Care service inspection report Full inspection Bankfoot House Care Home Service Beechgrove 14 Well Street Moffat Inspection completed on 10 June 2015
Inspection report Service provided by: Bankfoot House (Moffat) Ltd Service provider number: SP2003002525 Care service number: CS2003010779 Inspection Visit Type: Unannounced Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and set out improvements that must be made. We also investigate complaints about care services and 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. Contact Us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com 0345 600 9527 www.careinspectorate.com @careinspect page 2 of 32
Inspection report 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 5 Quality of environment 5 Quality of staffing 5 Quality of management and leadership 5 Very Good Very Good Very Good Very Good What the service does well The overall atmosphere throughout the home was relaxed, cosy and homely. Staff provided support in a well organised, calm manner adding to the pleasant, friendly environment within the home. There is an enthusiastic and committed caring team of staff, who demonstrate a commendable attentive quality in their interactions with the residents. The service benefits from a manager who is proactive and demonstrates person centred values and principles in their dealings with residents, relatives, staff and other professionals. What the service could do better The manager has been responsive to areas of development we discussed during our inspection visits. These included additions to the medication recording procedures, decorating bedrooms and laundry. We noted that the manager encouraged residents, relatives and staff to provide their suggestions and comments to improve the quality of the service. page 3 of 32
What the service has done since the last inspection Inspection report The service has responded to address requirements made in previous inspection report. This has included installation of a new passenger lift to residents the opportunity to move easily between the two floors. Conclusion Bankfoot Care Home provides an overall very good standard of care and support, there is a relaxed atmosphere where residents feel welcomed and respected. page 4 of 32
1 About the service we inspected Inspection report 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. Bankfoot care home is situated in the town of Moffat within Dumfries and Galloway. The property is a converted and extended house over two floors, situated within accessible, well maintained gardens. The care home is situated a short distance from the main shopping area, which allows residents and families easy access to local facilities. Internally, the care home has 19 single bedrooms, 17 of which have en-suite facilities, and one double bedroom with en-suite. There are spacious communal areas throughout the building, which gives staff and residents a degree of flexibility for activities, quiet times and social gatherings. The care provider of Bankfoot house is Bankfoot House (Moffat) Ltd, which is a 'not for profit' organisation. The management of the care home is undertaken by a Board of Voluntary Directors who all have local connections with the town of Moffat. The aims and objectives of Bankfoot House state:- "The overall aim of the home is to provide a happy, safe, comfortable and secure environment for those elderly people unable to continue living in their own homes". Recommendations A recommendation is a statement that sets out actions that a care service provider should take to improve or develop the quality of the service, but where failure to do so would not directly result in enforcement. Recommendations are based on the National Care Standards, SSSC codes of practice and recognised good practice. These must also be outcomes-based and page 5 of 32
if the provider meets the recommendation this would improve outcomes for people receiving the service. Requirements A requirement is a statement which sets out what a care service must do to improve outcomes for people who use services and must be linked to a breach in the Public Services Reform (Scotland) Act 2010 (the "Act"), its regulations, or orders made under the Act, or a condition of registration. Requirements are enforceable in law. We make requirements where (a) there is evidence of poor outcomes for people using the service or (b) there is the potential for poor outcomes which would affect people's health, safety or welfare. Based on the findings of this inspection this service has been awarded the following grades: Quality of care and support - Grade 5 - Very Good Quality of environment - Grade 5 - Very Good Quality of staffing - Grade 5 - Very Good Quality of management and leadership - Grade 5 - Very Good Inspection report 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 0345 600 9527 or visiting one of our offices. page 6 of 32
Inspection report 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 after undertaking unannounced inspection visits on the following days, Monday 8 June 2015 between the hours of 12.50pm and 5pm then again on Wednesday 10 June 2015 between the hours of 10.20am and 4pm. We met with the manager and discussed the progress of the service since the last inspection. We completed a walk round of the care home environment. We reviewed the following list of documentation:- - registration certificate - insurance certificate - staff rotas - care plans - risk assessments - residents meetings - relatives' meetings - staff recruitment records - induction booklet - staff meetings - staff training records - staff support and supervision records - servicing records - maintenance records We reviewed the five completed Care Inspectorate questionnaires we received from relatives. When we asked them if they were overall satisfied with the quality of the service, four strongly agreed and one agreed with this statement. page 7 of 32
