Ashton Grange Care Centre Care Home Service

Ashton Grange Care Centre Care Home Service 9a Hamilton Road Mount Vernon Glasgow G32 9QD Inspected by: (Care Commission Officer) Type of inspection: Annmarie Palmer Announced Inspection completed on: 17 January 2008 1/14

Service Number Service name CS2007155414 Ashton Grange Care Centre Service address 9a Hamilton Road Mount Vernon Glasgow G32 9QD Provider Number dummy Provider Name SP2005007835 Canterbury Care Homes Ltd Inspected By dummy Inspection Type Annmarie Palmer Care Commission Officer Announced dummy Inspection Completed Period since last inspection 17 January 2008 First Inspection of Service dummy Local Office Address Central West Region 4th Floor No 1 Smithhills Street Paisley PA1 1EB Tel: 0141 843 4230 Fax: 0141 843 4289 dummy 2/14

Introduction Ashton Grange Care Centre is a Care Home registered to provide care to a maximum of 39 older people. The Home is situated in Mount Vernon, which is in the East End of Glasgow. Ashton Grange Care Centre is owned and managed by Canterbury Care. The Home is readily accessible by public transport, and has good transport links to the city of Glasgow and the surrounding towns. The accommodation comprises of thirteen double bedrooms and thirteen single bedrooms and is provided over two floors. Eleven service users are accommodated on the ground floor and twenty eight service users have their rooms on the upper floor. Only four of the bedrooms have ensuite facilities. The upper floor can be accessed either by stairs or a lift. There is a mixture of bathing and showering facilities: the ground floor has one bathroom and one shower room, while on the first floor there are two bathrooms and one shower room. Toilets are within easy reach of most bedrooms. The communal areas within the home are provided on the ground floor. The main lounge; conservatory sitting area, and dining room are adjacent to the entrance foyer in the home. The Home also has a smokers' room on the ground floor for the use of residents. Canterbury Care has undertaken a programme of works to upgrade the communal areas, refresh decoration and replace bedroom furniture and soft furnishings. The upgrading to the sitting areas had created a quieter area and more privacy for residents and visitors using the conservatory sitting room. Off street parking is provided at the front entrance to the Home, with a small garden area available for the use of residents and visitors at rear. Ashton Grange Care Centre was registered with the Care Commission on the 1st October 2007. Basis of Report Before the Inspection Regulation Support Assessment This service was inspected after a Regulation Support Assessment (RSA) was carried out to determine the intensity of inspection necessary. The RSA is an assessment undertaken by the Care Commission Officer (CCO) which considers: complaints activity, changes in the provision of the service, nature of notifications made to the Care Commission by the service (such as absence of a manager) and action taken upon requirements. The CCO will also have considered how the service responded to situations and issues as part of the RSA. This assessment resulted in this service receiving a low RSA score and so a low intensity inspection was required as a result. The inspection was then based upon the relevant inspection focus areas and follow up on any recommendations and requirements from previous inspections, complaints or other regulatory activity. Views of service users Five service users were interviewed during the inspection. They were very complimentary of 3/14

the staff and were pleased with the changes made to the sitting areas and the redecoration throughout the areas of the home. They did complain that there were not enough activities provided to stimulate them and they were bored watching TV. Those residents able to read used this activity to keep themselves engaged but there was a significant number of residents dependant on staff or visitors to facilitate activities for them. On the afternoon of the first day of inspection entertainment had been arranged which was enjoyed by all the residents. The Inspection report was written following an Announced Inspection. The inspection took place over two days on the 17th and 18th of January 2008, with final feedback to the Regional Manager taking place on the 28th February 2008. The inspection took place between 10:00am and 6:00pm on the first day and 9:30am and 5:00pm on the second day. This was the first inspection of this care service since its registration on the 1st October 2007. Staff at inspection The inspection was conducted by Annmarie Palmer, Care Commission Officer. Evidence A range of evidence was evaluated as part of the inspection, this included the following: Protecting People Child Protection Policy Restraint (adult services) Restraint Policy Restraint Records Restraint Training Adult Protection Policy Inter-agency Procedures Abuse Concerns Reporting Staff Training -- adult abuse and protection Staff training/training plans SSSC Staff training needs assessment Learning and Development Policy Training Programme SSSC codes - staff qualifications Statutory training Non - statutory training Palliative care Staff awareness and training Policy on health care support Staffing Schedule Compliance Compliance for a four week period prior to the inspection day. Examination of Accident and Incident Records Interviews with 5 service users 4/14

