Hamewith Lodge Care Home Service

Hamewith Lodge Care Home Service 1 Marchburn Drive Aberdeen AB16 7NL Telephone: 01224 692600 Type of inspection: Unannounced Inspection completed on: 28 June 2017 Service provided by: HC-One Limited Service provider number: SP2011011682 Care service number: CS2011300711

About the service Hamewith Lodge provides a care home service for up to 60 older people. As part of the registration the home may accommodate up to 18 younger adults. The service occupies a purpose-built building on two floors in a residential area on the northern edge of Aberdeen. At the time of the inspection visits there were 57 people living in the home. This service has been registered with the Care Inspectorate since 31 October 2011. What people told us We spoke with 14 residents and two relatives during our visit. Before our visit we sent 40 Care Standards Questionnaires (CSQs) for random distribution to the residents and their relatives/friends. We received back 11 completed questionnaires. All but one indicated they were very happy or happy with the overall quality of care provided at Hamewith Lodge. People generally expressed a good level of satisfaction with the care provided. Comments from people in person or in questionnaires included: - "Great care here. I am very comfy. I can get my door locked for me when I'm out. The manager is great. She passes messages to my family for me." - "Absolutely fab here - can't fault anything. Such good communication with staff. I like the management's straight talking, really appreciate that. I am always made welcome. My relative is so well cared for. The staff know what they are doing. They are kind to me and my relative and all the residents. This home suits my relative's needs. I've been to many other homes. There seems to be enough staff but they are very busy, they are easy to get a hold of. I can visit at any time. I cannot fault this place. I have no negatives at all. Staff are kind to everyone." - "I am happy with the care, staff are brilliant but lack of them. Staff are always on the go. Even when hurrying to answer the call buzzer and I come to see my friend they offer tea/coffee and I see that they are run off their feet. I can see they laugh and joke with other people that stay there. I know that there are a lot of troubled people that stay at Hamewith because I can see and hear them shouting at staff but staff are always polite to them." - "The staff are good, I can talk to any of them. I am happy with the management. I have no complaints so far." - "The mince and tatties are tasty! I like the visiting entertainer. The home is clean. The staff are good." - "The staffing is quite good. They respond quite quickly if required." - "I am quite happy here. I love the meals. The staff are alright to me. I am content with things generally. No complaints." - "The care and support is good. I am happy with the quality of the environment. Good staff respond when necessary." Less favourable comments included: - "There is a difference between the quality of activities provided by the different staff." page 2 of 13

- "The home itself could do with a bit of painting and a bit brighter. It is so dated and dull." One resident's friend disagreed with many of the statements on our questionnaire and were not happy with the overall quality of care, making the following comments: "More activities and more outings on the bus". Overall, the vast majority of people were satisfied with the quality of care provided at Hamewith Lodge. Self assessment We did not request a self assessment prior to 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 We assessed that people were receiving a good level of care and support. Feedback from residents was positive with good levels of satisfaction being expressed about the quality of care. We observed some very good interactions between staff and residents, such as staff getting good eye contact, using touch, and getting down to the resident's level when communicating with them. Residents were supported to be well presented at all times. We were pleased to see prompt responses made by staff following lunch to help people maintain a good standard of appearance thus promoting people's dignity. Good verbal communication between staff at handovers and flash meetings helped to ensure a good consistency of information and care for people. Staff had a good knowledge about the likes and needs of the residents. We saw good accident and fall reporting by staff who ensured each incident was followed up in an effort to prevent future incidents and update risk assessments. We liked that a team approach was taken to look at each incident. We saw some improvement in the care planning used to support each individual resident's care. However, there continued to be inconsistencies and incomplete records. Please see the progress made as a result of requirement 1 made at the last inspection at the end of this report in the section 'What the service has done to meet any requirements we made at or since the last inspection'. The requirement will remain in place (see requirement 1). We saw that, generally, staff supported a very positive dining experience for people, although work should continue to ensure everyone receives high standards of experience at all mealtimes. page 3 of 13

