William Simpson's Care Home Service Main Street Old Plean Stirling FK7 8BQ Telephone: 01786 812421 Type of inspection: Unannounced Inspection completed on: 4 October 2017 Service provided by: William Simpson's Service provider number: SP2010011371 Care service number: CS2010279960
About the service William Simpson's is a care home registered to provide care to 71 people including seven on a respite basis. The location is the outskirts of a village which has local amenities. The main service is provided in a purpose built two storey building. This building has four individual units on each floor, known as flats. Each flat has its own lounge, dining area and small kitchen. Meals are provided from the main kitchen. The bedrooms are all ensuite with shower. Additional facilities include a café with outdoor as well as indoor seating, games room, health and beauty salon and a small library. The respite service is in a separate older, period building nearby on the same large site. Rooms there are not ensuite. The service offers long term and respite care for adults and older people with mental health issues. The buildings are set in very extensive, beautiful, well kept grounds with a variety of trees, planting, grassed areas, a walled garden and plentiful seating. What people told us Here are some views from people who completed our questionnaires: Person A: ''I get plenty of good support with my care and everything I do. I feel there are too many new staff who do not have the experience to provide the care needed in certain situations. Sometimes staff changes are too frequent. Activities staff, carers and senior staff frequently ask my opinion if I am happy with the care and service provided and how these could be improved. I inform carers and seniors if I have any concerns or complaints.'' Person B: ticked the box to say he was not involved in choosing personal items for his room and also did not know how to complain. But he did tick there was nothing he would change. Person C: did not know how to complain but also ticked they were happy with the service. Person D has respite: (form completed by family) ''Staff work closely with family - wonderful. Treated with respect. Staff demonstrate knowledge and understanding. Newsletter sent home every month.'' Here are some comments from service users we spoke with during the inspection: One person said they would like a sofa as well as chairs in their flat's lounge and also more activities including movie nights with popcorn. We fed this back to the manager. Every service user we asked said the food was good or very good. Here are some comments from relatives we spoke with: a) "The service is really good. They do involve him (my relative). He is reluctant to go out but recently after he was at the dentist with staff he went shopping and enjoyed it.'' (We have asked the manager to ensure this progress is built on.) page 2 of 12
b) ''Lovely place. Very good. I used to worry the quantity of food was not enough but he (my relative) won't say if that is the case. He doesn't socialise much. He likes snooker. I am concerned he no longer plays.'' (We looked into this and found the service user plays regularly. We asked the manager to feed this back to the relative.) c) ''Activities variety and regularity for my relative needs improved.'' (We looked into this and saw photos of the service user enjoying various activities. The manager agreed communication with relatives could improve in this respect.) ''Food is very good and they look after his (my relative's) clothes. They give him regular fruit now. His room is nice and clean. He is drinking (alcohol) occasionally and I do not wish this." (The manager intends to have a meeting to discuss.) Self assessment The Care Inspectorate did not ask for a self assessment this year. From this inspection we graded this service as: Quality of care and support Quality of environment Quality of staffing Quality of management and leadership Quality of care and support Findings from the inspection Daily notes about service users and recording in general was of a broadly good standard. We saw improvements from the last inspection in the written care plans and risk assessments. Also in the regularity and standard of review minutes. Efforts made by staff and managers were clear. Managers have been holding regular care plan 'surgeries' i.e. coaching workshops for staff. Many new staff had never developed care plans previously. Managers plan to continue with these as they recognise there are further improvements to be made. This work means that the quality of care is likely to be of a more reliably consistent standard. Medication practice: we were impressed with the standard of auditing and practice. The medication trainer was a valuable member of staff. We suggested occasional live shadowing of medication administration, with feedback to staff, would improve the auditing even further. We made suggestions to assist staff's understanding of changes to complex medication dosages. Managers agreed to implement these. This should further improve safety for service users. Finance records were of a clear and consistent standard. We observed staff to be caring and respectful to service users. A busy bingo session was fun, inclusive and suitable for the client group present. page 3 of 12
We suggested the menu should have two choices at lunch time both in the main service and respite. Service users should be consulted and involved regularly about the food in a structured, planned way. The chef and managers recognised this as an area to work on. We will expect to see improvement next time. Person centred activity can be therapeutic, health promoting and enjoyable. Some service users and relatives noted there were not enough activities and they were not sufficiently varied. Managers agreed they should ensure they improve communication with relatives about activities. Activities should be more person specific, have more choice and variety. They should have specific goals for each person, to be monitored by the person and their key worker. Service users should be more involved in activity planning. Written care planning in regard to activities was too vague, generalised and repetitive. The service could be more ambitious and adventurous with and on behalf of the individual. The nearby local communities could be used more, rather than most activities taking place within the buildings and grounds. We have made a recommendation. Reviews