Millport Care Centre Care Home Service Adults 19 George Street Millport Isle of Cumbrae KA28 0BQ

Millport Care Centre Care Home Service Adults 19 George Street Millport Isle of Cumbrae KA28 0BQ Inspected by: Michael Hilston Elaine Allison, Mina Cassidy, Kirsty Porter Type of inspection: Unannounced Inspection completed on: 12 July 2012

Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 13 4 Other information 28 5 Summary of grades 29 6 Inspection and grading history 29 Service provided by: European Care (Combined) Ltd Service provider number: SP2007009177 Care service number: CS2007157969 Contact details for the inspector who inspected this service: Michael Hilston Telephone 01294 323920 Email enquiries@careinspectorate.com Millport Care Centre, page 2 of 31

Summary This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change after this inspection following other regulatory activity. For example, if we have to take enforcement action to make the service improve, or if we investigate and agree with a complaint someone makes about the service. We gave the service these grades Quality of Care and Support 2 Weak Quality of Environment 1 Unsatisfactory Quality of Staffing 2 Weak Quality of Management and Leadership 1 Unsatisfactory What the service does well The Home had adequate systems and processes for involving service users and carers in assessing and improving the quality of the service. The processes for the recruitment and induction of staff were also adequate. What the service could do better A number of areas were identified as requiring improvement including: * How service users health and wellbeing needs were being met * Ensuring that the environment was safe and that service users were protected * Ensuring that the environment allows service users to have as positive a quality of life as possible * Training and supervision of staff * The promotion of leadership values throughout the workforce * Quality assurance systems and processes. * It was the professional opinion of the inspecting officers that in addition to the registered service provided by the Home that they were also providing an unregistered service in the form of Day Care. What the service has done since the last inspection Since the last inspection a number of concerns have been identified and are discussed within the body of this report. Whilst some improvements have been made in relation to the decor of some areas within the home other previously Millport Care Centre, page 3 of 31

identified issues relating to the overall environment remain a concern and must be addressed as a matter of urgency. Conclusion The concerns identified within the body of this report will require to be addressed. The service will be required to submit an action plan detailing how these are to be resolved. Although the RSA Level at the time of this inspection as noted within this report is Medium this will be reviewed as a result of this inspection. Who did this inspection Michael Hilston Elaine Allison, Mina Cassidy, Kirsty Porter Millport Care Centre, page 4 of 31

1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Prior to 1 April 2011, this function was carried out by the Care Commission. Information in relation to all care services is available on our website at www.scswis.com. The Care Inspectorate awards grades for services based on findings of inspections. Grades for this service may change after this inspection if we have to take enforcement action to make the service improve, or if we uphold or partially uphold a complaint that we investigate. Requirements and recommendations: If we are concerned about some aspect of a service, or think it could do more to improve its service, we may make a recommendation or requirement. - A recommendation is a statement that sets out actions the care service provider should take to improve or develop the quality of the service but where failure to do so will not directly result in enforcement. - A requirement is a statement which sets out what is required of a care service to comply with the Public Services Reforms (Scotland) Act 2010 and Regulations or Orders made under the Act, or a condition of registration. Where there are breaches of the Regulations, Orders or conditions, a requirement must be made. Requirements are legally enforceable at the discretion of the Inspectorate." Millport Care Home is part of the company, European Care (Combined) Ltd. They have operated the service since 2007. The service is located on the island of Millport and provides care and support for up to 32 adults with a learning and/ or physical disability, including on a respite basis. The care and support needs of the resident group is diverse. The accommodation is provided in a two story building with a passenger lift between floors. Millport Care Home varied its registration to take over the running of an 8 bedded respite service, known as Taigh Mor in Beith, at the end of August 2011, on a temporary basis until a new provider could be identified. We agreed to the variation to Millport Care Homes Registration to allow the service to continue to operate but this registration is time limited till 1st September 2012. Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 2 - Weak Quality of Environment - Grade 1 - Unsatisfactory Quality of Staffing - Grade 2 - Weak Quality of Management and Leadership - Grade 1 - Unsatisfactory Millport Care Centre, page 5 of 31

