Campsie Neurological Care Centre Care Home Service

Campsie Neurological Care Centre Care Home Service Canal Street Kirkintilloch Glasgow G66 1QY Telephone: 0141 775 3756 Type of inspection: Unannounced Inspection completed on: 26 April 2017 Service provided by: Four Seasons Health Care (Scotland) Limited, a member of the Four Seasons Health Care Group Service provider number: SP2007009144 Care service number: CS2003010437

About the service Campsie Neurological Centre, (Campsie NCC), has been registered with the Care Inspectorate since 1 April 2011. It is registered to provides care and support for 22 adults who have support needs with their physical and/or cognitive abilities. The provider's website previously contained the following information about the service: "Campsie, in Kirkintilloch, near Glasgow, is a specialist centre providing long-term person-centred care and support for male and female adults (aged 18+ years) with either a brain injury or complex neurological condition. The 22 bed purpose-built centre provides the following three services: complex disability management, neuropalliative care and respite care. Our service has been designed to care for adults who are medically stable, with a range of neurological conditions including, but not limited to: Acquired Brain Injury, Huntington's Disease, Multiple Sclerosis, Motor Neurone Disease and Spinal Injury." At the time of this inspection the overall aims and objectives of the service were under review. There were 21 people living in the care home when we visited. The service is located in Kirkintilloch, East Dunbartonshire and is close to local amenities and public transport. Accommodation is provided via ground floor access, with single room and en-suite and shower facilities. Communal areas included a dining area, sitting areas, bathrooms, an activities area and a quiet room. There is a large outdoor area at the rear of the building. What people told us For this inspection we received views from seven of the 21 people living in the service. Four people completed our Care Standards Questionnaires and three people spoke with us during the inspection. We also spoke with three relatives of service users. Overall feedback about the quality of the service and staff was good but some areas for improvement were identified. We also used the Short Observational Framework for Inspection (SOFI2) to directly observe the experience and outcomes for people who were unable to tell us their views. (see http://www.bradford.ac.uk/health/dementia/ training/training-courses/short-observational-framework-for-inspection-(sofi-2)/). We discuss this further in Quality Theme 1. Most people spoke positively about how staff supported them. Additional paraphrased comments from service users and relatives included: "Whenever there is times that I have been unhappy the staff have been there to support me." (service user) "(anonymous) is well looked after and happy here." (relative of service user) "I am happy in my nice surroundings. The carers are very good. Always there to support me." (service user). "It's good that the manager has made herself familiar about my relative's condition." (relative of service user) page 2 of 15

"There are missed opportunities with activities with my relative" (relative of service user) "I didn't know who the keyworker was and they didn't make themselves known to me." (relative of service user) Self assessment We did not request a self-assessment before this inspection. From this inspection we graded this service as: Quality of care and support Quality of environment Quality of staffing Quality of management and leadership Quality of care and support Findings from the inspection People who used the service who completed our questionnaires or that we met when inspected the service told us that they were happy with the overall quality of care they received at Campsie Neurological Care Centre. Relatives that we spoke with had mixed views about the quality of the service although overall were happy with the care and support received by their relative at the time of our visit. We concluded that keyworker communication with families and carers needed to be more proactive. Suggestions for improvement included involving keyworkers more in the care review process and having more frequent interaction with relatives and carers. (see recommendation 1). A previous requirement about the dining arrangements had been met in part. We have repeated the area of the requirement that was not met. (see requirement 1). We used the Short Observational Framework for Inspection (SOFI2) (see http://www.bradford.ac.uk/health/ dementia/ training/training-courses/short-observational-framework-for-inspection-(sofi-2)/). This provides a framework that adds to the observations already made at inspections about the wellbeing of people using the service and staff interaction with them. Staff were speaking and engaging with service users frequently and the quality of staff interaction was good. This was an improvement from previous inspections. The range of activities had increased since previous visits and a second activities coordinator had been very recently employed. Service users told us, or expressed their views in non-verbal ways, that they enjoyed participating in community based activities. People who needed one to one support to take part in meaningful activities were supported to do this. However this is an area that needs to continue to be developed. Having an accurate and update support plan for each person is an important part of providing care and support. We saw improvements in plans that detailed how to communicate with people who had speech and other sensory impairments and how some people used aids to help them communicate. There was also good evidence of regular reviews by health professionals. page 3 of 15

