Greenlaw Grove Care Home Service 1 North Greenlaw Way Newton Mearns Glasgow G77 6GZ Telephone: 0141 661 5060 Type of inspection: Unannounced Inspection completed on: 27 March 2017 Service provided by: Thistle Healthcare Limited Service provider number: SP2003002348 Care service number: CS2013320045
About the service we inspected Greenlaw Grove provides care and support for up to one hundred older people with a range of physical and cognitive impairment. The home is purpose-built over three levels with a passenger lift providing access to all floors. The lower ground floor is registered to provide a care service to a further thirteen adults with physical and mental health needs. At the time of this inspection there were no residents residing within this unit. The service was registered with the Care Inspectorate in December 2014 and is provided by Thistle Healthcare Limited. The home is situated in a residential area of Newton Mearns and is in close proximity to local amenities and public transport links. There are five units, four of which are currently in use. All rooms have full ensuite facilities and people are encouraged to bring in their own furnishings to personalise their rooms. Each unit has communal lounge and dining areas. There is a bistro style café, hairdressing and beauty salon as well as a cinema and multi faith room. There are enclosed landscape gardens with seated areas for people to enjoy in the better weather. How we inspected the service This unannounced, follow-up inspection took place on the 20 and 21 of February 2017 between the hours of 7am and 6.50pm. Feedback was given to the Operations Director, Project Manager and Service Manager on 27 February 2017. At this inspection we focused on the four requirements and five recommendations from the previous inspection we carried out in September 2016. We also looked at one requirement and five recommendations which were made following two complaints we received in September and November 2016. We recommend this report is read in conjunction with the previous inspection report. Details of complaints which have been upheld can be found on the Care Inspectorate website (www.careinspectorate.com). We also looked at: - personal plans - medication administration records - additional monitoring charts - activity programme and records - managers quality assurance systems including accident and incident records - staff training, induction, supervision - maintenance records - recent fire risk assessment We also spent time observing how staff supported and interacted with residents as well as the general environment of the home. We spoke to fifteen residents and one relatives/carer at this inspection. page 2 of 12
Taking the views of people using the service into account This follow-up inspection focused on the progress made in meeting the requirements and recommendations made at the previous inspection. Therefore no Care Standards Questionnaires were issued prior to this inspection. During the inspection visit we spoke to fifteen residents who provided the following comments: - "don't know about care plans" - "food is not good, have spoken to staff who are trying to improve it" - "no proper management" - "you're free to get up when you want, happy with my room and the church support comes in and out" - "there is a choice of food but it's not good, not enough taste" - "it's a very nice place to be in and the food is nice" - "the staff are very, very nice and I do love them" - "sometimes the food is alright but others not. On the whole staff are nice, needs a manager". Taking carers' views into account This follow-up inspection focused on the progress made in meeting the requirements and recommendations made at the previous inspection. Therefore no Care Standards Questionnaires were issued prior to this inspection. What the service has done to meet any requirements we made at or since the last inspection Previous requirements Requirement 1 The service provider should ensure that there is a consistent approach in line with best practice guidance regarding the management and records of medication prescribed to be administered 'as needed'. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for care services) Regulations 2011/210 Regulation SSI 2011 No 210, 4, a regulation concerning the welfare of users. Timescale: Immediate and ongoing. This requirement was made on 4 April 2016. Action taken on previous requirement We noted an improvement in the standard of medication administration recording records since the previous inspection. An audit of all residents medication records had just commenced. From the completed audits we looked at we could see that these identified current stock balance and discrepancies, medication discontinued page 3 of 12
but still recorded and medications prescribed but not administered. Once the audit was fully completed the project manager planned to address issues with staff individually and through group supervision. There had been some staff coaching sessions on medication management last year with plans to continue these within this years training programme. Where medication was prescribed 'as required' the records we sampled provided the reason for administration and outcome recorded. We saw one medication that was out of stock however this had been highlighted to pharmacy and received within forty-eight hours. The medication administration records could be further improved by reviewing the administration and recording of supplementary medication toe ensure these are being administered as prescribed. We saw a large stock of dietary supplements. We highlighted this to the project manager in order to check and ensure these were being administered correctly as the records did not provide us with this level of information. Not all residents had protocols for as required medication. We looked at the management of covert medication. This involves the administration of prescribed medication in disguised form usually involving food and drink. These records could be improved by including the guidance provided by the pharmacist. We have acknowledged the improvement and ongoing progress made since the last inspection and will continue to monitor this at future inspections Met - within timescales Requirement 2 The service provider must ensure that service users' personal plans set out how the health, welfare and safety needs of the individual are to be met. In order to do this the service must ensure that the personal plans: - Accurately reflect all the current needs of individuals - Ensure that service users' nutritional care needs are identified and met. This will include effective monitoring of service users' weight. - Include information about care and support that is up to date and regularly evaluated. This is to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI2011/210), Regulations 5(1) Personal Plans. Timescale - Within six weeks from receipt of this report. This requirement was made on 4 April 2016. Action taken on previous requirement From the sample of care plans we looked at we concluded that there is still significant work required to improve these. The concerns noted in the previous report around the lack of information recorded in the care plans remains the same. We highlighted this during the inspection and at feedback and were assured that this would be addressed as a matter of priority. page 4 of 12