Inspection report We reviewed the service's own quality assurance questionnaires and noted favourable comments given by relatives about the quality of the service. We spoke to the following people during our visits: - eight residents - three relatives - five staff - manager - two visiting professionals We sat down to afternoon lunch with five residents in the dining room and talked about life in Bankfoot and listened to their comments and views of the qualities of the service. We spoke to three relatives visiting the care home and discussed how satisfied they were with the standards of care and support provided by the service. We spoke to two visiting professionals including the district nurse and a local college lecturer involved with student placements at the home. 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 page 8 of 32
inspection focus area we will clearly identify it under the relevant quality statement. Inspection report 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.firescotland.gov.uk page 9 of 32
Inspection report 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. The Care Inspectorate received a fully completed self assessment document from the service manager. The service had identified what they thought they did well, and some areas for development. Taking the views of people using the care service into account We spoke to residents during our inspection visits and heard very positive and appreciative comments about the quality and standard of the staff team. The residents described the staff team as caring and helpful, we heard comments such as: "The girls are so lovely and nice, very helpful". "The manager is always willing to listen she is always here whenever you need her". Taking carers' views into account We received very positive comments from the relatives in their completed Care Inspectorate questionnaires including the following: "Could not ask for better care. The staff are very friendly and helpful at all times". page 10 of 32
"I am pleased to see on going improvements with the new fresh painted walls. The garden area looks lovely and well maintained. All staff are polite and respectful towards relatives visiting my mother". "... The staff could not have been kinder or more helpful. Nothing was too much trouble and it was apparent that hey had a very personal understanding and treated my relative as an individual with TLC until the end. They not only cared for her but looked after and made me as comfortable as possible". "I think a minibus would be a huge asset and allow for more outings". Inspection report page 11 of 32
Inspection report 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: 5 - Very Good 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 After we had reviewed the information and evidence that the service had provided, in relation to this quality statement we decide the service had achieved an overall grade of very good. The service had a written participation strategy and the manager demonstrated a very good understanding of the principles of good participation. Various systems were in place to ensure residents and relatives could get involved in evaluating the quality of the care and support provided as well as providing ideas, suggestions and comments for further improvements and developments within the service. The manager ensured that every resident had the opportunity to complete the service satisfaction questionnaire. Some residents required the assistance of their relatives of the care staff to accomplish this task. This made sure that everyone living in the home had the chance to communicate their level of satisfaction with the care and support provided. We reviewed the methodology of this process and checked the cognitive levels of residents to assure proper information was gathered. We were satisfied that page 12 of 32
staff had undertaken this process with integrity and proper regard for the residents as individuals. We found an overall high standard of satisfaction and appreciation of the quality of the service provided. Some of the comments included: "No complaints and find the staff very helpful". "Nice meals". "Always a warm welcome". "I find the manager and the staff easy to talk to". We also noted some comments about a bedroom that needed painted and one comment about the laundry. The information we received from residents and relatives in their completed Care Inspectorate questionnaires corresponded to the information we obtained through our inspection procedures. Some of the comments relatives made included: "Could not ask for better care. The staff are very friendly and helpful at all times". "I am pleased to see on going improvements with the new fresh painted walls. The garden area looks lovely and well maintained. All staff are polite and respectful towards relatives visiting my mother". "... The staff could not have been kinder or more helpful. Nothing was too much trouble and it was apparent that they had a very personal understanding and treated my relative as an individual with TLC until the end. They not only cared for her but looked after and made me as comfortable as possible". "I think a minibus would be a huge asset and allow for more outings". Inspection report During our inspection visit, we sat down to afternoon lunch with five residents. page 13 of 32
The dining experience was very nice, relaxed and enjoyable the menu was nutritional with fresh local produce, well prepared and presented. We chatted with residents about living at Bankfoot. They told us that all the staff were very good and the manager was welcoming and easy to talk to and approach. Areas for improvement Overall, the service has achieved a very good standard in this quality statement and they should continue to implement the practices and procedures currently operating. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 14 of 32