This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change following other regulatory activity. You can find the most up-to-date grades for this service by visiting our website www.careinspectorate.com or by calling us on 0845 600 9527 or visiting one of our offices. Millport Care Centre, page 6 of 31

2 How we inspected this service The level of inspection we carried out In this service we carried out a medium intensity inspection. We carry out these inspections where we have assessed the service may need a more intense inspection. What we did during the inspection As requested by us the Home sent us an annual return. The Home also sent us a self assessment form. We issued a number of care standards questionnaires for people who use the service and their carers. In this inspection we gathered evidence from various sources, including the relevant sections of policies and procedures and other documents, including: Service User (SU) Questionnaires Meeting Minutes Review Planner Care Plans Newsletter Activities Plan and Records Staff training Records Induction Programme Recruitment Policy Sample of staff files Policy and Procedure Manual Supervision Planner and Records Quality Audits Risk Assessments Menus Insurance Certificate Recruitment policy Service and maintenance contracts and health and safety checks we spoke with service users during the inspection visit. We also walked round the Home and observed staff practice and the environment. Grading the service against quality themes and statements We inspect and grade elements of care that we call 'quality themes'. For example, one of the quality themes we might look at is 'Quality of care and support'. Under each quality theme are 'quality statements' which describe what a service should be doing well for that theme. We grade how the service performs against the quality themes and statements. Millport Care Centre, page 7 of 31

Details of what we found are in Section 3: The inspection Inspection Focus Areas (IFAs) In any year we may decide on specific aspects of care to focus on during our inspections. These are extra checks we make on top of all the normal ones we make during inspection. We do this to gather information about the quality of these aspects of care on a national basis. Where we have examined an inspection focus area we will clearly identify it under the relevant quality statement. Fire safety issues We do not regulate fire safety. Local fire and rescue services are responsible for checking services. However, where significant fire safety issues become apparent, we will alert the relevant fire and rescue services so they may consider what action to take. You can find out more about care services' responsibilities for fire safety at www.firelawscotland.org Millport Care Centre, page 8 of 31

What the service has done to meet any requirements we made at our last inspection The requirement The provider must ensure that the fabric of the building is maintained to an appropriate standard. This is to comply with SSI 2002/114 Regulation 10(2)(b)(c) - a requirement that premises are unfit to be used for the provision of a care service unless they are of sound construction and kept in a good state of repair externally; and have adequate and suitable ventilation, heating and lighting. Timescale for completion: one week from receipt of this report (repeat requirement). What the service did to meet the requirement Not Met The requirement is: Not Met The requirement The Provider must draw up a full refurbishment and upgrading programme for the service to ensure that the accommodation is fit for the use of and meets the needs of the current client group. This is in order to comply with SSI/2002/114 Regulation 10(2)(a)(b) - a requirement that premises are [unfit] to be used for the provision of a care service unless they are suitable for the purpose of achieving the aims and objectives of the care service which are set out in the statement of aims and objectives; and are of sound construction and kept in a good state of repair externally and internally. Timescale for implementation: 3 months from receipt of this report (repeat requirement). What the service did to meet the requirement Although there is a refurbishment plan in place the Home the environment continues to be unsatisfactory. The requirement is: Met The requirement The provider must ensure that where essential equipment needs to be replaced or repaired that this is done quickly so that it does not impact on resident care. 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) a requirement that the Provider shall make proper provision for the health and welfare Millport Care Centre, page 9 of 31

of service users. Timescale for implementation: one week from publication date of this report. What the service did to meet the requirement Not Met The requirement is: Not Met Inspection report continued The requirement The provider must ensure that all risk assessment documentation is appropriately completed to identify the potential risks for service users and what actions the service plans to take to minimise these risks. These plans must be regularly reviewed and updated as necessary. 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) - a requirement that the provider must make proper provision for the health, welfare and safety of service users Timescale for implementation - within 1 week of service users admission to the service What the service did to meet the requirement Not Met The requirement is: Not Met The requirement The provider must ensure that an accurate record is maintained of all incidents that occur within the service. Where action is required to reduce the risk of an incident reoccurring this must be reflected in the individuals personal care plan. 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) - a requirement that the provider must make proper provision for the health, welfare and safety of service users Timescale for implementation - 1 week from receipt of this report What the service did to meet the requirement Not Met The requirement is: Not Met The requirement A detailed training programme needs to be developed that addresses all staff training needs; including the need for staff to obtain a relevant recognised qualification in care. This is in order to comply with The Social Care and Social Work Improvement Millport Care Centre, page 10 of 31

Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210) regulation 15 (b) - a requirement that The provider must, having regard to the size and nature of the care service, the statement of aims and objectives and the number and needs of service users ensure that persons employed in the provision of the care service receive training appropriate to the work they are to perform and suitable assistance, including time of work, for the purpose of obtaining further qualifications appropriate to such work. Timescale for implementation: 3 months form receipt of this report. What the service did to meet the requirement Not Met The requirement is: Not Met Inspection report continued The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: Yes - Electronic Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. The Home have a fully completed self assessment in place. Taking the views of people using the care service into account During the inspection service users were spoken with, comments were generally positive but one service user noted that the home was too busy. Thirteen care inspectorate questionnaires were returned by service users, indications were generally positive. Specific comments included: '' Like it'' '' My Keyworker helps me'' '' I go places and do things every week'' '' I feel safe'' Millport Care Centre, page 11 of 31

Taking carers' views into account Fifteen Care Inspectorate questionnaires were returned by carers Comments were again generally positive : Specific comments included : ''Our family is very happy with the care'' ''Staff are always very approachable'' ''The staff have been wonderful'' ''I do not feel that I am kept up to date with information'' ''I do not feel staff are on top of health issues'' '' Staff are very helpful'' Inspection report continued During the inspection some carers were spoken with whilst visiting the service and again comments were generally positive. Millport Care Centre, page 12 of 31

3 The inspection We looked at how the service performs against the following quality themes and statements. Here are the details of what we found. Quality Theme 1: Quality of Care and Support Grade awarded for this theme: 2 - Weak Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths Taking into account the evidence presented and discussions with residents and staff the service was found to be performing at an adequate level in relation to this Quality Statement. The service had a range of ways in which to seek the views of residents in assessing and improving the quality of care and support provided by them but these were not all up to date. A number of surveys have been conducted including drink preferences, a catering survey, menu preferences, and a focus food meeting which Indicated that Service Users would like the dining room decorated. The Home had a good newsletter which included some feedback to Service Users on complaints. They had an introductory brochure and information sheets which included the use of pictures. There was evidence that in general reviews were taking place 6 monthly within the part of the service in Millport. Service users were encouraged to participate in recruitment to some degree by their inclusion at Jobs fairs. The manager stated that service users were consulted at a meeting in March 2012 with regard to the Home's self assessment. Areas for improvement Although there was evidence that there had been monthly residents meetings in the past there were no records to evidence that the standing monthly meetings had taken place since January 2012. Millport Care Centre, page 13 of 31

Although the service had a range of ways in which to seek the views of residents in assessing and improving the quality of care and support provided there was less evidence of engagement with carers. The Home previously held carers meetings but these were not well attended. Alternative methods of consulting carers should be strengthened. The Home's Brochure was very basic and not particularly suited to adults with a learning disability, although it might have been more useful to family members. The Home did have additional information sheets which did contain pictures to aid understanding and the brochure could be developed in a similar way. Although in general there was evidence of reviews taking place as noted above, there was evidence that not all reviews were taking place within the 6 month timescale. In Taigh Mor it was less clear that reviews had been taking place within the 6 month timescale. (See Requirement) Whilst there had been some use of advocacy services in the past there were no leaflets or posters advertising their availability. The recruitment process should be extended further to involve Service Users/Carers in the recruitment process beyond attendance at Jobs fairs, for example by involving them in the interviewing process or devising interview questions. Grade awarded for this statement: 3 - Adequate Number of requirements: 1 Number of recommendations: 0 Requirements 1. Personal Plans Must be reviewed at least once in every six month period whilst the service user is in receipt of the service. This is in order to comply with SSI 2011/210 Regulation 5 (2)(b)(iii). Timescale for meeting this requirement: To commence within 1 month of the receipt of this report. Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths Inspection report continued Personal Plans and Essential Lifestyle Plans sampled were generally detailed enough to direct staff in relation to the individual care requirements of service users, and there were some good examples of person centred information. Activity plans were generally adequate but the standard was variable. There was evidence that the activities provided for service users reflected their personal preferences. Millport Care Centre, page 14 of 31