Interviews with 4 members of staff, including the manager Examination of 4 Service User's Care Plans Inspection Focus Areas and associated National Care Standards for 2007/08 Protecting People Palliative care Staffing Schedule Compliance National Care Standards associated with the Inspection Focused Areas. Standard 5: Management and Staffing Arrangements Standard 19: Support and care in dying and death. In addition to the above elements of Standard 4 - your Environment were reported on as part of this inspection. Fire Safety Issues The Fire (Scotland) Act 2005 introduced new regulatory arrangements in respect of fire safety, on 1 October 2006. In terms of those arrangements, responsibility for enforcing the statutory provisions in relation to fire safety now lies with the Fire and Rescue service for the area in which a care service is located. Accordingly, the Care Commission will no longer report on matters of fire safety as part of its regulatory function, but, where significant fire safety issues become apparent, will alert the relevant Fire and Rescue service to their existence in order that it may act as it considers appropriate. Further advice on your responsibilities is available at www.infoscotland.com/firelaw Action taken on requirements in last Inspection Report Not applicable Comments on Self-Evaluation Not applicable View of Service Users The five Service Users interviewed were very complimentary about the recent changes to the environment. There was one concern raised about the loss of the quiet sitting room which has been converted into office space. However, the manager is seeking to identify another area within the home that can provide a small quiet sitting area for residents at a distance from the current siting areas. View of Carers Two carers were interviewed as part of the inspection. There was some concerns about the number of staff leaving the service in the recent past. However, there was a recognition that the staff recruited were kind and caring but did need to develop their knowledge of the residents. There was some concerns also about the recent changes of menus and whether these were to the residents' tastes. This was discussed with the manager and chef who gave assurances that residents would be consulted about their preferences for the menu and the menus would be reviewed to take account of this. 5/14

There were also ongoing concerns regarding the quality and operation of the heating system. The visitors found bedrooms areas exceptionally cold with inadequate heating inn he winter and oppressively warm in the summer Examples of comments made were as follows: 'The staff are very good here, there has always been a lot of good staff.' 'The staff don't have an easy job but they are very patient, I visit nearly every day and they are so helpful and caring to everyone. 6/14

Regulations / Principles National Care Standards National Care Standard Number 4: Care Homes for Older People - Your Environment Strengths The Environment The Provider had undertaken a programme of refurbishment, decoration and restructuring of internal areas within the home. This had a positive impact upon the environment. The main sitting area / conservatory area had been separated and this provided two distinct areas for services users with additional privacy, it also eliminated the need for staff and visitors to access the conservatory via the dining area which had improved the privacy and dignity of service users at meal times. The areas that had been redecorated where bright and redecoration of corridor walls had added reflected light to the internal corridors. Several service users bedrooms had been decorated, and supplied with new bedroom furniture and soft furnishings which had improved the quality of the rooms. Areas for Development The Service s building has had an ongoing problem with the installed heating system which failed completely during December 2007. As a consequence the service had purchased portable heaters to warm the Home until the heating system could be repaired. A further concern is that the service users have no control over the heating system either in their rooms or in the communal areas and this continues to cause discomfort for both residents and visitors in the summer and winter months, and fails to meet the environmental standard expected within the NCS Care Homes for Older People Standard: 4.7: Your Environment. Although the Provider had taken measures to reduce the impact of the heating failure on the residents and staff any temporary measures would be inadequate to provide heat and warmth throughout all the areas of the Home. The condition and design of the heating system must be addressed to provide a modern standard of heating and environmental controls for the service users and the building in general. See Requirement 1 National Care Standard Number 5: Care Homes for Older People - Management and Staffing Arrangements Strengths Protecting People Child protection in services for adults The Service allowed children to visit the Home. Restraint The Service had a policy for restraint which was developed by the former Provider of the care service. 7/14

