Tranent Care Home Care Home Service

Tranent Care Home Care Home Service 1 Coal Neuk Court Tranent EH33 1DR Telephone: 01875 616 560 Type of inspection: Unannounced Inspection completed on: 4 September 2017 Service provided by: HC-One Limited Service provider number: SP2011011682 Care service number: CS2011300790

About the service Tranent Care Home is situated in a residential area of the town of Tranent, East Lothian. It is close to local transport links and amenities. The service is registered to provide care for up to 60 older people. The accommodation is purpose-built with 60 single bedrooms with ensuite toilet and wash hand basin facilities. Bedrooms, communal lounge areas and dining rooms are available on each of the two floors which can be accessed by stairs or lifts. Baths, showers and additional toilets are available throughout the home. There are separate kitchen, laundry and staff facilities in the home. The home has its own car park and there is a pleasant garden area around the home with seating areas. The provider, HC-One Limited, state that its aim is: "To have the kindest homes in the UK with the kindest and most professional staff." What people told us Before the inspection we received eight response to Care Standard Questionnaires (CSQ) from relatives/carers and no responses from residents. 30 CSQ's were sent to each group. These were returned to us during the months of March and April 2017. One person out of the eight stated that they were overall unhappy with the quality of care in the service. The positive aspects of the service, they thought were that their relative's healthcare needs were met and that their relative was treated politely and respectfully. Four of people thought that the care of clothing and the knowledge and skills of staff could be better and three people said that they thought that there not was enough staff on duty. One commented, "The care home is improving but still requires additional staffing and training to reach an acceptable level to obtain top rating". During discussion with six relatives during inspection it was clear that there continued to be some work to do in respect of caring for clothing. However, people were very complimentary about staff working in the service and gave comments such as, "I cannot praise them highly enough. They look after her very well". Residents spoke with us and told us about how they enjoyed the food and how staff supported them. Some commented, "They are much more responsive to requests and anything suggested - things happen" and "I love it here, I always have". Self assessment We did not request a self assessment prior to this inspection. From this inspection we graded this service as: Quality of care and support Quality of environment Quality of staffing Quality of management and leadership 5 - Very Good 5 - Very Good Quality of care and support page 2 of 14

Findings from the inspection Residents looked well presented and cared for. They looked comfortable and at ease using the full facilities of the home. Some chose to spend time in lounges or in bedrooms or freely go around the unit. Planned activities took place and residents were also enjoying the outdoors on a pleasant day. The atmosphere in the home was calm and organised. This is important to minimise stress and distress of residents. Relatives and carers were welcomed into the home and were offered refreshments and we saw that residents enjoyed their company. Mealtimes are an important part of home life. Residents were seen to be offered choices and there were many tempting snacks available, particularly at tea times. For those who needed soft or pureed options, these were attractively presented which would help encourage people to eat. The manager had an overview of important information such as, weights, wounds, legal status and reviews of care. Links were made to other professionals where there were any concerns. For example, dieticians who gave advice and support in instances of weight loss. Wound care was well recorded and showed that assessments and treatment was carried out. This evidenced that wounds were recorded and improving. There were some issues where recording of care had not been completed and this could be improved, for example in recording and/or explaining when personal care or repositioning was not delivered. Additionally, prescribed topical medications had differences in the quality of recording, for instance, where, when and why this was applied. Topical medication administration is part of a requirement that was outstanding. We acknowledged that the standard of practice was better in the service. However, gaps in the recording of care are set out in a recommendation. (Recommendation 1). There was some good information in care plans and these covered care issues such as continence management, skin care and nutrition. These set out the care needs of residents following risk assessment and included how best to communicate with families. However, we suggested where some improvements could be made in expanding information so that staff worked in a consistent manner. This was acknowledged by management. It was pleasing to see the improvements in the service and to observe residents looking well and living in a calm environment. There are important strengths in this quality theme and the service should try to address the issues we have identified to further improve. Requirements Number of requirements: 0 Recommendations Number of recommendations: 1 1. The provider should monitor the recording of care delivery in the home and make sure that staff have sufficient guidance to complete records. This should include, administration of topical medications, personal care and repositioning. page 3 of 14