The Home have started to compile life story books for residents but these are as yet at an early stage of development. Areas for improvement Although Personal Plans and Essential Lifestyle Plans within the Millport centre were generally detailed enough this was not the case within Taigh Mor. These documents should be reviewed and all necessary information should be included (See Requirement) Some documentation sampled was not fully complete and was not signed or dated. Some indicated that they should be reviewed within a set period of time but this had not taken place. (See Recommendation) There was evidence that there had been instances where it had been necessary for staff to use physical restraint techniques to control the violent / aggressive behaviour of individual service users. In discussion with staff and the examination of records there was evidence that this training was out of date for some staff, and that their understanding of techniques to be used was unclear. Techniques had been adapted for one service user but this adaptation was thought by some staff to apply to all, which could potentially place service users at risk. Where restraint is to be used individual risk assessments should be in place reflecting a multi disciplinary consultation, and these must consider all risk factors including the effects of medication and any adaptation of technique. (See Requirement). In addition personal plans did not always identify triggers for challenging behaviour and strategies for responding to it. (See Requirement) The Home have two recording systems in place for recording incidents of restraint depending on the duration, one on paper and the other on computer. On the day of the inspection those records on the computer could not be accessed. The Home should consider consolidating the recording processes and should ensure that records are available at any time. Where a service user is prescribed medication ''as required'' and in varying strengths in order to control aggression, there should be a clear protocol and clearer information within the individuals personal plan as to when and in what dose this medication should be given. This was not clear for records examined during the inspection (See Requirement) During the inspection there were some concerns regarding the prevention and control of infection as we found the standard of cleanliness in some areas to be poor, including communal shower rooms, fridges and an instance of faeces on the bedding in one room sampled. On examining cleaning records these were found to be inaccurate. (See Requirement) Millport Care Centre, page 15 of 31

The procedures for obtaining prescribed medication for service users does not include seeing the original prescription. Although service users had individual prescriptions for ''thick and easy'' these were combined in one large tub and administered from this. Where service users receive a prescription these should be administered from their own prescription in the original packaging. On examination of the medication held by the Home it was noted that this included a number of unlabeled pills for a non resident contained within a Dossette box. In one communal bathroom inspected there was a basket containing prescribed creams for 3 service users, these should have been stored safely. The Home should ensure that the temperature of the medication storage room is taken and recorded daily and also the maximum and minimum temperatures of the of medication fridge. (See medication Requirement) On examination of Nutritional Assessments some indicated little or no risk but further examination of the personal plan indicated that there were clear risks for the person involved. The current tool does not include weights and BMI. These should be reviewed in addition to the Homes adapted Waterlow Risk Assessment for similar reasons. (See Requirement) The Home had a medication audit but this was not accurate and did not reflect actual practice. (See Recommendation) A number of service users required 1:1 care. Although staffing numbers allowed for this it was not always clear how and by whom this care was being provided and what needs in terms of the personal plan were being met. In addition to the Home's staff being present, staff from the providers Housing Support and Care at Home service were also present. The Home should have a separate rota and this should clearly indicate roles and responsibilities. (See Recommendation) Not all service users who had been identified as at risk of falls had a falls risk assessments. (See Requirement) Files sampled indicated that those who required a Certificate of Incapacity had one in place, however these were not always accompanied by a treatment plan. Whilst it is acknowledged that the Home are not responsible for the completion of this plan, where these are absent the Home should be proactive in following this up with the the GP and should record this within the Personal Plan. Grade awarded for this statement: 2 - Weak Number of requirements: 5 Number of recommendations: 4 Inspection report continued Millport Care Centre, page 16 of 31

