New Monteith House Care Home Care Home Service Adults New Monteith House Care Home Carstairs Lanark ML11 8QP

New Monteith House Care Home Care Home Service Adults New Monteith House Care Home Carstairs Lanark ML11 8QP Inspected by: Ann Marie Hawthorne Alison Iles Type of inspection: Unannounced Inspection completed on: 22 July 2013

Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 6 3 The inspection 12 4 Other information 28 5 Summary of grades 29 6 Inspection and grading history 29 Service provided by: Monteith House Limited Service provider number: SP2011011422 Care service number: CS2011281041 Contact details for the inspector who inspected this service: Ann Marie Hawthorne Telephone 01698 897800 Email enquiries@careinspectorate.com New Monteith House Care Home, page 2 of 30

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 3 Adequate Quality of Environment 2 Weak Quality of Staffing 2 Weak Quality of Management and Leadership 3 Adequate What the service does well In the previous inspection we were encouraged to see that a change of management and leadership within the service had contributed to an improvement in the care and support provided. We could see that improvement was being sustained in all quality statements. We could see that the new manager had established links between the home and a range of external agencies. What the service could do better The service needs to continue to develop regular and accurate maintenance and environmental safety checks. They also need to review recruitment practice in relation to existing staff and any new staff being employed. What the service has done since the last inspection The service had taken action to develop some aspects of the environment. They had established links with external health and social care agencies and were continuing to provide good care and support for people helping them to achieve good outcomes. Conclusion There are a number of aspects of this home that continue to need improved and developed, however residents and their relatives were positive in their views of the home and we saw that for some people outcomes were good. We saw that some New Monteith House Care Home, page 3 of 30

progress had been made and that the manager was committed to continuous improvement within this home. Who did this inspection Ann Marie Hawthorne Alison Iles New Monteith House Care Home, page 4 of 30

1 About the service we inspected The service is provided from a very large "Category A" listed building in its own grounds. It is situated in a rural area of Carstairs, with the small village of Carstairs a short drive from the care home service which has transport links and some small local shops. Users and visitors to and from the service would require transport to and from Carstairs Village and beyond as there are no public transport facilities in the immediate vicinity of the home. The care service provider is Monteith House Limited. The service was registered with the Care Inspectorate in October 2011 to provide a care service to up to twenty five service users, of whom fourteen may be older people accommodated on the ground floor, and a maximum of eleven may be younger service users, who have mental health or physical needs, and will be accommodated on the upper floor. At the time of this inspection there were eight service users living in the ground floor of the home and six younger adults living in the upper area of the home. There was also a large kitchen and laundry located in wings of the building that were not residential. Communal rooms, corridors and bedrooms were large and spacious. Bedrooms had en-suite facilities and most provided an open outlook to the surrounding countryside. We saw evidence of new carpets, curtains and furnishings in some of the bedrooms. Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 3 - Adequate Quality of Environment - Grade 2 - Weak Quality of Staffing - Grade 2 - Weak Quality of Management and Leadership - Grade 3 - Adequate 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 0845 600 9527 or visiting one of our offices. New Monteith House Care Home, page 5 of 30

2 How we inspected this service The level of inspection we carried out In this service we carried out a high 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 We compiled this report following an unannounced inspection. The inspection took place between 10:30 and 21:30 on the 22nd July 2013. The inspection was carried out by inspectors Ann Marie Hawthorne and Alison Iles. Following the inspection feedback was given to the manager. During the inspection we gathered information from various sources, including: relevant sections of policies and procedures, records and other documents; Registration certificate Participation policy Policies and procedures Minutes of meetings Questionnaires Accidents and incidents Complaints Staff training and supervision Personal plans Medication records Maintenance records We also spoke to service users, staff and relatives. We observed staff practice, looked at the environment and activities and the dining experience. 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 Inspection Focus Areas (IFAs) 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 New Monteith House Care Home, page 6 of 30

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 New Monteith House Care Home, page 7 of 30

