Pitlair House Nursing Home Care Home Service Bow Of Fife Cupar KY15 5RF Telephone: 01337 831 159 Type of inspection: Unannounced Inspection completed on: 14 March 2017 Service provided by: Pitlair Limited Service provider number: SP2003002300 Care service number: CS2003010322
About the service Pitlair House Nursing Home is registered to provide 24-hour nursing care for a maximum of 40 older people and younger people with physical disabilities. The home is situated in the Bow of Fife and is privately owned and run by Pitlair Limited. The care home has extensive, well-maintained, attractive grounds, with pleasant seating areas, summer-house and during the summer, a marquee for events. Situated over two floors, the care home provides an ample number of public rooms, seating areas, activity room, conservatory and dining area. The accommodation consists of 28 single bedrooms and six double bedrooms, which are personalised to the residents' choice and preference. What people told us On the whole we received positive comments from both residents and relatives regarding the standard of care at Pitlair, with all people telling us they were either happy or very happy with Pitlair. When we received a negative comment we anonymised the information and followed this up with the service, in order to gain improvement. Comments included: "High standard of care. Pleasant, cheerful, helpful staff." "The care and support I have is very good indeed. My only adverse comment is the fact that for me the green vegetables are overcooked." "Friendly helpful staff, both to us and to our relative. Home is always clean and fresh. Home is well-appointed, including the grounds and garden, which help to make it a good experience for the residents and the family/ relatives." "Mum has improved so much from the hospital she was at, that it is obviously an environment which suits her, gives her comfort, feels safe in and is healing. I visit often and always feel happy with the experience whatever member of the staff I come into contact with. Pitlair doesn't have one key staff member, but around five per client, so that whatever day you visit, you can speak to someone who knows mum well. All staff seem approachable. So far, I am very happy with the environment and level of care and stimulation given to mum." "The following are relatively minor points but worth making. When I come in to visit, my relative's flowers are dead because there is no water in the vase. Could flowers be checked? I have noticed before, but don't know if it still happens, that staff hand out a biscuit with residents' tea/coffee. I don't think food should be handed by staff plus it takes away choice and is slightly degrading. I have asked many times that the sliding door to the toilet be closed so that my relative does not have to look into the toilet. It makes their living space feel completely different when it is closed." "As before only concern is communication between staff members from one shift to another and even though it is not the key member, all staff should be told about changes happening to clients." "I am confident that my (relative) is well cared for and happy in Pitlair. It means that a huge worry has been lifted from me. I find the quality of care at Pitlair to be of a very high standard especially as I do not live locally." "All the staff are fully trained to look after my (relative) and he enjoys the banter and teasing. If I have any problems, I can talk to the nurses and they sort it out quickly. He is well looked after and is very happy with all the staff." page 2 of 8
"I would feel happier if management listened to us. On the whole the nursing staff are very good. Our views aren't listened to, nor are they asked for." "Residents' meetings aren't helpful. We get told what is happening." "I'm very happy here. The staff are good. We get asked for our comments about the meals but our suggestions aren't taken up." Self assessment The Care Inspectorate received a fully completed self-assessment from the provider. The provider identified what it thought the service did well and it identified areas that could be improved and showed how the service intended to do this. 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 The service had many strengths and in some areas provided very good care, which resulted in very good outcomes for people. However, there were some areas that required improvement and for this reason we reduced the grades to good for care and support and for staffing. On the whole the service had a motivated and dedicated staff team that worked together well in order to meet the needs of residents. We saw that residents were treated with respect and dignity and staff responded to their requests quickly and empathetically. This included offering reassurance and support to people when they were confused or unsure which helped to prevent distressed behaviours. For example, one resident was distressed at the presence of another resident and staff quickly and sensitively diffused the situation so both individuals were kept in good humour and free from harm. Another individual was confused and thought that they needed to contact their family urgently. Staff calmly and kindly reassured the person and then distracted them so that they were no longer distressed. This was excellent practice and left the person feeling calm, reassured and happy with the situation. The majority of residents told us the meals were very good with hot choices for lunch and dinner, as well as sandwiches for supper. The meals were varied, with alternative choices for those that did not like the hot options. From our observations we saw that meal times were an enjoyable experience for residents, with lots of conversation, attentive staff and most people finishing with empty plates. Residents chose where they ate their meal and this varied between the main dining room, the lounge, the sun-room and their bedrooms. The environment was spacious, clean, homely and well maintained. The residents told us they particularly loved the views and the gardens, which they accessed in better weather. page 3 of 8
