Glenlivet Gardens Care Home Care Home Service Adults Glenlivet Place Darnley Glasgow G53 7LA Type of inspection: Unannounced Inspection completed on: 29 September 2014
Contents Page No Summary 3 1 About the service we inspected 6 2 How we inspected this service 8 3 The inspection 13 4 Other information 25 5 Summary of grades 26 6 Inspection and grading history 26 Service provided by: JSL Care Ltd Service provider number: SP2008010034 Care service number: CS2008184419 If you wish to contact the Care Inspectorate about this inspection report, please call us on 0345 600 9527 or email us at enquiries@careinspectorate.com Glenlivet Gardens Care Home, page 2 of 28
Summary This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change after this inspection following other regulatory activity. For example, if we have to take enforcement action to make the service improve, or if we investigate and agree with a complaint someone makes about the service. We gave the service these grades Quality of Care and Support 4 Good Quality of Environment 4 Good Quality of Staffing 4 Good Quality of Management and Leadership 4 Good What the service does well The service had maintained a good level of involving both residents and relatives. We found that the service continued to provide a good level of care and support to residents. The service provided a very good level of cleanliness and safety for residents. We found that the service provided a good level of support and training opportunities for staff. The systems and processes used by the service provided a good level of quality assurance. What the service could do better It was not always clear what action had been taken to address any areas highlighted at meetings or in questionnaires. In the personal plans viewed, the preventative measures and outcomes of the management of falls, weight loss and behaviour that may challenge was not always clearly recorded. Glenlivet Gardens Care Home, page 3 of 28
The service was considering implementing a form to record the management of resident's finances and any relevant authority for other people to act on their behalf, for example Guardianship or Power of Attorney. The manager was asked to ensure that people had the relevant authority prior to signing consent forms and that if residents were still capable that they were allowed to sign. The internal doors in the Step Down unit, identified as fire doors, had not yet been fitted with door closures and were still being wedged open. The manager was asked to action this as a matter of urgency. There was still evidence of some storage in bathroom areas but we were told that this was being monitored on a daily basis. From the audits viewed, it was evident that some issues were recurring and it was not always evident how the areas for improvement had been addressed. What the service has done since the last inspection Since the last inspection consultation with residents and relatives had continued through meetings, questionnaires and care reviews. The service had attained a copy of the Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) NHS policy and procedure as well as developing guidance for staff on the implementation within the care home. The areas highlighted in the last report in relation to the environment had been progressed. Staff rotas viewed over a four week period from August to September 2014 showed that the skill mix in relation to the number of senior care staff on duty had improved and the four weekly resident care need and staffing assessments now included the Step Down service. Since the last inspection, the service had progressed with moving and assisting, adult support and protection, oral care and dementia training. The manager was aware of the care staff who had submitted their applications for Scottish Social Services Council (SSSC) registration and staff continued to be supported to achieve a relevant qualification. The manager now had a record of when staff received supervision meetings with an expected frequency of three per year. Glenlivet Gardens Care Home, page 4 of 28
Conclusion Inspection report continued There was evidence of improvement in the areas highlighted in the previous inspection report and this had resulted in an increase in the quality grades awarded. Feedback from residents and relatives remained overall positive. Glenlivet Gardens Care Home, page 5 of 28
1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at www.careinspectorate.com. This service registered with the Care Inspectorate in November 2012. Requirements and Recommendations If we are concerned about some aspect of a service, or think it could do more to improve, we may make a recommendation or requirement. A recommendation is a statement that sets out actions the care service provider should take to improve or develop the quality of the service but where failure to do so will not directly result in enforcement. Recommendations are based on National Care Standards, relevant codes of practice and recognised good practice. A requirement is a statement which sets out what is required of a care service to comply with the Public Services Reform (Scotland) Act 2010 and Regulations or Orders made under the Act, or a condition of registration. Where there are breaches of the Regulations, Orders or conditions, a requirement must be made. Requirements are legally enforceable at the discretion of the Care Inspectorate. Glenlivet Gardens Care home provides accommodation for up to 56 Older People. The building is purpose built on two levels. Part of the home provides an eight-bedded 'Step Down' unit which facilitates discharge from hospital and supports return to the community. All bedrooms offer single accommodation with en-suite facilities. There is parking and a garden area to the rear of the building. It is situated in a residential area of south Glasgow, near to public transport and community resources. The service is provided by JSL Care Limited. Glenlivet Gardens Care Home, page 6 of 28
Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade Quality of Environment - Grade Quality of Staffing - Grade Quality of Management and Leadership - Grade This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change following other regulatory activity. You can find the most up-to-date grades for this service by visiting our website www.careinspectorate.com or by calling us on 0345 600 9527 or visiting one of our offices. Glenlivet Gardens Care Home, page 7 of 28
2 How we inspected this service The level of inspection we carried out In this service we carried out a medium intensity inspection. We carry out these inspections where we have assessed the service may need a more intense inspection. What we did during the inspection This report was written following an unannounced inspection which was carried out on 18 September 2014 between 09.00am and 6.00pm. Feedback was provided to the management team on 29 September 2014. As requested by us, the care service had previously submitted a self assessment and an annual return. We sent forty questionnaires to the manager to distribute to residents and relatives. Eight relatives and two residents returned completed questionnaires. In this inspection we gathered evidence from various sources, including the relevant sections of policies, procedures, records and other documents, including: - resident personal plans - resident and relative meetings - observation of the environment - maintenance records - accident and incident records - staff training records - staff rotas - staff recruitment files - audits - discussions with residents, relatives, staff and management. Grading the service against quality themes and statements We inspect and grade elements of care that we call 'quality themes'. For example, one of the quality themes we might look at is 'Quality of care and support'. Under each quality theme are 'quality statements' which describe what a service should be doing well for that theme. We grade how the service performs against the quality themes and statements. Details of what we found are in Section 3: The inspection Glenlivet Gardens Care Home, page 8 of 28
Inspection Focus Areas (IFAs) Inspection report continued In any year we may decide on specific aspects of care to focus on during our inspections. These are extra checks we make on top of all the normal ones we make during inspection. We do this to gather information about the quality of these aspects of care on a national basis. Where we have examined an inspection focus area we will clearly identify it under the relevant quality statement. Fire safety issues We do not regulate fire safety. Local fire and rescue services are responsible for checking services. However, where significant fire safety issues become apparent, we will alert the relevant fire and rescue services so they may consider what action to take. You can find out more about care services' responsibilities for fire safety at www.firelawscotland.org Glenlivet Gardens Care Home, page 9 of 28
What the service has done to meet any requirements we made at our last inspection The requirement The provider must address all the environmental issues highlighted and submit a plan of action with timescales to the Care Inspectorate. What the service did to meet the requirement Progress reported under Quality Theme 2 Statement 2. The requirement is: Met - Within Timescales The requirement The provider must demonstrate that the levels of staff on duty meet the needs of residents. What the service did to meet the requirement Progress reported under Quality Theme 2 Statement 2. The requirement is: Met - Within Timescales The requirement The provider must ensure that all staff receive Adult Support and Protection training and other refresher training within required timescales. What the service did to meet the requirement Progress reported under Quality Theme 3 Statement 3. The requirement is: Met - Within Timescales Glenlivet Gardens Care Home, page 10 of 28
The requirement The provider must demonstrate the action taken and the improvements achieved, where areas for improvement are highlighted. What the service did to meet the requirement Progress reported under Quality Theme 4 Statement 4. The requirement is: Met - Within Timescales Inspection report continued The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: Yes - Electronic Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. n/a. Taking the views of people using the care service into account We spoke to eight residents during this visit and feedback was very positive. Two Care Inspectorate questionnaires were completed and returned from residents prior to the inspection visit. They were overall happy with the quality of care received. Additional comments received were: 'I can't fault the staff and service here.' 'Step down unit not as active socially.' Glenlivet Gardens Care Home, page 11 of 28
Taking carers' views into account We spoke to two relatives/friends during this visit and feedback was very positive. Eight Care Inspectorate questionnaires were completed and returned from relatives prior to the inspection visit. They were all overall happy with the quality of care received. Additional comments received were: 'I don't think there is a named key worker but a team designated to residents care. This will depend on which staff is on. Relatives often have to flag up health issues and report concerns which are then dealt with.' 'All staff in Glenlivet gardens are very person centred. This priority is first and foremost the person in their care. It is a pleasure to visit our relative here knowing they are happy, content and enjoying life here.' Glenlivet Gardens Care Home, page 12 of 28
