Singleton Park Care Home Care Home Service

Singleton Park Care Home Care Home Service Singleton Park Care Home Courance Lockerbie DG11 1TS Telephone: 01387 860748 Type of inspection: Unannounced Inspection completed on: 19 September 2016 Service provided by: Singleton Park Ltd Service provider number: SP2012011899 Care service number: CS2012310748

About the service This service has been registered since 2013. Singleton Park Care Home is situated near the town of Lockerbie in Dumfries and Galloway. Singleton Park Care Home (referred to in the report as "the service") provides care to 44 older people (referred to in the report as "residents"). The service is provided in two distinct units Singleton View - which accommodate 27 older people and Singleton Lodge which accommodates 17 older people. Out of the 44 places, the service is registered to provide a service to 2 people on a respite/short break basis. At the time of this inspection, the service had 42 residents of which 2 were receiving support on a respite basis. The service is located in a rural location on its own extensive grounds. The service offers single room accommodation for all residents ensuring privacy. What people told us We spoke with 29 residents, relatives and carers during inspection. In addition, 11 people gave their views through Care Standards questionnaires. We also observed how staff responded to residents and visitors in public areas within the home and spoke with 12 staff. In addition, we received 10 staff questionnaires. We also spoke with 2 professionals. Comments from relatives and residents included: "X is happy with the care in the home although misses home". "I feel that home could be slightly cleaner and with less clutter". "I feel that staffing levels could be improved which does effect care I receive". "I have always found my X to be clean and tidy. I have also found the staff to be very pleasant and helpful to both me and my X. Yes you might find odd crumb or tissues on floor etc., but its her home so she is going to be dropping odd things as we all do. To know that she is cared for 24/7 with people who treat her with respect and dignity is good". "The staff are very friendly and helpful. X (staff member is brilliant. If I have any worries, I talk to her and she always takes steps to put my mind at rest. I can talk to a lot of staff if I have any worries and they can always help. Very happy with care". "Food good - staff great". "Food not great - response if don't like what's on the menu - take it or leave it". "Nothing to do except sit or sleep". "Very happy, home-from-home". "There's not enough staff". page 2 of 11

"Short of staff and have to wait to get up". Self assessment The Care Inspectorate received a completed self assessment document from the manager. The manager has identified some areas for development. The self assessment was a list of information rather than an evaluation of what the service does well. There is scope to develop this to evaluate the service taking account of views of people using and working in the service. From this inspection we graded this service as: Quality of care and support Quality of environment Quality of staffing Quality of management and leadership 4 - Good 3 - Adequate not assessed not assessed What the service does well Residents had a personal plan which contained information about their care and support needs and how these were to be met. At a basic level people's needs were being met. However, there needs to be improved management oversight of this to ensure that reviews are consistently taking place within the required timeframe. We have repeated a previous recommendation and requirement. Residents were enabled to access community based health resources such as GP's and district nurses. For some residents, there were good examples of use of life histories and using information to support people. The service had introduced "This is your life" for some individuals and should expand this positive development. There were some good examples of residents being supported to attend events which were important to them. Support plans and other documentation such as communication records, were written in a respectful and person-centred way. There was evidence that personal choices were sought from individuals. People told us staff treated them with respect and dignity. For some residents, there were good examples of use of life histories and using information to support people. The service had introduced "This is your life". An activity coordinator was employed to plan and coordinate activities including support for people to access community groups/events. There were some good examples of residents being supported to attend events which were important to them. However, overall there were limited activities available for residents which was reflected in comments from residents, families and staff (see what the service could do better). Residents were encouraged to bring photographs, ornaments or other treasured keepsakes or small items of furniture to help personalise their room. Some bedrooms we visited were observed to be very personalised. We noted some good signage has been introduced to enable people to find their way around the buildings. The atmosphere in both buildings was relaxed and residents told us they were largely happy with the environment. page 3 of 11

