Dalawoodie House Nursing Home Care Home Service Newbridge Dumfries DG2 0QY Telephone: 01387 720 905 Type of inspection: Unannounced Inspection completed on: 7 February 2018 Service provided by: Downing Care Limited Service provider number: SP2013012042 Care service number: CS2013316350
About the service we inspected Dalawoodie House Nursing Home is a care home service, registered to provide care to a maximum of 36 older people with physical or sensory impairment and/or memory impairment or dementia. The provider is Downing Care Limited. The home is situated in a quiet location near Newbridge in Dumfries and Galloway. Accommodation is over two floors, with stairs, two passenger lifts and a chair lift to enable people to access the upper floor. All bedrooms are single rooms. Six bedrooms have en suite toilet. Shared bathroom and toilet facilities are available on both floors. There are two lounges on the ground floor. One of which has access to a pleasant garden area. A separate dining room is also on the ground floor. At the time of the inspection 32 people were living in the home, six of whom had contracts for nursing care the remainder were contracted for residential care only. The service employs nurses but also uses district nurses when necessary. The provider's philosophy of care includes aiming "to provide a service which promotes independence and gives encouragement to lead an active and full life as far as age and health allows." How we inspected the service We carried out an unannounced inspection to assess the progress of the service in meeting the eight recommendations made in the previous inspection report of 29.6.17. During this visit two inspectors spent time talking with residents, relatives and staff. We examined three personal plans in some detail. An evening meal was observed and evening routines. The Manager provided an update on progress being made to develop the service. We were pleased to hear about the development of senior carer roles within the service. A new hairdressing salon had been completed since the last visit. This was a popular improvement to the service. A new activities co-ordinator was enhancing approaches within the home to make activities more individualised. Taking the views of people using the service into account We spoke with a number of residents who live at the service. Most were contented with the service provided and said staff were friendly and their needs were being met. Two residents told us they were concerned at the length of time it can take for staff to respond to buzzers. page 2 of 9
Taking carers' views into account We spoke with three relatives who were visiting the service. All told us the service was doing a good job and they were grateful their relative had found a place there. Relatives told us staff were busy but always able to explain things to them. One relative told us they had asked to view the care plan with their relative but this had not been forthcoming. We asked them to take this up with staff as care plans should be made available on request. What the service has done to meet any requirements we made at or since the last inspection Previous requirements There are no outstanding requirements. What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 The service provider should ensure residents with stress/ distress are responded to readily by staff and best practice is followed in terms of assessment and record keeping. National Care Standards for care homes for older people, Standard 5.4 Management and Staffing arrangements. We could not see the results of any actions taken to address this recommendation. Although staff were aware of which residents could become stressed or distressed their ability to respond was limited. This was partly due to the need to improve knowledge and skills of staff as well as the layout of the building. The outcome for residents with stress/ distress was that sometimes they were upset for protracted periods of time without appropriate interventions. page 3 of 9
Personal plans did not show us how this had been risk assessed and what triggers and diffusers should be used. A small number of residents had "as required" sedative medication prescribed. In order for this to only be administered as a last resort it is usual to see protocols in place describing actions to be taken. This had not been carried out. Further development on this subject is needed to ensure better outcomes for residents. This recommendation is not met. Recommendation 2 The service provider should ensure personal plans show evidence of involvement and agreement by the resident/ legal representative or next of kin. The 6 monthly review format should be further improved to ensure important documents are kept up to date such as adults with incapacity certificates, do not attempt resuscitation and advance care plans. National Care Standards for care homes for older people, Standard 6.3 Supporting Arrangements. We could not see the results of any actions taken to address this recommendation. Although all residents had a personal plan those examined were completed to a basic standard. This meant important information was not always captured to enable plans of support to be put in place. A more outcome focused approach would be good practice and information on this has been shared with the manager. The 6 monthly review format had changed and did serve as a check to ensure all agreements and documents were in place. We will review this further at the next inspection visit. We could see that AWI/ DNA CPR documents were monitored for expiry dates. However, advance care plans were not up to date and effective. Using these documents effectively can help to support good end of life care. This recommendation is not met. Recommendation 3 The service provider should improve the mealtime experience for residents. This should be based on best practice to ensure food is served attractively and residents are assisted appropriately. National Care Standards for care homes for older people, Standard 13 - Eating Well. The mealtime observed was carried out well. Residents food was served attractively and residents were assisted with dignity and respect. A new stay warm hot plate had been purchased which helped to keep food at a good temperature. page 4 of 9
