Ardencraig Care Home Care Home Service

Ardencraig Care Home Care Home Service 15 Ardencraig Place Castlemilk Glasgow G45 9US Telephone: 0141 634 4243 Type of inspection: Unannounced Inspection completed on: 30 June 2017 Service provided by: Thistle Healthcare Limited Service provider number: SP2003002348 Care service number: CS2003015202

About the service Ardencraig Care Home is registered to provide a care service to a maximum of 35 Older People and 55 People with Mental Health Problems in two separate units. This service has been registered with the Care Inspectorate since 2011. The service operates from a purpose-built two storey building. The ground floor provides support to older people. Younger people with a diagnosis of alcohol related brain damage, (ARBD), are supported on the first floor and one wing of the ground floor. The accommodation includes single en suite bedrooms, communal lounges and a cafe area. There are mature well maintained gardens and an inner courtyard that can be used when the weather allows. The provider's website states that: "The staff at Ardencraig Care Home are committed to supporting the people who live here to fulfil a full and active life. Our dedicated team of staff will work in partnership with you and the wider multidisciplinary team to provide you with the highest standard of quality nursing, medical, spiritual and social care and attention, tailored to your needs and wishes and as required by the National Care Standards." (accessed from http://www.thistlehealthcare.co.uk/find-a-care-home/ardencraig/ on 30/07/17). The service is located in the Castlemilk area of Glasgow and is near some local shops and public transport links. There were 77 people living in the service when we visited. What people told us For this inspection we received views from 15 people using the service. Four people gave their views via care standard questionnaires that we asked the manager to give to people using the service. We spoke with 11 service users when we visited the service. People who lived in Ardencraig spoke positively about living there. This was especially true when speaking of staff and the quality of food. Comments included: "They do bingo and make things. I can't make things but it's the fun of the group." "The staff are very good. They know me." "The food is very good. They feed me too well." We spoke with 11 relatives of people who lived in the service. Relatives had mixed views about the service, particularly about the number and continuity of staff. Some people told us that they were happy with the care their relative received. Other people were less positive. Comments from relatives included: "They (management) keep me informed. They run it well." "She has blossomed since she came here. She's going out two to three times a week." "The staff have all changed. There is no continuity, too may agency staff. " "It's not the worst. Some people have unrealistic expectations and expect five-star." page 2 of 13

"We were thinking of moving Dad. It was unsettling when staff left but things have improved lately." "There's not enough staff but they are caring for our sister well." "They (staff) don't always follow the care plan." We observed how staff interacted with people living in the home, particularly people who couldn't always express their views. Overall staff were positive and kind when caring for people. Staff generally interacted well with people. However, some staff engaged with people better than others. Self assessment The service was not 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 Quality of care and support Findings from the inspection People who used the service spoke positively about their experiences. People who completed our questionnaires, (four out of 30 sent to the service), agreed that they were happy with the overall quality of care. People said "Staff are all nice people, every one of them." and "There's nothing I don't like.". Relatives had mixed views about some aspects of care. Example included varied standards in personal care often associated with changes in staff. We did not find this at our visit but asked the provider to explore this further with families and carers. We observed how staff supported people who lived in the home during lunch and at other times. Staff served lunch in a patient, unhurried manner. They were good at supporting people who needed help to eat and drink. However, we saw that staff inconsistencies in explaining the choices available. People commented positively on the quality of food. One person said "The food's good and it's nicely cooked." Another commented "They are very good cooks." Dining areas were attractive. However in one dining-room the radio was very loud and this may have been irritating for some people. Staff's understanding about keeping protected from harm was good. The service managed medication well. We suggested getting more advice on the using covert medicines. page 3 of 13

People enjoyed a range of outdoor activities such as shopping, dances, and canal trips. People who were unable to go out also took part in activities that they enjoyed. Examples included bingo, baking and singing entertainment. These activities were less obvious on the first day we visited but happened more on subsequent days. Personal plans were of variable quality. Some had better detail than others. Good plans used one page profiles and were in pictorial and written formats for easier reading. This helped staff less familiar with people in their care access important information about them. It also made it easier for people to understand their own care plan. The roll out outcome focussed personal plans was slow. (see recommendation 1). We saw that people had their physical, social and psychological needs assessed through regular reviews of their care needs. Requirements Number of requirements: 0 Recommendations Number of recommendations: 1 1. The provider should prioritise the roll out of outcome focussed personal plans. Regular checks should be carried out on all personal plans to make sure that key information is consistently recorded accurately and that only information that is relevant to individual service user needs is contained in each plan. If staff need more training on care planning then the provider should arrange this. NCS 5 Care Homes for Older People - Management and Arrangements. NCS 6 Care Homes for Older People - Supporting Arrangements. Grade: 4 - good Quality of environment Findings from the inspection The provider was improving the inside the home. This included laying new carpets in corridors and upgrading the lighting to make it brighter. This was good for people who had visual or cognitive impairments and helped people find their way around the home. The service planned to continue with this programme of refurbishment and redecoration in other parts of the home. People who lived and visited the home had access to a pleasant café area on the ground floor. Some activities occasionally took place here. However people said it was rarely used. The service should explore how to use the café more. This may enhance the experience for people who spend more time inside the home. The home was clean and well maintained. However on the day we arrived we noticed that two areas that had unpleasant smells. Some relatives told us that this was evident on other occasions. When we pointed this out staff acted immediately to remove the odours. The smell was not there on subsequent days of our inspection. page 4 of 13

