Grahamston House Care Home Service Mandela Avenue Bainsford Falkirk FK2 7BD Telephone: 01324 501860 Type of inspection: Unannounced Inspection completed on: 12 April 2017 Service provided by: Falkirk Council Service provider number: SP2004006884 Care service number: CS2003011555
About the service Grahamston House is located in landscaped gardens close to Falkirk town centre. The service offers long-term care and support for up to 36 older people with dementia. Within this limit up to four places may be offered for short breaks (respite). When this inspection took place there were 29 people living at Grahamston House with a further 4 people residing for a short period of respite. People who use the service prefer to be known as residents, therefore we have used this term throughout this report. All accommodation is single rooms within four separate units. Each unit has a communal lounge area that includes integrated dining space and facilities for the making of drinks and snacks. There is also a large central communal area which is used for entertainment and social purposes. The stated aims of the service are to support each individual centred around their specific needs, chosen lifestyle, likes, dislikes and abilities to make the person feel valued and respected, encouraging feelings and emotions to be recognised as a means of communication and self-expression. The home also delivers a day service from within its premises and this is registered separately. What people told us Prior to our inspection we sent twelve questionnaires to relatives, residents and staff. During our visits to the service we spoke with six residents, six relatives and four staff members. We received seven returned questionnaires from relatives, six of whom strongly agreed that they were happy with the quality of care their relative received at Grahamston House. Everyone who responded were confident that staff had the knowledge and skills to care for their relative. Comments in general were very positive and made reference to the kind and helpful staff as well as the cleanliness and homeliness of the building. One relative commented that they were unhappy about having to replace clothes not returned from the laundry. Another relative commented that they did not think there was enough staff presence in lounge areas. We received very positive overall comments from residents and relatives we spoke with. We heard residents had their routines and preferences adhered to and their choices were respected. People had opportunities to socialise both within the home and with organised outings. Relatives told us communication was very good from staff and they were included in regular reviews of care. Residents also told us they were attended to quickly and did not have to wait for anything and everyone was complimentary about the food. Eleven out of twelve people we spoke with felt there was enough staff to attend to their needs. Self assessment We did not request a self assessment this year. We discussed and considered the service's own development plan as part of this inspection. page 2 of 8
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 Residents receive a very good level of care at Grahamston House. Residents and relatives we spoke with spoke very highly of the staff and the attention to detail that they paid. We saw during one of our meal time observations that staff were knowledgeable about individuals dietary requirements. Meal times were pleasant and efficient with enough staff in attendance. In addition to this we saw caring and effective interaction from a staff member with a resident who had became distressed. Our observation informed us that staff knew the needs of residents very well and how to meet them. We saw from records we looked at these were thorough in detail and included in put from various health professionals. We saw in particular extensive multi-agency input with one resident that ensured various approaches and techniques had been identified to alleviate distress. This meant the resident was more receptive to the care they received. We saw that people had a range of activities to choose from as well as being able to go on trips on the mini bus. The medication records held by the service were of a high standard. It was pleasing to note that there were no residents who were receiving medication for signs of distress as the staff were able to use their skills and knowledge to de-escalate these situations and provide reassurance to residents. This was also recorded well in the care plans and in particular, close attention was paid to observing body language of residents. This ensured that people with non verbal communication were also being considered. The staff team can approach management at any time to discuss any aspects of their work. There are frequent team meetings that are undertaken that includes agenda items such as training, every day practice and staff rotas. The management team had an overview of staff who had conditions of their registration with the Scottish Social Services Council (SSSC) and what qualifications the staff team had to achieve within specific timescales. We heard that staff members were encouraged to have additional responsibility in specific areas of care. This promoted the continuing development of staff. The management team were able to demonstrate that regular audits were undertaken that covered all aspects of the service including the environment and information held from external agencies such as environmental health and pharmacy audits. The audits in most cases, identified areas of improvement and action to be undertaken to achieve this. We were able to see that residents, relatives and other professionals were asked for their views and in particular, how the service could develop and improve. page 3 of 8
What the service could do better We did not see drinks in communal areas or lounges that residents could help themselves to and management have agreed to address this. We noted from minutes of team meetings that on occasion these could become challenging as some staff were using the meetings to highlight issues that were causing disharmony within the team that may be best discussed privately. The management team need to ensure that staff have regular individual formal supervision in line with their policy guidelines. This would ensure staff have the opportunity to discuss any matters that may need to be resolved as well as ensuring that gaps in training and development are identified. Supervision should also be an opportunity to discuss adult support and protection and ensure staff are knowledgeable in this area as any gaps identified in supervision would ensure staff have further opportunities to refresh their knowledge in this area. The management team should undertake observations of staff practice as part of their audits. This would highlight any improvements in care delivery that could be made as well as identifying training and development needs for staff. This would ensure that staff are supported to deliver and continue very good levels of care. Some of the audits we looked at listed everything that was looked at using a tick box exercise but in some instances these did not fully record whether any improvements were identified. Not all audits were undertaken within the time frequency identified. The management team have agreed to address this. The service should develop an action/improvement plan from the analysis of their audits to identify how improvements are taken forward. This should also consider where the service feel they could further develop as part of their own assessment. We will follow this up at future inspections We have made recommendations below from our findings. Requirements Number of requirements: 0 Recommendations Number of recommendations: 3 1. The management team should ensure that all documentation relating to nominated welfare appointees are provided and kept by the service as part of the pre-admission process. This will ensure that the information sharing and decision-making regarding the welfare of individuals are adhered to and undertaken by the legally nominated person. This is to meet National Care Standard 5, Care Homes for Older People - Management and Arrangements. page 4 of 8
2. The management team should undertake direct observation of staff practice as part of the audit process. This will also be useful in identifying if there is any training and development need for staff. This is to meet National Care Standard 5, Care Homes for Older People - Management and Arrangements. 3. The management team should analyse the findings of their quality assurance audits and produce from this an overall development and improvement plan for the service. This is to meet National Care Standard 5, Care Homes for Older People - Management and Arrangements. Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at www.careinspectorate.com. Inspection and grading history Date Type Gradings 21 Apr 2016 Unannounced Care and support Not assessed 5 - Very good Management and leadership Not assessed 5 Oct 2015 Unannounced Care and support 5 - Very good 5 - Very good Management and leadership 5 - Very good 31 Oct 2014 Unannounced Care and support Management and leadership page 5 of 8
Date Type Gradings 28 Nov 2013 Unannounced Care and support Management and leadership 26 Feb 2013 Unannounced Care and support Not assessed Management and leadership 29 May 2012 Unannounced Care and support Management and leadership 26 Jan 2012 Unannounced Care and support Not assessed Management and leadership 3 - Adequate 9 Sep 2011 Unannounced Care and support Management and leadership 3 - Adequate 19 Jan 2011 Unannounced Care and support 3 - Adequate Not assessed 3 - Adequate Management and leadership Not assessed 2 Sep 2010 Announced Care and support 2 - Weak Management and leadership 23 Feb 2010 Unannounced Care and support Management and leadership page 6 of 8
Date Type Gradings 23 Sep 2009 Announced Care and support 3 - Adequate Management and leadership 17 Mar 2009 Unannounced Care and support 2 - Weak 2 - Weak 5 - Very good Management and leadership 2 - Weak 23 Oct 2008 Announced Care and support 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