What the service has done to meet any requirements we made at our last inspection The requirement The care service provider must ensure the home is safe and secure at all times and service users are protected. Safety measures identified to the service provider at feedback must be acted upon immediately in order to maintain the safety of service user and staff. A person responsible for risk assessing the premises on a regular basis must be appointed in order to ensure the safety and protection of the people who live, work and visit the care home. Appropriate records must be kept of the environmental risk assessment and what action was taken and when. 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 (1) - Fitness of premises. Timescale for completion:one month from receipt of this report. What the service did to meet the requirement The provider had taken action to secure and restrict access to areas within the home that had been identified as potential hazards. The requirement is: Met - Within Timescales New Monteith House Care Home, page 8 of 30

The requirement The provider must ensure that if service users choose to lock their doors that all staff can gain direct access in the event of an emergency situation. If necessary the provider should consider changing the current locks to a mechanism that allows bedroom doors to be opened without the use of a key. 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 Timescale for completion: to begin immediately and be completed within one month from receipt of this report. What the service did to meet the requirement As an interim measure, the provider had issued a master key to staff which enabled them to access all rooms in the event of an emergency. They also informed us that new doors had been sourced with more appropriate locking mechanisms. The requirement is: Not Met Inspection report continued The requirement The service provider must complete the garden area as stated in the conditions of registration in order to provide the service users with an accessible outdoor space. 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 10(2) (a) - Fitness of premises. The Social care and Social Work Improvement Scotland (Applications) Regulations 2011 (SSI 2011/29), Regulation 4(1) (a), (2)- Variation, removal and addition of conditions. Timescale for completion:one week from receipt of this report. What the service did to meet the requirement Work in the garden area had been completed at the time of this inspection. The requirement is: Met - Within Timescales The requirement All staff must have a Protection of Vulnerable Adults check performed and returned prior to commencing employment in the care home. The provider must also ensure that all staff have the skills, knowledge and expertise to carry out the role they are employed for. All staff must participate in induction,mandatory and role-specific training. 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 9(1) - Fitness of employees. and The Social care and Social Work Improvement New Monteith House Care Home, page 9 of 30

Scotland (Requirements for Care services) Regulations 2011 (SSI 2011/210), Regulation 15(a) (b) - Staffing Timescale for completion: with immediate effect as discussed at feedback with the manager. What the service did to meet the requirement We identified that there continue to be areas of concern in relation to recruitment within this home. We will repeat this requirement. The requirement is: Not Met 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. We did not receive a self assessment prior to this inspection. Taking the views of people using the care service into account The people that we met during this inspection told us that they liked living within new Montieth House. We received four completed care standard questionnaires from people who live within this care home, one person commented that the "care is very good". All four respondents agreed or strongly agreed with the statement "I am treated fairly" and "I am encouraged to discuss any views about the care home". When we spoke to residents they told us that they liked the food and that it was "always lovely", another said they enjoyed the garden and the views from the dining area. One person told us that the staff within the service went out of their way to be helpful. Taking carers' views into account We did not have the opportunity to meet with relatives /carers during this inspection. We received two completed care standard questionnaires from relatives prior to the inspection and both respondents agreed or strongly agreed with all quality statements within the questionnaire, for example, "My relative/friend is encouraged to discuss any concerns or views about the care home with their key worker, with New Monteith House Care Home, page 10 of 30

other residents, or with management of the care home" and "I am confident that my relative/friend is safe and secure in the care home". New Monteith House Care Home, page 11 of 30

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: 3 - Adequate 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 We have considered participation across all of the quality themes within this statement. The manager had developed a new participation strategy and was reviewing the way in which the views of the people who use this service and their families were sought and the way in which these were captured and shared to influence the service. We saw a folder which contained a range of photographs and documents to evidence that views had been sought. and action taken in response to the views and wishes of people living within this service, for example, in January 2013, someone had requested that the minister carried out a service within the home, this started to happen in May 2013. We saw feedback from people who had attended indicating that they had enjoyed this. We saw that residents had asked for pamper sessions to start, this was facilitated and started in April 2013, we saw that the manager had captured a range of positive statements evaluating the service these indicated that the outcome had been good for people. People said, " I loved it", "It was good","yes beautiful nice smell". One person has been very involved in planting in the garden, he had been shopping to choose plants and worked with the handyman to plant them. We saw further examples that people were enjoying a range of experiences based on what they had asked for and we thought this was good practice. New Monteith House Care Home, page 12 of 30

