Collisdene Care Centre Care Home Service 126/128 Glasgow Road Strathaven ML10 6NL Telephone: 01357 521250 Type of inspection: Unannounced Inspection completed on: 21 November 2017 Service provided by: Canterbury Care Homes Limited Service provider number: SP2005007835 Care service number: CS2006137442
About the service Collisdene Care Centre is operated by Canterbury Care Homes Ltd. It is registered to provide a care service to a maximum of forty people including ten older people, twenty-six adults with learning disabilities and four adults with physical and sensory impairment. There is also some provision for respite accommodation. The home is situated in a residential area of Strathaven, a rural town in South Lanarkshire. The home is close to local amenities and public transport routes. The home has accommodation on two levels. There are three distinct units in the building. Castle Unit supports adults with a combination of learning disability, mental health issues and physical disability. Avon Unit supports frail elderly adults with a combination of dementia and physical disability. Parkview Unit supports adults with a more profound learning disability and physical disability. The service has three lounges and two dining rooms; with a separate recreational room. There are outdoor spaces to the front, rear and side of the building, although some areas have steep slopes. The service is in the process of reviewing its function and service provision with a view to providing more singular, focussed and specialised care and support to vulnerable adults. The philosophy of the service is to provide "clients the opportunity to enhance their quality of life by providing a safe manageable and comfortable environment, as well as support and stimulation to help them maximise their potential with regard to their particular physical, emotional and social capacity". What people told us We spoke with a number of individuals who use the service throughout the inspection. The people we spoke with were generally complimentary and positive about the staff who support them within Collisdene Care Centre. Some residents were unable to tell us their views on the service and the care they received and we spent time observing and engaging with residents. We used the Short Observational Framework for Inspection (SOFI) to directly observe the experience and outcomes for some people who were unable to tell us their views as part of the inspection. We observed staff chatting and interacting with residents in a respectful manner during our inspection. The staff appear to know the residents personalities and preferences and this ensured that residents were responded to appropriately. Comments from the residents during the inspection included: "I like to get out on the bus, I get out a lot" "The lassies are great" "I like to get a cup of tea when I'm watching the TV" "It gets a bit cold, could be warmer in here". page 2 of 14
Self assessment 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 Quality of care and support Findings from the inspection We found the quality of care and support to be good. Staff interacted with residents in a respectful and courteous manner, often with humour. Residents were encouraged to spend time engaged in activities that they enjoyed both within and out with the service. This helped create an atmosphere of calm. We examined support plans and found them to contain a good level of personalised, current and needs specific detail. This enabled staff to deliver effective person-centred care. Discussion with residents and relatives/carers was on-going and promoted inclusion and feedback. The lounge area had recently been equipped with a large screen television and a TV subscription service had been purchased. This was sourced after requests by residents and we observed residents enjoying this in the communal lounge, searching for Christmas films and discussing options with staff. We found gaps in the daily monitoring charts, this included gaps in the recording of oral care and in the application of topical creams. We found some issues with Medication Administration Records (MARs). Some records indicated that records were being signed prior to medication being given. (see recommendation 1) We reviewed accident and incident records. We noted occasions where appropriate referrals had not been made to the Care Inspectorate or through the appropriate Adult Support and Protection procedures. We asked that the manager submit these retrospectively. (see recommendation 2) At times there appeared to be a lack of numbers of staff or that the deployment required reviewed. The service has advised that a variation in staffing is being requested. We will await the outcome of this and review as necessary. (see recommendation 3 which has been repeated and reworded) page 3 of 14
Requirements Number of requirements: 0 Recommendations Number of recommendations: 3 1. The provider should ensure that medication is managed safely including: a) Ensure that medication is in stock b) Ensure that medication is given as prescribed c) Ensure that a consistent approach is taken to recording the application of topical creams d) Ensure Medication Administration Records are only signed after the medication has been given to show that this has been taken by the resident, as required. National Care Standards: Care homes for people with learning disabilities; Standard 15 Keeping Well: Medication 2. The provider should ensure that, where issues are identified that relate to residents needs, a review of any care and involvement of other health & social care professionals, as required, is undertaken without delay. Adult Support and Protection notifications should be submitted to the relevant social work department and the care inspectorate as a matter of priority, detailing when the incident took place, referral was made and the outcome of any investigations. National Care Standards: Care homes for people with learning disabilities; Standard 9 Feeling Safe and Secure 3. The provider should determine the correct dependency levels for each resident, to ensure that the needs of residents can be safely met. The dependency tool used by the service should take into account: a) The free movement of residents around the service b) The extended waking hours of residents c) The environmental layout of the service. d) Residents who require assistance to access community resources, as highlighted in any support plan and/or participation strategy. National Care Standards: Care homes for people with learning disabilities; Standard 5: Management and Arrangements, Grade: 4 - good Quality of environment Findings from the inspection At the time of inspection we found that service had assisted residents to personalise their own bedrooms. An artist had been commissioned to paint murals in some bedrooms, which residents stated they enjoyed. page 4 of 14