Requirements 1. The Provider Must ensure that Personal Plans contain all necessary information as to how the service user's health, welfare, and safety needs are to be met. This is in order to comply with SSI 2011/210 Regulation 5 (1). Timescale for meeting this Requirement. Within 28 days of receipt of this report. 2. Where restraint is to be used: Inspection report continued i) Within 28 days individual risk assessments should be in place in the personal plan reflecting a multi disciplinary consultation considering all risk factors including the effects of medication and any adaptation of technique. ii) Within 3 months all Care Staff Must be trained in the use of appropriate restraint techniques including where appropriate regular refresher training. iii) Within 28 days personal plans should identify triggers for challenging behaviour and strategies for responding to it. iv) Within 24 Hours where a service user is prescribed medication ''as required'' and in varying strengths in order to control aggression, there should be a clear protocol and clearer information within the individuals personal plan as to when and how to determine what dose this medication should be given. This is in order to comply with SSI 2011/210 Regulation 4 (1) (a) and (c). Timescale for meeting this Requirement as detailed above. 3. The provider Must ensure that appropriate procedures for the prevention and control of infection are followed. This is in order to comply with SSI 2011/210 Regulation 4 (1)(d) 4. The Provider Must ensure that the ordering, storage and administration of medication follows best practice guidance and legislative requirements. This is in order to comply with SSI 2011/210 Regulation 4 (1)(a)Timescale for meeting this requirement : Immediately on receipt of this report. 5. The Provider Must ensure that assessments accurately reflect the needs of service users and how these are to be met, specifically Nutritional assessments, Falls Risk Assessments, and Waterlow assessments. This is in order to comply with SSI 2011/ 210 Regulation 4 (1)(a)Timescale for meeting this requirement : Within 28 days of receipt of this report. Recommendations 1. Documentation and other records should be fully completed and where appropriate dated and signed. National Care Standards for Care Homes for People with Learning Disabilities. Standard 5 Management and Staffing Arrangements Millport Care Centre, page 17 of 31

2. Audits should be based on accurate information. National Care Standards for Care Homes for People with Learning Disabilities. Standard 5 Management and Staffing Arrangements 3. The Home should have a staffing rota which clearly indicates what staff are working and their deployment including where they are assigned to a specific resident. National Care Standards for Care Homes for People with Learning Disabilities. Standard 5 Management and Staffing Arrangements Millport Care Centre, page 18 of 31

Quality Theme 2: Quality of Environment Grade awarded for this theme: 1 - Unsatisfactory Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the environment within the service. Service strengths See 1.1 Areas for improvement See 1.1 Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0 Statement 2 We make sure that the environment is safe and service users are protected. Service strengths Environmental risk assessments were in place, and there was evidence of `environmental checks being conducted. COSHH paperwork was noted to be up to date. Areas for improvement Although the Home had a report which stated that Health and safety risk assessments were up to date there was no evidence of this. A general service inspection had been conducted for the Home and although passing, those areas examined were graded as poor. The Home's Gas safety maintenance was overdue by a year and electrical testing was also overdue. (See Requirement) On the day of the inspection the medication room was found to be unlocked. (See Requirement 1.3 above) On sampling the water temperatures in communal bathrooms and some bedrooms it was found to be very high. There was evidence that this had been identified previously by the Home and it was unclear what action had been taken. One temperature was recorded as 52 Degrees Centigrade. Records indicate this as a long standing issue. (See Requirement) Within the Taigh Mor en-suite doors were defective and there was evidence of individuals injuring hands when trying to open them. In addition one automatic Millport Care Centre, page 19 of 31

