Ranfurly Care Home Care Home Service 69 Quarrelton Road Johnstone PA5 8NH Telephone: 01505 328811 Type of inspection: Unannounced Inspection completed on: 20 December 2017 Service provided by: Silverline Care Caledonia Limited Service provider number: SP2014012299 Care service number: CS2014326139
About the service Ranfurly Care Home was registered with the Care Inspectorate in September 2014 and provides care for up to 60 older people. At the time of our inspection 52 residents were living in the home. The provider is Silverline Care Caledonia Ltd. The purpose-built home is located in the residential area of Johnstone and is near bus routes. It is set on two levels and divided into four units. Each unit has a lounge and a dining room. The bedrooms have en-suite shower facilities and communal bathrooms and toilets are also provided. Residents have access to three large and safe garden areas. The home has a minibus for outings. The provider's mission statement is 'to provide high quality care to our residents, peace of mind for their families, and be a great place to work'. What people told us During the inspection we spoke to 30 residents and relatives. We received eight questionnaires from relatives. People told us that they were generally happy with the care received at Ranfurly Care Home. They said that staff were friendly, kind and dedicated. Relatives told us that they find the home very welcoming and that the management team is approachable and keen to listen to people's views. One person said 'some lovely carers make my life a lot easier'. Another relative found the home 'warm and welcoming'. Several relatives commented on how quickly people settled into living in the Home. One resident said: 'My room is lovely. This is my home'. Residents commented overall positively on the menu offered at mealtimes. One person said 'if you don't like anything they'll make you something else'. Another resident felt that there was 'plenty of choice for dinner'. Residents said that they enjoyed joining in with the activities in the home. One resident told us that staff supported residents 'to go out to the shopping mall'. Another resident stated: 'I know what activities are on and staff encourage me to take part'. Several residents commented positively on being given the opportunity to 'do exercises'. One relative said they wished that staff had 'more free time for conversations'. Relatives told us that staff were good at keeping them informed about their relatives' health and what is happening at the home. Self assessment We did not ask the service for a self assessment. From this inspection we graded this service as: Quality of care and support 3 - Adequate page 2 of 11
Quality of environment Quality of staffing Quality of management and leadership Quality of care and support Findings from the inspection The home provided a friendly and welcoming atmosphere. People told us that staff were kind and we saw a good relationship between the people who live and work in the home. Residents and families knew their keyworkers well and staff were very aware of individual likes and preferences. People's healthcare needs were supported well. This was confirmed by external healthcare professionals we spoke with. The home carried out necessary assessments and healthcare reviews correctly and timely. A new electronic care plan system was recently introduced to improve communication and to ensure safe care. Whilst there were still some gaps in the new system, we saw a number of detailed, well written personal plans. Staff supported people to be included in meaningful everyday activities. Residents said they enjoyed taking part in activities and having the company of other people. The home's minibus was a valuable resource that enables people to stay connected to their community. Service users told us that they enjoyed going to do their shopping and on trips. The service was working on creating enjoyable mealtime experiences. However, during our visit we found that mealtimes need further improvement. Our observations showed long waiting times between courses and difficulties with maintaining a good mealtime atmosphere and enabling choices. We made a recommendation to stress the importance of mealtimes as opportunities to enhance physical and mental wellbeing (see recommendation 1). There was a need to improve medication administration records to reflect best practice guidance. This would ensure the safety and wellbeing of residents. We made a recommendation to that effect (see recommendation 2). The home needs to improve practice around the use of bedside rails. We found bedside rails were used without a detailed risk assessment or appropriate written consent. We made a recommendation to protect residents' rights in line with best practice guidance (see recommendation 3). Requirements Number of requirements: 0 Recommendations Number of recommendations: 3 1. People living in the home should be able to eat well and enjoy their food and drink. To ensure best practice around mealtimes the provider should: page 3 of 11
- Ensure that the quality of the mealtime experience is regularly monitored by carrying out practice observations at mealtimes. - Evaluations should include, but not be limited to, the mealtime environment and atmosphere, enabling choices, meeting individual needs and providing assistance appropriately. - The frequency of the observations should be based on the unit's performance. - The findings of the observations should inform a regularly updated action plan. - Staff on each unit should be actively involved in observations and action planning. - The length of time people wait for their food at the beginning of meals or in between courses should be reviewed National Care Standards for Care Homes for Older People: Standard 5 - Management and staffing arrangements and Standard 13 - Eating well. 2. People living in the home should be able to live as well as possible and be protected from risk and harm. To ensure best practice guidance for medication management is being followed, the provider should: - Ensure there is a complete, accurate and consistent auditable record of all prescribed medicines