Whilst there were activities, events, and entertainment, the management need to invest in staff training, guidance, and evaluation of the quality provided to ensure good outcomes for people. This is because we didn't see people's choices always being respected to not participate when asked or to always be meaningfully involved, such as choosing colours of pencils to use when colouring in. Recommendation 4, in the section 'What the service has done to meet any recommendations we made at or since the last inspection', made at a previous inspection will remain in place (see recommendation 1). Requirements Number of requirements: 1 1. The provider is to ensure that in order for people's health, safety, and wellbeing to be maintained, a robust and comprehensive assessment of need, appropriate risk assessment, and plan of care clearly sets out guidance for staff on how to meet those needs. Planned care needs to take into account and reflect best practice. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, (SSI 2011/210) Regulation 4(1)(a) - Welfare of Users. Timescale: by the end of 29 September 2017. Recommendations Number of recommendations: 1 1. It is recommended that a review of the current activity provision is undertaken to ensure residents have opportunities to participate in community life and meaningful activities that reflect their individual preferences. National Care Standards, Care Homes for Older People - Standard 12: Lifestyle - Social, Cultural, and Religious Belief or Faith. Grade: 4 - good Quality of environment Findings from the inspection We found the quality of the environment to be of a good standard. The home was seen to be clean and tidy. There was good personalisation in people's bedrooms. People told us their rooms were very comfortable. People could choose to have a key to lock their rooms, if they wished. This helped people feel their rooms were safe when they were away from the home. We saw that there was a good variety of areas where people could sit outwith their own bedrooms, such as lounges, alcove areas, dining rooms, and in the garden. Improvement had been made to the dining rooms. As well as looking very pleasing, the changes gave people more room and generally helped to improve the overall dining experience. Improved signage helped people to be better orientated in their home. Some more directional signage may help direct people to the lounges, for example. page 4 of 13

The garden was looking very nice and was seen to be maintained to a very good standard. It looked colourful, inviting, and easily accessible. People made use of the garden. We saw good evidence of ongoing investment and refurbishment in the home. The upper floor was to be redecorated and new flooring laid. The manager was looking at best dementia practice to inform the types of flooring and tones for the walls. The windows would benefit from dressing on the upper floor central hallway as there are curtain rails fitted with no dressings on them. This makes it look unfinished and not as warm and homely as it could be. There was a clear, well organised maintenance system in place in the home. We did, however, find a number of doors unlocked, such as storage cupboards. The management should ensure all staff are aware of the need to keep such doors locked when not in use to prevent people becoming accidentally shut in rooms or being at risk from items stored in the rooms, such as aerosol cans. The front reception/entrance area was seen to be more receptive and welcoming than previous inspection visits. The management told us there were hanging baskets about to be hung to further improve the ambiance in the area. Requirements Number of requirements: 0 Recommendations Number of recommendations: 0 Grade: 4 - good Quality of staffing Findings from the inspection We found the quality of the staffing to be good. We found a very calm atmosphere where staff appeared unhurried despite being kept very busy. Staff were very positive about working at the home and described good teamworking. Staff had a sense of ownership in the work they carried out, aiming to provide good quality care and support. They had a sense of pride and trying hard to provide a quality service. We saw that the management had focussed on staff training programmes, including ones designed to meet individual resident needs. Staff told us they enjoyed the training events. The management should carry out more observation of staff practice, at different times of the day, to ensure consistency and quality of practice is maintained at all times. The management should also evaluate the effectiveness of the training provided to staff and the competencies of the staff to ensure the quality of staff practice. The service should continue to focus on developing the skills of staff to meet the individual and complex needs of the residents. page 5 of 13

