Abercorn House Care Home Care Home Service 184-192 Low Waters Road Hamilton ML3 7QH Telephone: 01698 423342 Type of inspection: Unannounced Inspection completed on: 25 October 2016 Service provided by: Embrace (Combined) Limited Service provider number: SP2007009177 Care service number: CS2007157972
About the service Abercorn Care Home is part of the Embrace Group who have operated the service since 2007. It is a purpose built care home, in the town of Hamilton. It has sixty-one single rooms thirty-eight of which have en-suite toilet facilities. Residents have access to shared bathrooms and shower facilities which have been upgraded in recent years. Lounge/dining areas are available on each floor as well as a smoke room and family/garden room on the ground floor. A lift was available between floors. The service is registered to provide care and support to a maximum of sixty-one older people, which includes five for respite/short break and a maximum of ten places for people under the age of sixty-five years. At the time of this inspection there were forty-six people residing in the home. The company state: "we offer care that is of the highest standard and is tailored to meet individuals with specific wishes and choices. These choices will be respected and honoured at all times". The inspection focused on standards of care for people living with dementia. We are using a sample of one hundred and fifty care home services to look in detail at the standards of care for people living with dementia and this service is one of those selected as part of the sample. The areas looked at were informed by the Scottish Government's Promoting Excellence: A framework for health and social care staff working with people with dementia and their carers and the associated dementia standards. It is out intention to publish a national report on some of these standards during 2017. What people told us An Inspection Volunteer took part in the inspection. They spoke with five people using the service and six relative/friends. The following highlights comments and discussions carried out with these people during the inspection: Quality of Care and Support: Residents general comments about Care and Support: "I am quite happy and content." "The staff are busy. Sometimes it takes longer to answer when I buzz." "I have had to wait ten or fifteen minutes when I buzz." "You can never be happy because you are not in your own home." "I don't think that there is enough staff to give everyone the attention they need." "It takes a wee while to respond to the buzzer, particularly at night time." "I don't know if I was a part of my care plan." "You can't get a cup of tea when you want it. They are always too busy." Relatives general comments about Care and Support: "We're happy that mum is safe." "We had a care plan review recently. We had one over the phone in December, six months page 2 of 17
after she came and then a long chat about a year after she came." "At the last review, I had a list ready for them." "Yesterday, he was very comfortable and well attended to. Today no teeth, no glasses and his feet were frozen." "Dad is well looked after." "He has come on well since being here." "We have to keep asking them to do her nails. They always seem dirty." "I think care could be better - more staff, regular staff - the same faces would be helpful." "We are doing the washing. Clothes were disappearing." "Sometimes they put her in clothes that are not hers." Residents general comments about food: "I have no complaints about food." "There seems to be too much milk and less of the cornflakes." "My tea is never hot enough." "I always have a full breakfast - cornflakes and four slices of toast." "I don't like the porridge. It comes in cartons and looks like wallpaper paste." "I've had macaroni cheese so often that I am fed up with it." "Sometimes they ask you what you want but sometimes you just get it." "There is no menu." "Generally, food is good." "There is no menu - someone asks you." "We have macaroni cheese and pastas often." "I don't like sandwiches." "The food is so so." "There is no menu but it is usually pasta." "I get more than enough." "Sometimes, there's tea and a biscuit." "We only get salad about once a week." Relatives general comments about food: "Food wise, I had to tell them that he needed finger food." "We don't think that nutrition is good enough. It is not a balanced diet." "Lunchtime is always egg or sandwiches." "I have never seen any vegetables." "Hydration is a problem." Residents general comments about Activities: "There are no activities." "The staff are supposed to take me a couple of walks but they are always too busy." "No activities are organised." "I just listen to my music." "Basically, I just watch TV." Relatives general comments about Activities: "Activities side needs to be looked at." "There are no activities. Everyone just seems to sit around - no stimulation." "There are no activities." "You have to make an appointment for the hairdresser." "Mum just stays in her room." page 3 of 17
Quality of the : Residents general comments about : "The new buzzer system is terrible. It goes all night." "My room is small and whitewashed. I brought a few pictures with me." "I don't go to the lounge. The language is terrible." "My room is okay. I am in bed all the time." "The place is kept clean." Relatives general comments about : "It is warm enough and the decoration is okay." "It is clean." "It is dismal to come in here." "He has two covers on his bed - none are from the home." "The home could be doing with new carpets and a coat of paint." "The dining area is nice." "The temperature is always hot!" "The hallways could be freshened up." "The cleaner is always on the go." "His room has new flooring." Quality of : Residents general comments about : "The staff are very kind." "During the day, they're falling over each other. At night time there's three and one is usually taken upstairs." "The nurses are really good." "There are not enough staff. Then they started getting agency." "The girls are run off their feet." "I am happy with the staff but there's not really enough." "When staff come in they say they will come back but they don't." "They are full of good intentions." Relatives general comments about : "The staff are excellent. They have all been nice." "They give mum a lot of time." "They are always short staffed." "There have been lots of changes recently." "Some don't seem to have any common sense." "Some are good; some don't seem capable - is it because they are rushed?" "... is a good wee lass." "There are some that I would never have appointed." "The staff are welcoming." "They are short staffed." "There are lots of new faces. I don't know them from week to week." page 4 of 17