People were also asked for their views about the environment, bedroom areas were personalised and we saw that where requests for changes to be made that these were responded to positively. We saw a range of thank you cards from relatives, we saw that one relative of a recently deceased resident stated that " My uncle was a resident and the staff were very good to him, they let him keep his dog and walked it and fed it when my uncle couldn't, they phoned us regularly to let us know how he was getting on, we wouldn't have wanted any more. Thank you" We saw that people were being supported to celebrate birthdays and seasonal or local events, people had gone to the theatre. One family had written to thank the manager and the staff on behalf of their relative, they said " Thank you all for helping to make [name}, birthday so special for him and us. He clearly enjoyed himself as did all the guests who attended. Once again thanks to all who rose to the occasion and were very helpful on the day". We saw that a range of meetings had been set up and that the manager had informed everyone that she had an open door policy and could be approached to discuss all matters at any time. The advocacy project in South Lanarkshire is advertised in the reception area and can be accessed by service users. An advocacy policy has been written and implemented. Areas for improvement A service user/carer questionnaire has been devised - this covered four quality themes and is in the process of being distributed. Service user and Carer meetings have been commenced (although first planned carers meetings were not attended therefore all relatives were asked when they would prefer to have meetings and this is being addressed). The manager planned to suggest at the next carer meeting that perhaps carers would like to form their own committee and thus be able to discuss issues independently and then bring the ideas from these forward to the service. The Manager is also looking for an independent chair to hold service users meetings to ensure that discussions and decisions are not staff led or influenced. They are also reviewing the most appropriate way to engage with relatives and carer as meetings have not previously been well attended. We will look at ways in which participation has been developed at the next inspection. Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0 Inspection report continued New Monteith House Care Home, page 13 of 30

Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths People that we met who were living within this home at the time of the inspection looked well. Staff were seen to interact with people in a way that was respectful and took account of their individual needs and wishes. We saw examples of people being supported in activities of their choice, one person was being supported to do the garden, another had been supported to go fishing. People were sitting in small groups with staff facilitating discussion around the daily newspaper. People were dressed comfortably and appropriately for the warm weather conditions on the day of the inspection. We could see from the personal plans and from discussion with the service manager that there are a number of good links established with health professionals from multi disciplinary teams and with the care home liaison service. We saw evidence that members of these teams had been involved in supporting the service in a number of ways to achieve good outcomes for people. People who live in the home were supported from one GP practice, there were good links with the GP. The home manager had introduced a range of risk assessments and support plans for where additional needs had been identified, these included falls risk assessment, nutritional status, hydration assessment, mobility and continence assessments for each resident. We were satisfied these tools were being used appropriately and independent advice sought when required from the dietician, speech and language therapist and GP. We could see that six monthly reviews had been taking place with service users and relatives being invited to participate in these. A guardianship checklist had been put in place and there was information in each plan that we looked at about who had the legal powers to make decisions for each individual in relation to Adults with Incapacity (Scotland) Act 2000. We looked at nutrition within this home and saw that the menus incorporated a range of varied balanced foods. the service use the Malnutrition Universal Screening Tool to monitor weights, we saw these were in place and completed accurately. people were offered a range of snacks, fresh fruit and drinks throughout the day. We saw that tables were nicely set with menus displayed. People told us the food was "excellent", they told us they always had enough to eat. Areas for improvement Inspection report continued We looked at medicine management within the home, we saw that some systems were in place to reflect good practice, fr example, there was a homely remedy protocol which was signed by the GP and the home manager. However we saw that there were inaccuracies in the dosage of medicines being administered. We also observed that where as required medicine was being administered there was no New Monteith House Care Home, page 14 of 30

