Urray House Care Home Service Tarradale Gardens Muir of Ord IV6 7SJ Telephone: 01463 870516 Type of inspection: Unannounced Inspection completed on: 13 October 2016 Service provided by: Parklands Highland Ltd Service provider number: SP2012011901 Care service number: CS2012310891
About the service Urray House is a new purpose built care home, which is registered to provide a service to a maximum of 34 older people. The service is situated in the town of Muir of Ord in Ross-shire. All bedrooms are spacious, bright and have private ensuite facilities. The service is provided by Parklands Highland Ltd. What people told us The inspection volunteer spoke with five people who used the service during the inspection. Comments from these discussions were mostly positive. People spoke about staff being kind, cheerful and approachable. People told the inspection volunteer that they were very happy with the environment of the home and how they could choose to eat in their rooms, or in the dining areas. One person stated that they felt the new home lacked the atmosphere of the "old Urray House" because of the three wings. They told us that there was less interaction now. During a discussion one person who used the service stated that they were offered a shower regularly, however, they would prefer a bath. One person told us that "the staff are fine but they are too busy to speak to you". People told us that they were very happy with their room and liked the décor and furniture. One person felt that there was not enough staff. The inspection volunteer spoke with four relatives/carers. Comments from these discussions were mostly positive. When asked about the quality of care provided one relative stated that the care was "excellent". Relatives/carers commented that the environment of the home was lovely, clean and spacious. One relative stated that they felt there could be more activities. Some people stated that they thought the meals could be improved. Self assessment The self assessment was completed by the manager and contained good detail of the service strengths and also highlighted areas where the service could improve. From this inspection we graded this service as: Quality of care and support Quality of environment 4 - Good not assessed page 2 of 12
Quality of staffing Quality of management and leadership not assessed 4 - Good Quality of care and support Findings from the inspection We found that the service was performing at a good level for the theme of care and support. We looked at a sample of care plans and found that these were generally of a good standard. There was some further work needed to develop care plans for people who experienced times of stress and distress with dementia. Staff also needed to ensure that where there were changes to people's care, that care plans were updated to reflect the changes. (See recommendation 1) We found that people were offered a regular review of their care plan and the minutes were of a good standard. We could see that issues were followed up and care plans updated as a result of the review process. We interviewed a GP who was visiting the home and he spoke very positively about the quality of service provided at Urray House. We looked at the care documentation such as, personal care sheets, skin bundles and topical medication administration records (TMARs) and found that, generally, the standard of record keeping had improved. However, the manager needs to consider how these documents are being stored and whether staff have access to information when they need it, when they are supporting people with their personal care. (See recommendation 2) Improvements were noted when we observed the mealtime experience. People were supported well and there was a nice relaxed atmosphere. There were some areas where further improvements were needed. (See recommendation 3) We looked at the medication system and found that there were areas where improvements were needed. (See recommendation 4) We could see evidence that there was a range of planned activities and there was information about these on the notice board. Consideration should be given to how activities are provided when the activities co-ordinator is on annual leave or absent from work. (See recommendation 5) Requirements Number of requirements: 0 Recommendations Number of recommendations: 5 1. The provider should ensure that work continues on care plans for people who have dementia and experience times of stress and distress. Where it has been identified that the use of behavioural monitoring charts would page 3 of 12
be beneficial these should be completed and regularly evaluated. Care plans should then be updated with guidance for staff on how to support people during these difficult times. Staff also need to ensure that they regularly evaluate each specific care plan. Where there have been any changes to people's health and wellbeing needs the care plans should be updated to reflect the changes to care. National Care Standards Care Homes for Older People. Standard 6: Support arrangements. 2. The manager should ensure that care documentation, required by staff to support people with their personal care needs, is stored appropriately. Staff should be able to access current information on prescribed creams, frequency of positional changes and oral hygiene at the time they are delivering the care and not retrospectively. National Care Standards Care Homes for Older People. Standard 6: Support arrangements. 3. The provider should ensure there is a system in place to ensure that people's mealtime experience is pleasant and enjoyable. Tables in each dining room should be set appropriately with tablecloths/mats (if appropriate), condiments and menus. National Care Standards Care Homes for Older People. Standard 4: Your environment. 4. The provider should ensure they make further improvements to the way they manage medications for service users. In order to do this they should: - Keep a complete audit trail of all medications in the home. - Evaluate the effectiveness of any 'as required' medications for example, pain relief. - Ensure that all TMARs are completed where topical medications had been applied. - Implement an effective audit of the medication system which should pick up all of the above. National Care Standards Care Homes for Older People. Standard 15: Keeping well - medication. 5. The provider should ensure that there is a varied programme of activities, both group and one to one, provided for people who use the service. These activities should be available on a daily basis. There should be a system in place to ensure that activities continue when the dedicated member of staff is on annual leave or absent from work. National Care Standards Care Homes for Older People. Standard 12: Lifestyle - social, cultural and religious belief or faith. Grade: 4 - good Quality of environment This quality theme was not assessed. page 4 of 12
