Adamwood Nursing Home Care Home Service

Adamwood Nursing Home Care Home Service 47c Ravensheugh Road Musselburgh EH21 7PY Telephone: 0131 665 8032 Type of inspection: Unannounced Inspection completed on: 1 February 2017 Service provided by: Rollandene Ltd Service provider number: SP2003002438 Care service number: CS2003010608

About the service Adamwood Nursing Home is registered to provide a care home service to a maximum of 13 older people. The service is owned and managed by Rollandene Ltd. The home is situated in a residential area of Musselburgh, close to local transport links and amenities. The property is a converted and extended house. Accommodation is provided over two floors in a variety of single and double bedrooms, some with ensuite facilities. A stair lift and stairs gives access to the upper floor. On the ground floor there is a lounge and a conservatory, which is used as a dining/sitting area. There is an attractive enclosed rear garden. The aim of the service as stated in its brochure is: "To create a small exclusive home where the residents will integrate as part of the local community and enjoy quality living". What people told us Before the inspection we received 11 responses to Care Standard Questionnaires (out of 13 sent) from relatives/ carers and no responses from residents (out of 13 sent). Overall, everyone was satisfied with the quality of care in the home. There were particularly positive comments about the care and support, stimulation of residents and the friendliness of the home. Written comments from relatives included: "Outstanding service with an exceptional level of care". "I couldn't be more satisfied". "Staff genuinely interested and involved in xxx(relative's name) care". "Always made welcome". "Seen as an individual and so well cared for". "There's a total commitment to meeting the needs of the residents n an individual basis". "Very much like a home". "I am especially impressed by the management of the home". "xxx(resident's name) is given lots of high quality one-to-one stimulation". "Atmosphere is always warm and welcoming". Five residents were able to tell us their views and spoke warmly about the staff working in the service. We were given examples of how they were supported to carry out things they liked to do, for example enjoy the garden. Some residents were unable to tell us what they thought about the service or the care they received. We used the Short Observational Framework for Inspection (SOFI 2) to directly observe the experience and outcomes for some people. page 2 of 13

Self assessment Last one taken into account and received 18 March 2014. Discussed with the manager who believed that a further SA had been completed. From this inspection we graded this service as: Quality of care and support Quality of environment Quality of staffing Quality of management and leadership 5 - Very Good 5 - Very Good 5 - Very Good Quality of care and support Findings from the inspection Responses we received from relative/carers were extremely positive about the quality of care and the 'homeliness' in Adamwood. Some told us about how their relative was treated as an individual. This was supported in our findings where staff knew residents well and this understanding of each resident was used to tailor activity and stimulation. Music therapy was impressive with a violinist playing songs to individuals which triggered responses from some residents. Life story work was of a high quality and this included photos of events of the individual's life which was said to be used to help engage the resident in conversation. Residents looked well presented in their personal appearance and looked comfortable and relaxed. Whilst a number of residents shared a bedroom, their own space was defined and personalised and ensured that privacy could be respected. Staff told us that they had time to speak with the residents and we saw this happen on many occasions during inspection. Some residents liked to spend time on their own and their wishes were acknowledged by staff. There was involvement of healthcare professionals and they were positive that there was good working relationships with the GP practice. Currently all legal documents were being updated and reviewed. This included 'Do not attempt resuscitation' and 'adult with incapacity' certificates. An electronic system of care planning had been introduced in the home. The quality of information was good. Care plans were person centred and set out the needs of the individual and how these needs were to be met. There was good guidance for staff, for example, to be aware that an individual may be stressed or when they were thirsty. Risk assessments were up to date and there was an alert to indicate when these were due for evaluation. Reviews of care were carried out and we saw examples of relatives being involved and having the chance to make comment about their relative's care. page 3 of 13

The management of topical medications needed to be improved and we have discussed this in Quality of environment. We have concluded that Adamwood operated at a very good level for care and support. Requirements Number of requirements: 0 Recommendations Number of recommendations: 0 Grade: 5 - very good Quality of environment Findings from the inspection Adamwood is a small home with limited space but residents were comfortable and relaxed. There were a number of shared bedrooms but the personal space for each resident was personalised. We discussed the use of signage in the home. We acknowledged that the provider wished the home to remain like the residents' own home. One resident did have detailed information to guide them to their bedroom and this was positive. We suggested that the King's Fund al Tool could give some ideas for improvement. The home was generally clean with no malodours, however there was some deep cleaning needed to make improvements to demonstrate that the home was well cared for. This included carpets and furniture. The manager confirmed that this was being progressed. Whilst there had been some improvement work in the environment, such as installing two wet rooms, the home decoration and some maintenance work needed to progress to maintain a good standard. We were informed that this was being planned. There were systems in place for the maintenance of equipment, portable appliances and services. The manager had contacted the contractor to check the water temperatures as some outlets were hot during the inspection. Specialist equipment was used, such as hoists, stand aids and pressure mats and these were checked in accordance with Lifting Operations and Lifting Equipment Regulations 1998. Call bells were in place for people who were able to use them to summon assistance. The manager took action to progress any recommendations made by other regulatory bodies. For example, a new fridge had been purchased following the environmental health inspection and there was a plan to address recommendations from the fire department. levels in the home were over that stated in the staffing schedule. Generally residents and relative/carers page 4 of 13

