Barlochan House Care Home Care Home Service Palnackie Castle Douglas DG7 1PF Telephone: 01556 600287 Type of inspection: Unannounced Inspection completed on: 15 November 2017 Service provided by: Barlochan House Ltd Service provider number: SP2005007671 Care service number: CS2005102686
About the service The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at www.careinspectorate.com This service registered with the Care Inspectorate on 1 April 2011. Barlochan House is a care home registered to accommodate 50 older people of whom 8 may be accommodated in a designated wing for people living with dementia. This includes provision for 2 younger adults with either physical or sensory impairment. Situated on the outskirts of the village of Palnackie in Dumfries and Galloway, the home comprises of an old house and a modern building, linked together. Most of the accommodation is on ground floor level, but there are four first floor bedrooms in the old house and these are served by a passenger lift. The home is divided into three areas, with a team of staff designated to work in each area; these are Barlochan (the old house), Clifford (the new building) and, also in the new building, Solway - an area for people who are living with dementia. All bedrooms have en suite facilities, comprising a toilet and wash-hand basin and some also have showers. The home is well-provided with shared bathrooms suitable for assisted use and also offers a choice of sitting and activity areas throughout the home. The service describes its aims as: "to promote a safe, homely environment which acknowledges the individual's rights to privacy and choice". It describes staff as "committed to providing a friendly, caring home". What people told us We spoke with 21 residents, 6 relatives and carers in person during the inspection. In addition, 16 people gave their views through care standards questionnaires. All respondents told us that they were happy with the quality of care provided at Barlochan House. We also observed how staff responded to residents and visitors in public areas within the home. People we met were highly positive about the service. They said: "It's a good place" "Staff are very good" "Yes- very well looked after". "Good- mother is well looked after" "Excellent cook/chef in the house" "I think the staff know the residents' likes and dislikes well" "The manager is good and we are involved in residents and relatives' meetings" "I like it here -it is good fun" "Excellent Care" "Staff are attentive and know what they are doing" "We are fortunate to have Barlochan House Care home in our area, providing such high quality care for our loved ones. Nothing is too much trouble for the staff and there is always someone available to answer any queries". We used the Short Observational Framework for Inspection (SOFI) to help gather information on the experience of people. We observed residents over lunchtime. We saw that they appeared to be relaxed and received good support and encouragement with their nutrition and hydration needs. page 2 of 10
Staff made a real effort to create a relaxed and sociable mealtime experience. They showed warmth and respect to people experiencing care engaging them in conversations which were meaningful to them. The catering staff also sought views from residents about the quality of food. Self assessment The service had not been asked to complete a self assessment in advance of this inspection. We looked at the service's quality assurance paperwork. We advised that they should re-evaluate the service's development plan. From this inspection we graded this service as: Quality of care and support Quality of environment Quality of staffing Quality of management and leadership not assessed not assessed What the service does well We found a team approach to supporting health and wellbeing needs, including good involvement of other health professionals. The person-centred care plans were of a good standard and showed that residents had access to a range of healthcare professionals, including district nurses, dentists and GP's. The staff team worked well with other professionals. Relatives spoke highly of the care delivered. Personal plans clearly noted each residents' legal status to ensure their rights are upheld and their wishes are known. Residents and their relatives were involved in all aspects of the care planning process. Reviews were held six monthly and relatives told us that staff were good at communicating with them and updating them about changing needs. Personal Plans were implemented with agreement from individual residents, relatives and other agencies. This meant that people experiencing care could be confident that they would receive the right support and that care would be adapted as their needs and choices changed. There was a planned programme of activities which included mental stimulation, engagement and entertainment. Residents spoke positively of the entertainment programme. We found that staff were working hard to offer choices and enable people to reach their potential. We advised that the activity programme should continue to be implemented in the absence of the activity coordinator. However, we observed some good engagement and some people were particularly fond of looking for the peacock in the grounds of the care home and being involved in looking after the care home's pet cat. There was a relaxed and welcoming atmosphere within the home. Residents were observed to be happy, relaxed and well cared for. Interaction between staff and residents was highly positive. On the days of inspection, we observed warm, friendly exchanges with staff asking residents about their choices and wishes. People told the inspectors that they are treated with respect and dignity and that the staff are "very good" and listen to them. We noted some positive relationships and staff knew the residents' behaviours and personalities well. We noted that a significant number of residents had varying degrees of cognitive impairment. As previously recommended, staff had undertaken the Promoting Excellence Framework, Scottish Government 2011 training. page 3 of 10
