Bon Accord Care - Fergus House Care Home Service Fergus Place Dyce Aberdeen AB21 7DE Telephone: 01224 724147 Type of inspection: Unannounced Inspection completed on: 12 July 2017 Service provided by: Bon Accord Care Limited Service provider number: SP2013012020 Care service number: CS2013315405
About the service Bon Accord Care - Fergus House is a care home for older people, with 43 registered places. It is a purpose-built facility in Dyce, which is a suburb of Aberdeen. The service provider, Bon Accord Care Ltd, have aims and objectives which state that they will "provide a safe, secure and homely environment in which residents can live as full a life as possible". Their philosophy states that they will "value each person and treat them as an individual". This service registered with the Care Inspectorate on 1 August 2013. What people told us We received completed Care Inspectorate questionnaires from 10 residents and relatives prior to the start of the inspection and we spoke with 14 residents and relatives during the inspection. All of the residents and relatives who we spoke with and who completed questionnaires told us that they were either satisfied or very satisfied overall with the service provided. Residents' and relatives' comments included: "I am very happy with the care and support my relative receives at Fergus House. All the carers and staff are first class in my opinion." "My relative is cared for very well at Fergus House." "The quality of accommodation is of a high standard." "I cannot fault the care and support my relative receives by the staff. My relative is always clean and tidy and they help sort out any problems with pain." "I have no complaints at all about Fergus House. It is clean, homely and always free from any kind of smells. Lovely care home. The overall service is outstanding. Staff are always available if you need to ask anything and they are always polite." "Excellent care and support. Excellent environment." We received a number of comments about an unpleasant odour coming from the lift shaft which had been ongoing for some time. Drainage contractors were working on resolving this issue at the time of this inspection. Self assessment The service had not been asked to complete a self assessment in advance of this inspection. From this inspection we graded this service as: Quality of care and support Quality of environment 4 - Good 4 - Good page 2 of 8
Quality of staffing Quality of management and leadership not assessed not assessed What the service does well This was a well-managed service with a committed and competent management and staff team. Residents and relatives told us that staff created a friendly atmosphere, made them feel welcome and worked hard to ensure that residents were well cared for. We found that staff knew the residents well, knew what was important to them and how they liked to be supported and cared for. We observed many warm interactions between staff and residents and much shared laughter. Many of the residents told us that they enjoyed it when staff 'had a laugh with them'. Each resident had in place a personal plan which contained information about their care and support needs and how these were to be met. The management team had started to undertake regular audits of the personal plans to ensure they contained all the necessary information, and were clear and up-to-date. There was evidence that residents' and their representatives' views had been taken into account in the development of their personal plans and arrangements were in place to ensure that all residents received a review of their personal plan at least every six months. (See also 'What the service could do better'). Effective arrangements were in place to support residents with any health care needs. This included promptly identifying any health concerns and making referrals to relevant health professionals. Residents were supported to access a range of external health professionals including; GPs, Community Nurses, Optician and Dental health care. It was good that the service had worked closely with clinical psychology to support a resident who was experiencing distressed reactions and had implemented the guidance provided. Falls risk assessments had been completed for those service users identified as being at risk of falling. The provider had developed a multi-factorial risk assessment tool for this purpose. Accident records had been completed following any falls and these recorded the actions taken to ensure that the service users involved were appropriately examined and received any medical attention necessary. (See also 'What the service could do better'). It was good that the service had started work with the provider's Occupational Therapists to implement an enablement approach to supporting residents. This means that residents are actively involved in their own support. The approach has been shown to improve people's health, wellbeing and overall independence by ensuring they are engaged and active partners in the support they receive. The home continued to engage positively with families and the community. This provided for many enhanced experiences for residents and kept the home well-connected with the local and wider community. A good programme of activities and entertainment was provided and this included regular armchair exercises to help residents to maintain their strength, balance and flexibility. Good standards of cleanliness were maintained throughout the home and efforts had been made to make residents' rooms and communal areas homely. Arrangements were in place to ensure that routine health and safety checks and minor repairs were completed. A range of contractors were employed to carry out scheduled maintenance and servicing of equipment and to ensure that any repairs were completed competently. The provider was in talks with the landlord to explore ways in which the process of getting required maintenance work and minor repairs completed and could be streamlined. Replacement of floor coverings in many of the residents' bedrooms had been completed and work on a page 3 of 8
comprehensive programme of redecoration was due to start once the installation of a new nurse call system was completed. The provider advised that a long-standing issue in relation to the front door entry arrangements for visitors to the home would be resolved as part of this work and that access to the fire escape stairwells from the communal parts of the ground floor would be made more secure. (See also 'What the service could do better'). The service had a stable staff team who were well supported by the provider in their professional development. Staff who we spoke with told us that they greatly enjoyed their work and that they felt well supported by colleagues and management. All staff, who required to be, were registered with the appropriate professional body. Most staff had already achieved the qualifications which were a condition of their registration. The provider advised that a small number of vacancies in the care team would be filled in the coming weeks once a restructure across the organisation was fully implemented. The provider should develop a staff development strategy for the home which supports the further development of a system of care champions or practice leads. At the time of this inspection an interim management arrangement was in place. The interim manager operated an open door policy and residents and relatives told us that the management of the home were accessible to them and that they could approach them to discuss any