A variety of equipment was used to reduce risks to residents. These included pressure mats, profiling beds and specialist mattresses. Maintenance checks were up to date for all equipment. The care home covers an extensive area of the grounds and has been added to over the years. The various units are on different levels and offer different facilities according to the needs and wishes of residents. We found that tea and coffee-making facilities remained available for residents able to assist themselves with this task, maintaining and encouraging levels of independence. We found some out of date foodstuff within two storage cupboards and highlighted this to the manager. However, this had still not been checked on the second day of the inspection. The manager should ensure that thorough environmental audits include checking the dates of produce being used within the service, ensuring the health and wellbeing of residents is maintained. Previous inspections highlighted the improvements which had been made to the service over a number of years. However, on-going improvements and investment remain required. The service should continue prioritising improvements to the environment, involving residents, their relatives/carers and relevant stakeholders whenever possible. Requirements Number of requirements: 0 Recommendations Number of recommendations: 0 Grade: 4 - good Quality of staffing Findings from the inspection We observed interactions between staff, which showed they knew residents well and were respectful. The staff we spoke with appeared committed to the care service and dedicated to delivering a high standard of care for the residents. Staff told us that they received training to support them in their role and deliver positive outcomes for residents. This was supported by the training matrix, on online system that provides management with an overview and breakdown of all training completed by the staff group. The service had, at the time of inspection, an overall training compliance score of 84%. Staff continued to be supported through regular supervision sessions. Supervision could be further improved by being more reflective, highlighting what was discussed, any learning outcomes identified/achieved and how improved practice and/or training has impacted on outcomes for service users. page 5 of 14
We have identified some aspects of care and support that should be improved upon, for example completion of daily charts and medication recording. However, this did not detract from the quality of care from staff that we observed. Recent complaint activity had resulted in two requirements related to staff training. These requirements have been met. Requirements Number of requirements: 0 Recommendations Number of recommendations: 0 Grade: 4 - good Quality of management and leadership Findings from the inspection We found that the manager had a quality assurance system that allowed an overview of resident risk assessment. These audits were completed monthly and included accidents/incident, falls, nutrition and wounds. Action plans were in place where issues had been identified. Regional managers were also carrying out monthly quality assurance audits. We received positive feedback about the manager from both staff and residents during the inspection. People advised that they felt supported and comfortable approaching the manager with issues and reassured that these would be addressed. Management should ensure that the quality assurance system is completed regularly within the service. This will ensure that any issues and/or concerns are noted and dealt with in a timely manner, such as some concerns that have been highlighted through the inspection report. 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 provider must ensure that staff have training appropriate to the work they are to perform, in this case specifically in food preparation. 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 15 (b). This requirement was made on 19 September 2017. Action taken on previous requirement The service had ensured that all staff had now received appropriate food hygiene training Met - within timescales Requirement 2 The provider must ensure that appropriate procedures for the prevention and control of infection are in place and complied with. 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)(d). Timescale for meeting this requirement: To be completed by 27 October 2017. This requirement was made on 19 September 2017. Action taken on previous requirement This requirement is in relation to staff wearing appropriate protective clothing within the service. During inspection we did not see any staff working within the kitchen without appropriate clothing/equipment. The staff we spoke with all advised that they were aware to bring an appropriate change of clothing if they were working within the kitchen area throughout the day/night. Met - within timescales Requirement 3 The provider must, having regard to the size and nature of the care service, the statement of aims and objectives and the number and needs of service users, ensure that at all times suitably qualified and competent persons are working in the care service in such numbers as are appropriate for the health, welfare and safety of service users. page 7 of 14
