Aden House (Care Home) Care Home Service Adults 5 Annfield Road Inverness IV2 3HX Telephone: 01463 234667 Inspected by: Shona Smith Type of inspection: Unannounced Inspection completed on: 21 March 2014
Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 13 4 Other information 21 5 Summary of grades 22 6 Inspection and grading history 22 Service provided by: Mr Malcolm McKinlay Service provider number: SP2005007555 Care service number: CS2003008467 Contact details for the inspector who inspected this service: Shona Smith Telephone 01463 227630 Email enquiries@careinspectorate.com Aden House (Care Home), page 2 of 24
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 N/A Quality of Staffing 4 Good Quality of Management and Leadership N/A What the service does well The home consults with residents and their families and staff were seen to promote choice in all daily activities. Staff are committed to providing good standards of care. Management and staff were friendly and approachable. What the service could do better The home is surrounded by attractive gardens but residents cannot access these safely unless accompanied by staff. There are plans in place to develop an enclosed garden area that residents will be able to access independently. Care plans and risk assessments for residents should be further developed to ensure that there is information, support and guidance for staff for all identified needs and risks. Accidents and incidents should be evaluated for possible action to prevent reoccurrence. The manager hopes to introduce falls assessment tools. Staff providing personal care should have safe people handling. Aden House (Care Home), page 3 of 24
What the service has done since the last inspection There has been some refurbishment to bedrooms and a wet shower room has been created. Residents have been consulted about the menu. Inspection report continued More staff have been working to complete a Scottish Vocational Qualification (SVQ). Conclusion This small residential care home is highly valued by relatives and residents. The service provides a homely and welcoming atmosphere. The manager and staff work together to provide a good standard of care. Who did this inspection Shona Smith Aden House (Care Home), page 4 of 24
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 was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April 2011. Requirements and recommendations If we are concerned about some aspect of a service, or think it could do more to improve its service, 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. - A requirement is a statement which sets out what is required of a care service to comply with the Public Services Reforms (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 Inspectorate. Aden House is a privately owned care home. It is located in a large Victorian detached house that has been extended to provide single bedrooms which all have en-suite toilets and wash basins. The house sits in large landscaped gardens in a residential area of Inverness within easy reach of the amenities of the city centre. The service's philosophy is to 'create a homely atmosphere and comfortable lifestyle whilst encouraging residents to be as independent as possible'. The aims and objectives of the service are to 'provide a high level of quality care in a warm, friendly, safe environment where residents' privacy, dignity and independence are respected. The service aims to promote a culture of 'respect for all'. Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade Quality of Environment - N/A Quality of Staffing - Grade Quality of Management and Leadership - N/A Aden House (Care Home), page 5 of 24
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. Aden House (Care Home), page 6 of 24
2 How we inspected this service The level of inspection we carried out In this service we carried out a low intensity inspection. We carry out these inspections when we are satisfied that services are working hard to provide consistently high standards of care. What we did during the inspection We wrote this report following an unannounced inspection which was carried out by Shona Smith, Care Inspector. We visited the home on 20 and 21 March between the hours of 9.30am and 6.30pm. We provided feedback to the registered manager and the provider at the end of the visit. The feedback included requirements, recommendations and areas of improvement made as a result of these visits. The purpose of this visit was to follow up the requirements, recommendations and areas of improvement made in the last report to see what progress had been made. During the inspection process we gathered evidence from various sources, including the following: We spoke with: * Three people who use the service. * Two relatives. * Provider. * Registered manager. * Depute manager and activity organiser. * One senior carer. * Two carers. We looked at: * Personal plans of people who use the service. * Formal care reviews and records. * Participation information, including results of questionnaires. * Accident and incident records. * Risk assessments. * Minutes of residents' and relatives' meetings. * Notice boards. * Newsletter. * Health and safety records. Aden House (Care Home), page 7 of 24
We observed staff interacting with residents and looked round the building and grounds and at the equipment used. *Consideration of the National Care Standards - Care homes for older people. 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 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 Aden House (Care Home), page 8 of 24