The Policy outlined the role of the policy in minimising the use of restraint, some examples of forms of restraint, the role of staff in relation to restraint issues, a flow to guide staff in assessing and reviewing restraint, and the need to involve relatives and carers in assessment and review. The policy noted alternatives to restraint that the staff should employ. The Service had copies available of the Mental Welfare Commission s (MWC) best practice guidance: Rights, Risks and Limits to Freedom -2006 and Safe to wander MWC 2003. One member of staff reported that they had attended an intensive course of training for the use of restraint organised by Canterbury Care. Protection of Vulnerable Adults The Service had a Protection of Vulnerable Adults (POVA) Policy in place for Canterbury Care dated November 2007. The policy instructed care centre managers to obtain a copy of the local Council s policies for adult protection issues, and that all reported incidents will be dealt with in accordance with these procedures. The policy outlined the roles and responsibilities of staff in relation to POVA and stated that it was the responsibility of the care centre manager to make arrangements, by training staff or by other measures to prevent service users from being harmed or suffering abuse, or being placed at harm of risk or abuse. All members of staff had been issued with a copy of the POVA Policy. SSSC Codes and Staff Training The manager informed the officer that there an intention to have all staff participate in induction training for Canterbury Care policies and procedures. The Provider s Staff Supervision Recording Form had a section for the identification of training needs. The Service did have a system for Induction training in place for staff. The Service did have a copy of the provider s training programme in place. Members of staff had attended statutory training for Moving and Handling, Elementary Food Hygiene, and Infection Control. There was a training programme in place for non-statutory training. The service had a small number of staff in place who had an SVQ qualification. The Service employed Registered Nursing staff who were appropriately trained. Areas for Development Protecting People 8/14

Child protection in services for adults The Service did not have a policy in place for protecting visiting children. See Recommendation 1 Restraint The Restraint Policy did not reference the Mental Welfare Commission for Scotland s best practice guidance: Rights, Risks and Limits to Freedom -2006. The restraint policy in place did not outline the types of restraint in regular use for example: locked doors, staff observation; lap straps on wheelchairs etc. or those permitted for use within the home. The Policy did not clarify the rights of service users to have restraint applied only when they consented, if they are able to represent themselves, and who was authorised to consent in their behalf if they could not represent themselves. The policy did not clarify the role of risk assessment in the use of restraint. or the health and safety assessments and audits required, for example: in the use of bedrails or mechanical devices. See Requirement 1 Staff had not received training for restraint assessment and risk assessments. Only a minority of staff had received training in restraint issues or the safe application of appropriate techniques of physical restraint for older people. See Requirement 2 Although the Service had copies available of the Mental Welfare Commission s (MWC) best practice guidance: Rights, Risks and Limits to Freedom -2006 and Safe to wander MWC 2003 staff were not familiar with the contents. Service users did not have an initial assessment in place related to restraint which detailed their abilities and needs in relation to their rights, risks and limits to freedom. See Requirement 1 The recording of the use of restraint, and processes for reviewing risk assessments within care plans was inadequate in meeting service users needs, and was not carried out in appropriate timescales to meet service users changing needs. For example: changes in behaviour were not acknowledged or the impact reviewed, or changes due to illness did not trigger a review process of the care and support needs of the service user. Where restraint was noted it was within risk assessments for care needs and not risk assessed as part of the support. See Requirement 2 Protection of Vulnerable Adults The Canterbury Care POVA policy did not reflect current Scottish Legislation or Disclosure Processes, or National Care Standards. The Policy did not reflect the need to notify the SCRC of any incidents of suspected abuse, or reference the role of notification to the SSSC if a member of staff had been investigated and undergone disciplinary action for a POVA related offence. The policy did not give staff guidance on the information to be recorded, and how they should interact with the persons at the point of the disclosure of abuse taking place. The policy had not been localised to include appropriate contact numbers for external agencies for reporting abuse or seeking guidance. The policy did not contain information for accessing independent support and advice for service users, or the arrangements for policy review. See Requirement 3 9/14