could be more outcome focussed. We gave examples at feedback of good comments and where improvement could be made. A previous requirement included reference to lack of preventive strategies for distressed behaviour in individuals. We will not repeat the requirement but expect to see evidence of further improvement at the next inspection. Requirements Number of requirements: 0 Recommendations Number of recommendations: 1 1. Staff should be familiar and up to date with what interests each service user in both the main and respite services. They should understand what might support the individual's independence and stimulate both cognition and enjoyment. There should be more choice, variety and person centred activities. Service users should have more individualised support to take part. Goals in care plans regarding activities should be more specific and person centred. Plans should be less repetitive. Outcomes should be monitored. National Care Standards, Care Homes for People with Mental Health Problems: Standard 17 - Daily Life. Grade: 4 - good Quality of environment Findings from the inspection The grounds of the service are outstanding in beauty, variety and extent. They are used by residents but improvements in usage is needed and planned. page 4 of 12
The new building where the main service is provided is impressive. It includes a games room (including exercise bikes), a café and library as well as meeting and staff training space. The kitchen is suitable. Each of the flats for eight people has its own small kitchen for snacks as well as a lounge. There is no central dining room, with meals delivered to the flats. The building where respite takes place is Victorian and there are no en suites or private toilets. Some respite residents noted this as a drawback to the service. We were advised fundraising is underway to make improvements. The café is a pleasant, light filled resource including an outside seating area. However, the kitchen is tiny and there is insufficient staff to support it other than for a couple of hours in the morning when tea and coffee are available. It is also used for organised group activities but the manager agreed more use could be made of it as an actual café. A broadly positive health and safety audit by an external organisation had recently been undertaken. The relevant manager intends to monitor health and safety using the criteria from that report. We will assess outcomes of this next time. Smoking: the majority of service users living here smoke tobacco. Most flats had external smoking areas for service users, usually communal balconies. However there were a small number that had enclosed conservatories used as smoking areas, directly off the lounges. The smell of smoke was very noticeable in the kitchens, lounges and corridors of these flats. This suggests a health risk for staff, visitors and for non smoking service users. We discussed with managers and a board member, that plans should be made for each flat to have external smoking areas only. We have made a recommendation. Requirements Number of requirements: 0 Recommendations Number of recommendations: 1 1. Each flat should have only outdoor smoking areas to reduce any possible health risk to service users, visitors and staff. National Care Standard 4: Care Homes for People with Mental Health Problems - Your. Grade: 4 - good Quality of staffing Findings from the inspection Staff supervision records were comprehensive and of a good standard. This is an improvement. page 5 of 12
Staff comments included: ''I have never had the support I have here, anywhere else.'' ''The manager always comes back with an answer.'' ''We're a really good community. Anyone's happy to help, busy or not.'' Medication training was competency based and included observation by the dedicated medication trainer prior to being able to practise. This was positive and was likely to improve service user safety. Staff were very satisfied with the support, training and development available. Whilst the training programme was fairly comprehensive and suitable, Adult Support and Protection training had not been provided recently apart from brief e-learning. Similarly, training in working with people with lifelong alcohol abuse issues was not on the training schedule. We have made a recommendation. Requirements Number of requirements: 0 Recommendations Number of recommendations: 1 1. Suitable training on Adult Support and Protection and on working with people with chronic alcohol issues should be provided to all care staff both in the main and respite services on a regular basis. National Care Standard 5: Care Homes for People with Mental Health problems - Management and Arrangements. Grade: 4 - good Quality of management and leadership Findings from the inspection Managers were valued by staff who found them to be very supportive. Care plan auditing and feedback was done and recorded. Mixed results had been found during this process but it was a very positive innovation for service user safety and quality of service delivery. We encouraged managers to ensure this was maintained. We found staff morale to be good. This was an improvement including an improvement of the service's own recent internal self assessment. The service's own quality assurance returns were positive - both from service users and relatives. A question on 'enough to do' was the only one whose results stood out as being less impressive. 86% of service users who responded saw care and support as excellent. There was no seniors' meeting. Managers agreed to give this a try to see if it yields benefits. We suggested to managers they could seek more support for themselves in the local independent sector community. page 6 of 12