The manager was evaluating the staffing needs in the home to ensure the proper funding was in place to meet the needs of people already known to have complex needs. Staff felt they could do with more staff in the home. Whilst the home was maintained to a good standard, some of the staff cleaning practices should be revisited and improved. This is because we saw vacuuming being carried out at lunchtime which disturbs people's mealtime experience due to noise, smell, and dust. We also saw large amounts of soiled linen bags on the floor of the laundry room which compromised hygiene. Examination of the staff files demonstrated that safe recruitment practices were used to employ new staff in the home. Requirements Number of requirements: 0 Recommendations Number of recommendations: 0 Grade: 4 - good Quality of management and leadership Findings from the inspection We found the quality of management and leadership to be good. The atmosphere in the home was much improved from previous inspection visits. There had been stability in the management team. Key pieces of information were available for people to view, such as the staffing schedule and the previous inspection report. People we spoke with were reassured they could approach the management team. Everyone knew who the management team were. Staff told us there was a good team approach to working in the home. There were some good elements of inclusion in the home. There were resident and relative meetings, regular newsletters published, and easy access to the complaints procedure. We saw that the service attempted to deal with all complaints at source. There was a computer touch screen at the entrance to the home which anyone could use (and be shown how to use) to provide feedback. There were good quality assurance systems in place measuring the quality of the service being delivered. However, they were not always as effective as they could be. In order to demonstrate a more robust process of evaluation that focused on outcomes experienced by people, the quality assurance systems needed further work to be more meaningful. Please see information in action taken to meet outstanding recommendations. Recommendation 2, in the 'What the service has done to meet any recommendations we made at or since the last inspection' section of this report, made at a previous inspection will remain in place (see recommendation 1). page 6 of 13

There were very clear accountable financial systems used which were regularly audited, both by the organisation and externally. Requirements Number of requirements: 0 Recommendations Number of recommendations: 1 1. It is recommended that there is consistency in practice when internal quality assurance systems are implemented. For example, to include: - Timescales for completion of actions identified. - Details of who was responsible for completion of actions. - Outcomes for residents. The above would enhance the systems already in place. National Care Standards, Care Homes for Older People - Standard 5: Management and Arrangements. Grade: 4 - good What the service has done to meet any requirements we made at or since the last inspection Previous requirements Requirement 1 The provider is to ensure that in order for people's health, safety, and wellbeing to be maintained, a robust and comprehensive assessment of need, appropriate risk assessment, and plan of care clearly sets out guidance for staff on how to meet those needs. Planned care needs to take into account and reflect best practice. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, (SSI 2011/210) Regulation 4(1)(a) - Welfare of Users. Timescale: by the end of 30 November 2015. page 7 of 13

This requirement was made on 29 September 2015. Action taken on previous requirement The management were aware that there continued to be a need for work in this area. When we examined care records we saw: - Inconsistencies and inaccuracies in the quality of information recorded in some plans to provide consistent guidance for staff to follow. These included wound care plans and pain assessments. - Risk assessments needed to be more detailed and specific. Key risk assessments should be linked to what was happening with individual's care and needs. - There was a lack of detail in guidance to support staff in meeting specific health, mental health, stress, and distress needs. ABC (antecedents, behaviours, and consequences) recording charts were not being properly completed. - There was a lack of health promotion, independence, and rehabilitation for residents. - A lack of an enabling approach to promote people's wellbeing. - Lack of detail about how family and community links were going to be maintained. Specific details were shared with the manager and deputy at the time of our visits. This requirement will remain in place. Not met What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 It is recommended that there is clear signage throughout the home to aid residents' orientation and promote their independence and ability to move around the home. National Care Standards, Care Homes for Older People - Standard 4: Your. This recommendation was made on 29 September 2015. Action taken on previous recommendation We saw that more signage to aid orientation had been added and some had been moved so they did not pose a risk to people. We saw a good reduction in the notices aimed at staff. page 8 of 13