However we also noted some gaps in care plans where key information was not recorded. Examples included mental health care plans and records of service user participation, (or not), in reviews of their care. (see recommendation 2). Our assessment of how people were kept safe looked at the arrangements for giving people medication in a disguised form (known as covert medicines). We were satisfied that the service had the proper authority to do this and that it was being regularly reviewed. The way that service users were supported to manage their money was examined and we concluded that, overall, this was carried out in a safe way. Requirements Number of requirements: 1 1. The current dining arrangements should be improved so that they better support service users needs. In order to do this: - People living in the service must have a choice of meals that reflect their food preferences and dietary needs. Meals should be varied and nutritious. This is to comply with SSI 2011/210. Regulation 4 (1) (a) Welfare of users. A requirement where a provider must make proper provision for the health, welfare and safety of service users. and takes account of: NCS 13 Care Homes for People with Physical and Sensory Impairments - Eating Well Timescale: Fours weeks from receipt of the final inspection report. Timescale for improvement: 8 weeks from receipt of the final inspection report. Recommendations Number of recommendations: 2 1. Keyworkers should be more proactive in their communications with families and carers. A suggestion for improvement includes involving keyworkers more in the ongoing reviews of care as well as participation in formal care review meetings. NCS 6 Care Homes for People with Physical and Sensory Impairments - Support Arrangements. 2. The provider should continue to regularly audit and improve the quality of information in personal plans so that this better informs how support is provided. NCS 6 Care Homes for People with Physical and Sensory Impairments - Support Arrangements. Grade: 3 - adequate page 4 of 15

Quality of environment Findings from the inspection As noted at previous inspections, people who lived in the service were generally satisfied with the standard of the accommodation. Many service users had personalised their bedrooms with small pieces of furniture, pictures and other possessions that were important to them. Some people also had their bedrooms decorated to their own preferences. The service did not have a functioning kitchen or laundry so relied on the use of facilities in the adjacent care home (a separate care service). There were plans to address this but this was still to be progressed at the time of our visit. We will re-visit this at a future inspection. All the accommodation was at ground level which meant it was easy for service users who used wheelchairs or other mobility aids to access most parts of the home, including the garden. The garden area was enclosed and had outdoor furniture that service users and visitors could use. It also had a chicken coop and bird aviary which service users enjoyed having. At this inspection we found that the home was clean and generally well maintained. Some parts of the inside of the home were need in of redecoration and freshening up. The manager informed us that there were no plans by the current provider to invest in improving the environment. We sampled some maintenance records such as equipment checks, water outlet temperature checks and annual servicing of beds and slings. We found that there were appropriate systems in place to check that equipment was operating correctly but noted that some records were not up to date. We were told that this was because the appropriate books for recording checks had expired and had not been replaced. We asked the provider to address this at the time of the inspection and this was done. (see recommendation 1). Requirements Number of requirements: 0 Recommendations Number of recommendations: 1 1. The provider should ensure that all safety checks on the environment and equipment are properly recorded at the time that each check is carried out. NCS 4 Care Homes for People with Physical and Sensory Impairment - Your environment Grade: 3 - adequate Quality of staffing page 5 of 15