National Care Standards, Care Homes for Older People, Standard 5, Management and. Grade: 4 - good Quality of environment Findings from the inspection Residents used the accommodation and gardens provided as they chose. Bedrooms were clean and personalised with bed linen fresh and clean. People told us that they were happy with their rooms. There had been significant improvement in the cleanliness of the environment and housekeeping staff told us that they had enough supplies to maintain this standard. We continued to note a few malodours, in particular in one communal lounge. Despite regular deep cleaning this remained. The management told us that their next option was to replace the flooring. Maintenance and safety checks were in place and the frequency set out, including portable appliance testing and gas safety. These were up to date. Wheelchair checks did not always tell us if any deficits that were seen had been rectified, for example in missing footplates. These are important to make sure that residents are transferred safely. We advised the management that a system of signing off in an action plan could be used. There was analysis of falls from accident/incident records. Where there were recurring falls, assessment and reviews of care took account of the environmental safety and steps taken to manage and minimise risks to individuals. The care of clothing had improved in the service. Samples seen showed that these were well stored and laundered. However a system was continuing to be embedded in the service and staff were becoming familiar with their changing roles in respect of managing clothing. One resident and family commented to us that they still had issues with the management of their clothing. There was ongoing work in continuing to make improvements in managing clothing as this is an important issue for people. In recognition of the work to date, we have met the requirement but have made a recommendation so that this work continues. (Recommendation 1). There were improvements in the garden area and plans were in place for further refurbishment of the home. These help to create a pleasant and comfortable place to stay. Requirements Number of requirements: 0 page 4 of 14

Recommendations Number of recommendations: 1 1. The provider should continue to implement the system of managing residents' clothing and include a form of auditing that is effective in identifying where there are deficits. National Care Standards, Care Homes for Older People, Standard 16, Private Life. Grade: 4 - good Quality of staffing Findings from the inspection We received very positive comments about staff working in the service from residents and carers. People described them as being "kind" and "really lovely". Staff were complimentary about each other and felt that they worked well as a team. It was clear that the principles of dignity and respect, to residents, family and each other, were part of the practice of staff. Staff were recruited through safe recruitment practices and checks were in place to make sure that they were registered with their regulatory body. Recruitment was taking place to make sure that the service had their own consistent staff members. This is valuable in residents getting to know staff well and vice versa. Support was given by the manager and regular meetings were held where expectations and work practices were discussed. Work was discussed daily in the form of 'flash meetings' which informed staff of events of the day. For example, hospital appointments for residents and any concerns relating to individuals. Staff told us about their training and how they enjoyed it. Where the matrix showed any gaps, for example expired or late training, the manager clarified that there was a window of three months to complete specific training. Staff were extremely positive in respect of the staff numbers arrangements and deployment of staff to each unit. The staffing levels had been calculated from dependency assessments of residents' needs. A review of dependencies showed that there were occasions where the score allocated may not have captured the needs of an individual and/or that some assessments were on the cusp of needing medium to high hours for care. The management were keen to introduce a system of assessment that was responsive to the changing needs of residents. This is important to make sure that the numbers of staff working at any given time can meet the needs of residents. We gave them an example of one 'tool' for assessing needs for them to consider. Whilst we did not have concerns about the level of staffing during inspection, the registered nurse (RN) did not have much time to guide, direct and supervise the care of residents. Management and leadership is an important aspect of the RN role. A considerable amount of time was spent administering medications. The management were aware of this and had plans to up skill senior care staff to take on this role. We will look at how the service has progressed these issues at the next inspection. Requirements Number of requirements: 0 page 5 of 14

Recommendations Number of recommendations: 0 Grade: 5 - very good Quality of management and leadership Findings from the inspection The manager was very visible in the home and described as "approachable" and "listening" by staff and carers. One person summed up a number of views we received as part of this inspection stating, "From the low point of last year's experiences...the new manager has finally made good, lasting change and improvements. There is clear management practices now evident. The ambience and attitude of the home is so noticeably changed". The manager had a clear vision of the direction she wished to take the service and was proactive in seeking out information and ideas to improve the experiences of residents in the home. She was fully supported by external managers who had helped her to become familiar with policies and procedures of the company and to assist with advice and guidance where necessary. Systems of audit were in place to make sure that risks to residents were minimised, for example in weight loss, falls and skin damage. Audits showed that there had been improvement in aspect of care, such as falls and weight loss. Further audits would enhance the performance of the service as described in quality theme, care and support. Overall, we were pleased to see the changes in the service and how this had impacted on the experiences for residents, families and staff members. We thought that through the continued commitment and hard work seen the grades for other quality themes will improve. Requirements Number of requirements: 0 Recommendations Number of recommendations: 0 Grade: 5 - very good page 6 of 14