Quality of Management: Residents general comments on Management: "I don't know the manager." "We are getting a new manager - there's two - one for upstairs and one for downstairs." Relatives general comments about Management: "A new manager has been appointed but we haven't met her". "We are on the third or fourth person. They seem to get disheartened and give up." "I have met (previous) manager. I had a couple of issues but they haven't got back to me." We did not receive any completed questionnaires from those using the service prior to the inspection. We received four completed care standards questionnaires from relatives and/or friends prior to the inspection. Two strongly agreed and one agreed with the statement 'Overall, I am happy with the quality of care my relative/friend receives at this home. One person did not respond to this question. The following comments were taken from the questionnaires: - Always made welcome in home any concerns are taken seriously and acted upon. - Staff always helpful. - Bit smelly in morning but settles down. - Clothing/laundry could be better organised. - Home is clean. - Think they could do with more staff at times. - Sometimes we have to ask for underwear for my relative as drawer empty at times and as far as I am aware it is only carers who are allowed to handle underwear and sometimes they have to go and get some from laundry when changing my relative. - I understand staff are very helpful and respectful with my relative and our family at all times. Think they could do with more staff. - Other than this we are happy with the home and all who work there. - I think more training for staff would be helpful as my aunt is blind and sometimes needs more help than other service users. - I am overall happy with my mums care for the staff are very friendly and helpful also they have very good knowledge and understanding of my mums needs. page 5 of 17
Self assessment We received a completed self assessment prior to the inspection. Here the service had identified what it did well as well as identifying some areas for improvement over all the themes. There was room for improvement in relation to how the self assessment was completed by management by identifying what the outcomes were be for those living and working in the service. The service has indicated that it had involved those living in the service when completing as well as showing how people were fully involved in the completion of the 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 2 - Weak 2 - Weak Quality of care and support Findings from the inspection Taking into account the inspection gathered at this inspection we have graded the service weak in relation to this Quality Theme. We found that the overall outcomes for people living in the service were poor and that significant actions were needed to address this. Prior to this inspection external management, from Embrace, had identified key failings in the service and had developed an action plan on how these would be addressed. Areas identified relating to care and support included poor personal care planning and related documentation, including monitoring of people's weights and skin care. As a result of these findings Embrace had placed a voluntary hold on any new admissions to the service to allow them to address these issues. At the inspection we found that the service had acted on its findings and staff had a better understanding of the key care and support needs of those living here. This included overviews of people's weights and skin care and where needed appropriate referrals to external health specialist for support and guidance. However additional work was still needed to ensure that the outcomes for current residents improved in all aspects of care. This included the need to ensure that all staff interacted appropriately and meaningfully with residents. Three requirements previously made remain outstanding and these relate to key areas that the service needed to address. These include: development of personal care plans containing clear information on the care and support to be provided to those living in the service; ensure staff were trained to assist people to manage behaviours that cause residents distress so that they have a more positive life experience, and ensure that the social and recreational needs of service users were being met. Although the services action plan details how they plan to address these areas we will repeat the requirements and follow-up actions taken at the next inspection (see requirements 1,2 and 3). page 6 of 17