Staff told us this had raised awareness of how they should approach people with distressed reactions. We advised that staff should use their learning to develop their keyworker roles and improve experiences for people in the care home. For example, use of life story work and engagement with individuals rather than task orientated practice would enhance communication and support. The environment was clean, warm and bright. There had been continued investment in the refurbishment and development of the environment to ensure it allowed residents to have as positive quality of life as possible. For example, there was a continuous programme of re-decoration, new carpets had been fitted, and, during inspection, the service's fire safety system was being upgraded. Effective cleaning strategies were in place which ensured that the environment was free from offensive smells. Residents told us the home was always clean. Residents told us that staff respond quickly if they used the alarms fitted in their bedrooms. Communal areas were welcoming and a variety of pictures and well placed furniture and home furnishings gave the building a homely atmosphere. A current certificate of insurance was in place. Residents were encouraged to bring photographs, ornaments or other treasured keepsakes or small items of furniture to help personalise their room. People told us they were happy with their surroundings. Some bedrooms we visited were observed to be very personalised. We noted some good signage has been introduced to enable people to find their way around the buildings. The atmosphere was relaxed and residents told us they were largely happy with the environment. There was a good range of equipment throughout the home to support people's needs, such as hoists and pressure mats. This enabled people to be supported in a safer manner. Staff were observed to be confident in their roles and were caring and sensitive in the way that they responded to people's needs. We found that staff were clear about their responsibilities regarding professional registration and codes of practice. We found a very good annual training planner in place. It included a variety of formal and mandatory training. Effective communication systems were in place. This included a programme of scheduled meetings reviews and staff handovers. The manager provided good management and leadership. The culture within this service was an inclusive one where there were good examples of how residents' views had been listened to and followed through to make a difference to the quality care they received. page 4 of 10
What the service could do better We found that out of one requirement and five recommendations made at the last inspection, the service has only fully met 2 recommendations. (See sections on requirements and recommendations for more information). We have repeated the outstanding requirement and three recommendations as follows: Although the service has installed appropriate window restrictors, we concluded that there was still a need to review the safety and security of the premises. Internal lighting in most areas was sufficient, however, there is insufficient and poor lighting to the service's car park. We again found external fire doors open and, the medication cupboard was also left unlocked. We are concerned that there is staff complacency to matters of safety. For example, people with cognitive impairment exiting the premises without staff awareness to areas without boundaries. Relatives also raised concerns about safety and security. Comments included: "On a few occasions when collecting my relative for an outing, no-one around to notice I have removed my relative- security and issue." We consider that it was positive for people to access the outdoors and that they can go out in all weathers. However, we have asked the manager to ensure that this is done in a safe manner and to conduct risk assessments and review the security and safety of the premises. (See requirement 1). There was a planned programme of activities. Views and access to the outside are essential to wellbeing. We discussed with the manager the benefits of independent access to a safe outdoor space. In addition, we discussed the development of the keyworker role and linking this to individual residents' life histories. The service should continue to develop meaningful activities/engagement linked to the development of the keyworker role. (See recommendation 1). Medication was being administered as prescribed. However, we found instances in the medication administration records (MAR) where medication had not been given and the reason for not administering was not always noted on the reverse of MAR records. We discussed this fully with the manager and advised that all refusal and reasons must be recorded to ensure accountability. (See recommendation 2). There was some signage to help orientate residents and we signposted the manager to the Kings Fund EHE environmental assessment tool to enable