What the service has done to meet any requirements we made at or since the last inspection Previous requirements Requirement 1 The service provider must make proper provision for the health, welfare and safety of residents and ensure that improvement is made to the management of medicines in accordance with best practice guidance. In order to do so the provider must ensure that: a) Each resident receives their medication as prescribed including topical medicines and creams. b) Topical medicines and creams are marked to give the date of opening (as many of these have a short life span once opened). c) All handwritten entries on MAR charts must be signed and dated by the person making the change, and referenced to indicate where the handwritten information was obtained, or the authority for any change, for example instructions of the GP. d) More consistent use is made of the carers notes to explain omission of administration of medicines, changes to prescriptions and administration of "as required" medicines. e) Systems for recording and checking controlled medicines are improved. f) Review of "as required" protocols for the administration of "as required medicines" take place at the time intervals specified. This is to comply with SSI 2011/210 Regulation 4 (1) Welfare of users and consideration should be given to the National care standards, care homes for older people, Standard 15 Keeping Well - medication. Timescale: to commence on receipt of this report and to be completed by 30 September 2016. This requirement was made on 18 May 2016. Action taken on previous requirement Points a, b, and c of this Requirement was outstanding from the last inspection. We looked at the sample of topical medications. Some had no dates of opening and these are important to make sure that they are 'fit for use'. The service is moving to replace prescribed creams with 'over the counter' products and prescribed products being used for specific care needs. We thought that there had been improvement in respect of topical medication administration recording but there still needs to be some work. There were gaps in signing to show that these were applied and there was insufficient guidance for staff to inform them of when, why and where these were to be applied. To be fair and reasonable, we have met the requirement and made a recommendation relating to the recording. See Quality Theme of Care and Support. Met - outwith timescales page 7 of 14

Requirement 2 The provider must put in place systems to care for residents' clothing and personal belongings to ensure that they are cared for in a dignified manner. In order to achieve this the provider must: - In consultation with the resident and/or representative, review the clothing and personal property of each resident. - Ensure that each item is marked for individual use. - Compile an inventory of all items and have a system in place to update this. - Ensure that items are stored and cared for in a manner that takes dignity and respect into account. - Ensure that people are reminded of the policy in the home to highlight the steps to take when items are missing. (This must include when and what items are reimbursed). -Ensure that records are kept which will allow auditing of missing items. This is in order to comply with Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011(SSI 2011/210). Regulation 4(1) (a) requiring proper provision for the health, welfare and safety of service users. Timescale : To commence on receipt of this report and for completion by 30 September 2016. This requirement was made on 18 May 2016. Action taken on previous requirement Work continued in the home to make sure that clothing was cared for. Further invites were planned for relatives to be involved in this work and to identify their relatives' clothes and make sure that these items could be labelled. The manager had made some changes as to allocation of duties, such as putting away residents' clothing and naming these. Staff were becoming familiar with this process. Samples of clothing that were stored and cared for were orderly and tidy. Some items would have benefitted from renewing labelling as they were difficult to read. This would help make sure that clothing was returned to the correct person. Care files showed that a process was in place to record and update inventories of residents' clothing and belongings. We acknowledge the work that has taken place and thought it fair and reasonable for a recommendation to be made to continue this considerable piece of work. See Quality Theme of Care and Support. Met - outwith timescales Requirement 3 The provider must evidence that the management practices of the service are reviewed. In order to do this the provider: (a) Ensures that management and leadership practices are checked on a regular basis by a suitably qualified and competent person. (b) Where the said competent person identifies any unsatisfactory practice and poor outcomes for service users, you keep a record of this and take appropriate steps to effectively remedy the identified poor outcomes, and (c) Any instances of unsatisfactory practice identified through any quality assurance audits undertaken by a competent person are rectified and where appropriate training is provided to ensure that these instances do not recur. page 8 of 14

