Peacock Nursing Home Care Home Service Adults Garden Place Eliburn Livingston EH54 6RA Telephone: 01506 417 464 Inspected by: William Morrison Type of inspection: Unannounced Inspection completed on: 29 November 2012
Contents Page No Summary 3 1 About the service we inspected 4 2 How we inspected this service 6 3 The inspection 10 4 Other information 18 5 Summary of grades 19 6 Inspection and grading history 19 Service provided by: Peacock Medicare Ltd. Service provider number: SP2003002457 Care service number: CS2003010659 Contact details for the inspector who inspected this service: William Morrison Telephone 0131 653 4100 Email enquiries@careinspectorate.com Peacock Nursing Home, page 2 of 21
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 4 Good Quality of Environment 4 Good Quality of Staffing Quality of Management and Leadership N/A N/A What the service does well The service is provided in a warm and caring environment where the individuality of service users is valued. The staff team know service users and their families well and provide a consistently good level of care and support. What the service could do better The service should continue to develop the role of the keyworker. The service should continue to monitor the effectiveness of communication between itself, service users and their families. What the service has done since the last inspection The service has made progress on its programme of refurbishment. The service has appointed a new Activities Co-ordinator. Conclusion The service is keen to maintain a good standard of care whilst looking out for ways in which it can develop for the benefit of service users. Who did this inspection William Morrison Peacock Nursing Home, page 3 of 21
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.careinspectorate.com. his service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April 2011. Requirements and recommendations If we are concerned about some aspect of a service, or think it needs to do more to improve, 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 based on best practice or the National Care Standards. A requirement is a statement which sets out what is required of a care service to comply with the Public Services Reform (Scotland) Act 2010 ("the Act") and secondary legislation made under the Act, or a condition of registration. Where there are breaches of Regulations, Orders or conditions, a requirement may be made. Requirements are legally enforceable at the discretion of the Care Inspectorate. Peacock Nursing Home is a care home registered to provide care and accommodation for 80 older people. The home provides accommodation in mainly single rooms with 12 double rooms used as single rooms. The home comprises of two houses, named Peacock (House 1) and Primrose (House 2). Each of the houses has two floors, the upper floor can be accessed by either a lift or stairs. There are separate dining facilities on the ground floor of both houses. All residents' bedrooms have ensuite toilet and wash hand basin facilities. There are bathing facilities on both floors. The home is situated in a residential area and has its own parking and well maintained gardens. The home is owned by Peacock Medicare Ltd. The aims and objectives of the service state: "All residents are assured that they will be treated with dignity, and that their individual needs and wishes will be treated with respect. The purpose is to uphold dignity of all in our care. The spirit of this extends to staff, colleagues and visitors." Peacock Nursing Home, page 4 of 21
Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade Quality of Environment - Grade Quality of Staffing - N/A Quality of Management and Leadership - N/A 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. Peacock Nursing Home, page 5 of 21
2 How we inspected this service The level of inspection we carried out In this service we carried out a low intensity inspection. We carry out these inspections when we are satisfied that services are working hard to provide consistently high standards of care. What we did during the inspection During this inspection we gathered evidence from a variety of sources which included: A review of some bedrooms and all communal areas; review of equipment used; review of care-planning documentation and minutes of review meetings; review of questionnaires issued by us to people using the service and their relatives; review of service users', relatives' and staff meeting minutes; review of surveys and questionnaires carried out by the service; review of medication administration records; and, observation of care practices and interactions between staff and service users and discussion with various people including: the manager; members of care staff; people who use the service; and, relatives and friends of people who use the service. 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. 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. Peacock Nursing Home, page 6 of 21
Fire safety issues Inspection report continued 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 Peacock Nursing Home, page 7 of 21
