and record of any views expressed. National Care Standards for care homes for older people, Standard 6 - Supporting Arrangements. 2. The service provider should ensure that stress/ distress reactions are assessed using monitoring charts to help identify triggers and diffusers. This should link to a clear plan of care setting out strategies to be used and describing clearly any role of medication with review dates if used to calm distressed behaviours. National Care Standards for care homes for older people, Standard 6 - Supporting Arrangements. 3. The service provider should ensure legal status and decision-making is clear for all residents who lack capacity or require support with making decisions. With regards to finances a financial risk assessment and support plan should be put in place to make it clear what the individual arrangements are. National Care Standards for care homes for older people, Standard 6 - Supporting Arrangements. 4. The service provider should ensure a clear audit trail for medications. The balance counts should be periodic and targeted according to risk. National Care Standards for care homes for older people, Standard 15.9 - Keeping Well - medication. 5. The service provider should ensure residents who wish to have a key and lock their bedroom door can do so. National Care Standards for care homes for older people, Standard 16.1 - Private life. Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at www.careinspectorate.com. page 5 of 8
Inspection and grading history Date Type Gradings 31 Mar 2017 Unannounced Care and support 5 - Very good 5 - Very good Management and leadership 5 - Very good 26 Nov 2015 Unannounced Care and support 5 - Very good Management and leadership 27 Nov 2014 Unannounced Care and support 5 - Very good Management and leadership 5 - Very good 12 Dec 2013 Unannounced Care and support Management and leadership 11 Jan 2013 Unannounced Care and support Management and leadership 8 Sep 2011 Unannounced Care and support Management and leadership 24 Jan 2011 Unannounced Care and support 5 - Very good Management and leadership 30 Sep 2010 Announced Care and support page 6 of 8
Date Type Gradings Management and leadership 2 Nov 2009 Unannounced Care and support 3 - Adequate Management and leadership 6 May 2009 Announced Care and support 3 - Adequate Management and leadership 3 - Adequate 22 Jan 2009 Unannounced Care and support Management and leadership 12 May 2008 Announced Care and support 3 - Adequate 3 - Adequate Management and leadership 3 - Adequate page 7 of 8
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 8 of 8