entering, administered or destroyed, and leaving the service. - Ensure that protocols for every medication prescribed 'as needed' are in place. - Covert medication should be managed following current best practice guidance from Mental Welfare Commission. - Ensure that prescriber's instructions are fully adhered to. National Care Standards for Care Homes for Older People: Standard 15 - Keeping Well - medication and Standard 5 - Management and Staffing Arrangements 3. People living in the home should not be unnecessarily restricted. To ensure this, the provider should ensure the use of equipment that can be seen as restraining is assessed. Appropriate consent for the use of bedside rails should be obtained and documented in line with Mental Welfare Commission Scotland guidance - Rights, risks and limits to freedom. National Care Standards for Care Homes for Older People: Standard 5 - Management and staffing arrangements and Standard 9 - Feeling safe and secure Grade: 3 - adequate Quality of environment page 4 of 11
Findings from the inspection We found that the home was overall clean, tidy and odour free. This contributed to the welcoming and calm atmosphere we experienced during the inspection. People told us that they found the home comfortable and that they liked their bedrooms. The service supported people to personalise their own bedrooms by bringing in items from their home. This good practice can help people to settle into a new environment and to make bedrooms feel more homely. The clear and simple layout of the home made it easy for people to move about. Only one unit used a number lock at the front door to increase safety for people living with dementia. We saw evidence of recent refurbishment in the downstairs units that improved lighting and floors. The improvements made it easier and safer for people to walk, particularly in the corridor areas. The layout of the home created useful spaces and promoted social life. People in each unit had access to a large, comfortable lounge and a separate dining room. A few shared communal rooms were available for visits or activities. The home had large, safe and accessible garden areas. It was good to hear that the home had plans to further enhance some of the outdoor spaces to give people living in the home more opportunities to spend active and enjoyable time outside. Having regular opportunities to spend time outdoors can help to improve physical and mental health. There was scope for the environment of the home to be more dementia friendly. A well assessed and adapted environment can help people living with dementia to maintain a higher degree of independence and reduce distress. The service should use the King's Fund assessment tool 'Is your care home dementia friendly?' to assist them to affect changes in the home. This will be the subject of a recommendation. (See recommendation 1). We found that staff maintained the home well. Maintenance and housekeeping staff were evident during our inspection. However, we found gaps in completing necessary maintenance records and documenting of checks. To ensure people's safety in the home we made a recommendation (See recommendation 2). Requirements Number of requirements: 0 Recommendations Number of recommendations: 2 1. The home's environment should enable people to be as independent as possible. To achieve this, provider should carry out the King's Fund environmental assessment tool 'Is your care home dementia friendly?' to support them to affect changes in the home. The tool should be used with involvement of people living with dementia, family members and staff. The ongoing use of the tool and any actions based on its use should form part of the home's service development plan. page 5 of 11
National Care Standards for Care Homes for Older People: Standard 4 - Your Environment. 2. People living in the home should be safe and their environment well maintained. To do this the provider should keep all records of regular maintenance checks used to protect people from harm and infection complete and up-to-date. National Care Standards for Care Homes for Older People: Standard 4 - Your Environment Grade: 4 - good Quality of staffing Findings from the inspection Staff were kind and helpful when attending to residents' needs. They created a calm and friendly atmosphere that helped putting people using the service at ease. People told us that they appreciate the staff members and found that they were approachable and had an open ear for their concerns and wishes. A well-trained workforce can support better outcomes and safer care. The records for mandatory training were completed and up-to-date. They showed that sufficient numbers of staff had received mandatory training. The home had a training plan and a dedicated trainer. The service had recognised a need for further moving and handling training and had a plan in place. This included the implementation of regular observations of practice to ensure safe and competent moving and handling of people. Our observations confirmed the need for training and observations to continue as planned. We saw that staff recruitment followed best practice to ensure the safety of people living and working in the home. All care staff had registered with the Scottish Social Services Council (SSSC) and a system was in place to monitor registration renewal dates. This helped raise standards of practice, support the workforce and increase the protection of people who use the service. A large number of the residents are living with dementia and are on various stages of their dementia journey. During our inspection we observed that not all staff members appeared to have the necessary knowledge and skills to ensure best practice in caring for people living with dementia. We have repeated a recommendation to ensure that the home will progress with their plans to give all staff members access to their relevant level of Promoting Excellence in Dementia Care learning (see recommendation 1). The home had a system to ensure that all staff members receive regular, formal supervision. We saw that the recordings of the individual supervision sessions were of a good standard. However, the recent records showed that many supervision sessions were overdue. We have therefore made a recommendation. The purpose of supervision is to monitor tasks and workload, solve problems, support them in dealing with complex situations and to promote their development (see recommendation 2). page 6 of 11