What the service has done to meet any requirements we made at our last inspection The requirement The provider must ensure that the Care Inspectorate is notified of matters listed in the document 'Guidance on notification reporting - All registered care services'. In order to achieve this, staff who take charge of the home should be familiar with this notification guidance. Any accidents and/or incidents that have occurred since 1 April 2011, that require to be notified to the Care Inspectorate, should be reported within one week of receiving this report. This is in order to comply with The Public Services Reform (Scotland) Act 2010 andsocial Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011(SSI 2011/210). 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. What the service did to meet the requirement The provider had ensured that senior staff were familiar with current guidance on notification reporting. The service had since been making appropriate notifications to the Care Inspectorate. The requirement is: Met 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. We received a fully completed self assessment document from the service provider. We were satisfied with the way the service provider had completed this and with the relevant information they had given us for each of the headings that we grade them under.the service provider identified what they thought they did well, some areas for development and any changes they planned. Peacock Nursing Home, page 8 of 21
Taking the views of people using the care service into account People using the service expressed a largely positive view of the care home. Everyone who completed questionnaires issued by us were happy overall with the service provided. Taking carers' views into account Carers with whom we spoke or who completed questionnaires, were happy with the overall service provided. Some people who returned questionnaires expressed concerns about specific areas. These are noted under Quality Statement 1.1 Peacock Nursing Home, page 9 of 21
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: 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 We found that the service was demonstrating good practice in areas covered by this Quality Statement. We found a number of examples of positive outcomes arising from service user/carer participation. There were service users' and relatives' meetings being held and we reviewed the minutes of both. The minutes of service users' meetings demonstrated that issues were being raised by service users and action was being taken by the service in response to these. The minutes of these meetings were included in the service's newsletter. This helped to ensure that people were informed about decisions made during the meetings. We noted that a service user was involved in the production of the newsletter. We felt that this was positive as the perspective of service users was being represented. We found that the newsletter included details of forthcoming, rather than past events. We concluded that this made the newsletter more useful and informative. Although relatives' meetings had been held these were reported by the manager as being less well attended. (See areas for improvement) The manager was keen to improve the level of attendance at relatives' meetings and aid communication with relatives generally. They had been consulting with relatives to establish how this might be done. A letter had been sent to the families of all service users inviting suggestions for improving attendance and asking whether greater use could be made of e-mail to improve communication. Peacock Nursing Home, page 10 of 21
We reviewed a number of personal plans and found that much of the information they contained demonstrated the involvement of service users and their family members. Areas for improvement Questionnaires which we received from service users and relatives all indicated overall satisfaction with the service provided. We found that there were specific areas where some people shared concerns or required information. These included, the role of the keyworker, staffing levels and overall cleanliness. During our inspection we took the view that the role of keyworker needed to be clarified with service users and relatives and developed in practice. (See recommendation 1) We had no concerns regarding staffing levels or cleanliness during our inspection. We were concerned, however, that people who had concerns had not discussed these directly with the management of the home. This represents an area where communication could be improved. We concluded that better attendance at relatives' meetings and more effective use of the keyworker role were two factors which could promote more effective communication. Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 1 Recommendations 1. It is recommended that the service should develop the effectiveness of the keyworker role within the home. National Care Standards Care Homes for Older People, Standard 5: Management and staffing arrangements. Peacock Nursing Home, page 11 of 21
Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths We found that the service was demonstrating good practice in areas covered by this Quality Statement. We reviewed a range of care documentation and found that reviews of care were regular. We could see that family members were involved in reviews. We reviewed a number of personal plans and noted an emphasis on helping people to retain independent living skills wherever appropriate. We also saw good examples of the use of M.U.S.T. (Malnutrition Universal Screening Tool), falls risk assessments and pressure area risk assessments. We concluded that staff at the home understood the importance of keeping service users safe and well whilst promoting peoples' dignity by supporting them to remain as independent as possible. A review of care-planning documentation and observation of staff practice showed us that staff had good knowledge of the needs and abilities of service users who had dementia. We reviewed medication administration records in House 2 and found that good practice was being demonstrated. Audits of medication administration were being carried out. The manager told us that these were demonstrating improved practice. We observed staff as they assisted service users. We concluded that staff worked well together, communicated well with each other and were very