St. Drostans House Care Home Service Adults 5 Infirmary Street Brechin DD9 7AN Telephone:

St. Drostans House Care Home Service Adults 5 Infirmary Street Brechin DD9 7AN Telephone: 01356 622050 Inspected by: Timothy Taylor Type of inspection: Unannounced Inspection completed on: 6 July 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 17 5 Summary of grades 18 6 Inspection and grading history 18 Service provided by: Angus Council Service provider number: SP2003000043 Care service number: CS2003000359 Contact details for the inspector who inspected this service: Timothy Taylor Telephone 01382 207200 Email enquiries@careinspectorate.com St. Drostans House, page 2 of 20

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 N/A Quality of Environment 4 Good Quality of Staffing N/A Quality of Management and Leadership 5 Very Good What the service does well This is a high quality service which bases its care on the individual needs of residents. It provides them with a high level of participation, community involvement and well trained staff. There is good communication between relatives of residents and the service. The home makes the best of an environment which does not always reach standards expected in care homes in relation to the environment. What the service could do better The service should make the upgrade of the environment of the home a matter of priority in relation to bedrooms not being en suite. What the service has done since the last inspection Since the last inspection the service has had its exterior painted. It is in the process of revamping its care plans in relation to palliative care and is rolling out best practice training for staff in relation to infection control. Conclusion This is a high quality service. Who did this inspection Timothy Taylor St. Drostans House, page 3 of 20

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. The Care Inspectorate will award 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." St Drostans is a care home for older people which provides residential care for 16 older people which is provided by Angus Council. It has 15 permanent placements and one respite bed. The service was registered with the Care Commission on 1 April 2002 and is now registered with the new regulatory body the Care Inspectorate. Accommodation is provided on two floors with each service user having their own room. None of the rooms have en suite facilities although all have private wash hand basins. Shared facilities within the service include bathrooms, two lounges, dining room, library and gardens. The service aims to provide a "high quality care home service for vulnerable older people in Angus which meet their specific present and future needs in settings that are locally accessible and which maximise their independence." Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - N/A Quality of Environment - Grade 4 - Good St. Drostans House, page 4 of 20

Quality of Staffing - N/A Quality of Management and Leadership - Grade 5 - Very Good Inspection report continued 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. St. Drostans House, page 5 of 20

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 This report was written following an unannounced inspection that took place on July 6 2012. During the inspection evidence was gathered from a number of sources including: Informal discussion with service users and relatives. A review of service users personal plan documentation and other records kept by the service. Discussion with staff and manager. Observation of staff interaction with residents. Observation of 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. 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. St. Drostans House, page 6 of 20

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 St. Drostans House, page 7 of 20

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. A comprehensive self assessment was submitted for this inspection. Taking the views of people using the care service into account 13 care service questionnaires were returned and the views expressed were overwhelmingly positive with high levels of satisfaction expressed and two residents were interviewed on the day of inspection. Here are some of the things that were said:- My room is always warm clean and tidy. The staff are very nice and always knock on my door before coming into the room. 5-star food and plenty of choice. I chose the colour of the paint in my room. I feel safe here. I have put up my own photos and pictures on the walls of my room. St. Drostans House, page 8 of 20

Taking carers' views into account 2 care service questionnaires were returned to the service and one relative was interviewed on the day of inspection. Here are some of the largely positive views which were expressed:- I have always found the staff very caring and look after... with TLC. I usually arrive unannounced and have no cause for concern. When I visit the home I am always made to feel welcome. I do get invited to relatives meetings but I don't always go. I get offered a cuppa when I visit. The manager is very approachable should I have any concerns. I do attend review meetings and they listen to my views. The home will ring me if there is a problem. St. Drostans House, page 9 of 20

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 - NOT ASSESSED St. Drostans House, page 10 of 20

Quality Theme 2: Quality of Environment Grade awarded for this theme: 4 - Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the environment within the service. Service strengths The service provided a very good standard of participation for its stakeholders. Here are some examples of its good practices:- The home holds regular resident's meetings which are facilitated by a worker external to the home so that people are free to speak their minds. Any feedback is analysed by the manager and any required actions are taken. The home holds regular focus groups for relatives. These are designed to gather views on the service from relatives. Any feedback is used to improve the service where needed. Satisfaction surveys are also sent out to residents and feedback assessed. All service users has individual review meetings in relation to their care plans. These take place a minimum of every six months. This gives service users and their families or representatives a chance to have input on the care they receive. The home's complaints procedure is on public display within the home and copies of it are give to residents and families when a person begins to live there. The manager of the home has an open door policy which means anyone who wants to discuss any aspect of the running of the home is free to discuss their concerns. In relation to the environment residents are free to decorate their rooms with their own things and when any refurbishment of the home takes place residents are consulted via surveys. Areas for improvement The service should continue to look for ways to involve residents in improving quality in the home. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 St. Drostans House, page 11 of 20

Statement 2 We make sure that the environment is safe and service users are protected. Service strengths Inspection report continued The service provides a very good level of security and protection for service users. Here is some evidence of its strengths:- Policies are in place for recording accidents and incidents. The manager monitors these to see if any patterns develop which can be addressed. Staff have all the healthcare and infection control equipment they need for working with vulnerable older people. The home has a restraint policy which applies to the use of bed-rails. When these are used a risk assessment is in place to ensure they are being used correctly. The home has regular health and safety audits done to ensure the environment is safe for its users. Call system alarms are attached to all external doors so that staff are aware when an outside door has been opened and can investigate to ensure the safety of residents. The home is covered by public liability insurance. The home has regular fire service checks and all staff are trained in fire evacuation drills. Each service user has their own evacuation plan. Residents have a call system in their room should they need assistance. On the day of inspection staffing levels in the home were in excess of the staffing schedule which has been agreed with the Care Inspectorate. When interviewed residents stated that they felt safe within the home and that when staff assisted them with personal care it was done in a professional and secure manner. Observation of the environment of the home showed it to be clean, bright and well maintained. There were safe and well maintained areas of the grounds where residents could walk and sit. St. Drostans House, page 12 of 20