Inspection report Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths After we had reviewed the information and evidence gathered during this inspection process, we decide the service had achieved an overall grade of very good for this quality statement. We noted during our inspection visits that the care staff demonstrated a good rapport with the residents dealing with them in a respectful and dignified manner one relative commented: "... The staff could not have been kinder or more helpful. Nothing was too much trouble and it was apparent that they had a very personal understanding and treated my relative as an individual". The manager had implemented appropriate documentation including the safety cross to evaluate any residents with pressure care issues. We met the visiting district nurse who provides support to the home through treatment programmes and ensuring that the care staff follow advice and best practice guidance for the assessment and treatment of pressure care issues. We also noted that the documentation utilised to help prevent falls and fractures within the care home environment was based on best practice guidance, the manager had completed to a very good standard. The care plans we reviewed were well organised with clear indexing identified in each section, which made them easy to follow with important information readily accessible. There were relevant risk assessments and health assessments completed, which aided in identify resident's health and well being needs. We noted that any interventions required had appropriate plans of care completed and page 15 of 32
evaluated as necessary with regular care reviews undertaken. The manager had a significant role in the development and completion of the care plans and the ensured that the care staff followed these instructions. Relatives we spoke to and from comments received in the Care Inspectorate questionnaires, indicated a high degree of confidence and recognition that the manager and staff team were appropriately addressing the health care needs of the residents of Bankfoot. We reviewed the medication administration procedures and saw that the manager had ensured all staff involved in the administration of medication had appropriate training and competency to undertake these duties. The pharmacy provider undertook audits of the medication procedures within the care home and the manager implemented additional checks to safeguard the residents. Areas for improvement We noted very good records of medical conditions and terminology within the care plans, further explanation in terms of how these conditions affect people in their daily lives and how staff can best support people to address these issues would be beneficial. The manager should review the consistency of this throughout the documentation, some care plans we read had very good descriptions whilst others require some development. Overall, there was a commendable amount of work put into these documents, this was reflected in the knowledge the manager and staff had collected about each resident. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 16 of 32
Inspection report Quality Theme 2: Quality of environment Grade awarded for this theme: 5 - Very Good Statement 2 We make sure that the environment is safe and service users are protected. Service strengths After we had reviewed the information and evidence that the service had provided with reference to this quality statement, we decide the service had achieved an overall grade of very good. There was one requirement made at the last inspection visit regarding access to the new extension of the building. Requirement 1 The service must follow through with plans to provide appropriate access from the extension to the main building. The plans must be drawn up and executed within a reasonable period. This is to ensure that all residents have equal opportunity to participate fully in the life in the care home. This is to comply with: The Social Care & Social Work Improvement Scotland (Requirements for Care Services) Regulation 2011 10 2(a). Action taken to address this requirement We saw that the provider had installed a new passenger lift. We observed this in operation during our visits and residents could therefore now access this area of the care home. page 17 of 32
Inspection report This requirement is met. We reviewed the service's maintenance procedures and checked the following documentation: - registration certificate - insurance certificate - gas safety certificate - portable electrical equipment testing - moving and handling equipment - emergency lighting - waste removal contracts - passenger lift installed march 2015 - catering equipment - fire safety equipment servicing - stair lift - food hygiene certificate On one inspection visit, we noted residents sitting out in the garden area of the extension terrace enjoying the fresh air and sunshine. The overall care home environment was clean tidy and free from odours. Moving and handling equipment was clean and regularly service to ensure that staff could attend to resident physical and personal care needs safely. We noted comments about the home environment including: "I am pleased to see on going improvements with the new fresh painted walls. The garden area looks lovely and well maintained". page 18 of 32
Areas for improvement Some comments received indicated that attention was required to some decorating of bedrooms we found the overall standard to be very good, therefore the manager should continue to ensure that any feedback received about any general areas of decorating are attended to. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 19 of 32