We found gaps in the additional monitoring charts used for recording oral hygiene. Diet and fluid charts require further improvement to include any drinks/snacks provided in the evening or overnight, by recording the amount of food eaten and by giving a total of fluid intake over a twenty-four hour period. Not met Requirement 3 The service provider must develop a training plan that details mandatory and needs led training taking the outcome of the inspection into account. This is to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI2011/210), regulation 15 (a). Timescale - within three months of receipt of this report. This requirement was made on 4 April 2016. Action taken on previous requirement Since the previous inspection a training needs analysis had been developed and we were given a training matrix for mandatory training. We continued to find gaps in the mandatory training matrix which included fire safety, moving and handling, adult support and protection and infection control. The service were in the process of reestablishing training with the care home liaison team for more healthcare specific training. Not met Requirement 4 The provider should ensure that effective audits are carried out in relation to resident care plans, accidents/ incidents and the overall environment of the service with sufficient information held and/or recorded to ensure the health and welfare of service users. The provider should ensure that, where areas for improvement have been identified within the auditing system, there is sufficient information to show how risks have been minimised and progress made. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI2011/210) Regulation 4 (1) Welfare of Users and 5 Personal Plans. Timescale: Within twelve weeks on receipt of this report. This requirement was made on 4 April 2016. Action taken on previous requirement The foundations for a quality assurance system were now in place however as this had only recently been established we were unable to see how this had been used to improve staff practice, standard of care and support and improve documentation in particular care plans. Not met page 5 of 12
Requirement 5 The provider must review and implement changes to the menu to ensure residents receive a balanced and nutritious diet which is appropriate to their individual needs and of a high standard and quality to maintain their health. In order to do this residents must be properly consulted about the menu as they are being developed and ongoing, to make sure they cater for residents' preferences including culture and faith and offer choice. This is in order to comply with: The Social care and Social Work Improvement Scotland (Requirements for Care services) Regulations 2011 (SSI 2011/210), Regulation 4(1)(a) - Welfare of users. Timescale: to start within one week and completed within six weeks from receipt of this report. This requirement was made on 28 October 2016. Action taken on previous requirement Since the previous inspection staff had introduced daily mealtime observations and a resident food group forum. Questionnaires had been issued providing people's likes/dislikes and how improvements could be made to ensure a better dining experience. This had resulted in a recent change to menus, introduction of fruit smoothies and daily home baking. We were informed that the menus had been nutritionally assessed and took into account individual choice, culture and faith. The chef and kitchen staff were speaking to residents on a daily basis and were knowledgeable of individuals preferences. This level of information and consultation was not recorded within the care plans we looked at (see requirement 2). The chef was currently reviewing the choice and presentation of textured diets, we will follow this up at the next inspection. Met - within timescales What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 The service should further develop the range of activities that are available for residents on a day-to-day basis and ensure that those activities are responsive to the age, abilities and preferences of residents. National Care Standards - Care Homes for Older People; Standard 12 - Lifestyle - social, cultural and religious belief or faith; Standard 17 - Daily life. This recommendation was made on 4 April 2016. page 6 of 12
Since the previous inspection two activity lounges had been created in two of the units. During the inspection we saw these areas being used by residents participating in group activities, for example exercises, dominoes and a quiz. These rooms provided a range of games and arts and crafts for people to use. There was a pantry area where residents could request light snacks, fruit and drinks. Activity folders had been introduced with each residents physical activity level recorded and how they enjoyed it. Community links were being established and residents from sister homes had attended recently for a cinema afternoon. The home benefits from a cinema room, café style bistro, multi-faith room and landscaped gardens. However residents were unable to access any of these areas independently without staff accompanying them. We noted during the inspection some of these areas were not being used to their full potential. We discussed this with the project manager who assured us this would be reviewed. We have acknowledged the improvements made since the previous inspection however these changes had just been implemented. We will review how this has progressed and benefitted the outcomes for people at the next inspection. Recommendation 2 The provider should ensure that residents can have a hot or cold drink at any time whenever they want to reduce the likelihood of dehydration. National Care Standards - Care Homes for Older People; Standard 13 - Eating Well. This recommendation was made on 4 April 2016. Each unit had a pantry area where staff could provide snacks and drinks to residents/relatives. There was a café style bistro area where we saw residents enjoying food and drinks with visitors and staff. This recommendation has been met. However, we discussed how the dining experience could be improved for some residents by providing milk jugs and tea on tables promoting independence and choice where appropriate. We will review how this has progressed at the next inspection. Recommendation 3 The provider should ensure there is a regular audit of any accidents and/or incidents that occur within the service. The audit should take into account how staff are completing records and put into place any training that is subsequently identified. National Care Standards - Care Homes for Older People; Standard 5 - Management and staffing arrangements; Standard 9 - Feeling safe and secure. This recommendation was made on 8 November 2016. page 7 of 12