The service were working to improve how people's medication was managed and administered. However the records we reviewed identified a range of issues which would highlight that the service were not effectively managing people's medication. This could lead to poor outcomes for people in relation to how their health needs were being met (see requirement 4). The service also needed to re-establish ways in which it involved residents and their families in making decisions around what was happening in the service, including being able to comment on care and support provided (see recommendations 1 and 2) Requirements Number of requirements: 4 1. The Provider must ensure that care plans clearly direct staff on the care and support to be provided to all those living in the service. In order to achieve this the Provider shall: - identify those staff who require to record care and support planning to an improved standard; - provide such training to those staff to ensure appropriate detailing of care plans to direct staff on the care and support to be provided to each service user; - ensure that where a care need is identified that an appropriate plan is put in place to support the individual to address this; This is in order to comply with SSI 2011/210 Regulation 4(1)(a) - welfare of service users and Regulation 15(b) -. Timescale for implementation: Three months from receipt of this report. (repeat requirement) 2. The provider must ensure that where people are showing signs of behaviours that cause distress that all staff working with the individual receive appropriate training. This is to allow staff to help that person reduce their levels of distress so that they have a more positive life experience. This is in order to comply with SSI 2011/210 Regulation 4(1)(a) - welfare of service users and Regulation 15(b) -. Timescale for implementation: Two months from receipt of this report. 3. The provider must ensure that the social and recreational needs of service users are met. This must include: - If a person continually refuses an activity then an alternative should be offered. -A clear record of the level of active participation should be recorded. - How the service user can be supported to be as active as possible must be contained within the personal plan. - There must be a record of what social activities and recreational diversions can be used when a service user is agitated. This is in order to comply with; SSI2011/210 Regulation 4(1) (a) Welfare of users. Timescales: Within three months of receipt of this report. 4. The service provider must ensure the health and welfare of residents by ensuring safe administration and recording of medicines. To do this they must ensure that: - medication is given in a manner that allows the resident to get the intended benefit page 7 of 17
of the medicine - medication is administered as instructed by the prescriber. In order to achieve this, the service will need to ensure that medication is available at the time of administration. - that where a regular medicine is not given as prescribed a reason for this must be clearly annotated on the Medicines Administration Recording [MAR] chart - where a "when required" medicine is given (e.g. to manage an emotional or mental health need) the service should ensure that the reason for use and outcome are recorded. - all medication records including those used to record the use of prescribed creams are appropriately maintained. This is in order to comply with: SSI 2011/210 Regulation 4 (1)(a) - a requirement to make proper provision for the health and welfare of people, SSI 2011/210 Regulation 4 (1)(c) - a requirement to ensure that no-one is subject to restraint unless it is the only practicable means of securing the welfare of that or any other resident, and SSI 2002/114 Regulation 19(3)(j) - a requirement to keep a record of medicines kept on the premises for residents The following National Care Standards have been taken into account in making this requirement: NCS Older People 5.11, 5.12, 15.6. and 15.9. Timescale for implementation: one week from receipt of this report. Recommendations Number of recommendations: 2 1. The service should consider and implement a strategy on how they plan to gauge the views of those service users with significant memory impairments. National Care Standards: Care Homes for Older People Standard 11 Expressing Your Views. 2. The service need to develop ways in which it can engage other service users and carers who do not attend the residents/relative meetings/forums. National Care Standards: Care Homes for Older People Standard 11 Expressing Your View. Grade: 2 - weak Quality of environment Findings from the inspection Taking in to account the evidence seen at this inspection we have graded the service as adequate in relation to this Quality Theme. We found that the lay out of the lounge areas could be improved to encourage people to interact with each other as well as to enjoy the views from the windows. The service had been developing the service to include areas such as a resident kitchen area, bar and sweetie shop, however further thought needed to be put in to ensuring these areas would operate to the benefit of those living in there. page 8 of 17
Areas were generally kept clutter free to ensure people could walk round the accommodation and not be at risk of tripping. There was plenty of natural light in communal areas and bedrooms. During the inspection we used The King's Fund al Assessment Tool which assesses 'is your care home dementia friendly'. Overall based on the areas looked at which included how the environment promoted wellbeing and safety and security we graded the service as only adequate. This was taking information from across the whole building and not just the dementia unit. Areas identified for action included the use of communal space, directional signage, access to and development of the garden area and re-decorating. However during the inspection the service gave us an action plan for the environment that included addressing all of the above. We are satisfied that the Company will progress in these areas and we will review at future inspections. We found that all appropriate safety checks had been carried out on the accommodation to ensure it was safe for those living, working and visiting the service. The majority of repairs were carried out quickly due to the service employing its own handyman. The service needs to review how it encourages people to relearn skills which they may have lost, or to develop new skills, so that people can be more independent and improve