Inspection report Statement 3 The environment allows service users to have as positive a quality of life as possible. Service strengths The home was clean and tidy. All communal bathroom and toilet areas were free from odours. There was a call system throughout the home, including the residents bedrooms to allow anyone use to activate if they required assistance or in the event of emergency. There was a range of appropriate comfortable seating, pressure relieving cushions, moving and handling equipment, profile beds, hoists to assist people with their comfort, well being and attend to their personal care needs. We saw that the service had ensured that resident's bedrooms were, well presented and the furnishings appropriate to their needs. The bedrooms we inspected were personalised and decorated to the individuals choice and people were supported to express their choices and wishes. Prior to moving in to the care home, resident could have the opportunity to decorate and furnish their new rooms and bring personal items. This helps to smooth the transition to the care home environment by giving people a sense of control over their personal space. The staff demonstrated very good standards in their daily interactions with residents. Treating them with dignity, showing respect for their privacy, and attending to their personal care needs with regard to their feelings and wishes. Bankfoot Care Home has an overall very good standard of environment that supports residents health and well being needs. The large rooms and communal lounge and dining areas of the old style country house with period furniture provided a comforting relaxed atmosphere. page 20 of 32
Areas for improvement The service should continue to maintain the very good standards within the care home environment. The manager should continue to involve residents and their relatives in the developments relating to improvements in the care home environment. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 21 of 32
Inspection report Quality Theme 3: Quality of staffing Grade awarded for this theme: 5 - Very Good 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 After we had reviewed the information and evidence gathered during this inspection process, we decide the service had achieved an overall grade of very good for this quality statement. We reviewed a number of staff recruitment files to ensure that anyone employed within the care home environment were appropriately vetted and checked prior to working with residents. The files we sampled had the necessary checking procedures in place such as police disclosure, employment references, appropriate registration relevant to position held, copies of training certificates, support and supervision records. The manager had implemented an induction checklist that staff signed, this ensured that all staff where knowledgeable and competent at all necessary areas of responsibility relevant to their job descriptions. New employees would spend some time with senior staff shadowing them to ensure that they were operating and working to appropriate standards of care and practice. The manager ensured that all staff had copies of any relevant documentation such as the Scottish Social Services Codes of Practice The manager ensures effective communication through regular posters, checklists for staff to sign, updates on responsibilities including appropriate registration requirements, policies and procedures operating within the home. page 22 of 32
This ensured that all the staff were fully aware of their duties and responsibilities within the care home environment. Areas for improvement Due to the rural location we heard of the difficulty of recruiting positions, however the manager complimented the existing staff team on their flexibility and willingness to assist by covering during periods of absenteeism or holidays. The manager addressed this by trying to create a bank of sessional staff. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 23 of 32
Inspection report Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths After we had reviewed the information and evidence that the service had provided with reference to this quality statement, we decide the service had achieved an overall grade of very good. There was an active and progressive training plan in place for the year ahead. This ensured that the staff team had the skills and knowledge to provide appropriate care and support to the residents. The manager had implemented a training matrix using tools available through the best practice guidance, which again demonstrated their commitment to respond to advice offered during previous inspection visits. There was information available on policies procedures and best practice guidance so that the staff team had up to date material about providing good standards of care to people in a care home environment. The manager ensured that after staff signed these documents to say they had read them. There was also evidence that the manager used this as part of the staff supervision procedures to embed the knowledge and practice within the care home. We reviewed the medication administration system and found the staff operated a good standard of competence. The manager ensured that all staff undertaking medication administration had proper training and were competent at these tasks. In the last inspection report, we asked the manager to develop the consistency of the staff supervision system to ensure more regular sessions took place. The service has achieved this reflecting the willingness of the manager to listen and respond to advice that could help improve the quality of the service they provided. page 24 of 32
From the staff files we checked, we saw that the manager ensured that all staff were registered with the appropriate regulatory authorities. From the observations during our inspection visits, we saw a committed and competent team of staff delivering a caring and considerate standard of care to their residents. Areas for improvement The manager should continue to develop the staff involvement systems within the care home. This could include involvement in the service self assessment documentation. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 25 of 32