Inspection report continued Areas for improvement It was noted when reviewing the home's own surveys that some relatives had mentioned that it would be nice for rooms to be en suite. While it is acknowledged that St Drostans in an old building and is otherwise well provisioned in its facilities it would be desirable for residents to have their own en suite facilities. Discussion with the Inspectorate's professional advisor on infection control took place and she felt that a lack of en suite facilities could present an infection risk where toilets are used communally. It is also the case that not having a toilet in ones own room may presents issues in terms of privacy and dignity. See recommendation 1. It was also noted that the entrance to the home was open during the day which might present a risk of unauthorised access to the building. See recommendation 2. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 2 Recommendations 1. The service should give serious consideration to upgrading the accommodation in order to include the provision of en suite facilities for all residents. NCS 4 Care Homes for Older People - Your Environment. 14 If the provider is upgrading accommodation, they must discuss this with the Inspectorate's inspectors. 2. The service should ensure that entry to the building is regulated. See NCS 4 Care Homes for Older People - Your Environment. 2 You can expect that the home is run in a way that protects you from any avoidable risk or harm, including physical harm and infection. The nature of its design, facilities and equipment also protect you. St. Drostans House, page 13 of 20

Quality Theme 3: Quality of Staffing - NOT ASSESSED St. Drostans House, page 14 of 20

Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 5 - Very Good 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 The service provided a very good standard of participation for its stakeholders. Here are some examples of its good practices:- The home holds regular resident's meetings which are facilitated by a worker external to the home so that people are free to speak their minds. Any feedback is analysed by the manager and any required actions are taken. The home holds regular focus groups for relatives. These are designed to gather views on the service from relatives. Any feedback is used to improve the service where needed. Satisfaction surveys are also sent out to residents and feedback assessed. All service users has individual review meetings in relation to their care plans. These take place a minimum of every six months. This gives service users and their families or representatives a chance to have input on the care they receive. The home's complaints procedure is on public display within the home and copies of it are give to residents and families when a person begins to live there. The manager of the home has an open door policy which means anyone who wants to discuss any aspect of the running of the home is free to discuss their concerns. In relation to the environment residents are free to decorate their rooms with their own things and when any refurbishment of the home takes place residents are consulted via surveys. Areas for improvement The service should continue to look for ways to involve residents in improving quality in the home. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 St. Drostans House, page 15 of 20

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 Inspection report continued The service has a good quality assurance system. Here are some of the strengths:- Environmental health do regular checks of the kitchens. A record is kept of staff training and any refresher courses they need to complete. Staff attend regular staff meetings, get supervision and get annual appraisals. Staff who are required to - are registered with the SSSC. Records of accidents and incidents are kept and monitored by the manager. regular environmental risk assessments take place as well as fire drills and fire training. The service has a very good participation process which ensures residents and relatives have a say in the quality of the home. Care planning for residents is comprehensive and individualised. Relatives, representatives and service users have a say in their care at review meetings. The home's external manager monitors a variety of aspects of the provision such as:- SVQ training for staff, repairs, Fire Service reports, environmental reports and does a health and safety visit to the home on a regular basis. Each year the manager of the home produces a management report which outlines the developments made by the service, the feedback it has gained form all the agencies that inspect and regulate it, outlines of staff development and training and future plans to develop the service. Areas for improvement The service should continue to look for ways to improve its quality assurance systems. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 St. Drostans House, page 16 of 20

4 Other information Complaints No complaints have been upheld, or partially upheld, since the last inspection. Enforcements We have taken no enforcement action against this care service since the last inspection. Additional Information None noted 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). St. Drostans House, page 17 of 20

5 Summary of grades Quality of Care and Support - Not Assessed Quality of Environment - 4 - Good Statement 1 Statement 2 5 - Very Good 4 - Good Quality of Staffing - Not Assessed Quality of Management and Leadership - 5 - Very Good Statement 1 Statement 4 5 - Very Good 5 - Very Good 6 Inspection and grading history Date Type Gradings 3 Nov 2010 Unannounced Care and support 5 - Very Good Environment Not Assessed Staffing Not Assessed Management and Leadership Not Assessed 17 May 2010 Announced Care and support 4 - Good Environment Not Assessed Staffing 5 - Very Good Management and Leadership Not Assessed 1 Dec 2009 Unannounced Care and support 5 - Very Good Environment Not Assessed Staffing Not Assessed Management and Leadership 4 - Good 21 May 2009 Announced Care and support 5 - Very Good Environment 4 - Good Staffing 5 - Very Good Management and Leadership 4 - Good St. Drostans House, page 18 of 20

29 Dec 2008 Unannounced Care and support 4 - Good Environment Not Assessed Staffing Not Assessed Management and Leadership 4 - Good 27 May 2008 Announced Care and support 4 - Good Environment 5 - Very Good Staffing 4 - Good Management and Leadership 4 - Good All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. St. Drostans House, page 19 of 20

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 St. Drostans House, page 20 of 20