What the service has done to meet any requirements we made at our last inspection The requirement It is required that the provider ensures that all residents within the care home have a written personal plan in place. This should assess and record all identified health, welfare, social and safety needs and how these are to be met and the plans implemented. Each plan should detail how you intend to promote the independence of each service user and make proper provision for their health, welfare and safety. There should be evidence that the service user or relative/carer (where appropriate) have been involved in the development of their personal plan. This is in order to comply with: Regulations 5(1)(a) of the Social Care and Social Work Improvement Scotland (Requirements of Care Services) Regulations 2011 Scottish Statutory Instrument 2011/210. Timescale for this requirement - three months from receipt of this report. In making this requirement we also took into consideration the National Care Standards for Older People: Standard 6 - Support Arrangements. What the service did to meet the requirement This requirement has not been met. It is reported in statement 1.3 and requirement will be continued. The requirement is: Not Met Aden House (Care Home), page 9 of 24
The requirement All accidents and incidents should be reviewed and evaluated.they should be linked to the risk assessment process where appropriate. All identified risks to residents should be fully assessed and recorded along with the measures and support to be put into place by staff to ensure that residents are kept safe whilst promoting and maintaining their independence. All risk assessments should be kept under review and updated as required. This is in order to comply with: Regulations 4(1)(a)of the Social Care and Social Work Improvement Scotland (Requirements of Care Services) Regulations 2011 Scottish Statutory Instrument 2011/210. In making this requirement we also took into consideration the National Care Standards for Older People: Standard 9 - Feeling Safe and Secure. What the service did to meet the requirement This requirement has not been met and will be continued. It is reported in statement 1.3. The requirement is: Not Met Inspection report continued The requirement The provider must ensure that all persons employed in the provision of the care service receive training appropriate to the work they are to perform and suitable assistance for the purpose of obtaining further qualifications appropriate to their work. Priority should be given to moving and handling training for new staff and restraint training for all staff. This is to comply with SSI 2011/110 15 9(a) Staffing. Timescale - within eight weeks of receipt of this report. What the service did to meet the requirement This requirement has not been met and will be continued. It is reported in statement 3.3. The requirement is: Not Met What the service has done to meet any recommendations we made at our last inspection N/A Aden House (Care Home), page 10 of 24
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 Inspection report continued 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 received a fully completed self assessment document from the service provider. We were satisfied with the way the service provider had completed this and with the relevant information they had given us for each of the headings that we grade them under. The service provider identified what they thought they did well, some areas for development and any changes they planned. Taking the views of people using the care service into account We spoke with three residents who all made complimentary remarks about the care home and the staff. Comments included: "It is second best to being at home" "This is the best care home in Inverness" "The staff are kind to all the residents. I have never heard them being short or impatient with them" " The food is fine. I have never had to leave anything" "There is a nucleus of very good staff though some staff have not got a clue" Taking carers' views into account We spoke with two carers ( eg relatives or friends of the resident). Both were positive about the quality of care their friend/relative received. "I am very happy that she is staying here. All the staff are very good with her. They let me know of any problems" Aden House (Care Home), page 11 of 24
"I think she is settling well here. They are very welcoming to me. I am always offered a cup of tea" Aden House (Care Home), page 12 of 24
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 We decided that the service grade for this statement should continue to be very good. We concluded this after we spoke with management, staff, residents and relatives. We also looked at the results of questionnaires and minutes of meeting. There were a number of ways that residents and their families could influence the service. These included: Keyworker system. The keyworker's role was to get to know the resident(s) they were responsible for and to sort out any concerns the resident might have. Care plan reviews. Each resident had a care plan which assisted staff to know how to meet their health and well being needs. These plans were reviewed usually within 6 monthly periods. Reviews were a good opportunity for the resident or a close relative to highlight any issue to improve the care of that person. The provider and management were accessible and approachable. There was an open door policy and the manager also advertised specific times sometimes in the evenings when she was available. Residents spoken with confirmed that they would speak to the manager if they had any complaints. Questionnaires- These were issued to residents, relatives and staff annually. Results were collated and management followed up specific issues. Aden House (Care Home), page 13 of 24