door opened into the path of service users when they exited an adjacent bathroom, these issues should be rectified as soon as possible. Although Individual risk assessments were in place these failed to identify control measures and these should be further developed. On examining the premises it was noted that equipment such as stand aids was often stored in communal areas including corridors, and in one corridor the emergency exit was blocked by two wheelchairs. (See Requirement) Grade awarded for this statement: 1 - Unsatisfactory Number of requirements: 4 Number of recommendations: 0 Requirements 1. Maintenance of equipment and utilities must be conducted within the timescales detailed in maintenance contracts and Health and Safety best practice, and manufacturers guidelines. This is in order to comply with SSI 2011/210 Regulation 4 (1)(a)Timescale for meeting this requirement : Within 28 days of receipt of this report. 2. Water temperatures within the home should be regulated to within safe standards. This is in order to comply with Health and Safety Executive Guidelines and SSI 2011/210 Regulation 4 (1)(a)Timescale for meeting this requirement : Immediately on receipt of this report. 3. Corridors and other communal areas should allow freedom of movement and emergency exits should be kept clear at all times. This is in order to comply with SSI 2011/210 Regulation 4 (1)(a). Timescale for meeting this Requirement: Immediately on receipt of this report. Statement 3 The environment allows service users to have as positive a quality of life as possible. Service strengths Inspection report continued Taking into account the evidence presented and discussions with residents and staff the service were found to be performing at an unsatisfactory level in relation to this Quality statement. The home consists of 20 single and 6 double bedrooms some of which had been well personalised with the choice of colour schemes and the service users own belongings. Some corridors had also been decorated with service users own art work. Throughout the Home there had been some effort to decorate communal areas but this was limited. Residents who were able could control their own heating, lighting and ventilation in their rooms. A call system was fitted throughout the building that Millport Care Centre, page 20 of 31

allowed residents to call for staff assistance when needed. A range of communal areas were available for residents to access. Areas for improvement Inspection report continued As stated the Homes own quality indicators observation tool identifies environment as poor. The majority of the Home is in need of urgent refurbishment and decoration. Much of the building inspected was found to be dirty, including walls and skirting boards, there were several damaged doors, a broken toilet cistern, and broken oven. Some areas had no wallpaper or paint on the wall, and some wallpaper was torn. A handle was missing from a window frame and door closers were broken. Within one of the lounges the Pool Table cloth was badly ripped, and furniture was threadbare. Emergency pull cords were noted to be tied up, and an Electricity cupboard was unlocked which in addition to the electricity box also contained a sledge hammer. The upstairs shower room was in poor condition. Some areas within the Home were odorous. In one room faeces were found on bed sheets despite the bed being made, though it was unclear whether this room had been made up by staff or the service user. The dining room was in need of upgrade which had been identified by service users themselves. Within double rooms there was inadequate screening which did not allow for adequate privacy. Within Taigh Mor one room had been adapted resulting in the occupant having no control of heating or lighting. Whilst this was for the benefit of one service user who used the room on an occasional basis all subsequent occupants were limited in this way. In Taigh Mor the water temperature in room 6 was reported as too high in May 2012 but had not been rectified. The Home is registered to provide a Care Home Service to 32 service users in Millport. However there was evidence that the numbers of people using the building is increased substantially by the addition of service users from the Housing Support and Care at Home Service with their support staff in addition to other frequent visitors to the Home. This resulted in making the Home crowded and noisy and reduced the privacy of those living there. Millport Care Centre, page 21 of 31

Grade awarded for this statement: 1 - Unsatisfactory Number of requirements: 2 Number of recommendations: 0 Requirements Inspection report continued 1. The Provider must implement a full refurbishment and up-grade programme for the Home to ensure that the accommodation is fit for use and meets the needs of the current client group. This is in order to comply with SSI/2011/210 Regulation 10(2)(a)(b)(d) - a requirement that premises are [unfit] to be used for the provision of a care service unless they are suitable for the purpose of achieving the aims and objectives of the care service which are set out in the statement of aims and objectives; and are of sound construction and kept in a good state of repair externally and internally and are decorated and maintained to a standard appropriate for the care service. 2. Until the Provider a full refurbishment and upgrade has been completed the Provider Must be kept the Home clean, safe and hygienic and free from offensive odours This is in order to comply with SSI/2011/210 Regulation 10(2)(a)(b)(d) Timescale for meeting this requirement: On receipt of this report. Millport Care Centre, page 22 of 31