narrative being recorded on the back of the medicine administration record to indicate why this was given or how effective it had been for the person. We also saw that hand written entries on the medicine administration record did not reflect best practice (requirement 1). We saw that the support needs of those living within this care home vary greatly. We saw some very good support plans that were in place to support people who have a history of behaviour described as challenging, however there is a need for these to be developed to ensure that they clearly specify steps that need to be taken to manage behaviour where redirection and diffusion do not work. This should reflect steps that will be taken to protect other, often more vulnerable people living within this care home and should be known to and complied with by staff who are trained and competent in the management of challenging behaviour (recommendation 1). We saw good examples of risk assessments being reviewed in partnership with residents, families and professionals involved in care for individuals who had left the building unattended, however, we did not see reference to best practice guidance or pathways to ensure that the rights of individuals were being upheld. We also saw some examples of staff signing documents on behalf of residents, this is not good practice (recommendation 2). There were no dental services being accessed for people who live within this home, the manager had identified this as an area for development and we will look at progress with this at the next inspection. Grade awarded for this statement: 4 - Good Number of requirements: 1 Number of recommendations: 2 Requirements Inspection report continued 1. The provider must ensure that; medication is administered as prescribed; this must include a)checking that the dosage is accurate; b)checking that the Medication Administration Records are signed both on the front and, where appropriate on the back sheet each time medication is given; c)compliance with best practice when writing entries onto the Medication Administration Records, that is to ensure that handwritten entries are written clearly, accurately and include the date, detail of the change in prescription, the identity of the prescriber authorising the change in medicine, and the identity of the person making the handwritten entry This is in order to comply with the Social Care Social Work Improvement Scotland (Requirements for Care Services) Regulations 201 1, SSI/201 1/210 regulation 4(1)(a). Timescale within 4 weeks of receipt of this report. New Monteith House Care Home, page 15 of 30

Recommendations Inspection report continued 1. The provider should ensure that support plans and risk assessments that are in place are reviewed to ensure that they reflect steps that need to be taken until the situation is diffused. This should consider the safety of other residents. National Care Standards 9 Care Homes for Older People - Feeling Safe and Secure 2. The provider should review the practice within the home in relation to the use of assistive technology and in relation to the knowledge and skills of the staff team and ensure that best practice guidance issued by the mental welfare association (Scotland) is reflected at al times. National Care Standards 6 Care Homes for Older People - Supporting Arrangements New Monteith House Care Home, page 16 of 30

Quality Theme 2: Quality of Environment Grade awarded for this theme: 2 - Weak Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the environment within the service. Service strengths We have considered this quality statement in the narrative under quality statement 1.1 Areas for improvement We have considered this quality statement in the narrative under quality statement 1.1 Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0 Statement 2 We make sure that the environment is safe and service users are protected. Service strengths We saw that health and safety meetings take place and that action plans are developed from these. We saw that where issues had been identified, there was evidence that action had been taken to address concerns. We looked at the maintenance records and saw that it was being used appropriately to record areas for improvement and action taken. We saw that safety checks had been carried out on portable electrical equipment. We saw that areas of concern identified within the previous inspection in relating to safety in areas of the home that were not in use had been addressed and that the building had been secured and access restricted. The home was clean and fresh, it was odour free. Areas for improvement At the previous inspection we identified that door locks in bedrooms were not satisfactory. While staff had been issued with a master key as an interim measure, action had not been taken to replace the locks on the bedroom doors. We have made New Monteith House Care Home, page 17 of 30