A persistent smell of smoke came from the smoking room on the first floor. The service used ventilation to reduce the potential harmful effects. This was partially successful. The provider should continue reducing this hazard for everyone in the home. We saw that some people had personalised their rooms with furniture and other individual items. Families could choose to have rooms decorated to their own taste. However a small number of people were living in bedrooms with carpets and curtains that were "tired" and worn. Improving people's living space can also improve their mental health and wellbeing. We looked at how the service maintained the building and equipment. We checked the environment and sampled maintenance records. The service was generally good at carrying out and recording environmental checks. However, we noted some gaps in records at weekends. The manager said she would address this. The service had an attractive and well maintained garden. People who lived in the service also had use of an enclosed courtyard. This was a quiet, attractive area with outdoor plants and seating. Requirements Number of requirements: 0 Recommendations Number of recommendations: 0 Grade: 4 - good Quality of staffing Findings from the inspection People using the service spoke highly of the staff working in the service. They said staff were "kind" and "caring". A relative commented "the nurses are good". Another said "night staff are nice." Some relatives shared the view that there was not enough staff at times. However, the home was not full when we inspected and we found that the service was complying with staffing requirements. The service had good procedures for selection of new staff. This followed best practice including carrying out background checks and looking at previous skills and experience. The provider was recruiting new staff to help reduce the use of temporary staff and improve continuity of staffing. Having support from staff that people knew well is helpful as staff should have a better knowledge and understanding of people's needs. We recommended at previous inspections that the service needed to further develop staff training in areas of mental health, ARBD, (Alcohol Related Brain Damage), and dementia. The aim was to develop staff learning beyond the foundation or informed practice level in order to improve the quality of specialist support for people using the service. Some staff that we spoke with indicated that they had foundation training and coaching in these areas. However the service needed to develop this. (see recommendation 1). The service was revising the training programme page 5 of 13

with the input of a training manager. Staff that we spoke with were enthusiastic about their learning opportunities. Good staff training means that people can benefit from support from knowledgeable staff who understand how to meet their needs. The timing of staff participation needed to improve so that staff had access training when needed. An example of this was the varied staff experience of induction. The service needed to define learning objectives better so that evaluation of learning outcomes was clearer. The majority of staff had registered with Scottish Social Services Council, (SSSC). This is the regulator for the social service workforce in Scotland. Two members of staff had let their registration lapse. We asked the provider to address this with the staff concerned. Requirements Number of requirements: 0 Recommendations Number of recommendations: 1 1. Staff training in areas of mental health, ARBD and dementia needs to be developed beyond the foundation or informed practice level in order to further improve the quality of specialist support service users at Ardencraig receive. Such training should take account of, (but not exclusively), best practice guidance from the Mental Welfare Commission and Scotland's National Dementia Strategy, (see http://www.gov.scot/topics/health/services/mental-health/dementia/dementiastrategy1316. ). Consideration should be given to accessing specialist training in these areas using existing professional networks as well as local training resources. Other useful information is available at http://www.ssks.org.uk/ http://hub.careinspectorate.com/ http://dementia.stir.ac.uk/information/links NCS 5 Care Homes for Older People - Management and Arrangements. Grade: 4 - good Quality of management and leadership Findings from the inspection Staff were positive about the support that they received from the senior staff and managers. They told us that the appointments of a new deputy manager and clinical services managers were positive. Having good mentorship and peer support can help staff in their roles. This in turn can benefit people living in the service who are cared for by a well-managed staff team. However, some relatives of people that used the service said that managers needed to have more of a presence page 6 of 13

in the home. We shared these views at inspection feedback with the management team. This was to allow managers to explore this further with people living or visiting Ardencraig. The service had good systems in place for checking the quality of medicines management and the environment. The service should also review how it audits the quality of information in personal plans. Such an audit should include how staff are using personal plans. (see also Quality of care and support). We also looked at how the service managed and recorded accidents and incidents. We had previously made a recommendation about this. Examples that we looked at indicated that the service was managing accidents and incidents appropriately. Staff were recording these well and carrying out relevant observations when people were unwell or had sustained an injury. The service's responses to most of the recommendations that we had made following the last inspection and as a result of previously upheld complaints was positive. We have repeated two recommendations that the service had not addressed so that the provider can prioritise them. (See Quality of care and support and Quality of staffing). 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 There are no outstanding requirements. page 7 of 13