the persons quality of life (see recommendation 1) Requirements Number of requirements: 0 Recommendations Number of recommendations: 1 1. The service should look at how it can further enable people to re-learn skills they may have lost, or to develop new skills, in order that they can be more independent and improve their quality of life. National Care Standards; Care Homes for Older People; Standard 17- Daily Life. Grade: 3 - adequate Quality of staffing Findings from the inspection Taking in to account the information gathered at this inspection we have graded the service as adequate in relation to this theme. External management had been in the service for a number of weeks and had identified key areas for action in relation to staff recruitment, staff training and staff moral. They had produced an action plan in relation to how they planned to address these key areas which was being regularly reviewed and updated. We examined staff personnel files and spoke with people recently employed staff at the service. We found that all had been safely recruited and undertook a period of induction. However we identified that the service had not followed its own recruitment procedures in terms of accounting for gaps in employment over a set period The page 9 of 17
service need to ensure that it follows its Companies policy when recruiting staff to ensure it complies with what is expected when recruiting (see recommendation 1). Due to concerns regarding staffs uptake of compulsory training the Company had developed a workforce development plan. This was an overview of all staff in terms of training undertaken and any qualification and highlighted specific training people had still to complete. The training co-ordinator was using this information to prioritise staff training and ensure training was delivered as planned. It was clear that the training provided by, or sourced by, the Company was aimed at improving the outcomes for residents. We will monitor how well this plan has been delivered at the next inspection. Staff supervision had not been taking place in line with Company's policy. This was acknowledged by external management who advised that this would be reintroduced as soon as the new manager took up post. Effective supervision sessions allow management to monitor staff practice and ensure that any staff development needs are identified and actioned quickly. We will review how effective this has been at the next inspection. We spoke with a range of staff during the inspection New staff stated they felt supported by other staff and the management, they also advised that the training they had was relevant to their roles and responsibilities. Other staff advised that they were starting to see positive changes in the service in recent weeks this related both to training opportunities, staffing levels and staff moral. Staff spoken with did feel that they needed further training in dementia. The service acknowledge that staff working in the dementia unit skills and knowledge on dementia needed to be improved and plans were being put in place to address this. Requirements Number of requirements: 0 Recommendations Number of recommendations: 1 1. The service should ensure it follows the Companies policy in relation to recruitment. This specifically relates to ensuring the persons last three year employment record and gaps are checked. National Care Standards Care Homes for Older People Standard 5 Management and staffing arrangements. Grade: 3 - adequate Quality of management and leadership Findings from the inspection At this inspection we considered how well the service evaluated the service provided and how it improved outcomes for people living in the home. Taking in to account the information gathered we have graded the service as weak in relation to this theme. The service submitted all necessary documentation to us when asked for or when legally obliged to. page 10 of 17
Due to issues in the service external management from Embrace had been providing seven day cover in the service since September 16. They had identified a wide range of concerns that impacted on the care being provided to those living in the service as well as issues relating to staffing, training and lack of measures in place to assess the quality of service being provided. As a result of this the Company made a decision to cease admissions to the service, on temporary bases, to allow for actions to be taken to address these issues and stabilise the service. An action plan had been devised highlighting the key areas that needed to be addressed and this was regularly updated to show progress. This information was being shared with us and Social Work. A new experienced manager took up post prior to the inspection being completed. From discussions they had been made aware of the issues and felt that they, along with the new unit managers, had the skills and knowledge to move the service forward and to improve the outcomes for those living there. Management were aware of the need to re-establish the quality assurance systems and to make improvements where needed. They were also committed to obtaining feedback from those using the service, their families and staff and to show how it used this information to make improvements. We will monitor progress in these areas at future inspection. Requirements Number of requirements: 0 Recommendations Number of recommendations: 0 Grade: 2 - weak 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 care plans clearly direct staff on the care and support to be provided to all those living in the service. In order to achieve this the Provider shall: - identify those staff who require to record care and support planning. to an improved standard;- provide such training to those staff to ensure appropriate detailing of care plans to direct staff on the care and support to be provided to each service user; - ensure that where a care need is identified that an appropriate plan is put in place to support the individual to address this; page 11 of 17