matters they were concerned about. Some formal quality assurance processes had been implemented to ensure that standards were maintained and to support continuous improvements in the service. This included; audits of residents' personal plans, a recent full audit by the provider's quality team and a recent environmental audit completed by the organisation's facilities department. There was evidence that the quality assurance arrangements were effective at identifying any areas where improvements could be made. (See also 'What the service could do better'). What the service could do better We looked at a sample of residents' personal plans which indicated that, whilst some progress had been made, including transferring the plans to an improved format, significant further work was needed in order to ensure the plans are of a suitable standard. The quality assurances process should be used to support improvements in the following areas: - reducing the use of basic good practice statements and replacing with detail which is more meaningful to each individual resident. - ensure that the relevant and most up-to-date information is easily accessible by ensuring that proper indexing is used and that documentation which is no longer relevant is archived. - following up to obtain any information which is not available at the time the personal plan is initially competed. - ensuring that once residents are initially settled in the home that the issue of end of life wishes is discussed. - ensuring that information from ABC charts is used to inform care plans relating to distressed behaviour. The provider should consider developing a register of legal powers in respect of all residents to ensure that all the correct information has been obtained and any changes or further actions are easily identifiable. (See requirement 1). The service should review and further develop its fall prevention approach. This should include a review of the way in which the individual multifactorial risk assessment is used to provide a clearer method of identifying the most up-to-date information for those residents who had experienced multiple falls. The provider should complete the service audits contained in 'Managing falls and fractures in care homes for older people' published page 4 of 8
by the NHS Scotland and the Care Inspectorate. The service should also further develop falls analysis to better identify any possible trends. (See requirement 2). We found that significant aspects of the environment were worn out and were overdue to be replaced or upgraded. This included areas of flooring, decoration, curtains and furnishings. The provider had developed an action plan, however, this needed to be updated to include all elements of the improvements identified and updated timescales. (See requirement 3). The provider told us that they planned to install new dementia friendly signage. The provider should complete the King's Fund dementia audit to identify other ways in which the environment could be improved to meet the needs of residents living with dementia. The provider should consider putting in place arrangements to enable residents and their guests to be able to independently access water and other beverages. Some residents and staff told us that during the busy periods of the day staff could be overstretched and residents sometimes had to wait longer to receive support. In order to ensure that a sufficient number of staff are available at all times, the provider needs to undertake a formal assessment of the staffing requirements of the home which takes into account the dependency levels of all the residents and the routines of the home. (See recommendation 1). The provider should continue to develop and implement the formal quality assurance arrangements to ensure that minimum standards are maintained and that continuous improvement in the service is supported. The provider should consider undertaking focus areas to support improvements in various areas of practice such as falls prevention and personal planning. It would be beneficial for the provider to develop a service action plan to support reviewing of progress in meeting all identified areas for improvement. (See recommendation 2). The provider should consider whether practice leads could play a key role in completing in-house quality assurance checks for their lead areas. Requirements Number of requirements: 3 1. The service provider must continue to review all residents' personal plans to ensure that they are of a suitable standard. This should include ensuring that: - each resident's care and support needs are clearly identified. - all elements of each resident's personal plan has been completed meaningfully and is up-to-date. - key information about needs and risks is easy to access. - appropriate records are maintained which enable the care and support provided to be evaluated. - all information about any legal powers is recorded and kept up-to-date. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210), Regulation 4(1)(a) - Welfare of Users; and Regulation 5 - Personal Plans. page 5 of 8
Timescale: A significant improvement should be evident by 30 November 2017. 2. The provider should further develop its fall prevention approach through the implementation of the individual multifactorial risk assessment contained in 'Managing falls and fractures in care homes for older people' published by the NHS Scotland and the Care Inspectorate. The provider should ensure that information from accident records is used to review the risk assessments and to ensure that any further action necessary to prevent further falls is clearly documented. Clearer evidence should be available of how falls analysis information is actively used to identify potential trends. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, (SSI 2011/210) Regulation 4 (1)(a) - Welfare of users and Regulation 10 - Fitness of premises. Timescale: To be completed by 30 November 2017. 3. The provider must, in consultation with staff, residents and relatives, develop an updated environmental improvement plan with timescales. A copy should be submitted to the Care Inspectorate. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, (SSI 2011/210) Regulation 4 (1)(a) - Welfare of users and Regulation 10 - Fitness of premises. Timescale: To be completed by 30 September 2017. Recommendations Number of recommendations: 1 1. In order to ensure that adequate numbers of staff are available at all times to meet the care and support needs of residents, the provider should continue to review staffing levels. This should include maintaining a record of the assessment that identifies service users' dependency levels and the minimum staffing levels and deployment of staff on each shift. This will take into account the needs, views and experiences of service users and the routines of the home. National Care Standards Care Homes for Older People - Standard 5: Management and staffing arrangements. Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at www.careinspectorate.com. page 6 of 8
Inspection and grading history Date Type Gradings 28 Feb 2017 Unannounced Care and support 4 - Good Not assessed Not assessed Management and leadership 4 - Good 22 Jan 2016 Unannounced Care and support 4 - Good 4 - Good 4 - Good Management and leadership 4 - Good 6 Mar 2015 Unannounced Care and support Management and leadership 19 Jun 2014 Unannounced Care and support Management and leadership 31 Jan 2014 Unannounced Care and support Management and leadership 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