Recommendation 4 The service should use methods that reflect up-to-date knowledge and best-practice guidance to inform the plan of refurbishment and redecoration in the home in order to meet the needs of older people with dementia. A copy of this plan should be shared with the Care Inspectorate. National Care Standards - Care Homes for Older People - Standard 4.1 - Your Environment & Standard 5.4 Management and staffing arrangements. Redecoration of bedrooms and replacement of furnishings was on-going. We saw the home continues to be welcoming and clean. A new hairdressing salon had been put in place and this helped to develop facilities. However, there were limitations to the bathing and shower facilities which were highlighted at the last inspection. This included an opportunity to fit a wet floor shower on the ground floor to enable residents with higher dependency to use this. Instead a fixed height bath was installed which is not easy for staff to use. At present most bedrooms lack en-suite facilities and there is regular use of commodes. This is less dignified than toilet use and a long-term strategy to improve the facilities should be developed. No refurbishment plan had been shared with the Care Inspectorate as requested. The layout of the home would meet best practice for care of older people better if it was broken down into areas of smaller group living and staffed accordingly. The current arrangements continue to cause difficulty for staff in terms of observation of the two main lounges as well as meeting the needs of frail older people on the upper floor. We recommend advice is taken on how to improve the layout and usage of the building. This recommendation is not met. Recommendation 5 The service provider should evaluate the deployment of the staff team to ensure that at all times the number of staff who are trained and who have the necessary skills will be sufficient to meet the support and care needs of people using the service. National Care Standards - Care Homes for Older People - Standard 5 'Management and staffing arrangements' Staff were allocated to areas of the care home. Improvements had been made by the introduction of the senior carer role. This was still in the early stages but provided a better framework to devolve tasks from the nurse who was the shift leader. The continued development of the senior carer role provided a better skill mix and this was beneficial. We commented in the last inspection on the lack of staff visibility around the lounge areas particularly in the evening. On this visit we saw this was still the case and at times can cause concern for the safety of residents. page 5 of 9
We also observed periods of time which the lounges were unsupervised and saw records which indicated staff carried out checks on the lounges but sometime this could be an hour apart. Further development is still needed to ensure residents needs can be met more easily by the staff on duty. This links with recommendation 4 above which also recognises the limitations of the layout of the building. Recommendation 6 The service provider should develop staff roles to ensure effective leadership in order to promote and deliver high quality care practices in order to meet the needs of residents. National Care Standards for care homes for older people, Standard 5.4 Management and staffing arrangements. The introduction of the senior carer role was in progress. We saw an increase in numbers of senior carers and heard their role was developing. At present the nurse was still acting as the shift leader but it was planned for this to be devolved at times as this would free up nursing time to provide more clinical expertise. Senior carers had started training in medication administration and some had been assessed as competent and were carrying out this role. This again can help to free up nurses time. As yet we are still to see how the nurses role will develop and have asked for more information on this. The reduction in use of nurses at times is the subject of a variation of registration and further discussion was ongoing in order to look at this further. Recommendation 7 The service provider should review the quality assurance policy and bring this up to date to reflect current practice in audit and other methods of monitoring the quality of the service such as monthly reports and the development of a home improvement plan. National Care Standards Care Homes for Older People: Standard 5 - Management and staffing arrangements. A quality assurance framework was in place. This set out how the service was to be monitored. Further development was needed to bring about the use of a home improvement plan and audit the service further against best practice. Recommendation 8 The provider should ensure that information is gathered from audits, meetings, surveys and other ways, and that this is used to move the service forward. In order to do, this they should: page 6 of 9
a) collate information gathered; b) devise action plans to implement any areas identified; c) work through devised action plans; d) re-visit action plans to ensure they have been completed; and e) feedback the outcomes to those who you have gathered the information from. National Care Standards Care Homes for Older People: Standard 5 - Management and staffing arrangements. The manager has been proactive in devising action plans in response to issues raised. However, further development is needed to ensure a more robust analysis of serious incidents is carried out to identify learning points and ensure learning is embedded into practice. Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at www.careinspectorate.com. Enforcement No enforcement action has been taken against this care service since the last inspection. Inspection and grading history Date Type Gradings 25 May 2017 Unannounced Care and support 3 - Adequate Environment 3 - Adequate Staffing 3 - Adequate Management and leadership 3 - Adequate 31 Mar 2017 Unannounced Care and support 2 - Weak Environment 2 - Weak Staffing 2 - Weak page 7 of 9
Date Type Gradings Management and leadership 2 - Weak 30 Sep 2016 Unannounced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and leadership 2 - Weak 17 Sep 2015 Unannounced Care and support 3 - Adequate Environment 4 - Good Staffing 4 - Good Management and leadership 4 - Good page 8 of 9
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 9 of 9