This is to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011(SSI 2011/210), Regulation 4(1) (a) - health and welfare. Timescale: To commence on receipt of this report and for completion by 30 September 2016. This requirement was made on 18 May 2016. Action taken on previous requirement The manager of the home informed us about how she had been supported into her role and become familiar with the company policies and procedures. Regular one to one supervision was given where there was discussion on any aspect of the service. There had been management support from senior staff in the company and this continues. Met - outwith timescales What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 The provider should ensure that advice is sought from other agencies where there are presenting difficulties in supporting the needs of a resident with complex care needs. National Care Standards, Care Home for Older people, Standard 5, Management and. This recommendation was made on 2 May 2017. Action taken on previous recommendation The manager was proactive in seeking guidance and support from other agencies. For example, the community health team were contacted in the event of issues arising in respect of care in the home. There was an example of one person with complex care and the manager had linked with a specialist in the field to present a talk to staff and other care homes about the condition. This recommendation was met. Recommendation 2 The provider should ensure that they fully involve family members to participate in the formulation of their relative's care plan where applicable. National Care Standards, Care Home for Older people, Standard 6, Support Arrangements & Standard 5, Management and. This recommendation was made on 2 May 2017. Action taken on previous recommendation Reviews of care had been carried out in the service and relevant family members were invited to contribute to the care planning for their relative. Discussions were recorded in care files that had taken place with family members. Where significant events were reviewed, we saw that family members were involved. page 9 of 14

This recommendation was met. Recommendation 3 The provider should ensure that an appropriate oral health care assessment is in place to meet residents' needs. National Care Standards, Care Home for Older people, Standard 5, Management and. This recommendation was made on 2 May 2017. Action taken on previous recommendation Assessments relating to oral health were in place and we saw that residents were supported with this aspect of care. This recommendation was met. Recommendation 4 The provider should ensure that there is documented evidence within care files that demonstrates that health appointments are being followed up. National Care Standards, Care Home for Older people, Standard 14, Keeping Well Healthcare. This recommendation was made on 2 May 2017. Action taken on previous recommendation There was evidence in care files and the diary to show that residents were supported to attend healthcare appointments. This recommendation was met. Recommendation 5 The provider should ensure that there is adequate care planning in place where a resident has communication difficulties and is required support to use specific aids. National Care Standards, Care Home for Older people, Standard 6, Support Arrangements & Standard 5, Management and. This recommendation was made on 2 May 2017. Action taken on previous recommendation Care files showed that information was in place when there was communication needs of residents. This included glasses and hearing aids and we saw residents who were supported by staff to use these. Where communication was an issue, care files set out guidance on how staff could best communicate with an individual. This recommendation was met. Recommendation 6 The provider should ensure that on admission to the care home, a detailed continence assessment requires to be completed that clearly explains if a resident is continent or if they require support. This should also involve input by the resident and family where appropriate. National Care Standards, Care Home for Older people, Standard 6, Support Arrangements & Standard 5, Management and. This recommendation was made on 2 May 2017. page 10 of 14

Action taken on previous recommendation Continence assessments were carried out as part of the admission assessment. Care plans detailed the needs of the resident and how staff could support them. Assessments were evaluated on a monthly basis. This recommendation was met. Complaints Please see Care Inspectorate website (www.careinspectorate.com) for details of complaints about the service which have been upheld. Enforcement No enforcement action has been taken against this care service since the last inspection. Inspection and grading history Date Type Gradings 19 Oct 2016 Unannounced Care and support Not assessed Management and leadership 10 Nov 2016 Re-grade Care and support Management and leadership 18 May 2016 Unannounced Care and support 1 - Unsatisfactory 1 - Unsatisfactory 1 - Unsatisfactory Management and leadership 2 - Weak 21 Aug 2015 Unannounced Care and support page 11 of 14

Date Type Gradings Management and leadership 13 Jan 2015 Unannounced Care and support Management and leadership 13 Jun 2014 Unannounced Care and support Management and leadership 9 Apr 2014 Unannounced Care and support 2 - Weak Management and leadership 2 - Weak 10 Oct 2013 Unannounced Care and support Management and leadership 17 May 2013 Unannounced Care and support Management and leadership 2 - Weak 26 Sep 2012 Unannounced Care and support Management and leadership 19 Jun 2012 Unannounced Care and support 2 - Weak Not assessed Management and leadership 2 - Weak 29 Feb 2012 Unannounced Care and support page 12 of 14

Date Type Gradings Management and leadership page 13 of 14

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 14 of 14