Findings from the inspection We sent eight staff questionnaires to the service and received four completed questionnaires back. We also spoke with four staff members when we visited the service. Everyone who completed our staff questionnaires, (four people), strongly agreed that they were confident that they had the skills to support people who used the service. Three people also indicated that they did not have any training needs directly related to their job that were not being met by the service, (one person said they did have training needs). Staff told us that training opportunities in the service were good. Our review of a sample of staff training and supervision records indicated to us that staff would benefit from having a better balance of face to face learning and "e-learning". The majority of training was online and there were limited opportunities for staff to reflect and discuss the content of training. There was also limited evaluation of how theoretical training was applied in practice. As noted at previous inspections individual staff learning objectives could have been more specific and targeted to the role and duties of each staff member. This would allow for more measurable and achievable objectives that were linked to the needs of both staff members and service users. We made a requirement previously about improving how staff training and supervision was planned, organised and evaluated. Although we noted some progress with this there was still room for more improvement. We have repeated our requirement about this. (see requirement 1). Staff were recruited in a safe way to the service. This meant that appropriate checks such as references, criminal records checks and registration with professional bodies were carried out before each employee started working with people who lived in the service. Induction to the service covered many topics over a short period of time (usually 2-3 days). We thought that there was an opportunity to introduce new employees to the subjects of acquired brain injury, neurodisability and adult protection earlier than was currently happening. (see recommendation 1). Requirements Number of requirements: 1 1. The provider must improve upon approaches to staff supervision, appraisal, training/education and team meetings across the service to ensure that staff practice and knowledge reflects the needs of service users. The aim of this is to improve outcomes for service users by supporting staff within a continuous learning framework. In order to demonstrate this: - supervision, appraisal and team meetings must take place as per organisational policy; - supervision must include evaluations of training/education and 'observational monitoring' in relation to what difference it has made to staff knowledge and practice; - management processes must demonstrate checks on the frequency and quality of staff supervision, appraisal, training/education and team meetings. This is to comply with SSI 2011/210. Regulation 4 (15) (a). A requirement is to ensure that at all times suitable and qualified and competent persons are working in the care service. page 6 of 15

Timescale: Three months from receipt of the final inspection report. Recommendations Number of recommendations: 1 1. The provider should introduce new employees to the subjects of acquired brain injury, neurodisability and adult protection early in their employment. This could be included in staff induction to the service. NCS 5 Care Homes for People with Physical and Sensory Impairment - Management and Arrangements. Grade: 3 - adequate Quality of management and leadership Findings from the inspection The grade awarded for this quality theme also takes account of our findings note in the three previous quality themes. We examined the records of accidents, incidents and complaints that the service had recorded since we last visited. We were satisfied that there were appropriate systems in place to address and record these. There had been no complaints to the service since our last inspection. Accidents and incidents were low in number and records showed that they were managed appropriately. We made a requirement following an inspection in September 2016 that the provider must ensure that all staff were familiar with the Adult Support and Protection (Scotland) Act 2007 and the associated local authority adult protection procedures. This meant that if a potential adult protection concern was identified in the service then staff would know what procedures to follow. We also stated that the provider's own procedures and staff training must reflect this legislation and guidance. The provider's response to this requirement was that "All staff will receive training on adult support and protection and will be issued with clear guidelines about what to do if a potential concern is identified in the service training will be sourced externally." We identified that this action had not been fully addressed. Some limited discussions about Adult Support and Protection had taken place with some, but not all, staff. Staff had not received training in this area other than online training that referred to English legislation. We provided the manager with some information about this that could be used as part of coaching and training in Adult Protection. We have repeated the requirement. (see requirement 1). We checked that the manager had a safe system in place to check that all staff were appropriately registered with a regulatory body (or were in the process of applying to do this). This had been identified as an area for improvement at a previous inspection. This had been properly addressed. page 7 of 15