the continued development of a supportive environment for people with dementia. (See recommendation 3). The service continues to maintain records of any accident/incidents occurring within the service. These were collated by the management. We discussed with the manager the need to improve the management and support for residents regarding falls prevention in a pro-active manner. We advised the manager to review falls management taking account of the 'Managing Falls and Fractures in Care Homes for Older People' published by Social Care and Social Work Scotland(SCSWIS) 2011 and NHS 2011. (See recommendation 4). People spoke highly of the quality of the food. We observed that there is potential to improve the mealtime experiences for residents - particularly people with cognitive impairment. For example, the service should consider the use of heated plates and adaptive cutlery for people who need additional support. page 5 of 10
Staff should strive to make it a more meaningful occasion rather than a task orientated process. This would create a relaxed ambience for residents. (See recommendation 5). As areas of improvement, we advised that the service introduce directional signage to assist residents and visitors negotiate the home with ease. As already recommended, the service should use the Kings Fund al Assessment tool to evaluate the premises. We found some areas of the home to be cold and have advised the manager to monitor room temperatures throughout the home. OTHER ISSUES We advised the manager of the following issues as areas for development: As part of the service's safer recruitment processes, the service should enhance their processes by routinely asking applicants for professional registration details and checking relevant registers. The manager is good at notifiying the Care Inspectorate of any reportable events as required. We discussed and advised that the service is clear about the difference between accidents and incidents. We noted that the manager had not submitted a notification of death and accept that this was an error. We advised that the service re-evaluate their development plan to take account of and address any issues identified. We discussed that it may help the service to implement a working development plan with actions taken and note when they have been addressed. We advised the manager and staff to familiarise themselves with the new National Health and Care Standards to continue to promote good outcomes for people using their service.. Requirements Number of requirements: 1 1. The provider, manager and staff must review the safety and security of the premises, including exit routes, lighting, perimeter of external grounds and internal areas which should be kept locked at all times to ensure safety. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210) Regulation 4(1)(a) Welfare of users. Timescale: to be met by 5 March 2018 Recommendations Number of recommendations: 5 1. The service should continue to develop individual life story work, ensuring that this is linked to the keyworker role and a more personalised activity programme. In addition, the activity programme should be extended to include physical activity and use of external areas. page 6 of 10
National Care Standards care homes for older people - standard 6: support arrangements. 2. The service should ensure that where medication had not been given, the reasons for this must be accurately recorded on the reverse of MAR sheets to ensure accuracy and accountability. National Care Standards care homes for older people - standard 6: support arrangements. 3. The manager should use the Kings Fund EHE environmental assessment tool to evaluate and implement the continued development of a supportive environment for people with dementia. National Care Standards care homes for older people - standard 4: your environment. 4. The manager and staff should introduce strategies for falls prevention and management. National Care Standards, care homes for older people, standard 6: support arrangements. 5. The service should improve the mealtime experiences for residents - particularly people with cognitive impairment. Staff should strive to make it a more meaningful occasion rather than a task orientated process. Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at www.careinspectorate.com. page 7 of 10
Inspection and grading history Date Type Gradings 20 Jan 2017 Unannounced Care and support 5 - Very good Not assessed 5 - Very good Management and leadership Not assessed 5 Feb 2016 Unannounced Care and support 5 - Very good 5 - Very good 5 - Very good Management and leadership 5 - Very good 4 Feb 2015 Unannounced Care and support 5 - Very good Management and leadership 18 Mar 2014 Unannounced Care and support Management and leadership 2 Aug 2013 Unannounced Care and support Not assessed Management and leadership Not assessed 1 Nov 2012 Unannounced Care and support Management and leadership 6 Jan 2011 Unannounced Care and support Not assessed Management and leadership Not assessed page 8 of 10
Date Type Gradings 11 Aug 2010 Announced Care and support 3 - Adequate Not assessed 3 - Adequate Management and leadership Not assessed 11 Mar 2010 Unannounced Care and support 3 - Adequate Management and leadership 29 Sep 2009 Unannounced Care and support 3 - Adequate 3 - Adequate Management and leadership 21 Nov 2008 Announced Care and support Management and leadership 3 - Adequate 19 Mar 2009 Unannounced Care and support Management and leadership page 9 of 10
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 10 of 10