Quality Theme 3: Quality of Staffing Grade awarded for this theme: 2 - Weak Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service strengths See 1.1 Areas for improvement See 1.1 Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0 Statement 2 We are confident that our staff have been recruited, and inducted, in a safe and robust manner to protect service users and staff. Service strengths The Home had a written recruitment process which generally included taking up 3 references, one from the candidate's previous or last employer. New staff had access to a good induction booklet and were allocated peer mentors. Areas for improvement On sampling staff recruitment files it was noted that one file was missing a reference from the candidate's previous or last employer At the time of the inspection the reason for this was unclear but was given later. This should be recorded clearly within the file and an alternative sought. The Home's own audit identified an another staff member who did not have a second reference Although a good induction booklet was available to new staff this was not always being used. Staff interviewed were vague about the induction process and said that contact with mentors was limited. There was also evidence of a lack of ongoing supervision of some inductees. There was evidence from one staff member that a Protection of Vulnerable Groups ( PVG) update had not been obtained prior to them starting work because they had PVG some months earlier for a previous employer. The reason for this appears to have been a misunderstanding of Disclosure Scotland's current procedures for obtaining updates. Millport Care Centre, page 23 of 31

Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths Staff interviewed appeared to be well motivated and practice discussed was in generally in line with the National Care Standards. Staff spoke positively of service users and were well informed regarding their care and support needs. The Home had a induction programme for new staff including the allocation of peer mentors. Staff undertook Moving and Handling training but in most cases this had not been done since February 2010. There was evidence of ongoing training including the protection of vulnerable adults. Some staff stated that they received regular supervision. Staff were committed to the involvement of service users in their care and were able to outline the ways in which the organisation supports this. Areas for improvement Moving and Handling training for staff had not been done since February 2010. In addition, Health and Safety training had not been done recently. The manager stated that it was company policy for refresher training in moving and handling and health and safety to be conducted every 3 years. Although food Hygiene training was underway 20 staff had yet to complete this. Training in Non Violent Crisis Intervention was overdue in terms of the company's policy of yearly refresher training, and as previously stated there was some confusion about the appropriate methods of restraint to be used. (See Requirement) Not all staff had received regular supervision. Some staff were not sure who was responsible for their supervision. There was evidence of one staff member not having had supervision for 2 years. This was a particular issue within Taigh Mor. Grade awarded for this statement: 2 - Weak Number of requirements: 1 Number of recommendations: 0 Inspection report continued Millport Care Centre, page 24 of 31

Requirements Inspection report continued 1. Staff should receive up to date training appropriate to the work they are to perform. This is in order to comply with SSI 2011/ 210 Regulation 15 (b)(i) Timescale for meeting this requirement: within 3 months of receipt of this report. Millport Care Centre, page 25 of 31

Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 1 - Unsatisfactory Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the management and leadership of the service. Service strengths See 1.1 Areas for improvement See 1.1 Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0 Statement 3 To encourage good quality care, we promote leadership values throughout the workforce. Service strengths An appropriate management structure was in place internally and externally. Within the home there were a wide range of appropriate management systems in place and there was evidence that these had been used to good effect in the past. Some supervision was taking place, but this was inconsistent across the service as a whole. The use of mentors within the induction process had the potential to promote good leadership values throughout the workforce. Areas for improvement The Home is registered to provide a Care Home Service to 32 service users in Millport. However there was evidence that the numbers of people using the building is increased substantially by the addition of service users from the Housing Support and Care at Home service along with their support staff. This resulted in making the Home crowded and noisy and reduced the privacy of those living there. It was the professional opinion of the inspecting officers that in addition to the Registered Service operating from the premises that the Provider was also operating an unregistered Support Service in the form of day care. This situation has existed for some time and must be resolved. (See Requirement) Although the Home's audits and other systems had highlighted issues there was insufficient evidence that management had taken appropriate action to respond to those issues. Millport Care Centre, page 26 of 31