Requirements Number of requirements: 1 1. The provider must ensure that all staff are familiar with the Adult Support and Protection (Scotland) Act 2007 and the associated local authority adult protection procedures. If a potential adult protection concern is identified in the service then these procedures must be followed. The provider's own procedures and staff training must reflect this legislation and guidance. This is in order to comply with SSI 2011/210. Regulation 4 (1) (a) Welfare of users. A requirement where a provider must make proper provision for the health, welfare and safety of service users and takes account of: NCS 5 Care Homes for People with Physical and Sensory Impairment - Management and Arrangements Timescale: Immediately on receipt of the final inspection report. Recommendations Number of recommendations: 0 Grade: 3 - adequate What the service has done to meet any requirements we made at or since the last inspection Previous requirements Requirement 1 The current dining arrangements should be improved so that they better support service users needs. In order to do this: - People living in the service must have a choice of meals that reflect their food preferences and dietary needs. Meals should be varied and nutritious. - Service users must be free to eat meals wherever they like and take them in their own time. - Staff need to communicate better with service users at mealtimes especially around the choice of food, when assisting people to eat and drink and when checking if people have finished dining. This is to comply with SSI 2011/210. Regulation 4 (1) (a) Welfare of users. A requirement where a provider must make proper provision for the health, welfare and safety of service users. and takes account of: page 8 of 15

NCS 13 Care Homes for People with Physical and Sensory Impairments - Eating Well Timescale: Fours weeks from receipt of the final inspection report. This requirement was made on 2 September 2016. Action taken on previous requirement Meals were still being prepared and delivered from adjacent care home. Menus were available but these did not consistently reflect what food was actually offered. This meant that residents were not sure what was available.the issues around choice of food and drink were sometimes compounded by the memory difficulties that some service users experienced. For example some people had difficulty remembering what they ordered and if they did get what they ordered, may no longer want it and asked for something else. The manager felt this contributed to people's views on lack of choice. That said, feedback from service users about the quality of food and drink available was positive. We observed the dining experience again. Staff shared with people what was available for lunch. People who needed assistance got this in an unhurried way. Staff supported people to eat and drink appropriately. Interaction between service users and staff members was better than observed at previous inspections. As suggested at a previous inspection, we discussed with the manager that she should consider carrying out her own observations of the dining experience with particular focus on the interaction between staff and service users that have communication impairments and cannot fully express their needs. This had not yet been done. We have made a revised requirement under Quality Theme 1. Not met Requirement 2 The provider must improve upon approaches to staff supervision, appraisal, training/education and team meetings across the service to ensure that staff practice and knowledge reflects the needs of service users. The aim of this is to improve outcomes for service users by supporting staff within a continuous learning framework. In order to demonstrate this: - supervision, appraisal and team meetings must take place as per organisational policy; - supervision must include evaluations of training/education and 'observational monitoring' in relation to what difference it has made to staff knowledge and practice; - management processes must demonstrate checks on the frequency and quality of staff supervision, appraisal, training/education and team meetings. This is to comply with SSI 2011/210. Regulation 4 (15) (a). A requirement is to ensure that at all times suitable and qualified and competent persons are working in the care service. Timescale: Two months from receipt of the final inspection report. This requirement was made on 30 November 2015. Action taken on previous requirement This requirement was first made following an inspection by us in November 2015. At this inspection we sampled training records for four staff and spoke to staff about their professional development. page 9 of 15