Inspection report Quality Theme 4: Quality of management and leadership Grade awarded for this theme: 5 - Very Good Statement 2 We involve our workforce in determining the direction and future objectives of the service. Service strengths After we had reviewed the information and evidence gathered during this inspection process, we decide that the service had achieved an overall grade of very good for this quality statement. The manager encouraged the staff team to feel part of the service and provide their input into how the service developed. This included; staff meetings, support and supervision sessions, identifying areas for development and always making people feel able to contribute with ideas and suggestions. Staff we spoke to during our inspection visits told us the manager encouraged them to participate, through meetings and one to one support sessions, in the developments within the service. They said they felt able to speak to the manager and always listened to their opinions and views. As a small service, the manager has a regular daily contact with the staff team and we observed a very good team dynamic operating within Bankfoot Care Home. page 26 of 32
Areas for improvement The manager should continue to implement the very good standards and ethos operating within the care home. There is an opportunity for the staff team to participate in the completion of the next self assessment document to share their ideas opinions and views of the standards within the service. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 27 of 32
Inspection report 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 After we had reviewed the information and evidence the manager provided, during this inspection process, we decide the service had achieved an overall grade of very good for this quality statement. The manager was welcoming and friendly, operating an open door policy within the service. Everyone we spoke to commented on how supportive and helpful she was and this helped to create an overall positive and progressive working environment. The discussions we had and the evidence the manager provided during our inspection visits demonstrated a very good understanding of the issues relevant to running an effective care home service. The external professionals we spoke to supported these findings and described the manager as providing a very good professional role model with a caring and competent approach to how they ran the service. The manager had implemented reviews of the quality assurance systems to ensure on going evaluation of the quality of the service provided in the care home. Some of these audits included; medication administration procedures, care plans, falls prevention, support and supervision sessions, staff training and development and other relevant factors to improve and develop the standards of care and support for the benefit of the residents. From the audit and review work undertaken by the manager, we saw they were working towards continuous improvements and developments within the service. page 28 of 32
Areas for improvement The manager should continue to implement and maintain the very good standards of service development through the quality assurance activity in operation. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Inspection report 5 What the service has done to meet any requirements we made at our last inspection Previous requirements 1. The service must follow through with plans to provide appropriate access from the extension to the main building. The plans must be drawn up and executed within a reasonable time frame. This is to ensure that all residents have equal opportunity to participate fully in the life in the care home. This is to comply with: The Social Care & Social Work Improvement Scotland (Requirements for Care Services) Regulation 2011 10 2(a). Timescale: Within six months from receipt of this report. This requirement was made on 12 June 2014 We saw that the provider had installed a new passenger lift. We observed this in operation during our visits and residents could therefore now access this area of the care home. Met - Within Timescales page 29 of 32
6 What the service has done to meet any recommendations we made at our last inspection Previous recommendations There are no outstanding recommendations. Inspection report 7 Complaints No complaints have been upheld, or partially upheld, since the last inspection. 8 Enforcements We have taken no enforcement action against this care service since the last inspection. 9 Additional Information 10 Inspection and grading history Date Type Gradings 12 Jun 2014 Unannounced Care and support 5 - Very Good Environment 4 - Good Staffing 5 - Very Good Management and Leadership 5 - Very Good 25 Jun 2013 Announced (Short Notice) Care and support Environment Staffing 4 - Good 4 - Good 5 - Very Good page 30 of 32
Inspection report Management and Leadership 5 - Very Good 30 May 2011 Unannounced Care and support 4 - Good Environment Not Assessed Staffing Not Assessed Management and Leadership 4 - Good 16 Mar 2011 Unannounced Care and support 5 - Very Good Environment Not Assessed Staffing Not Assessed Management and Leadership Not Assessed 15 Oct 2010 Announced Care and support 6 - Excellent Environment Not Assessed Staffing Not Assessed Management and Leadership Not Assessed 4 Mar 2010 Unannounced Care and support 5 - Very Good Environment Not Assessed Staffing 5 - Very Good Management and Leadership Not Assessed 23 Oct 2009 Announced Care and support 5 - Very Good Environment Not Assessed Staffing 5 - Very Good Management and Leadership Not Assessed 12 Mar 2009 Unannounced Care and support 5 - Very Good Environment 4 - Good Staffing Not Assessed Management and Leadership Not Assessed 18 Dec 2008 Announced Care and support 5 - Very Good Environment 4 - Good Staffing 5 - Very Good Management and Leadership 5 - Very Good page 31 of 32
To find out more This inspection report is published by the Care Inspectorate. You can download this report and others from our website. You can also read more about our work online. Contact Us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com 0345 600 9527 www.careinspectorate.com @careinspect Other languages and formats This report is available in other languages and formats on request. Inspection report Tha am foillseachadh seo ri fhaighinn ann an cruthannan is c?nain eile ma nithear iarrtas. page 32 of 32