The accident/incident records require further improvement. An overview of the content of information recorded in these by staff is necessary to ensure the information recorded is accurate and appropriate actions are then being taken. Staff were recording incidents which should have been investigated by the service or referred to social services for further investigation. Similar to the previous inspection report we continued to find a lack of followup checks carried out by staff following an accident with evidence of actions taken, further advice sought or how to minimise risk. Recommendation 4 The service provider must implement the systems that it has developed record, track and evaluate new staff to ensure that those staff employed in the service are suitably qualified and competent. National Care Standards - care homes for older people; Standard 5 - Management and staffing arrangements. This recommendation was made on 8 November 2016. Newly recruited staff received a comprehensive induction at head office which covered a range of topics including fire safety, principles of care, stress and distress, adult support and protection, dementia and falls prevention. New staff shadowed a more experienced staff member for a day, then commenced a twelve week induction period. We could see that coaching sessions were taking place with all staff however it was not evident how new staff were being supervised and had their practice and competency was reviewed throughout the twelve induction process. Recommendation 5 The provider should look at ways of improving the quality and content of staff supervision in particular where staff have identified specific training requests. Supervision records should be fully completed and evaluated to demonstrate that staffs' requests have been positively actioned within an agreed timescales. National Care Standards Care Homes for Older People; Standard 5 Management and Staffing Arrangements. This recommendation was made on 8 November 2016. A new manager and management team had just been appointed. The new manager discussed plans to commence staff supervision once established in the post. We have acknowledged that this remains work in progress and will review this again at the next inspection. page 8 of 12
Recommendation 6 The provider should ensure the resident and or their representative is fully involved in the planning and agreement of their care. Where it is possible the resident and or their representative should sign and date as evidence they have read and agreed to this. National Care standards, short breaks and respite care services for adults, standard 6: Individual Agreement. This recommendation was made on 28 October 2016. This was not evident in the care plans we looked at, we will repeat this recommendation and review how this has been implemented as the care plans are rewritten and updated. Recommendation 7 Where a resident has equipment to assist them with their communication, the service must ensure that there are systems in place to ensure that staff are fully aware of the practical steps to ensure that this equipment is well maintained and used appropriately. National Care Standards Care Homes for Older People; Standard 14.11 Keeping Well-Healthcare This recommendation was made on 7 February 2017. These four recommendations were made following a complaint we received in November 2016. The provider received the outcome of our investigation along with a copy of the report on 7 February 2017. The project manager received an action plan on 17 February which was returned to us with details on how the service planned to meet these recommendations on 20 February 2017. Due to the short period of time between returning the action plan and this inspection we were unable to review the progress made in meeting these recommendations. We will therefore review this again at the next inspection. Recommendation 8 If mobility issues are identified the service must ensure that the individual receives appropriate professional assessments and that the equipment provided has been assessed as appropriate for them and their needs. National Care Standards Care Homes for Older People; Standard 14.8.9.11 Keeping Well - Healthcare. This recommendation was made on 7 February 2017. As previously stated we were unable to see this level of information within the care plans. We have repeated the previous requirement made in relation to the care plans and will monitor how this information has been incorporated into the relevant plans once they have been rewritten and updated at the next inspection. page 9 of 12
Recommendation 9 The service must ensure that all residents, regardless of their needs have access to regular meaningful activities and that these are recorded in a manner that provides a clear record of what activities they participated in. Care plans should include activity preferences and how to support each individual to participate. National Care Standards Care Homes for Older People; Standard 17.1 Daily Life. This recommendation was made on 7 February 2017. As previously stated in recommendation 1 of this report. We have acknowledged the improvements made to improve the activities offered since the previous inspection however these changes had just been implemented. We will review how this has progressed and benefitted the outcomes for people at the next inspection. Recommendation 10 The service must ensure that were identified a change in medication needs, an individual should have access to their GP or other relevant medical professionals to make necessary changes. This should be fully recorded in their care plan and staff should endeavour to ensure the appropriate changes are implemented as soon as possible. National Care Standards Care Homes for Older People; Standard 15.5.8 Keeping Well - Medication. This recommendation was made on 7 February 2017. As previously stated we were unable to see how this level of information had been recorded within the care plans. We have repeated the previous requirement made in relation to the care plans and will monitor how this information has been incorporated into the relevant plans once they have been rewritten and updated at the next inspection. 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. page 10 of 12
Inspection and grading history Date Type Gradings 15 Sep 2016 Unannounced Care and support 3 - Adequate Environment 4 - Good Staffing 3 - Adequate Management and leadership 3 - Adequate 26 Nov 2015 Unannounced Care and support 3 - Adequate Environment 4 - Good Staffing 4 - Good Management and leadership 4 - Good page 11 of 12
To find out more This inspection report is published by the Care Inspectorate. You can download this report and others from our website. Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and help services to improve. We also investigate complaints about care services and can take action when things aren't good enough. Please get in touch with us if you would like more information or have any concerns about a care service. You can also read more about our work online at www.careinspectorate.com Contact us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com 0345 600 9527 Find us on Facebook Twitter: @careinspect Other languages and formats This report is available in other languages and formats on request. Tha am foillseachadh seo ri fhaighinn ann an cruthannan is cànain eile ma nithear iarrtas. page 12 of 12