There was a good range of equipment throughout the home to support people's needs, such as hoists and pressure mats. A current certificate of insurance was in place. Staff were observed to work well under pressure. Staff told us that they supported one another and worked well as a team. Staff received training regarding their roles and responsibilities to enable them to meet the needs of the people living in the care home. This included support to achieve SVQ qualifications. Most staff were aware of the Scottish Social Services Council (SSSC) registration requirements and professional codes of practice which set out the conduct expected of staff. We noted that two new staff were being supported to register with the SSSC. What the service could do better The service has not met a requirement made at the previous two inspections regarding the management of medication. We have again repeated this requirement (see requirement 1). The service has not met the one requirement regarding conducting reviews nor three recommendations regarding the organisation of reviews, environmental checks and, improvement of auditing processes made at the last inspection (see requirement 2 and recommendations 1-3). The service used to employ two activity coordinators to plan and coordinate activities including support for people to access community groups/events. However, one activity coordinator had left employment and the second was leaving during inspection. A weekly programme of activities was displayed. There were some good examples of residents being supported to attend events which were important to them. However, overall there were limited activities available for residents which was reflected in comments from residents, families and staff. Furthermore, the service needs to improve the management and support for residents regarding falls and introduce anticipatory care planning. We advised the provider to manage falls taking account of the 'Managing Falls and Fractures in Care Homes for Older People' published by Social Care and Social Work Scotland(SCSWIS) 2011 and NHS 2011 (see requirement 3). We have recommended that the manager introduce a register of all legal documents, including power of attorney, guardianship orders, Section 47 consent to treatment certificates (Adults with Incapacity (Scotland) Act 2000 and Do Not Attempt Cardio - Pulmonary Resuscitation (DNACPR) forms. We advised that it was important that staff are aware of each residents legal status and rights (see recommendation 4). We found that the provider was not meeting the conditions of the current staffing schedule which states minimum staffing levels and has been staffing below the stated minimum numbers required. We consider this compromises safety and delivery of care. We noted that, for residents needing additional support due to changing physical and mental health needs, staff were struggling to provide the level of support required. We are concerned that a lack of appropriate staffing did not allow residents to make choices and raised concerns about delays in receiving adequate intervention such as support with toileting needs. When asked, the manager told us she did not conduct dependency assessments of individuals by using a formal dependency assessment tool to review staffing accordingly. We are concerned about the lack of attention to personal care, promoting continence and lack of activity and engagement. We require the service to ensure that there are enough staff on duty to meet the needs of all residents at all times in safety. We found that staffing levels were impacting on the care experience of people using this service and that access to meaningful engagement was limited. page 4 of 11

The staff team should consider developing meaningful engagement as part of their keyworker duties (see requirement 4). Some aspects of the environment need attention. We have recommended that to ensure a safe environment which does not compromise safety and privacy, the provider should: a) Conduct dependency assessments and ensure that the service is, at the very least, meeting the current staffing schedule. b) Ensure that there are appropriate window restrictors on all ground floor windows. c) Repair the lock on the toilet door in the hall/reception area to ensure privacy and dignity of residents. d) Review the arrangements at the front entrance to ensure safety. e) Ensure affective contingency planning in the event of an emergency such as power failure (see recommendation 5). The manager should continue to develop a supportive environment for people with dementia making use of resources such as the Kings Fund EHE Environmental Assessment Tool (see recommendation 6). We advised the manager to seek three references where references received gave scant information. This is to enhance safety for residents. OTHER ISSUES We noted that almost all residents had varying degrees of cognitive impairment. Staff have had some training in working with people with dementia. However, we have made a new recommendation that all staff should complete the skilled level, and all nurses and managerial staff should undertake the enhanced level of Promoting Excellence Framework learning resources. We were told that care staff have undertaken the informed level with the intention of starting the skilled level in the near future. The provider should use the Promoting Excellence Framework, Scottish Government 2011 to review staff training and development to ensure that staff have the necessary knowledge and skills to meet the needs of people with dementia (see recommendation 7). The service has undergone three changes of managers since the last inspection. Some aspects of quality assurance and management processes were not apparent at this inspection. We are concerned about confusion for staff, roles and responsibilities of senior staff and a lack of direction for all staff. We advised the manager to introduce an action plan and implement SSSC common Core of Skills, knowledge and values to promote teamwork. The provider should introduce and maintain: - Corporate/service action plan - Robust quality assurance systems which include training plans, audits and oversight - system for auditing which demonstrates change or improvement. (see recommendation 8). The provider told us that there have been no complaints against the service. She stated that "we don't have complaints, but have concerns". Subsequent to inspection, the provider has stated that "Singleton Park has had no complaints raised internally, however, families have raised concerns." We consider that the provider should be clearer that all "concerns" raised by residents, relatives and staff are treated with respect, are thoroughly investigated, appropriate remedial action is taken and documented. page 5 of 11