Most people told us they were happy or very happy living at Pitlair for a mixture of reasons. The main reasons being the kind and attentive staff, regular entertainment, the food, the homely building and attractive gardens. What the service could do better We found that some care staff had not maintained their registration with the Scottish Social Services Council (SSSC) because they had not paid their fees, which is a requirement by law. Due to the number of staff involved it would have had a detrimental impact on residents if they were not allowed to work until their new registrations came through. Therefore, the service agreed to complete a full risk assessment to ensure the safe supervision of those staff in practice until their registrations are renewed. The management team is now aware that registrations can be cancelled if fees are not paid and has a list of all staff payment dates to ensure that this does not happen again. The service also agreed to educate staff on their responsibilities in relation to the role of the SSSC and their post registration training and learning. Although staff were keen and motivated we found that there were missed opportunities in relation to staff's training and supervision. For example, some staff had a limited understanding of adult support and protection. Other staff told us that they had not received supervision. The service needed to update their training plan. They also needed to ensure regular supervision so that they could measure staff's skills and abilities in order to identify any training needs or knowledge gaps. We shared information from a range of sources to help the service improve this, which included Social Services Knowledge Scotland (SSKS), the SSSC and the Continuous Learning Framework. See recommendation 1. We looked at the safe use of bedrails within the service. Although bedrails can help to control the risk of people falling out of bed, their use is not without risk. People can become entrapped in bedrails resulting in sometimes severe injury. We found that there was a risk of entrapment that had not been adequately controlled. We discussed this with the service and provided the most current advice regarding the safe use of bedrails which we strongly recommend the service uses to control the risk of entrapment. Health and Safety Executive's, Health and Safety in Care Homes (2nd Edition), 2014 guidance, Chapter 5 Safe use of bed rails. See requirement 1. Some residents felt the service did not ask for their views and if they gave their views the service did not act upon them. Albeit this was a small number of residents in comparison to the number who felt they were consulted. There was limited evidence of residents' views being included in their reviews or care plans. We discussed this with the management team who were disappointed with this feedback as they felt they did listen to people and where appropriate took action. The management team agreed to be mindful of this situation and to look at ways they could enhance resident participation. This will be followed up at the next inspection. Sometimes staffing numbers dropped below the minimum number of staff required for a morning shift. This was usually because of last-minute staff sickness which the management team was in the process of addressing. Therefore, we have asked the service to let us know when they drop below their minimum staffing schedule so that we can monitor the situation. page 4 of 8
Requirements Number of requirements: 1 1. The service provider must make proper provision for the health, welfare and safety of service users by ensuring that bedrails are used correctly and safely. In order to do this the provider must: a) review and effectively risk assess the use of all bedrails within the service b) train staff in the risks and safe use of bedrails c) ensure that the rails and any accessories are compatible with the bed, mattress and occupant, and d) regularly inspect the bed rails to ensure that they are secure, maintained and any gaps that could cause entrapment are eliminated. This is in order to comply with regulation 4(1)(a) of The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, SSI 2011/210. Timescale: immediate action required and to be fully met by no later than 10 April 2017. Recommendations Number of recommendations: 1 1. The service should develop an effective yearly training and supervision plan for all its staff to ensure that they have the knowledge and skills necessary to do their job, including training in adult support and protection. National Care Standards Care Homes for Older People - Standard 5: Management and arrangements Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at www.careinspectorate.com. Inspection and grading history Date Type Gradings 14 Aug 2015 Unannounced Care and support 5 - Very good 5 - Very good 5 - Very good Management and leadership 5 - Very good 7 Aug 2014 Unannounced Care and support page 5 of 8
Date Type Gradings Management and leadership 5 - Very good 13 Aug 2013 Unannounced Care and support Management and leadership 3 Oct 2012 Unannounced Care and support 5 - Very good 5 - Very good Management and leadership 5 Jan 2012 Unannounced Care and support 5 - Very good Management and leadership 5 - Very good 15 Jun 2011 Unannounced Care and support 5 - Very good Management and leadership 16 Nov 2010 Unannounced Care and support 3 - Adequate Management and leadership 3 - Adequate 24 Aug 2010 Announced Care and support 3 - Adequate Management and leadership 3 - Adequate 2 Feb 2010 Unannounced Care and support Management and leadership 3 - Adequate 12 Aug 2009 Announced Care and support page 6 of 8
Date Type Gradings Management and leadership 3 - Adequate 12 Feb 2009 Unannounced Care and support Management and leadership 3 Jul 2008 Announced Care and support Management and leadership page 7 of 8
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 8 of 8