Quality of staffing This quality theme was not assessed. Quality of management and leadership Findings from the inspection We found the management receptive to feedback and keen to improve the service. They worked with us in a positive manner providing all the information we requested. There were good policies in place for staff guidance and care provision. There was a training plan in place and staff confirmed that they had been offered various training courses since the last inspection. (See recommendation 1) There were many positive comments made about the manager and senior staff and how supportive and approachable they were. The system of supervision and appraisal had improved since the last inspection. Staff confirmed that they received regular supervision and that they found this a meaningful process. (See recommendation 2) The methods of participation that the service had put in place, for example, questionnaires, care plans, reviews and meetings continued. We found evidence that the information gathered from these was used to make improvements to the service. The manager and nurse had made good efforts to expand the system of audits, however further improvements were still needed to ensure that audits were effective. (See recommendation 3) There was good evidence that service users were offered a regular review of their care plans with family present, where this was appropriate. There was a complaints policy in place. The manager completed action plans as appropriate and also the self assessment for the service when asked to do so. Requirements Number of requirements: 0 Recommendations Number of recommendations: 3 1. The provider should ensure they continue to develop the training and development system. In order to do this the provider should:- page 5 of 12
a. Evaluate all training to ensure that staff practice improves as a result of the training provided. b. Continue to implement the system of observed practice. This is to ensure that staff practice remains at a satisfactory level. c. Ensure that the staff induction programme and all other training are linked to the supervision and appraisal system. d. Provide all levels of staff with dementia awareness training which reflects the promoting excellence framework. National Care Standards Care Homes for Older People. Standard 5: Management and staffing arrangements. 2. The provider/manager should ensure they continue to work on the system of supervision and appraisal for all staff. This is to ensure that it becomes established practice and is an effective tool to support all levels of staff. National Care Standards Care Homes for Older People. Standard 5: Management and staffing arrangements. 3. The provider should ensure they continue the work to ensure that there are effective quality assurance systems and processes in place, to assess the quality of service they provide on a regular basis and ensure that all aspects of the service operate at an acceptable standard. National Care Standards Care Homes for Older People. Standard 5: Management and staffing arrangements and Standard 11: Expressing your views. Grade: 4 - good What the service has done to meet any requirements we made at or since the last inspection Previous requirements There are no outstanding requirements. page 6 of 12
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 work continues on care plans for service users, to ensure that they remain a current reflection of service users' health and wellbeing needs and how these are to be met with the support of staff. All service users should be offered a minimum of two reviews in each year with family present, where appropriate. The care plans should always be updated as a result of the review process. National Care Standards Care Homes for Older People. Standard 6: Support arrangements. Work was progressing in this area. The provider was in the process of implementing a new care plan template. The manager of the service was taking this forward. The information in the care plans was of a good standard and was very person centred. Staff need to ensure that where there are changes to service users' needs, the care plans are updated to reflect the changes to care. Care plans for people who experienced times of stress and distress due to dementia could be improved. A recommendation in relation to this has been made in this report. See Quality Theme 1 - Care and support. There was better evidence of reviews taking place at this inspection. Recommendation 2 The manager should ensure that they put a system in place to ensure that staff accurately and regularly complete SSKIN bundle monitoring charts. This is to ensure that care is being delivered to service users as detailed in their tissue viability care plan. National Care Standards Care Homes for Older People. Standard 6: Support arrangements and Standard 14: Keeping well - healthcare. The quality of this documentation had improved since the last inspection. At this inspection we have asked the manager to look at storing these documents appropriately to ensure that staff have access to information when they need it. See Quality Theme 1 - Care and support. Recommendation 3 The provider should ensure that the service make improvements in the way they manage medications for service users. In order to do this they should: - Carry out a regular check of all controlled medication. This should be carried out in line with the service policy. - Keep a complete audit trail of all medications in the home. page 7 of 12