this a repeat requirement (requirement 1). We also identified that some bedroom doors have windows which compromise privacy for residents, we have asked the manager to address this and we will look at progress at the next inspection. In some areas of the home the hot water was tepid, hot water checks were not being carried out monthly, we looked at checks carried out on shower heads and identified that these had not all been checked. The legionella certificate expired in April 2013. The service have identified that some aspects of the environment should be checked daily, this is not carried out at weekends or during any leave that the maintenance person may have. We looked for evidence that safety checks were being carried out on equipment, for example wheelchairs and bedrails, we did not see any records of this (requirement 2). There is a designated area within the home or the use of people who smoke, we saw that monitoring checks are not taking place regularly, we also identified that ventilation is poor and that ashtrays are shallow and glass. We did not see individual risk assessments in place for residents who smoke (requirement 3). We looked at the treatment room available on the lower floor and identified that it was very small with no ventilation and poor lighting. Room temperatures were being recorded at 27º with no action being taken to ensure the room temperature was maintained at less than 25º (requirement 4). We identified that there were no residency agreements in place, we discussed this with the manager and work is ongoing to ensure these are developed for all residents, we will look at progress with this at the next inspection. We identified that in the upstairs area, hallway hosted a desk, telephone, staff notices and confidential resident information, we did not see this as homely or confidential and we have asked the manager to address this, we will look at progress at the next inspection. Grade awarded for this statement: 2 - Weak Number of requirements: 4 Number of recommendations: 0 Requirements 1. This is a repeat requirement; Inspection report continued The provider must ensure that if service users choose to lock their doors that all staff can gain direct access in the event of an emergency situation. If necessary the provider should consider changing the current locks to a mechanism that allows bedroom doors to be opened without the use of a key. New Monteith House Care Home, page 18 of 30

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 Timescale for completion: to begin immediately and be completed within one month from receipt of this report. 2. The provider must develop a matrix of all checks that need to be carried out at what frequency to ensure the safety of the environment within this home. They must ensure that systems are put in place so that all checks happen to comply with the frequency stated. This is in order to comply with SSI 2011/210 Fitness of premises 10.-(1) A provider must not use premises for the provision of a care service unless they are fit to be so used. (2) Premises are not fit to be used for the provision of a care service unless they - (a)are suitable for the purpose of achieving the aims and objectives of the care service as set out in the aims and objectives of the care service;. (b) are of sound construction and kept in a good state of repair externally and internally;. (c) have adequate and suitable ventilation, heating and lighting; and. (d) are decorated and maintained to a standard appropriate for the care service. Timescale for completion: to begin immediately as discussed with the manager during feedback. 3. The provider must ensure that a risk assessment is in place for all residents of this home who smoke and who use the designated smoke area. they must also review the environmental risk assessment for this area and ensure that staff comply with the requirement to check the area at regular intervals identified through the risk assessment process and that action is taken to improve ventilation and make the area safe. 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 Timescale for completion: to begin immediately as discussed with the manager during feedback. 4. The provider should review the area identified as a treatment room on the ground floor of this home and take steps to ensure that the area is fit for purpose and that the temperature is maintained at less than 25º. This is in order to comply with SSI 2011/210 Fitness of premises 10.-(1) A provider must not use premises for the provision of a care service unless they are fit to be so used. (2) Premises are not fit to be used for the provision of a care service unless they - (a)are suitable for the purpose of achieving the aims and objectives of the care service as set out in the aims and objectives of the care service;. (b)are of sound construction and kept in a good state of repair externally and internally;. New Monteith House Care Home, page 19 of 30

(c)have adequate and suitable ventilation, heating and lighting; and. (d) are decorated and maintained to a standard appropriate for the care service. Timescale for completion: to begin immediately as discussed with the manager during feedback. New Monteith House Care Home, page 20 of 30