As noted at previous inspections there was evidence that staff were participating in training and supervision sessions. The frequency of supervision and appraisal was variable and the records relating to this very generalised. There continued to be a lack of clear development objectives that were relevant to the roles of staff in the service. The majority of training continued to be online "e-learning" but this was not consolidated by evaluation of staff training in day to day practice. Staff told us that they had good training opportunities. The service lacked a structured staff training plan that was relevant to the range of complex needs of the people being care for at Campsie Neurological Care Centre. We advised the manager this needs to be a priority going forward. We have repeated our requirement about this under Quality Theme 3. Not met Requirement 3 The provider must ensure that all staff are familiar with the Adult Support and Protection (Scotland) Act 2007 and the associated local authority adult protection procedures. If a potential adult protection concern is identified in the service then these procedures must be followed. The provider's own procedures and staff training must reflect this legislation and guidance. This is to comply with SSI 2011/210. Regulation 4 (1) (a) Welfare of users. A requirement where a provider must make proper provision for the health, welfare and safety of service users. and takes account of: NCS 5 Care Homes for People with Physical and Sensory Impairment - Management and Arrangements Timescale: Immediately on receipt of the final inspection report. This requirement was made on 2 September 2016. Action taken on previous requirement Staff had access to the local authority ASP procedures which were in the staff room. Discussions had taken place with nursing staff about Adult Protection matters. However discussions had not taken place with care staff. The training proposed by the manager following our last inspection had not taken place due to a lack of a training resource. We provided the manager with information on Adult Support & Protection that could be shared with all staff until such time that training was available. The provider's current ASP procedures and online training continued to be linked to English legislation rather than Scottish legislation. We have made an amended requirement about this under Quality Theme 4. Not met page 10 of 15

What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 The provider should consider producing an introductory pack which clearly explains the moving-in process. There should also be more detail around the reablement/rehabilitation aspect of the service and staff qualifications and training. The brochure should be informed by the National Care Standards and should be written where appropriate in plain English or in a language or format that is suitable for all residents. NCS 1 - Care homes for people with physical and sensory impairment - Informing and deciding This recommendation was made on 30 November 2015. Action taken on previous recommendation Discussion with the manager at inspection confirmed that this has not been progressed. The aims and objectives of the service are under review. Once this has been completed this recommendation will be revisited by the provider. This recommendation has not been met. Recommendation 2 The provider should develop appropriate services, adaptations and equipment for all residents who are assessed as having communication needs. Assessment records should be informed by the relevant health and social care professionals and family members. Communication plans should be monitored and reviewed at agreed times. NCS 18 - Care homes for people with physical and sensory impairment - Supporting communication This recommendation was made on 30 November 2015. Action taken on previous recommendation There was some limited evidence of communication aids in use such as computer tablets with applications that assisted people with communication impairments to express themselves. There was also some limited use of cue cards with symbols to aid communication. In the personal plans that we sampled communication care plans contained good detail about how to help people with a communication impairment to express themselves. However, this needs to be progressed further. This recommendation has been met. Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at www.careinspectorate.com. page 11 of 15

Enforcement No enforcement action has been taken against this care service since the last inspection. Inspection and grading history Date Type Gradings 14 Dec 2016 Unannounced Care and support Management and leadership 2 Sep 2016 Unannounced Care and support 2 - Weak 2 - Weak Management and leadership 2 - Weak 9 Mar 2016 Unannounced Care and support Management and leadership 30 Nov 2015 Unannounced Care and support 2 - Weak 2 - Weak Management and leadership 2 - Weak 5 Mar 2015 Unannounced Care and support Management and leadership 18 Mar 2014 Unannounced Care and support 5 - Very good Management and leadership 30 May 2013 Unannounced Care and support page 12 of 15

Date Type Gradings Management and leadership 25 Jul 2012 Unannounced Care and support Management and leadership 2 - Weak 24 Apr 2012 Unannounced Care and support 2 - Weak 2 - Weak Management and leadership 2 - Weak 31 Jan 2012 Unannounced Care and support Management and leadership 13 Jun 2011 Unannounced Care and support Management and leadership 22 Mar 2011 Unannounced Care and support Management and leadership 2 - Weak 13 Dec 2010 Unannounced Care and support Management and leadership 2 Sep 2010 Announced Care and support Management and leadership 12 Feb 2010 Unannounced Care and support page 13 of 15

Date Type Gradings Management and leadership 28 Aug 2009 Announced Care and support Management and leadership 17 Nov 2008 Unannounced Care and support 2 - Weak 2 - Weak Management and leadership 2 - Weak 11 Jun 2008 Announced Care and support 2 - Weak 2 - Weak 2 - Weak Management and leadership 2 - Weak page 14 of 15

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 15 of 15