- Evaluate the effectiveness of any 'as required' medications for example, pain relief. - Ensure that all TMARs are completed where topical medications had been applied. - Implement an effective audit of the medication system which should pick up all of the above. National Care Standards Care Homes for Older People. Standard 15: Keeping well - medication. At this inspection we found that there were still issues in relation to the above recommendation. A further recommendation has been made in this report to allow progress to be monitored in this area. See Quality Theme 1 - Care and support. Recommendation 4 The provider should ensure that there are senior staff available to supervise mealtimes. This is to ensure that service users are offered care and support, which reflects their needs, as identified in their plan of care. National Care Standards Care Homes for Older People. Standard 13: Eating well. We carried out an observation in all three of the units at this inspection. We found that, generally, mealtimes were a relaxed and pleasant experience. The manager should ensure that there is a member of staff allocated to each dining room, to ensure tables are set appropriately and that there are sufficient staff to support people to enjoy their meals. A recommendation has been made in this report. See Quality Theme 1 - Care and support. Recommendation 5 The provider should ensure that the practice of storing soiled, malodorous, linen in bathrooms, which the service may be using, ceases immediately. All soiled linen should be transferred to the laundry to ensure that odours are kept to a minimum. National Care Standards Care Homes for Older People. Standard 4: Your environment. This recommendation has now been met. Recommendation 6 The provider should ensure that the system in place for laundering of clothes is working effectively, in order that each service user has access to sufficient clean clothing when they need it. National Care Standards Care Homes for Older People. Standard 4: Your environment. page 8 of 12
There were still some issues in relation to clothes going missing. However, the manager was looking at ways of ensuring that people's clothes are being marked appropriately. Progress will be monitored on this at the next inspection. Recommendation 7 The manager should ensure they continue to progress in improving the environment of the home for those service users who live with dementia. National Care Standards Care Homes for Older People. Standard 4: Your environment. There was now some good signage around the home. People who used the service had a picture/plaque outside their door, with personal photographs or pictures, that were meaningful to them in it. Bathrooms/toilets had signs on the doors. Some of the signage had both pictures and words. The manager was looking into ways of ensuring that people were made aware of what was happening around the home. New notice boards had been ordered for each wing. There was an activity board in the reception area of the home. Recommendation 8 The manager should ensure they continue with plans to implement a new system for training and development of staff. All training should be evaluated to ensure that practice improves as a result of the training provided. National Care Standards Care Homes for Older People. Standard 5: Management and staffing arrangements. This area of work was progressing well. There was a training plan in place and this gave details of both mandatory and some non mandatory training. The manager was in the process of implementing some observed practice sessions with staff. Staff confirmed that they had been offered a lot of training since the last inspection. There will be a recommendation in this report about continuing with the work on the system of training and development. See Quality Theme 4 - Management and leadership. Recommendation 9 The manager should ensure they continue to develop the programme of supervision and appraisal to provide all staff with support, the opportunity to raise individual issues and as a means of monitoring staff awareness of working practices, effectiveness of induction and training and to identify any further training needs. National Care Standards Care Homes for Older People. Standard 5: Management and staffing arrangements. There was a good improvement noted in this area since the last inspection. Each senior member of staff had a supervision planner and were responsible for carrying out supervision with a group of staff. Staff we spoke with confirmed that they received regular supervision and found this a meaningful process. The manager had started to offer staff an annual appraisal. We could see that there was a plan in place for this to progress. page 9 of 12
Recommendation 10 The manager should ensure they put systems in place to monitor staff practice. Where areas of poor practice are highlighted further training should be offered to ensure practice improves. National Care Standards Care Homes for Older People. Standard 5: Management and staffing arrangements. This was in the early stages at the time of the inspection. We could see that there had been some observed practice carried out. The manager told us that this was something she was working on progressing. Recommendation 11 The provider should continue the work to ensure that there are effective quality assurance systems and processes in place, to assess the quality of service they provide on a regular basis and ensure that all aspects of the service operate at an acceptable standard. National Care Standards Care Homes for Older People. Standard 5: Management and staffing arrangements and Standard 11: Expressing your views. Work needs to continue on this recommendation. The manager and staff should ensure that where they are carrying out an audit, they complete the audit cycle to ensure that they are effective in bringing about improvements to the service. This recommendation will be repeated in this report to allow progress to be monitored in this area. See Quality Theme 4 - Management and leadership. 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 10 of 12
Inspection and grading history Date Type Gradings 17 Nov 2015 Unannounced Care and support 4 - Good Environment 5 - Very good Staffing 4 - Good Management and leadership 4 - Good 9 Mar 2015 Unannounced Care and support 4 - Good Environment 5 - Very good Staffing 4 - Good Management and leadership 4 - Good 18 Nov 2014 Unannounced Care and support 4 - Good Environment 5 - Very good Staffing 4 - Good Management and leadership 4 - Good page 11 of 12
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 12 of 12