The service did not have a copy of the Local Inter-agency Adult Protection Procedures. See Recommendation 2 Staff had not received training in awareness raising, or the implementation of the POVA Policy and procedures for Canterbury Care, and were not articulate about adult abuse issues. See Requirement 3 SSSC Codes and Staff Training The provider had not yet undertaken a audit of service users needs or a training needs assessment for each staff group. The Service did not have a Learning or Development policy in place at the time of inspection. The training programme did not reflect the need for development of best practice knowledge within the staff group and reflect the service users needs for example: wound assessment and management, prevention and treatment of pressure ulcers; nutritional assessment and support; holistic assessment of care and social needs. The Provider was in the process of identifying access to SVQ training for staff but this was not in place at the time of inspection. See Recommendation 3 for the above. The Service did not evaluate the effectiveness of staff training. The Service had not yet implemented a process of structured supervision for staff. See Recommendation 4 for the above. National Care Standard Number 19: Care Homes for Older People - Support and Care in Dying and Death Strengths The Service provided palliative care to residents with life limiting illnesses. The Service did have a copy of the Best Practice Guidance: Making Good Care Better, Scottish Partnership for Palliative Care -2006. Staff interviewed had a general awareness of the palliative care approach to end of life care. The Service had a local policy in place for accessing information and advice from the primary healthcare team, and there was evidence in care plans viewed that the links were being effectively used for making referrals for general medical concerns, to GP s, Community Psychiatric Nurses, and Tissue Viability Services etc. There was evidence of documentation within the care plans for factual recording of preferences for end of life care and funeral arrangements. The Service had links to the Marie Curie palliative care service. Areas for Development 10/14

The staff members interviewed during the inspection was unaware of the contents of the Best Practice Guidance: Making Good Care Better, Scottish Partnership for Palliative Care -2006. At the time of inspection the Service was in the process of introducing the Canterbury Care Policies and Procedures, and did not have a palliative care policy in place. At the time of inspection staff had not attended training in palliative care. The documentation for factual recording of preferences for end of life care and funeral arrangements within care plans was completed by staff and did not reflect discussion with the service user. Staff explained that they felt uncomfortable in discussing end of life care with service users. See Recommendation 5 for the above. The end of life care plan inspected evidenced poor practice in: care needs assessment; ongoing regular recording; referral for specialist palliative care support, and structured review of care planning. These issues in relation to nursing and social care were also noted in other care plans inspected. See Requirement 4. 11/14