and staff felt there were enough staff available. This is key to making sure that residents' care needs and safety can be met. We noted that the management of topical medications needed to be improved. Some items were unnamed or did not have dates of opening. This is important to ensure that each resident is given their prescribed creams and that they are 'fit' to be used. The manager stated that this would be rectified therefore, we have not made a requirement or recommendation about this. We will check progress at the next inspection. Requirements Number of requirements: 0 Recommendations Number of recommendations: 0 Grade: 4 - good Quality of staffing Findings from the inspection We observed staff working with residents and saw very pleasant, caring interactions. Staff spoken with enjoyed working in the home and staff who returned questionnaires to us supported this. There were a number of staff members who worked a few shifts each week and did not have a full time role however, they had clearly bought into the 'ethos' of the home. Staff demonstrated the principles of respect, dignity and realising potential when delivering person centred care. Relatives gave positive comments about the staff in the home stating, "Staff are genuinely interested" and "There is a total commitment to meeting the needs of the residents on an individual basis". Staff practice was supported by induction and training. A training matrix was held which showed that there was a range of training opportunities available in the home. Training covered moving and handling, both theory and practical, fire safety, infection control, continence promotion, adult protection and communication skills. Staff accessed a range of electronic learning and records highlighted when each session was due. There were plans for an in-house moving and handling facilitator. We advised the provider to seek out training events that could be accessed through the local authority and/or health board. A system of appraisal and supervision had been developed. This was comprehensive and planned to give staff the opportunity to reflect on their practice. The session was also to be used to include proof of learning and of the staff member's registration with their regulatory body so that records can continue to be updated. This was planned to commence late February 2017. page 5 of 13

We will look at how this has been implemented at the next inspection. The recruitment of individuals were recorded electronically. Appropriate checks were made before a member of staff took up post. New starts completed a three month period of induction and they were assessed and 'signed off' before being made permanent. We have assessed that this Quality Theme is graded at 5 - very good. There remains to be progress in some areas, such as supervision and the practice of managing topical medications to maintain this grade. Requirements Number of requirements: 0 Recommendations Number of recommendations: 0 Grade: 5 - very good Quality of management and leadership Findings from the inspection The manager had built good relationships with staff working in the service. Some staff members had been employed over many years, working a few shifts weekly. They were flexible and hence there was no agency usage in the home. This meant consistency of care by a team of staff who knew residents well. This helps to ensure positive outcomes for residents. Responses received from carers/relatives, such as, "I am especially impressed by the management of the home" showed that they viewed management and leadership in the home as high quality. The manager had an 'open door' policy and was fully involved in all aspects of the service. They engaged with other professionals and academics who wished to use the home as a learning experience and to share knowledge and expertise in dementia care. Whilst the manager stated that paperwork and records were not a priority in the service, progress had been made to address all the requirements and recommendations we made at the last inspection. Notifications are made to us appropriately and accident and incident recording had improved. We have assessed that this Quality Theme is performing at a very good level. Requirements Number of requirements: 0 page 6 of 13

Recommendations Number of recommendations: 0 Grade: 5 - very good 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 all new staff have completed an induction programme appropriate to their role in line with Scottish Social Services Council (SSSC) Codes of practice. In order to evidence this the service must ensure that records are kept of the completed inductions. This is in order to comply with Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011(SSI 2011/210) Regulation 5. See also: SSSC Codes of Practice for Social Service Workers and Employers 2011. In making this requirement the following National Care Standards, Care homes for older people, have been taken into account: Standard 5 Management and staffing arrangements. Timescale: The service should develop an induction programme by 30 September 2015. This requirement was made on 22 April 2015. Action taken on previous requirement We were informed about the induction system in place in the home. Induction included mandatory training sessions in moving and handling and fire safety. This was recorded electronically. There was a three month probationary period so that the staff member's ability to carry out the role was assessed prior to being signed off and made permanent. Met - within timescales Requirement 2 The provider must ensure that staff are trained to carry out their duties. In order to achieve this the provider must review its training strategy to identify the training that it expects staff to complete according to their role and develop a training plan which will enable staff to achieve this. Moving and handling training and adult support and protection training should be prioritised. This is in order to comply with Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011(SSI 2011/210) Regulation 4(1) (a) health and welfare, Regulation 9 Fitness of page 7 of 13