Grade awarded for this statement: 1 - Unsatisfactory Number of requirements: 1 Number of recommendations: 0 Requirements 1. The Provider Must not provide a service unless registered to do so. This is in order to comply with The Public Services Reform Scotland (Scotland) Act 2010. Statement 4 We use quality assurance systems and processes which involve service users, carers, staff and stakeholders to assess the quality of service we provide Service strengths A number of audits were taking place across the Home including a menu audit, accident and incident audit, kitchen audit, a bi- monthly Health & Safety checklist, and a medication management Audit. Areas for improvement Whilst audits were taking place these were not always accurate and were in some cases based on wrong and misleading information. Not all forms were signed and not all audits had resulted in an appropriate action plan to resolve issues. During the inspection there was evidence that cleaning records had been written in advance. These records indicated that some areas had been cleaned daily which in the opinion of the inspecting officers was inconsistent with observations. There was evidence of lack of attention to the content of accident and incident records within Taigh Mor as in one case the record was clearly only part completed but had been signed off by the senior staff member. Grade awarded for this statement: 1 - Unsatisfactory Number of requirements: 0 Number of recommendations: 1 Requirements Inspection report continued 1. Audits and other monitoring and tracking systems should be based on accurate inputs and where issues are identified which need to be addressed an appropriate action plan should be put in place, monitored and re-evaluated. National Care Standard for Care Homes for People with Learning Disabilities : Standard 5 Management and Staffing Arrangements. Millport Care Centre, page 27 of 31

4 Other information Complaints One complaint was made regarding the care provided to a resident. Overall this was partly upheld. Requirements resulting from this complaint will be assessed ant the next Care Inspectorate inspection. Enforcements We have taken no enforcement action against this care service since the last inspection. Additional Information Action Plan Failure to submit an appropriate action plan within the required timescale, including any agreed extension, where requirements and recommendations have been made, will result in SCSWIS re-grading the Quality Statement within the Management and Leadership Theme as unsatisfactory (1). This will result in the Quality Theme for Management and Leadership being re-graded as Unsatisfactory (1). Millport Care Centre, page 28 of 31

5 Summary of grades Quality of Care and Support - 2 - Weak Statement 1 Statement 3 3 - Adequate 2 - Weak Quality of Environment - 1 - Unsatisfactory Statement 1 Statement 2 Statement 3 3 - Adequate 1 - Unsatisfactory 1 - Unsatisfactory Quality of Staffing - 2 - Weak Statement 1 Statement 2 Statement 3 3 - Adequate 3 - Adequate 2 - Weak Quality of Management and Leadership - 1 - Unsatisfactory Statement 1 Statement 3 Statement 4 3 - Adequate 1 - Unsatisfactory 1 - Unsatisfactory 6 Inspection and grading history Date Type Gradings 13 Jan 2012 Unannounced Care and support 3 - Adequate Environment Not Assessed Staffing 3 - Adequate Management and Leadership 3 - Adequate 28 Sep 2011 Unannounced Care and support 4 - Good Environment 2 - Weak Staffing Not Assessed Management and Leadership 4 - Good Millport Care Centre, page 29 of 31

10 Nov 2010 Unannounced Care and support 4 - Good Environment 3 - Adequate Staffing 4 - Good Management and Leadership 4 - Good 7 Jul 2010 Announced Care and support 4 - Good Environment 3 - Adequate Staffing 4 - Good Management and Leadership 4 - Good 15 Mar 2010 Unannounced Care and support 5 - Very Good Environment Not Assessed Staffing Not Assessed Management and Leadership 5 - Very Good 22 Oct 2009 Announced Care and support 5 - Very Good Environment 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good 13 Mar 2009 Unannounced Care and support 5 - Very Good Environment 4 - Good Staffing 4 - Good Management and Leadership 4 - Good 28 Aug 2008 Announced Care and support 2 - Weak Environment 2 - Weak Staffing 2 - Weak Management and Leadership 2 - Weak All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Millport Care Centre, page 30 of 31

To find out more about our inspections and inspection reports Read our leaflet 'How we inspect'. You can download it from our website or ask us to send you a copy by telephoning us on 0845 600 9527. This inspection report is published by the Care Inspectorate. You can get more copies of this report and others by downloading it from our website: www.careinspectorate.com or by telephoning 0845 600 9527. Translations and alternative formats This inspection report is available in other languages and formats on request. Telephone: 0845 600 9527 Email: enquiries@careinspectorate.com Web: www.careinspectorate.com Millport Care Centre, page 31 of 31