3 The inspection We looked at how the service performs against the following quality themes and statements. Here are the details of what we found. Quality Theme 1: Quality of Care and Support Grade awarded for this theme: Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths The service had maintained a good level of involving both residents and relatives. We focused on the information available within the service and how the service had involved residents and relatives. Information available throughout the home included the complaints procedure, minutes of meetings, named nurse and key worker details, Care Inspectorate leaflets and inspection reports, advocacy and activity details. Since the last inspection consultation with residents and relatives had continued through meetings, questionnaires and care reviews. Residents meetings discussed the refurbishment of the hairdresser's room and involved residents in choosing the paint, pictures and blinds. There were also discussions about planning events, fundraising and entertainers. A food group meeting had been held in August 2014 between residents and the chef. Comments about the food and menus were overall positive and any suggestions for changes were actioned. The last relatives meeting had been held in July 2014 where there were discussions about meaningful activities and outings; the inspection report and grades; improvements to the garden and updates about new staff. There was positive feedback from relatives about the summer fete and the care and support received. Care Inspectorate questionnaires were handed out. Glenlivet Gardens Care Home, page 13 of 28
We were told that the relatives support group was to restart from November 2014. Questionnaires with residents and professional visitors were evident since the last inspection. These covered the environment, staff, care received, meals and choice. The majority of responses remained positive especially in relation to staff. The Summer's edition of the home's newsletter had been developed by the activity staff in consultation with residents. It included information about the changes in staff and residents, information and photos of events. In the personal plans viewed, there were entries of communication with relatives about health issues and relative involvement at care review meetings was evident. Areas for improvement The service should review the following areas to improve the involvement of residents and relatives in assessing the quality of care and support: - the participation strategy could be further improved by reflecting how often the methods of involvement would be carried out. - the action taken to address any areas highlighted at meetings or in questionnaires was not evident. Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 0 Inspection report continued Glenlivet Gardens Care Home, page 14 of 28
Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths We found that the service continued to provide a good level of care and support to residents. The four personal plans viewed showed a good level of detail in risk assessments and care plans for the management of falls and behaviour that may challenge. Where any equipment was used to support the resident, this was reflected in their personal plan with the relevant risk assessment and consent. Involvement of health professionals such as the GP, liaison nurse and physiotherapist was evident. The service had attained a copy of the Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) NHS policy and procedure as well as developing guidance for staff on the implementation within the care home. During this visit, we observed a lunch mealtime experience. Table presentation remained good and all residents, who wished to have their meal in the dining room, were accommodated in the dining room. The food served looked appetising and residents were seen to enjoy their meal. The service had two activity organisers and a plan of activities, outings and entertainers. Individual, group and outing records showed what each resident had been involved in. Skype was available for residents to keep in touch with friends and family. During the visit, we saw good interaction between residents and staff, with residents enjoying various games, listening to music and singing in the morning. Entertainment was enjoyed in the afternoon. Some one to one time was also evident throughout the day. Areas for improvement Some areas were found not to be as effective in meeting the care and support needs of residents. In the personal plans viewed, the preventative measures and outcomes of the management of falls, weight loss and behaviour that may challenge was not always clearly recorded (see Recommendation 1). Glenlivet Gardens Care Home, page 15 of 28
The service was considering implementing a form to record the management of resident's finances and any relevant authority for other people to act on their behalf, for example Guardianship or Power of Attorney. Some sections of the form were relevant but it may need adapted or the relevant information recorded in a care plan. The manager was asked to ensure that people had the relevant authority prior to signing consent forms and that if residents were still capable that they were allowed to sign. In the personal plans viewed, improvement was still needed in the frequency and details of the entries in key worker records. The role of the key worker should be developed. During the lunchtime observation, access to the menu remained limited which left both staff and residents unaware of what was for lunch. Fluid charts did not reflect daily fluid targets for individual residents and food charts did not reflect the amounts of food given therefore it was not clear how much had been taken. We were told that staff training was planned. We saw that some of the care staff time could have been spent more meaningful with residents not involved in group activities. Individual and group records were not always completed fully to show the benefit of the activity or any evaluation and interventions needed. The link between individual activity preferences and the activities provided was not clear. We were told that the service were planning to use the physical activity selfassessment tool from the 'Make every move count' guidance. Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The manager should ensure that the preventative measures and outcomes of the management of falls, weight loss and behaviour that may challenge are clearly recorded in personal plans. National Care Standards for Care Homes for Older People: Standard 6 - Support arrangements and Standard 9 - Feeling safe and secure. Glenlivet Gardens Care Home, page 16 of 28