employees and Regulation 15 - to ensure that people employed have training appropriate to the work they are to perform and to ensure that there is a competent workforce. In making this requirement the following National Care Standards, Care homes for older people, have been taken into account: Standard 5 Management and staffing arrangements. Timescale: An action plan indicating how the service would meet this requirement was to be submitted to us within three weeks of receiving this report. This requirement was made on 22 April 2015. Action taken on previous requirement A training matrix was in place and showed that staff training had been considered to take account of their role and responsibility. Training included moving and handling, adult support and protection, infection control, health and safety, food hygiene, continence awareness, hand hygiene and restraint. There is a rolling programme of training events and the electronic system highlights when training is due for each staff member. 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 the service regularly audits residents' personal plans to ensure that the documentation is consistently completed. This takes account of National Care Standards, Care homes for older people, Standard 5 Management and staffing and Standard 6 Support arrangements. The service had introduced an electronic system of care planning. This incorporates an alert system when any evaluations and updates are due. The system is currently being used by senior staff only and there are plans to cascade access to the system for care staff. The quality of information in the care plans is good. page 8 of 13

Recommendation 2 Accident and incident reports should be fully completed and any follow up action recorded. This takes account of National Care Standards, Care homes for older people, Standard 5 Management and staffing. A review of accident and incident reports showed that follow up actions had not always been completed. We discussed this with the management who planned to address this as the electronic system of recording allowed this to be completed. Subsequently information in notifications to us showed that follow up actions had been completed. Recommendation 3 It is recommended that the service reviews the measures taken to ensure that residents' privacy is maintained in the dining area. This takes account of National Care Standards, Care homes for older people, Standard 4 Your environment and Standard 9 Feeling safe and secure. The dining area did not have curtains. The manager stated that she had consulted with residents/ representatives in order to find out if they wished the windows to be covered. People responded that they were happy with the windows as they were. We spoke with some residents who enjoyed spending time sitting at the window area and they were happy with the situation. Recommendation 4 The service should review the provision of moving and handling equipment in the home to ensure that it is able to meet the needs of people using the service. This takes account of National Care Standards, Care homes for older people, Standard 4 Your environment, Standard 6 Support and Standard 9 Feeling safe and secure. A new hoist had been purchased by the provider following a review of the equipment. Staff told us that there was sufficient equipment for moving and handling in the home. page 9 of 13

Recommendation 5 The service should make a written assessment of the refurbishment work needed in the home and develop a refurbishment plan with timescales. This will evidence how progress is being made and help to prioritise areas in most need. This takes account of National Care Standards, Care homes for older people, Standard 4 Your environment. We received a written plan of refurbishment work for the year of 2017. This included decoration and maintenance work. Additionally we saw that there had been two wet shower rooms installed in 2016. These were of a good quality. Recommendation 6 It is recommended that recruitment files evidence that appropriate safe recruitment practices have been completed and record any additional evidence gathered to support the application. This takes account of National Care Standards, Care homes for older people, Standard 5 Management and staffing arrangements and Scottish Social Services Council (SSSC) Code of Practice for employers of social service workers. We saw one recruitment file of a new start and information was satisfactory. Additionally an electronic system of recording recruitment was in place and this also showed that checks were made prior to the staff member taking up post. Recommendation 7 It is recommended that all staff receive regular formal supervision that reviews the individual staff member's training needs, identifies any support needed and agrees objectives for them to achieve. This takes account of National Care Standards, Care homes for older people, Standard 5 Management and staffing arrangements. A policy and guidance on staff supervision has been developed. Individual staff supervision was planned to be introduced at end February 2017 and included staff training. One group supervision session had been completed in respect of managing topical medication management as this was highlighted at our inspection. page 10 of 13

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. Inspection and grading history Date Type Gradings 22 Apr 2015 Unannounced Care and support 3 - Adequate Management and leadership 3 - Adequate 13 Nov 2014 Unannounced Care and support 5 - Very good 2 - Weak Management and leadership 18 Nov 2013 Unannounced Care and support 5 - Very good Management and leadership 2 Nov 2012 Unannounced Care and support 5 - Very good 5 - Very good Management and leadership 27 Oct 2010 Unannounced Care and support Not assessed Not assessed Not assessed Management and leadership page 11 of 13

Date Type Gradings 11 Jun 2010 Announced Care and support 5 - Very good 5 - Very good Not assessed Management and leadership Not assessed 28 Oct 2009 Unannounced Care and support 5 - Very good Not assessed 5 - Very good Management and leadership Not assessed 7 Jul 2009 Announced Care and support 5 - Very good Management and leadership 23 Jan 2009 Unannounced Care and support 3 - Adequate 3 - Adequate Management and leadership 3 - Adequate 3 Jul 2008 Announced Care and support 3 - Adequate 3 - Adequate Management and leadership 3 - Adequate page 12 of 13

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 13 of 13