This is in order to comply with SSI 2011/210 Regulation 4(1)(a) - welfare of service users and Regulation 15(b) -. Timescale for implementation: Three months from receipt of this report. (repeat requirement) This requirement was made on 15 October 2015. Action taken on previous requirement This requirement has not been met. See Quality Theme 1 for details. Not met Requirement 2 The provider must ensure that where people are showing signs of behaviours that cause distress that all staff working with the individual receive appropriate training. This is to allow staff to help that person reduce their levels of distress so that they have a more positive life experience. This is in order to comply with SSI 2011/210 Regulation 4(1)(a) - welfare of service users and Regulation 15(b) -. Timescale for implementation: Two months from receipt of this report. This requirement was made on 15 October 2015. Action taken on previous requirement This requirement has not been met see Quality Theme 1 for detail Not met Requirement 3 The provider must ensure that the social and recreational needs of service users are met. This must include: - If a person continually refuses an activity then an alternative should be offered. - A clear record of the level of active participation should be recorded. - How the service user can be supported to be as active as possible mustbe contained within the personal plan. - There must be a record of what social activities and recreational diversion scan be used when a service user is agitated. This is in order to comply with; SSI2011/210 Regulation 4(1) (a) Welfare of users.timescales: Within three months of receipt of this report. This requirement was made on 15 October 2015. Action taken on previous requirement This requirement has not been met. See Quality Theme 1 for detail Not met page 12 of 17
What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 The service should consider and implement a strategy on how they plan to gauge the views of those service users with significant memory impairments. National Care Standards: Care Homes for Older People Standard 11 Expressing Your Views. This recommendation was made on 15 October 2015. Action taken on previous recommendation We were unable to see what actions the service had taken to address this recommendation. We will therefore re visit this at the next inspection to check how effective the service has been at obtaining people's views. Recommendation 2 The service need to develop ways in which it can engage other service users and carers who do not attend the residents/relative meetings/forums. National Care Standards: Care Homes for Older People Standard 11 Expressing Your View. This recommendation was made on 15 October 2015. Action taken on previous recommendation The service had still to progress this recommendation. Management were keen to re-establish regular contacts with residents and their relatives to encourage people to feedback on the service. We will review how effective it has been at the next inspection. Recommendation 3 The service should develop methods to enable residents and relatives to comment on the quality of staffing in the service on a regular basis. National Care Standards: Care Homes for Older People Standard 11 Expressing your Views (repeat recommendation). This recommendation was made on 15 October 2015. Action taken on previous recommendation The service had still to progress this recommendation. We will review how effective it has been at the next inspection. Recommendation 4 The service should be able to demonstrate how those who live in the service, relatives and staff are involved in completing the self assessment. National Care Standards Care Homes for Older People Standard 11: Expressing Your Views (repeat recommendation). This recommendation was made on 15 October 2015. page 13 of 17
Action taken on previous recommendation We were unable to see how the service had involved those living in the service, their relatives or staff in informing the content of the self assessment. We will therefore repeat this recommendation and follow-up on any progress made at future inspections. 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 17 Mar 2016 Unannounced Care and support Not assessed Not assessed Not assessed Management and leadership Not assessed 15 Oct 2015 Unannounced Care and support 4 - Good 4 - Good Management and leadership 4 - Good 9 Jan 2015 Unannounced Care and support 4 - Good Management and leadership 29 Sep 2014 Unannounced Care and support Management and leadership page 14 of 17
Date Type Gradings 20 Feb 2014 Unannounced Care and support 2 - Weak Management and leadership 27 Jun 2013 Unannounced Care and support Management and leadership 25 Feb 2013 Unannounced Care and support 4 - Good 2 - Weak Not assessed Management and leadership Not assessed 5 Nov 2012 Unannounced Care and support 2 - Weak 2 - Weak Management and leadership Not assessed 5 Nov 2012 Unannounced Care and support 2 - Weak 2 - Weak Management and leadership Not assessed 23 Jul 2012 Unannounced Care and support 2 - Weak 2 - Weak Management and leadership 11 Oct 2011 Unannounced Care and support 2 - Weak Management and leadership 9 May 2011 Unannounced Care and support 4 - Good Management and leadership page 15 of 17
Date Type Gradings 30 Sep 2010 Unannounced Care and support Management and leadership 27 May 2010 Announced Care and support Management and leadership 1 Feb 2010 Unannounced Care and support Not assessed Management and leadership Not assessed 8 Jun 2009 Announced Care and support 4 - Good 4 - Good 4 - Good Management and leadership 4 - Good 3 Feb 2009 Unannounced Care and support Not assessed 4 - Good 4 - Good Management and leadership Not assessed 16 Jun 2008 Announced (short notice) Care and support 5 - Very good 4 - Good 4 - Good Management and leadership 4 - Good page 16 of 17
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 17 of 17