Requirements Number of requirements: 0 Recommendations Number of recommendations: 2 1. People living with dementia in the home should be confident that staff have the necessary skills and knowledge to support them. To achieve this the provider should ensure that all staff members are trained to a level of the Promoting Excellence framework appropriate for their role. Staff should have personal development plans that include how they are developing their skills in supporting and caring for people with dementia and in using person-centred practices. The provider should consider staff to be identified as dementia ambassadors who are supported by the manager to identify areas for improvement and to facilitate dementia learning. National Care Standards for Care Homes for Older People: Standard 5 - Management and staffing arrangements. 2. Staff working in the home should be given the opportunity to reflect on and develop their practice through regular supervision. To achieve this the provider should ensure that regular supervision sessions are carried out on time and as scheduled in line with the provider's policy. National Care Standards for Care Homes for Older People: Standard 5 - Management and staffing arrangements. Grade: 4 - good Quality of management and leadership Findings from the inspection People who used the service told us that they were happy with the management of the service. They knew the management team and senior staff and found them all to be very approachable. Residents and families were confident that managers listened to them and responded to any concerns. The home displayed information about the service and any organised events or activities. The management also used regular newsletters to keep people informed. We saw that the service used a variety of ways to gather peoples' views and involve them into the running of the home. The management team arranged regular meetings and surveys to gather the views of residents, families and people who work in the home. There was evidence of acting on feedback in minutes of meetings and on suggestion boards. Keeping residents and their families well-informed and involved in the running of the home can lead to improved outcomes and greater confidence in the service. page 7 of 11
The leadership team appeared to manage the introduction of the new electronic care planning and quality assurance systems well and staff members felt supported with learning how to use the new systems and hardware. The managers had recognised that the new quality assurance systems and the existing service development plan were not yet sufficiently complete and effective. We saw this ability to self-assess weaknesses and take appropriate action as strength. During our visit we received assurances that the management team will work on this at pace with support of the regional manager. The home had a system in place to record accidents and incidents and to report incidents where necessary. However, we found that this needed improvement and made a recommendation (see recommendation 1). The existing system did not provide a clear trail of actions and decisions. Some accident forms were not fully completed and there was insufficient evidence of regular accident and incident analysis. Robust accident and incident recording and reporting systems as well as routine and regular analysis of accidents and incidents are essential for ensuring safety and for continuously developing the quality of care. Requirements Number of requirements: 0 Recommendations Number of recommendations: 1 1. People living in the home should feel confident that the service is managed in a way that ensures safe, positive and improving outcomes. To ensure this the provider should ensure that all records of incidents and accidents are completed fully and correctly. Records should be kept in a way that allows straightforward tracing of individual cases and actions taken. All reportable incidents should be reported timely in accordance with Care Inspectorate guidance on notification reporting for registered care services. National Care Standards for Care Homes for Older People: Standard 5 - Management and staffing arrangements and Standard 9 - Feeling safe and secure. Grade: 4 - good page 8 of 11
What the service has done to meet any requirements we made at or since the last inspection Previous requirements There are no outstanding requirements. What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 In order that people using the service receive good quality care and support, the service should ensure that staff training, particularly training in dementia care, should be sought and delivered to staff. National Care Standards for care homes for older people: Standard 5.1. - Management and staffing arrangements. This recommendation was made on 5 October 2016. Action taken on previous recommendation We saw good evidence that staff's core training was up to date and relevant to their individual role. However, there was a continued need for progress to be made in regards to dementia care training. There will be a continued recommendation regarding dementia care training. Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at www.careinspectorate.com. Enforcement No enforcement action has been taken against this care service since the last inspection. page 9 of 11
Inspection and grading history Date Type Gradings 2 Mar 2017 Unannounced Care and support 3 - Adequate Environment Not assessed Staffing Management and leadership 8 Jul 2016 Unannounced Care and support 3 - Adequate Environment Staffing Management and leadership 17 Mar 2016 Unannounced Care and support Not assessed Environment Not assessed Staffing Not assessed Management and leadership Not assessed 28 Aug 2015 Unannounced Care and support Environment Staffing Management and leadership 3 - Adequate 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