Enforcement There has been no enforcement action against this service. Other Information Requirements Requirement 1. The Provider Must ensure that the heating system is fit for the purpose of providing sufficient heat, as and when required, to meet the needs of the older people resident within the home and their heath and well-being is not adversely affected by extremes of temperature within the Homes' environment. Timescale; Within six months from the receipt of this report. This is in order to comply with SSI 2002 /114 Regulation 4.1(a) a requirement that providers shall make proper provision for the health and welfare of service users. Requirement 2. The Provider must ensure that a Restraint Policy is adopted and implemented that reflects the Mental Welfare Commission for Scotland s, best practice guidance: Rights, Risks and Limits to Freedom -2006, and the areas of development noted in this report. Timescale: within one month from the receipt of this report. This is in order to comply with SSI 2002 /114 Regulation 4.1(a)(c) a requirement that providers shall make proper provision for the health and welfare of service users and ensure no service user is subject to restraint unless it is the only practicable means of securing the welfare of that or any other service user and there are exceptional circumstances. This is in order to comply with SSI 2002 /114 Regulation 4.1(a)(c) a requirement that providers shall keep a record of any occasion on which restraint or control has been applied to a service user, with details of the form of restraint or control, the reason why it was necessary and the name of the person authorising it. Requirement 3. The Provider must ensure that staff receive training relating to Health and Safety legislation, procedures and safety checks required for the use of restraint equipment and restraint techniques and for assessing, implementing and reviewing the use of restraint as a support within care planning, and the risk assessments for the use of restraint that would meet the best practice principles within the MWC guidance. The provider must also ensure that care staff receive training in the safe application of physical restraint techniques appropriate to the needs of older people. Timescale: within two months from the receipt of this report. This is in order to comply with SSI 2002 /114 Regulation 4.1(a)(c) a requirement that providers shall make proper provision for the health and welfare of service users and ensure no service user is subject to restraint unless it is the only practicable means of securing the welfare of that or any other service user and there are exceptional circumstances. This is in order to comply with SSI 2002 /114 Requirement 4. The provider must review and develop its existing Protection of Vulnerable 12/14

Adults Policy to meet the areas of development outlined in this report, and ensure that staff are aware of adult protection issues and the policy and procedures to be implemented. Timescale: Within two months from the receipt of this report. This is in order to comply with SSI 2002 /114 Regulation 4.1(a) a requirement that providers shall make proper provision for the health and welfare of service users. This is in order to comply with SSI 2002 /114 Regulation 13(c) a requirement to ensure that persons employed in the provision of a care service receive (i) training appropriate to the work they are to perform. Requirement 5 - The Provider must ensure that staff record, review and act upon changes in physical well-being noted routinely in service users care plans. The provider must develop a process for auditing and monitoring the content of care plans to ensure that the care plan is accurate and that it reflects and meets the changing needs of service users. Where staff are failing to recognise or address service users changing needs the Provider must ensure that training is provided to staff in the delivery of best practice in nursing and social care relevant to the care needs of the service users living within the Home and that staff can demonstrate competency in the assessment, review and delivery of care that meets service users needs. Timescale: within three months from the receipt of this report. This is in order to comply with SSI 2002 /114 Regulation 4.1(a) a requirement that providers shall make proper provision for the health and welfare of service users. This is in order to comply with SSI 2002 /114 Regulation 5.2(b) a requirement that the provider of a care home service shall in addition review the personal plan at least once in every six months. This is in order to comply with SSI 2002 /114 Regulation 13(c) a requirement to ensure that persons employed in the provision of a care service receive (i) training appropriate to the work they are to perform. Recommendations Recommendation 1. A child protection policy for children visiting the care service should be developed and implemented. NCS Care Home s for Older People: Standard 5.1 and 5.2 Management and Staffing Arrangements. Recommendation 2 The Service should obtain a copy of the Local Inter-agency Adult Protection Procedures. NCS Care Home s for Older People: Standard 5.1 Management and Staffing Arrangements. Recommendation 3 - A training needs analysis which reflects the aims and objectives of the Service and takes account of service users needs should be developed, and statutory and non-statutory training, including the need for SVQ training, identified within the analysis should be provided to staff. NCS Care Home s for Older People: Standard 5.3 Management and Staffing Arrangements. Recommendation 4 -The Service should develop and implement a training policy. The policy should outline the link between this policy and the Staff Supervision process and how training 13/14

effectiveness will be evaluated. NCS Care Home s for Older People: Standard 5.1 Management and Staffing Arrangements Recommendation 5 -. The Service should continue to explore and make available training opportunities for staff that reflect the specific palliative care initiatives, including raising awareness of best practice guidance content and communication skills training for staff in discussing palliative care with service users. NCS Care Home s for Older People: Standard 5.4: Management and Staffing Arrangements. Annmarie Palmer Care Commission Officer 14/14