Meetings - There was a meeting held approximately bi-annually for residents and their families to meet with management to discuss the service and hear about any new developments. Consultations - Management and staff consulted with residents, for example, about the menu. Recently there had been tastings of new dishes organised which had influenced the menu. Information - The service provided residents and their families information about the service in a variety of ways including the welcome pack, notice boards, the written agreement, website and newsletters. Areas for improvement Management should continue to consider how to involve all residents in meaningful participation including those with dementia and communication difficulties. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths We decided that the service grade continued to be adequate after we looked at care plans, reviews, accident records and other documents. We also spoke to staff and residents. The purpose of this visit was to assess progress to meet the two requirements made from the last inspection. We found that both requirements had not been met. (See areas of improvement). Residents spoken with were happy with the food provided in the home. Menus displayed were appetising and varied. Residents generally enjoyed mealtimes. If staff were concerned about a resident's nutrition they were weighed more regularly and a referral was made to the dietician through the GP. We found that staff knew the residents and tried to meet their individual needs. Care plans showed that some of the personal knowledge about preferences and health and care needs were recorded. There was some information about residents' background and who was important to them in the care plans. Aden House (Care Home), page 14 of 24
We looked at medication arrangements. At present each resident had their medicines kept in a locked cupboard in their bedroom. Most have been assessed as needing help from staff with their medicines. Staff received training and were observed before they were able to give out medicines on their own. Areas for improvement Management had made little progress to meet the requirements made as it was stated that they had experienced staff shortages. Care plans did not give information about all residents' health and wellbeing needs. For example, a resident through mental health problems could have distressed and angry outbursts. There was no information to guide staff as to how to help her and reassure her. There may be details of her past life that might help staff to understand her distress. Some staff may have developed strategies that are successful and these should be recorded. There needs to be more details of residents' food preferences especially when their appetite is poor. (See Requirement 1). A resident was prescribed medicine to try and reduce her distress on an as required basis. There should be details of when this medicine should be given, dose, how often and the signs of success. There should also be details of alternative strategies. We could see that staff were recording on the MAR sheet when as required medication was administered, the dose and the reason for administration. We have made a recommendation about medication arrangements. We found that the controlled drugs were formally checked on a monthly basis. We have discussed this and have recommended that they be checked more frequently. It would be good practice to check daily. (See Recommendation 1). We could see that there had been incidents and accidents including falls which had not been followed up and nothing had been recorded as to how they might be prevented. The manager hoped to introduce the use of appropriate falls assessment tools. We will continue the requirement about accidents made at the last inspection. (See Requirement 2). Grade awarded for this statement: 3 - Adequate Number of requirements: 2 Number of recommendations: 1 Requirements Inspection report continued 1. It is required that the provider ensures that all residents within the care home have a written personal plan in place. This should assess and record all identified health, welfare, social and safety needs and how these are to be met and the plans implemented. Each plan should detail how you intend to promote the independence of each service user and make proper provision for their health, Aden House (Care Home), page 15 of 24
welfare and safety. There should be evidence that the service user or relative/carer (where appropriate) have been involved in the development of their personal plan. This is in order to comply with: Regulations 5(1)(a) of the Social Care and Social Work Improvement Scotland (Requirements of Care Services) Regulations 2011 Scottish Statutory Instrument 2011/210. Timescale for this requirement - Three months from receipt of this report. In making this requirement we also took into consideration the National Care Standards for Older People: Standard 6 - Support Arrangements. 2. All accidents and incidents should be reviewed and evaluated.they should be linked to the risk assessment process where appropriate. All identified risks to residents should be fully assessed and recorded along with the measures and support to be put into place by staff to ensure that residents are kept safe whilst promoting and maintaining their independence. All risk assessments should be kept under review and updated as required. This is in order to comply with: Regulations 4(1)(a)of the Social Care and Social Work Improvement Scotland (Requirements of Care Services) Regulations 2011 Scottish Statutory Instrument 2011/210. Timescale for this requirement is 3 months from receipt of this report. In making this requirement we also took into consideration the National Care Standards for Older People: Standard 9 - Feeling Safe and Secure. Recommendations Inspection report continued 1. It is recommended that management ensure that staff follow good practice with regards to medication arrangements including the need for care plans to support PRN medication, for example, when residents are on 'as required' medicine to relieve the symptoms of distressed and agitated behaviour or for pain relief. Controlled drugs should be checked at frequent intervals. This takes account of National Care Standards: Care homes for Older people - Standard 15 - Keeping Well - Medication. Aden House (Care Home), page 16 of 24