The management told us the hallways were about to be redecorated and have new flooring laid. The management reassured us this would be in keeping with best dementia care practice to aid orientation. The provider should continue to ensure people's independence and orientation is promoted at all times. This recommendation was seen to be met. Recommendation 2 It is recommended that there is consistency in practice when internal quality assurance systems are implemented. For example, to include: - Timescales for completion of actions identified. - Details of who was responsible for completion of actions. - Outcomes for residents. The above would enhance the systems already in place. National Care Standards, Care Homes for Older People - Standard 5: Management and Arrangements. This recommendation was made on 29 September 2015. Action taken on previous recommendation We saw some improvement in this area. There continued to be quality assurance systems in place in the home. Management undertook a vast amount of quality assurance processes. However, these were not as effective as they should be. The development plan was not risk-based, did not always identify who was responsible, and what the target dates were. We saw that some target dates had been missed. Outcomes for people were not being evaluated or achievements being noted. For example, training had been provided to staff but it was not noted how effective this was or if practice had improved. Flash meetings did not look at the previous day's action plan to see if actions had been achieved. In order to demonstrate a more robust process of evaluation that focused on outcomes experienced by people, the quality assurance systems need to be more meaningful. The Care Inspectorate will continue to monitor progress at the future inspections. This recommendation remains place. Recommendation 3 The provider should develop an audit system to address the standard and quality of written and verbal communication in the home and to help drive forward improvement where areas of deficit have been identified. National Care Standards, Care Homes for Older People - Standard 5: Management and Arrangements. This recommendation was made on 26 April 2016. page 9 of 13

Action taken on previous recommendation We saw that care plans were being regularly audited and improvements to the consistency of the information was seen. Flash meetings were seen to be well practiced and established. The Resident of the Day was working well in one of the floors in the home and was to be adopted throughout the home. Whilst we note the areas to improve in recommendation 1 and 2, we have deemed this recommendation to be met. Recommendation 4 It is recommended that a review of the current activity provision is undertaken to ensure residents have opportunities to participate in community life and meaningful activities that reflect their individual preferences. National Care Standards, Care Homes for Older People - Standard 12: Lifestyle - Social, Cultural, and Religious Belief or Faith. This recommendation was made on 29 August 2016. Action taken on previous recommendation We did not see a significant improvement in the quality of the activity provision. We provided detailed feedback about our observations of staff practice to the management at feedback. There continued to be a need for further development to be more meaningful by taking account of people's identified interests, hobbies, and past life experiences. The service could consider implementing the Playlist for Life where individual music libraries are identified for each person, especially those with dementias or cognitive impairment. Activity staff required to be trained in promoting and supporting activity, including meaningful activity. Staff practice in activity provision should be monitored to ensure good outcomes for people. This recommendation remains in place. Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at www.careinspectorate.com. page 10 of 13

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 Not assessed Not assessed Not assessed Management and leadership Not assessed 8 Aug 2016 Unannounced Care and support 3 - Adequate Management and leadership 3 - Adequate 27 Jan 2016 Unannounced Care and support Not assessed Not assessed Not assessed Management and leadership Not assessed 31 Aug 2015 Unannounced Care and support 3 - Adequate Management and leadership 10 Mar 2015 Unannounced Care and support Management and leadership 4 Dec 2014 Unannounced Care and support Management and leadership 3 Mar 2014 Unannounced Care and support 3 - Adequate 3 - Adequate page 11 of 13

Date Type Gradings Management and leadership 3 - Adequate 3 - Adequate 3 Oct 2013 Unannounced Care and support 5 - Very good 5 - Very good Management and leadership 15 Jan 2013 Unannounced Care and support Management and leadership 5 Sep 2012 Unannounced Care and support 3 - Adequate 3 - Adequate 3 - Adequate Management and leadership 3 - Adequate 13 Jan 2012 Unannounced Care and support 3 - Adequate Not assessed 3 - Adequate Management and leadership 3 - Adequate page 12 of 13

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 13 of 13