caring towards service users. Areas for improvement As noted in Quality Statement 1.1 the service should develop the effectiveness of the keyworker role. During our visit to the home we concluded that there appeared to be sufficient staff on duty to meet service users' needs. Some relatives who completed our questionnaires, however, did not share that view. The service must ensure that sufficient staff are present in the home at all times. With this in mind, the manager must be clear that assessment of staffing numbers based upon individual dependency levels is carried out frequently enough to ensure that staffing numbers accurately reflect service users' current needs. We discussed with the manager the need to be able to demonstrate how staffing levels relate to service users' current needs. We will review this issue during our next inspection of the service. Peacock Nursing Home, page 12 of 21
The service should continue to develop its audit of care-planning documentation. This will help ensure that care plans provide clear direction as to how service users' needs will be met and are being evaluated effectively. Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 0 Inspection report continued Peacock Nursing Home, page 13 of 21
Quality Theme 2: Quality of Environment Grade awarded for this theme: Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the environment within the service. Service strengths As noted in Quality Statement 1.1 we found that the service was demonstrating good practice in areas covered by this Quality Statement. Areas for improvement As noted in Quality Statement 1.1 with regards the environment. Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 0 Peacock Nursing Home, page 14 of 21
Statement 3 The environment allows service users to have as positive a quality of life as possible. Service strengths We found that the service was demonstrating good practice in areas covered by this Quality Statement. We found that the overall environment was clean, calm and pleasant. Interactions between staff and service users were friendly and respectful. We found that staff were very caring and clearly knew service users well. We saw lots of examples of staff giving service users 1-1 attention. We saw staff providing activities for service users in the absence of the activities co-ordinator. We concluded that this demonstrated an appreciation of the importance of providing meaningful activities and an understanding that this was part of everyone's role. Service users had recently played an active part in the recruitment of a new activities co-ordinator. We spoke to the activities co-ordinator who described a range of work already carried out to learn about the background and interests of individual service users. We noted that there was an emphasis on enablement within the service. Service users were encouraged to pursue their interests and maintain skills wherever possible. There had been service user involvement in the production of the service's newsletter and one service user hosted a reading group. Preparations were being made for Christmas celebrations in the home. Service users' relatives were invited to join their family member for Christmas dinner if they chose to. The service was currently undergoing a period of refurbishment. Peacock Nursing Home, page 15 of 21
Areas for improvement The service should carry on with it's current refurbishment programme. Staff should consider whether it is necessary to have television on in all lounge areas throughout the day. The home's layout makes it possible to easily overhear conversations which take place in corridors. Staff should be mindful of this when discussing service users' care. We were able to clearly hear staff, on one occasion, describe care which they were about to give to a service user. We discussed this with the manager who agreed to remind staff of the need to be discreet and to promote service users' privacy and dignity. Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 0 Inspection report continued Peacock Nursing Home, page 16 of 21
Quality Theme 4: Quality of Management and Leadership - NOT ASSESSED Peacock Nursing Home, page 17 of 21
4 Other information Complaints One complaint was received since the last inspection. The complaint was not upheld. 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). Peacock Nursing Home, page 18 of 21
5 Summary of grades Quality of Care and Support - Statement 1 Statement 3 Quality of Environment - Statement 1 Statement 3 Quality of Staffing - Not Assessed Quality of Management and Leadership - Not Assessed 6 Inspection and grading history Date Type Gradings 1 Feb 2012 Unannounced Care and support Environment Staffing Not Assessed Management and Leadership Not Assessed 30 Jun 2011 Unannounced Care and support Environment 3 - Adequate Staffing Management and Leadership 4 Nov 2010 Unannounced Care and support 5 - Very Good Environment Staffing Not Assessed Management and Leadership 5 - Very Good 23 Jun 2010 Announced Care and support 5 - Very Good Environment Staffing Not Assessed Management and Leadership 5 - Very Good Peacock Nursing Home, page 19 of 21
9 Feb 2010 Unannounced Care and support Environment 3 - Adequate Staffing 5 - Very Good Management and Leadership Not Assessed 26 May 2009 Announced Care and support Environment 3 - Adequate Staffing Management and Leadership 20 Feb 2009 Unannounced Care and support Environment Staffing Not Assessed Management and Leadership Not Assessed 3 Jul 2008 Announced Care and support 5 - Very Good Environment Staffing Management and Leadership All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Peacock Nursing Home, page 20 of 21
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 Peacock Nursing Home, page 21 of 21