Quality Theme 2: Quality of Environment - NOT ASSESSED Aden House (Care Home), page 17 of 24
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 We continued to find that the service grade for this statement was very good. The evidence reported in statement 1.1 is valid here. Areas for improvement See statement 1.1. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths We decided that the service grade for this statement remained the same as at last inspection - good. We concluded this after speaking to staff, provider, management and residents. We also looked at training and supervision records. Staff spoken with were motivated to provide a good standard of care. They enjoyed their work and thought that morale of staff was high and that management was approachable and supportive. New staff received an induction with a senior member of staff and the new employee shadowed more experienced staff until they felt confident to work on their own. Training records indicated what each member of staff had completed. Several of the experienced staff had a good range of training. Aden House supported staff to gain qualifications in order to register with the Scottish Social Services Council (SSSC). Aden House (Care Home), page 18 of 24
There were regular staff meetings to which staff felt that they could contribute. Staff received an annual appraisal. Areas for improvement Management had difficulties providing safe people handling and there were staff working who had not yet had moving and handling training. There had been training booked for the following month. From the training records we could see that no-one had first aid training. The requirement is continued. Many of the residents had dementia and staff need to understand about this condition and how best to support them. Management should ensure that all providing a service in the care home have an understanding of dementia. 'Promoting Excellence' a framework of levels of knowledge and skills should be used. It is provided by NHS along with the SSSC. All staff should have training appropriate to their role including kitchen, domestic and handyman staff. (See Recommendation 1). Grade awarded for this statement: Number of requirements: 1 Number of recommendations: 1 Requirements 1. The provider must ensure that all persons employed in the provision of the care service receive training appropriate to the work they are to perform and suitable assistance for the purpose of obtaining further qualifications appropriate to their work. Priority should be given to moving and handling training for new staff, training to cope with distressed and challenging behaviour and an appropriate number of staff trained in first aid. This is to comply with SSI 2011/110 Regulation 15 (b) Staffing. Timescale - within eight weeks of receipt of this report. Recommendations 1. It is recommended that all staff should have an understanding of dementia appropriate to their role. This takes account of National Care Standards - Care Homes for Older People - Standard 5 - Management and Staffing Arrangements. Aden House (Care Home), page 19 of 24
Quality Theme 4: Quality of Management and Leadership - NOT ASSESSED Aden House (Care Home), page 20 of 24
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). Aden House (Care Home), page 21 of 24
5 Summary of grades Quality of Care and Support - Statement 1 Statement 3 5 - Very Good 3 - Adequate Quality of Environment - Not Assessed Quality of Staffing - Statement 1 Statement 3 5 - Very Good Quality of Management and Leadership - Not Assessed 6 Inspection and grading history Date Type Gradings 29 Aug 2013 Unannounced Care and support Environment Staffing Management and Leadership 23 Jan 2013 Unannounced Care and support 5 - Very Good Environment Staffing Management and Leadership 2 Oct 2012 Unannounced Care and support 5 - Very Good Environment Staffing Management and Leadership 22 Mar 2012 Unannounced Care and support Environment Staffing 3 - Adequate Management and Leadership Aden House (Care Home), page 22 of 24
9 Feb 2011 Unannounced Care and support 5 - Very Good Environment Not Assessed Staffing Not Assessed Management and Leadership Not Assessed 9 Jul 2010 Announced Care and support 5 - Very Good Environment Staffing Not Assessed Management and Leadership Not Assessed 30 Jan 2010 Unannounced Care and support Environment Not Assessed Staffing Management and Leadership 3 - Adequate 9 Jun 2009 Announced Care and support Environment Staffing 3 - Adequate Management and Leadership 12 Mar 2009 Unannounced Care and support Environment Staffing Management and Leadership 23 Sep 2008 Announced Care and support 3 - Adequate Environment 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. Aden House (Care Home), page 23 of 24
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 Aden House (Care Home), page 24 of 24