Some people we met did not know about the services' complaints procedure or how to make a complaint to the Care Inspectorate (see requirement 5). The provider is not compliant with the current certificate of registration and staffing schedule which states that there should be two registered nurses on duty during the day. We concur that the staffing schedule may present as being confusing. However, since the manager is not conducting dependency assessments, she was not able to confirm levels of needs and we remain concerned that minimum staffing levels are not being implemented. We have advised that she submit a variation to the Care Inspectorate to review the staffing schedule. The service has also submitted a variation to increase number of residents (see requirement 6). We found incidents which the provider should have notified the Care Inspectorate as required. We discussed this with the provider during inspection. The provider must ensure they notify the Care Inspectorate of any notifiable events and updates as required, including incidents where the service is not compliant with the current certificate of registration (see requirement 7). Requirements Number of requirements: 7 1. The provider must ensure that medication administration records are fully complete. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210) - regulations 4(1)(a), a requirement relating to the health and welfare of service users. Timescale for meeting this requirement: immediately upon receipt of this report. 2. The provider must, after consultation with each service user and, where it appears to the provider to be appropriate, any representative of the service user, within 28 days of the date on which the service user first received the service prepare a written plan ("the personal plan") which sets out how the service user's health, welfare and safety needs are to be met. The provider of a care service must: (a) make the personal plan available to the service user and to any representative consulted, (b) review the personal plan - (i) when requested to do so by the service user or any representative; (ii) when there is a significant change in a service user's health, welfare or safety needs; and (iii) at least once in every six month period whilst the service user is in receipt of the service. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210) - regulations 5, a requirement relating to personal plans. Timescale for meeting this requirement: within 28 days of receipt of this report. page 6 of 11

3. The provider must ensure that residents are offered a range of activities in keeping with the statement of purpose and aims and objectives of the service. In order to achieve this, the provider must ensure that: (i) personal plans address the social, emotional and recreational needs of residents and detail how these needs are to be met. This should include how the provider intends to provide and support people to access meaningful activities which take account of their interests, needs and beliefs and enables them to fulfil their potential. (ii) there are sufficient resources available, including staffing to support residents to take part in activities, in keeping with the services statement of purpose and aims and objectives. All staff understand the importance of activity being essential to residents wellbeing and are supported through supervision, staff meetings and training to develop their knowledge and skills in this area. (iii) that the service introduce strategies for falls prevention and management. (iv) that the service ensures end of life wishes and anticipatory care management is in place and current. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/2010) Regulation 4 - Welfare of users Timescale for meeting this requirement: immediately upon receipt of this report. 4. The provider must ensure that adequate staffing levels are maintained at all times to deliver a safe service for residents which takes account of aggregated information of the physical, social, psychological and recreational needs and choices in relation to the delivery of care for all individuals, also taking into account the physical layout of the building, staff training and supervision needs. This is in order to comply with: SSI 2011/210 Regulation 15(a) - a requirement for a provider to ensure that at all times suitable qualified and competent persons are working in the care service in such numbers as are appropriate for the health and welfare and safety of service users. Timescale: within eight weeks from the date of issuing this report. 5. The provider must ensure that the complaints procedure is appropriate to the needs of service users and all complaints are fully, fairly and appropriately investigated taking account of the care needs of service users. In addition, the provider must supply written copies of the complaints procedure to every service user and/or their representative. This is in order to comply with: SSI 2011/210 Regulation 18 - Complaints. Timescale for meeting this requirement: immediately upon receipt of this report. 6. The provider must ensure that, having regard to the size and nature of service, the statement of aims and objectives and the numbers and needs of service users, ensure that at all times suitably qualified and competent page 7 of 11