Quality Theme 3: Quality of Staffing Grade awarded for this theme: 2 - Weak Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service Strengths We have considered this quality statement in the narrative under quality statement 1.1 Areas for improvement We have considered this quality statement in the narrative under quality statement 1.1 Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0 Statement 2 We are confident that our staff have been recruited, and inducted, in a safe and robust manner to protect service users and staff. Service strengths We saw that application forms that were in place and had been subject to relevant checks with professional bodies like the Scottish Social Services Council and the Nursing and Midwifery Council. These were recorded in the files. We saw some evidence that professional references had been obtained. We saw relevant safety checks had been performed in terms of the Protection of Vulnerable Adults scheme (PVG) and dates received recorded in some of the files. Areas for improvement We were concerned with some of the observations that we made in relation to safe recruitment within this home. We saw evidence that checks had not been carried out on residence permits, we discussed this with the manager and asked that immediate action be taken to clarify the status of staff in relation to eligibility to work in the UK (requirement 1). We were concerned to see that documentation indicated that employee start dates were prior to the date of receipt of information from the Protection of Vulnerable Adults scheme (PVG), or obtaining satisfactory references. We suggest that the New Monteith House Care Home, page 21 of 30

provider implement best practice outlined in Safer recruitment through better recruitment: Guidance in relation to staff working in social care and social work settings Scottish Executive 2007) which states that "In any case where a reference has not been obtained on the preferred candidate before interview, the prospective employer must ensure that it is received and scrutinised, and any concerns are resolved satisfactorily, before the person's appointment is confirmed". We identified that robust recruitment had not been followed for people who had been promoted into more senior roles within the home, references had been obtained for some staff from senior staff employed within the home and this is not good practice (requirement 2) (requirement 3). Grade awarded for this statement: 2 - Weak Number of requirements: 3 Number of recommendations: 0 Requirements 1. The provider must insure that all staff employed within this home are eligible to work within the UK and should introduce systems to monitor residency status of employees. This is in order to comply with SSI 2011/210 Fitness of employees 9.-(1) A provider must not employ any person in the provision of a care service unless that person is fit to be so employed. Timescale for implementation: With immediate effect as discussed with the manager at feedback. 2. This is a repeat requirement Inspection report continued All staff must have a Protection of Vulnerable Adults check performed and returned prior to commencing employment in the care home. The provider must also ensure that all staff have the skills, knowledge and expertise to carry out the role they are employed for. All staff must participate in induction, mandatory and role-specific training. 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 9(1) - Fitness of employees. and The Social care and Social Work Improvement Scotland (Requirements for Care services) Regulations 2011 (SSI2011/ 210), Regulation 15(a) (b) - Staffing Timescale for completion: with immediate effect as discussed at feedback with the manager. 3. The provider must ensure that they obtain satisfactory references prior to the appointment of any new staff to this service. New Monteith House Care Home, page 22 of 30

This is in order to comply with SSI 2011/210 Welfare of users 4.-(1) A provider must - (a)make proper provision for the health, welfare and safety of service users; Timescale for completion: with immediate effect as discussed at feedback with the manager. Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths The provider had introduced monthly staff meetings, we could see from the minutes of these meetings that they discussed a range of relevant issues including, for example, the need to ensure that a minimum of two staff were present on each floor of the home, activities, breaks, mobile phones, resident care etc. This forum was also used to focus on the 'policy of the month', we thought this was good practice. We saw evidence of a range of training having taken place in, for example, moving and handling, fire safety, managing challenging behaviour, oral health, dignity and respect, meaningful activities and dementia awareness. We saw that links had been made with a range of health professionals and that staff from this home had been involved in training in partnership with NHS Lanarkshire in anticipatory care. Many of the aforementioned training programmes had been provided my community nursing services and links were being developed with community mental health teams and community learning disability teams. We saw that staff had been supported through return to work interviews after a period of absence. Areas for improvement The provider needs to develop systems to make sure that staff who are at present at staff meetings are provided with the opportunity to raise any issues through the agenda and are provided with information resulting from the meetings, we will look at the way in which the manager has addressed this at the next inspection. The manager should develop a system to ensure that all staff are registered in accordance with the requirements of the Scottish Social Services Council. There is evidence that supervision is taking place but that there is a need to clarify lines of responsibility for supervisors. A schedule of supervision dates had been set but dates had all expired. Supervision was not identifying areas of development for staff. We noted that the range of training being facilitated for staff is good, however there is no systematic approach to this and no training matrix in place to identify New Monteith House Care Home, page 23 of 30

training that has been identified as required or training that has taken place and when. The training matrix needs to reflect that training is being identified to develop staff across the broad range of care needs that this home meets, in particular training in learning disability, acquired brain injury and mental health. We discussed this with the manager and we are aware that this is an area being developed, we will look at the progress in this at the next inspection. Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0 Inspection report continued New Monteith House Care Home, page 24 of 30

Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 3 - Adequate 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 We have considered this quality statement in the narrative under quality statement 1.1 Areas for improvement We have considered this quality statement in the narrative under quality statement 1.1 Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0 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 saw that the manager had recently introduced a range of audits which were being carried out monthly, these included, for example, care plan audits, infection control audits (three monthly), meal time audits, environmental audits, these were very comprehensive. The manager was in the process of involving the wider staff team in the audit process, this approach encourages accountability in staff and can have a positive influence on standards of care and support. We will look at how this has developed and how audit has been used to influence the quality of the service provided at the next inspection. The manager had started a system of auditing incidents and accidents. The tools that had been introduced for audit were good and incorporated information about actions taken and people contacted as an outcome of these events and links to review of risk assessments. The manager should continue to develop this system of audit. Daily meetings had been taking place with department heads including housekeeping, catering, maintenance and laundry staff to identify and address any New Monteith House Care Home, page 25 of 30

issues and aid good inter-departmental communication. Questionnaires were being distributed to ask service users, carers and staff what they think of the home and how it operated. Areas for improvement The manager recognised the areas for improvement that were necessary within this home and was fully engaged in supporting improvement. We thought that the quality of management and leadership within the home was improving, however, many of the systems and processed had recently been introduced and we will look at the impact these have had on the service and on outcomes for people who use the service at the next inspection (recommendation 1). The manager of the service had identified that there is a need for external audit to be established within the home, she was in discussion with the provider about ways in which this could happen. We will look at this at the next inspection. Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. The manager of this service should review all systems in place prior to the date on which she commenced post to ensure that any areas of poor practice are identified and action taken, for example an audit of recruitment systems for staff in post. National Care Standards 5 Care Homes for Older People - Management and Staffing Arrangements You experience good quality support and care. This is provided by management and staff whose professional training and expertise allows them to meet your needs. The service operates in line with all necessary legal requirements and best-practice guidelines (see annex B). 1 You can be assured that the home has policies and procedures which cover all legal requirements, including: - staffing and training; - administration of medication; - health and safety; - 'whistle-blowing'; - environmental health; - fire safety; - managing risk; - proper record-keeping, including recording incidents and complaints; and - visits made to the home, including visits by children. New Monteith House Care Home, page 26 of 30

New Monteith House Care Home, page 27 of 30

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 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). New Monteith House Care Home, page 28 of 30

5 Summary of grades Quality of Care and Support - 3 - Adequate Statement 1 Statement 3 3 - Adequate 4 - Good Quality of Environment - 2 - Weak Statement 1 Statement 2 3 - Adequate 2 - Weak Quality of Staffing - 2 - Weak Statement 1 Statement 2 Statement 3 3 - Adequate 2 - Weak 3 - Adequate Quality of Management and Leadership - 3 - Adequate Statement 1 Statement 4 3 - Adequate 3 - Adequate 6 Inspection and grading history Date Type Gradings 13 Sep 2012 Unannounced Care and support 3 - Adequate Environment 3 - Adequate Staffing 3 - Adequate Management and Leadership 3 - Adequate 10 May 2012 Unannounced Care and support 2 - Weak Environment 2 - Weak Staffing 2 - Weak Management and Leadership 2 - Weak All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. New Monteith House Care Home, page 29 of 30

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 0845 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 0845 600 9527. Translations and alternative formats This inspection report is available in other languages and formats on request. Telephone: 0845 600 9527 Email: enquiries@careinspectorate.com Web: www.careinspectorate.com New Monteith House Care Home, page 30 of 30