It was obvious managers had been working hard to improve leadership and management with positive results. Requirements Number of requirements: 0 Recommendations Number of recommendations: 0 Grade: 4 - good What the service has done to meet any requirements we made at or since the last inspection Previous requirements Requirement 1 The service must ensure that all residents have an assessment undertaken and personal plan developed which reflects their individual needs and how these will be met. The plan must be completed and reviewed by a member of staff with appropriate experience and skill in this area. This is in order to comply with: SSI 2004/114 Regulation 5(1) and 5(2)(b) Personal Plans. Timescale: Two weeks from receipt of this report This requirement was made on 5 April 2017. Action taken on previous requirement We could see that the service had made good progress in this requirement. People supported had personal plans which had been developed to incorporate a focus on the outcomes people wanted to achieve in various areas of their day-to-day life. Plans contained information about the individual and important people who were involved in their support. There was information about people's likes and dislikes and how they preferred to be supported. We felt people's personal plans needed more detailed information about their needs and the support they needed to keep well. For example where people had a specific health condition this was noted, however there was a lack of detail around how the person was affected by their condition, the support they needed to help promote their independence, and to help them to live as well as they can. page 7 of 12
Where a person displayed behaviours which could be perceived as challenging, we felt that personal plans would benefit from more information around the description of the behaviour, the triggers, and proactive and reactive support strategies to help promote positive behaviour. It was acknowledged by the registered manager that further work is planned in developing this aspect of support. They told us training and resources were being sought which would help develop staff knowledge and practice in this area. We found there were a number of systems in place to review the support provided for each individual. These included keyworker meetings with individuals, records of staff evaluations of each area of planned support provided, and review meetings held with the individual and those involved in their support. We found that these valuable opportunities to review what was working well and to make changes and adjustments to support, were not always taking place at recommended intervals. We also found that information gained from evaluations was not always being used effectively to inform and develop the support people needed. We could see that work was in progress with senior support staff planning review meetings for residents and recording when reviews had taken place and when reviews were due. This will help to prioritise and ensure review meetings are held within agreed timescales. We discussed with the manager the need to embed effective systems and practices which will help ensure support plans are timeously updated. This will help in ensuring support provided is in keeping with each individual's developing needs and preferences. We felt staff would benefit from further support to enhance their knowledge and confidence in support planning and to further develop their skills in reviewing and evaluating support plans. The manager and senior staff expressed they were keen to promote further staff learning in this area. Met - outwith timescales What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 It is recommended that ongoing recorded supervision is undertaken with all staff to ensure support, learning and development needs are met. National Care Standards, Care Homes for Older People: Standard 5 - Management and Arrangements. This recommendation was made on 5 April 2017. page 8 of 12
Action taken on previous recommendation Staff told us they felt senior staff were approachable and always around to provide advice and practice guidance. They told us they had regular opportunities to speak to senior staff and managers, to bring up any concerns they had and felt they were responsive to any issues they raised. Staff were receiving fairly regular supervision, although the frequency was not always in line with that set out in the provider's policy (six - eight weekly). Supervision records showed that constructive feedback was given to staff in areas such as performance and practice improvements. We saw evidence of good guidance and advice provided to staff, for example, in promoting best practice in supporting people with managing their medication, and in following up on areas where practice could be improved. This helped to promote staff development and to guide staff practice to ensure expected standards were being met. Staff spoke positively of the quality of the training they received and told us they could identify any training which would enhance their practice and this would be sourced. We could see where staff had attended training they had identified and this had contributed to positive outcomes for the people they supported. We discussed with the manager how it would benefit staff and the people they support for there to be a greater emphasis through supervision on staff reflecting on their practice such as their learning from training and how this impacted on their day-to-day practice. This would help support staff in developing their critical and analytical skills, in identifying further training needs, and would provide valuable practice insights to help enhance the support they provided. This recommendation has been met but remains an area for improvement which we will follow-up at our next inspection. 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 9 of 12
Inspection and grading history Date Type Gradings 18 Jan 2017 Unannounced Care and support Management and leadership 17 May 2016 Unannounced Care and support 3 - Adequate Management and leadership 3 - Adequate 3 Nov 2015 Unannounced Care and support Management and leadership 20 Nov 2015 Re-grade Care and support 3 - Adequate Management and leadership 3 - Adequate 6 Nov 2015 Re-grade Care and support Management and leadership 3 - Adequate 29 May 2015 Unannounced Care and support 2 - Weak 3 - Adequate Management and leadership 2 - Weak 4 Nov 2014 Unannounced Care and support 2 - Weak Management and leadership 3 - Adequate 7 May 2014 Unannounced Care and support 2 - Weak page 10 of 12
Date Type Gradings Management and leadership 3 - Adequate 8 Jan 2014 Unannounced Care and support 3 - Adequate Management and leadership 3 - Adequate 14 Jun 2013 Unannounced Care and support 3 - Adequate 3 - Adequate Management and leadership 2 - Weak 1 Mar 2013 Unannounced Care and support 3 - Adequate 3 - Adequate 3 - Adequate Management and leadership 3 - Adequate 15 Apr 2013 Re-grade Care and support Management and leadership 2 - Weak 23 Nov 2012 Unannounced Care and support 2 - Weak 2 - Weak Management and leadership 2 - Weak 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