persons are working in the care service in such numbers as are appropriate for the health, welfare and safety of service users. This is to comply with: The Public Services Reform (Scotland) Act 2010, and The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 210, regulation 15 and The Social Care and Social Work Improvement Scotland (Applications and Registration) Regulations 2011. Timescale for meeting this requirement: within four weeks upon receipt of this report. 7. The provider must ensure they notify the Care Inspectorate of any notifiable events as required, including incidents where the service is not compliant with the current certificate of registration. This is to comply with: The Public Services Reform (Scotland) Act 2010, and The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 and The Social Care and Social Work Improvement Scotland (Applications and Registration) Regulations 2011. Timescale for meeting this requirement: immediately upon receipt of this report. Recommendations Number of recommendations: 8 1. Records of reviews should be better organised and individual records should provide a more detailed and meaningful account of issues discussed. National Care Standards, care homes for older people - standard 6: support arrangements. 2. The provider should ensure that appropriate and regular environmental checks are completed and that these are recorded consistently. Where remedial action is to be taken, records should outline this action, including any reason for delay and the date that this action was completed. National Care Standards, care homes for older people - standard 4: your environment. 3. The auditing process should be further developed to include a formal accident and incident audit which links into other assessments; for example, the homes' falls risk assessment. In addition, where action plans have been produced the quality assurance system should ensure that the progress towards meeting the planned action is recorded. National Care Standards, care homes for older people - standard 5: management and staffing arrangements. 4. The manager should introduce a register of all legal documents, including power of attorney, guardianship orders, Section 47 consent to treatment certificates (Adults with Incapacity (Scotland) Act 2000 and Do Not Attempt Cardio - Pulmonary Resuscitation (DNACPR) forms. National Care Standards, care homes for older people - standard 5: management and staffing arrangements. page 8 of 11

5. The provider should address the issues highlighted to ensure a safe environment which does not compromise safety and privacy. In order to do this, the provider should: a) Conduct dependency assessments and ensure that the service is meeting the current staffing schedule and maintain adequate staffing levels. b) Ensure that there are appropriate window restrictors on all ground floor windows. c) Repair the lock on the toilet door in the hall/reception area to ensure privacy and dignity of residents. d) Review the arrangements at the front entrance to ensure safety. e) Ensure affective contingency planning in the event of an emergency such as power failure. National Care Standards, care homes for older people - standard 4: your environment. 6. The manager and staff should continue to develop a supportive environment for people with dementia using the Kings Fund Environmental Healing Assessment Tool. National Care Standards, care homes for older people - standard 4: your environment. 7. The provider should use the Promoting Excellence Framework, Scottish Government 2011 to review staff training and development to ensure that staff have the necessary knowledge and skills to meet the needs of people with dementia. This should include training at skilled and enhanced level for all staff working directly with residents. National Care Standards, care homes for older people - standard 5: management and staffing arrangements. Promoting Excellence Framework, Scottish Government 2011. 8. The provider must introduce and review quality assurance systems and processes to ensure the quality of this service is improved. They should take account of the views of residents, relatives staff and service users and other professional and agencies. The information gathered should be used to make improvements to the service. National Care Standards, care homes for older people - standard 5: management and staffing arrangements and standard 11: expressing your views. Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at www.careinspectorate.com. page 9 of 11

Inspection and grading history Date Type Gradings 2 Feb 2016 Unannounced Care and support 5 - Very good Environment 4 - Good Staffing 4 - Good Management and leadership 4 - Good 5 Dec 2014 Unannounced Care and support 5 - Very good Environment 4 - Good Staffing 5 - Very good Management and leadership 5 - Very good 18 Jun 2014 Unannounced Care and support 4 - Good Environment 5 - Very good Staffing 4 - Good Management and leadership 4 - Good page 10 of 11

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 11 of 11