What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 The home needs to review its arrangements for checking on residents' wellbeing while allocated workers are occupied elsewhere in the home. National Care Standards. Care Homes for Older People Standard 14 Healthcare Standard 6 Support Arrangements Standard 5 Management and Arrangements This recommendation was made on 16 November 2016. Communal lounge and dining areas had been reconfigured to allow for a better staff presence in these areas. Staff have been advised to seek other staff cover should they need to. Recommendation 2 The home should reinforce with nursing staff the importance of checking vital signs as a matter of routine following an accident like this and ensure that these checks are recorded. National Care Standards. Care Homes for Older People Standard 14 Healthcare Standard 6 Support Arrangements Standard 5 Management and Arrangements This recommendation was made on 16 November 2016. We looked at a sample of accidents and noted that vital signs had been recorded following accidents. This indicated that staff were aware of the need to do this following an accident to a service user. Recommendation 3 The provider should continue to roll out the new outcome focussed personal plans. Regular checks should be carried out on all personal plans to make sure that key information is consistently recorded accurately and that only information that is relevant to individual service user needs is contained in each plan. If staff need more training on care planning then the provider should arrange this. NCS 5 Care Homes for Older People - Management and Arrangements. NCS 6 Care Homes for Older People - Supporting Arrangements. This recommendation was made on 27 September 2016. page 8 of 13

This recommendation was not met and has been repeated. See the body of report for more information. Recommendation 4 Menu planning meetings with service users and/or their representatives should continue so that people who live in the service can further contribute their views to the choice of food and drink available. This will also help to make sure that menus continue to be appropriate to the needs of all service users. NCS 5 Care Homes for Older People - Management and Arrangements. This recommendation was made on 27 September 2016. Menu planning meetings were taking place with participation from service users and staff. The depute manager was completing nutrition champion studies. She was also working closely with the NHS dietician to ensure that menus were nutritionally balanced. Recommendation 5 Staff training in areas of mental health, ARBD and dementia needs to be developed beyond the foundation or informed practice level in order to further improve the quality of specialist support service users at Ardencraig received. Such training should take account of, (but not exclusively), best practice guidance publications such as those available from the Mental Welfare Commission and Scotland's National Dementia Strategy, (see http://www.gov.scot/topics/health/services/mental-health/dementia/dementiastrategy1316. ). Consideration should be given to accessing specialist training in these areas using existing professional networks as well as local training resources. Other useful information is available at http://www.ssks.org.uk/ http://hub.careinspectorate.com/ http://dementia.stir.ac.uk/information/links NCS 5 Care Homes for Older People - Management and Arrangements. This recommendation was made on 27 September 2016. Some limited progress had been made with this recommendation. More work was needed to develop staff knowledge in these areas. We have repeated the recommendation. Recommendation 6 When staff are on duty but have to leave areas of the home where service users are to attend training suitable arrangements must be put in place to cover for their absence at all times. This is to ensure that staffing is maintained at appropriate levels to care and support service users. NCS 5 Care Homes for Older People - Management and Arrangements. This recommendation was made on 27 September 2016. This recommendation was met. We confirmed this through discussion with staff and managers. page 9 of 13

Recommendation 7 Residents should be able to summon assistance easily and quickly using a reliable and efficient alarm system. NCS 9 Care Homes for Older People - Feeling Safe and Secure This recommendation was made on 27 September 2016. This recommendation was met. We observed at this inspection that buzzers were available and within reach of people in lounge areas and also in bedrooms that we looked at. Complaints Please see Care Inspectorate website (www.careinspectorate.com) for details of complaints about the service which have been upheld. Enforcement No enforcement action has been taken against this care service since the last inspection. Inspection and grading history Date Type Gradings 27 Sep 2016 Unannounced Care and support Not assessed Management and leadership Not assessed 28 Sep 2015 Unannounced Care and support Management and leadership 24 Sep 2014 Unannounced Care and support 5 - Very good Management and leadership page 10 of 13

Date Type Gradings 28 Sep 2013 Unannounced Care and support 5 - Very good Management and leadership 5 Oct 2012 Unannounced Care and support 5 - Very good 5 - Very good 5 - Very good Management and leadership 5 - Very good 18 Jan 2012 Unannounced Care and support 5 - Very good Not assessed Management and leadership Not assessed 28 Jul 2011 Unannounced Care and support 5 - Very good Not assessed Management and leadership Not assessed 26 Jan 2011 Unannounced Care and support Not assessed Management and leadership Not assessed 12 Aug 2010 Announced Care and support 5 - Very good 5 - Very good Management and leadership 5 - Very good 4 Mar 2010 Unannounced Care and support Not assessed Management and leadership Not assessed 26 Oct 2009 Announced Care and support Management and leadership page 11 of 13

Date Type Gradings 31 Mar 2009 Unannounced Care and support Not assessed Management and leadership Not assessed 25 Sep 2008 Announced Care and support 3 - Adequate 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