In this regard the provider must comply with their Schedule in line with their conditions of Registration. Any reduction in staffing must be agreed with the Care Inspectorate. 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 15 (a), and the Public Services Reform (Scotland) Act 2010 Timescale for meeting this requirement: To be completed by 07 November 2017. This requirement was made on 19 September 2017. Action taken on previous requirement The service had submitted a variation for their staffing numbers at the time of the inspection. However, the dependency tool being used by the service was limited and did not appear to reflect the needs of residents. The service should utilize a dependency tool that can calculate the level of need and staff resources required to ensure the health and wellbeing of residents continue to be met. We will reassess after the variation request has been assessed by the relevant inspector. Not met Requirement 4 1. The service provider must ensure that they respond to repairs in a timely manner to make proper provision for the health, welfare and safety of service users. They must also ensure that appropriate strategy's and risk assessments are in place in the event of the lift breaking down. 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) Welfare of users. Timescale for meeting this requirement: To be completed by 07 November 2017. This requirement was made on 19 September 2017. Action taken on previous requirement During the inspection we found that repairs recommended and requested were being dealt with in a timely manner. There were few outstanding repairs within the service. Risk assessments were now in place for residents in the event of the lift breaking down. Met - within timescales page 8 of 14
What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 The service should ensure that they aware of any order in force for residents such as Guardianship, Power of Attorney, Appointeeship and Section 47 Certificates. The existence of such orders should be clearly and prominently displayed in support plans and the service should ensure that staff are aware of the meaning and implications of them. NCS 6 Care Homes for People with Learning Disabilities - Support Arrangements. This recommendation was made on 27 June 2017. Action taken on previous recommendation The support plans that we viewed during inspection had clear information on legal powers. Staff we spoke with advised that they were aware of what different powers meant and the service had organised training sessions for staff awareness. MET Recommendation 2 The service should identify and provide CALMS or equivalent training for staff which will better equip them to deal with presentations of stressed and distressed behaviour in a confident, safe and professional manner. NCS 5 Care Homes for People with Learning Disabilities - Management and Arrangements. This recommendation was made on 27 June 2017. Action taken on previous recommendation We looked through the staff training and found that staff had received training on stress & distressed behaviour. We spoke with the manager who advised that this was ongoing and part of the training programme. We spoke with staff surrounding how they work with residents who are displaying stressed and distressed behaviour and they staff we spoke to appeared knowledgeable and confident in the techniques that they would use. MET Recommendation 3 The service should review the cause of staff shortages which result in supported outings in the community and one to one support for residents being compromised. Service users have a right to expect this and it should be the norm rather than the exception. The reliance upon staff to sacrifice their own time to meet this obligation, irrespective of their willingness to do so, is unsustainable. NCS 5 Care Homes for People with Learning Disabilities - Management and Arrangements. page 9 of 14
This recommendation was made on 27 June 2017. Action taken on previous recommendation At times there appeared to be a lack of numbers of staff or that the deployment required reviewed. The service has advised that a variation in staffing is being requested. We will await the outcome of this and review as necessary. This recommendation has been reworded for this most recent report NOT 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 14 Jun 2017 Unannounced Care and support 5 - Very good 5 - Very good Management and leadership 5 - Very good 29 Jun 2016 Unannounced Care and support Management and leadership 2 Dec 2015 Unannounced Care and support Not assessed Not assessed Not assessed Management and leadership Not assessed page 10 of 14
Date Type Gradings 10 Dec 2015 Re-grade Care and support Management and leadership 7 Jul 2015 Unannounced Care and support Management and leadership 15 Jan 2015 Unannounced Care and support Management and leadership 17 Jul 2014 Unannounced Care and support Management and leadership 18 Dec 2013 Unannounced Care and support 2 - Weak Management and leadership 2 - Weak 18 Sep 2013 Unannounced Care and support 2 - Weak Management and leadership 4 Feb 2013 Unannounced Care and support 2 - Weak 2 - Weak 2 - Weak Management and leadership 2 - Weak 16 Nov 2012 Unannounced Care and support Management and leadership Not assessed page 11 of 14
Date Type Gradings 16 Nov 2012 Unannounced Care and support Management and leadership Not assessed 14 Feb 2012 Unannounced Care and support Management and leadership 1 Sep 2011 Unannounced Care and support Management and leadership 4 Oct 2010 Unannounced Care and support Management and leadership 2 Jun 2010 Announced Care and support Management and leadership 3 Nov 2009 Unannounced Care and support Management and leadership Not assessed 4 Jun 2009 Announced Care and support Management and leadership 21 Jan 2009 Care and support Management and leadership page 12 of 14
Date Type Gradings 9 Sep 2008 Announced (short notice) Care and support 1 - Unsatisfactory 2 - Weak 1 - Unsatisfactory Management and leadership 1 - Unsatisfactory 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