Quality Theme 2: Quality of Environment Grade awarded for this theme: Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the environment within the service. Service strengths The methods of service user participation reported in Quality Theme 1 Statement 1 remain relevant for this statement. It was evident that residents had been involved in discussions about how to improve the hairdressers by choosing paint colours, blinds and pictures. Areas for improvement The areas for improvement reported in Quality Theme 1 Statement 1 remain relevant for this statement. Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 0 Glenlivet Gardens Care Home, page 17 of 28
Statement 2 We make sure that the environment is safe and service users are protected. Service strengths We found that the service provided a very good level of cleanliness and safety for residents. We looked at the condition of the environment and records in relation to maintenance, staffing, accidents and incidents. The areas highlighted in the last report in relation to the environment had been progressed: - doors closure devices had been installed to allow internal doors to remain open safely - the storage of equipment in bathroom areas and the access to an assisted bath had been rectified - both unit's lounge and corridor carpets had been replaced and all chairs steam cleaned - the room used by the hairdresser had been refurbished and a suitable sink for use with residents installed - the garden area had been tidied, landscaped, flowers planted and the back gate replaced providing a safe, enclosed area for residents. The home remained clean and odour free throughout. Hot water temperature checks for the Step Down unit were now being checked and recorded. A monthly overview of accident and incident records was completed by management and reflected any preventative action or follow-up. The analysis showed the location, time and total number of accidents as well as any resident with recurring accidents/ incidents and comments about the action taken. Staff rotas viewed over a four week period from August to September 2014 showed that the skill mix in relation to the number of senior care staff on duty had improved and the four weekly resident care need and staffing assessments now included the Step Down service. Two staff recruitment files were viewed and were found to follow good recruitment practice in relation to relevant checks. Areas for improvement We found that some areas within the service could be improved further to provide a better environment for residents to live. Glenlivet Gardens Care Home, page 18 of 28
The internal doors in the Step Down unit, identified as fire doors, had not yet been fitted with door closures and were still being wedged open. The manager was asked to action this as a matter of urgency. The assisted bath in Heatherview had sharp corner edges on the side panels and needed a protective edging applied the same as the bath in Irisview. There was still evidence of some storage in bathroom areas but we were told that this was being monitored on a daily basis. The room used by the hairdresser was still identified as the 'treatment room'. The manager stated that this would be addressed. Regular maintenance checks of all equipment used within the home such as bedrails, wheelchairs, zimmer aids and commodes was being introduced using the paperwork from the resource pack' Managing falls and fracture in care homes for older people'. The manager was reminded about submitting notifications following an accident where medical attention is sought, in line with the Care Inspectorate guidance, 'Records that all registered care services must keep and guidance on notification reporting'. The four weekly resident care need and staffing assessments were not calculated per unit to reflect the layout of building and staff deployment. We were advised that this would now be calculated per unit. It was evident from the staff recruitment files viewed that only one person had carried out the interviews when good practice indicates that at least two people should be involved in staff interviews. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Glenlivet Gardens Care Home, page 19 of 28
Quality Theme 3: Quality of Staffing Grade awarded for this theme: Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service Strengths The methods of service user participation reported in Quality Theme 1 Statement 1 remain relevant for this statement. Areas for improvement The areas for improvement reported in Quality Theme 1 Statement 1 remain relevant for this statement. There was no indication of the involvement of residents or relatives, through questions or in person, in the two staff recruitment files viewed. The service should also consider developing the involvement of residents and relatives in staff supervision and appraisals. Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 0 Glenlivet Gardens Care Home, page 20 of 28
Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths We found that the service provided a good level of support and training opportunities for staff. We looked at training records as well as observing staff working with residents. Since the last inspection, the service had progressed with moving and assisting, adult support and protection, oral care and dementia training. The manager had received training on Promoting Excellence and this was to be cascaded to all staff. The manager was aware of the care staff who had submitted their applications for Scottish Social Services Council (SSSC) registration and staff continued to be supported to achieve a relevant qualification. The manager now had a record of when staff received supervision meetings with an expected frequency of three per year. Some staff meetings were evident since the last inspection. There were good discussions about team work, SSSC registrations, training, development and practice issues. Staff were also informed of the positive feedback from families and visiting professionals. Areas for improvement The following areas were highlighted to provide further support for staff: - management needed to monitor the frequency of staff supervision meetings and ensure that any issues highlighted were addressed. - staff meetings needed to take place for all staff groups on a regular basis. Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 0 Glenlivet Gardens Care Home, page 21 of 28
Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the management and leadership of the service. Service strengths The methods of service user participation reported in Quality Theme 1 Statement 1 remain relevant for this statement. The manager operated an open door policy and was known to residents and relatives. Areas for improvement The areas for improvement reported in Quality Theme 1 Statement 1 remain relevant for this statement. Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 0 Glenlivet Gardens Care Home, page 22 of 28
Statement 4 We use quality assurance systems and processes which involve service users, carers, staff and stakeholders to assess the quality of service we provide. Service strengths We found that the systems and processes used provided a good level of quality assurance. We looked at how the service gained feedback from various people and the audits carried out by the service. There was evidence of improvement in the areas highlighted in the previous inspection report and these have been included throughout the report. The service had maintained a good level of involving both residents and relatives in assessing the service. Audits had been carried out to monitor staff practice and resident care. We saw audits for personal plans, medication, staffing levels, catering, accidents and incidents. The service worked with external regulators and health professionals to develop the service and improve resident care. Following the last inspection, an action plan was developed for the areas of improvement highlighted. The service had no record of any complaints received since the last inspection. Areas for improvement The organisation's quality assurance systems could be more robust and effective. From the audits viewed, it was evident that some issues were recurring and it was not always evident how the areas for improvement had been addressed (see Recommendation 1). The areas for improvement reported in previous statements within this report are also relevant to this statement. Glenlivet Gardens Care Home, page 23 of 28
Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The manager should continue to demonstrate the action taken and improvements made for any issues highlighted in audits. National Care Standards for Care Homes for Older People: Standard 5 - Management and staffing arrangements. Glenlivet Gardens Care Home, page 24 of 28
4 Other information Complaints No complaints have been upheld, or partially upheld, since the last inspection. Enforcements We have taken no enforcement action against this care service since the last inspection. Additional Information No additional information. Action Plan Failure to submit an appropriate action plan within the required timescale, including any agreed extension, where requirements and recommendations have been made, will result in the Care Inspectorate re-grading a Quality Statement within the Quality of Management and Leadership Theme (or for childminders, Quality of Staffing Theme) as unsatisfactory (1). This will result in the Quality Theme being re-graded as unsatisfactory (1). Glenlivet Gardens Care Home, page 25 of 28
5 Summary of grades Quality of Care and Support - Statement 1 Statement 3 Quality of Environment - Statement 1 Statement 2 5 - Very Good Quality of Staffing - Statement 1 Statement 3 Quality of Management and Leadership - Statement 1 Statement 4 6 Inspection and grading history Date Type Gradings 23 Apr 2014 Unannounced Care and support Environment 3 - Adequate Staffing Management and Leadership 3 - Adequate 26 Apr 2013 Unannounced Care and support Environment Staffing Management and Leadership 7 Aug 2012 Unannounced Care and support Environment Staffing Management and Leadership Glenlivet Gardens Care Home, page 26 of 28
21 Feb 2012 Unannounced Care and support Environment Not Assessed Staffing Management and Leadership Not Assessed 31 Oct 2011 Unannounced Care and support Environment Not Assessed Staffing Management and Leadership Not Assessed 12 Jan 2011 Announced Care and support Environment Staffing Not Assessed Management and Leadership Not Assessed 14 Jul 2010 Unannounced Care and support Environment Staffing Not Assessed Management and Leadership Not Assessed 5 Mar 2010 Unannounced Care and support Environment Staffing Management and Leadership 18 Sep 2009 Unannounced Care and support Environment 3 - Adequate Staffing 3 - Adequate Management and Leadership 3 - Adequate All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Glenlivet Gardens Care Home, page 27 of 28
To find out more about our inspections and inspection reports Read our leaflet 'How we inspect'. You can download it from our website or ask us to send you a copy by telephoning us on 0345 600 9527. This inspection report is published by the Care Inspectorate. You can get more copies of this report and others by downloading it from our website: www.careinspectorate.com or by telephoning 0345 600 9527. Translations and alternative formats This inspection report is available in other languages and formats on request. Telephone: 0345 600 9527 Email: enquiries@careinspectorate.com Web: www.careinspectorate.com Glenlivet Gardens Care Home, page 28 of 28