Redford Nursing Home Care Home Service 6 Dunure Road Ayr KA7 4HR Telephone: 01292 442983 Type of inspection: Unannounced Completed on: 17 May 2018 Service provided by: Redford Nursing Home Service provider number: SP2003002268 Service no: CS2003010273
About the service The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at www.careinspectorate.com This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April 2011. Redford Nursing Home is a privately owned home located in Alloway on the outskirts of Ayr. The service is registered to provide a care service to a maximum of 35 older people who may include three respite/short break places. Accommodation is provided in single and shared occupancy rooms. The service's stated aim is to "provide a service which will promote the independence and respect the individuality of the service user". What people told us People provided mixed views on their experience of the service, although people ultimately stated they were happy with the service they received. Feedback comments included: 'Very pleased with the overall health and wellbeing improvements to my relative since arriving at Redford.' 'Staff are very sensitive to me in difficult times.' 'Since the lounges have changed, the environment is more relaxed.' 'I attend meetings and my opinions are taken into account.' 'I feel looked after, sometimes it would be nice if activities could be done every day. I can get fed up sometimes when activity lady is off.' Observation through use of SOFI in two lounges demonstrated how some positive outcomes for specific residents who were more able to converse with staff received attention, whilst other residents should be more included during interactions to make them feel valued and validated. Self assessment We did not request a self assessment prior to this inspection. We reviewed the service development plan and used this information during the inspection to discuss improvement areas with the manager. From this inspection we graded this service as: Quality of care and support Quality of environment Quality of staffing page 2 of 13
Quality of management and leadership Quality of care and support Findings from the inspection Overall, residents and families described a positive culture towards care and support which enhanced the wellbeing of residents. Residents and families stated they were generally happy with the care and support for residents. Introduction to a new style of care plan had been implemented to provide guidance on the care and support that is right for each individual person. This plan includes assessment of resident needs and the impact this has on each individual and then sets out how their needs will be met with reference to their wishes and choices. Prior to the change in care planning, we found some aspects of care which were not provided as a result of an assessed need and was not found to be of benefit to the residents or support the resident to be involved in the control of their own health and wellbeing. We discussed this with management and staff who began to reflect on the practices raised and actual and potential outcomes for residents. (see recommendation 1) Medication administration was being monitored although could be more effectively audited to ensure medication was being reviewed and administered as prescribed and in accordance with the needs of residents and resident rights were being upheld. To promote the wellbeing of residents, medication systems could be enhanced to promote safer practice to minimise any potential complications with health conditions for which the resident receives medication. (see recommendation 2) A range of recreational, social, creative, physical activities were available when the activity coordinator was on site. Improvements should be made to provide and promote meaningful engagement with residents at all times to promote wellbeing. (see recommendation 3) A consequence of reviewing the use of living space, and introducing an alternative dining room supported unhurried snack and mealtimes in as relaxed an atmosphere as possible. Access to secure garden area and provision of equipment supported movement for residents, including walking aids, supported independence and freedom of movement for residents. Support from external health professionals provided guidance to staff in how to provide appropriate care for residents with particular health conditions. Good links had been established with local G.Ps, specialist nurses and Allied Health professionals including specialist nurses, dietician, dentist and physiotherapy. Implementation of health champion roles within the service had been initiated. This had supported sharing information, use of best practice and support for staff to continue to improve outcomes for residents. Intergenerational working with local schools and nurseries had improved the mood of, and stimulated the interest of residents in communicating with others through their feedback on meeting the children. page 3 of 13
Requirements Number of requirements: 0 Recommendations Number of recommendations: 3 1. Personal plans should include individual health needs of service users and how these are to be met. Health and Social Care Standards 1.19 My care and support meets my needs and is right for me. 2. Enhancement in the use of audit processes should support safe use of medication systems, identify areas for improvement and promote positive outcomes for residents Health and Social Care Standards 2.23 If I need help with medication, I am able to have as much control as possible and 1.13 I am assessed by a qualified person, who involves other people and professionals as required. 3. Meaningful engagement and activities should be available and accessible to residents in accordance with their wishes and preferences. Health and Social Care Standards 1.25 I can choose to have an active life and participate in a range of recreational, social, creative, physical and learning activities every day, both indoors and outdoors. Grade: 4 - good Quality of environment Findings from the inspection Improvements to the environment, including more effective use of space and changes to the dining room has promoted the dignity and wellbeing of residents. Feedback on changes has found them to be positive with approval from residents and relatives. Overall, the general environment was found to be well looked after with clean, tidy and well maintained premises, furnishings and equipment. However, some bedroom areas were found lacking in a standard of cleanliness whilst some bathrooms could be more effectively supportive of good infection control procedures, including use of pedal bins. Regular spot checks of different areas of the environment could support the manager to promote a safe environment. (see recommendations 1 and 2) Access to secure outside space was being monitored by staff to ensure residents were supported whilst upgrades to the external environment are being designed to promote this. Deployment of staff around the home should be to support the needs of residents, and less in a task orientated manner which would provide a more relaxed, timeous and responsive support for residents. Rota management and deployment of staff is central to ensuring assessment and care of resident needs are being met. page 4 of 13
Residents are encouraged to decide on the decoration, furnishing and layout of their bedroom, and bring their own furniture and fittings where possible. Recently, residents were involved in deciding colour schemes for communal areas of the home which they said made them feel valued. Residents were treated with respect during one to one or group interactions. Out of respect to residents, consideration should always be given to where staff discuss issues, and the manner in which they speak to colleagues within the home, minimising the risk of intrusive noise. Requirements Number of requirements: 0 Recommendations Number of recommendations: 2 1. Infection control procedures should be improved to enable residents to feel safer within their environment. Health and Social Care Standards 5.22 I experience an environment that is well looked after with clean, tidy and well maintained premises, furnishings and equipment. 2. Improvements to monitoring and checking of the environment would improve residents' experience of their environment. Health and Social Care Standards 4.23 I use a service and organisation that are well led and managed. Grade: 3 - adequate Quality of staffing Findings from the inspection Overall, ongoing development of a more positive culture of team working was generally described by staff. Some residents and relatives commented to changes in the staff team which had created some alternative methods of working practice and improved communication in support of achieving positive outcomes for residents. Recruitment of staff by the service could be more effectively managed to ensure that people are appropriately and safely recruited. (see recommendation 1) Development of a new supervision framework had been initiated to encourage a more reflective practice in pursuit of staff development. This could also support staff in also meeting the registration requirements of their respective regulatory body either the Nursing and Midwifery Council or Scottish Social Services Council. Leadership by the management to provide a clear direction to staff and includes their involvement in developing and improving the service had led to some suggestions in improving resident care. Ongoing attempts to develop staff to accept their accountability in seeking opportunities to improve their practice learning continued to be discussed at team meetings. page 5 of 13
More effective use of supervisions for staff of all disciplines through reflective practice would support residents to experience high quality care and support based on relevant evidence, guidance and best practice. (see recommendation 2). We identified during discussions that some increased awareness of the role of the Mental Welfare Commission guidance could support staff in promoting the protection of service users and their rights. (see recommendation 3) Residents and relatives spoke highly of the staff team and their appreciation for the care provided. Requirements Number of requirements: 0 Recommendations Number of recommendations: 3 1. More effective oversight by the manager could support safer recruitment to protect service users. Health and Social Care Standards 4.24 I am confident that people who support and care for me have been appropriately and safely recruited. 2. The provider should ensure that all staff supervision includes reflection in staff practice, leading to better outcomes for service users. Discussions could include, but not limited to mandatory and service user specific issues including: common core skills, knowledge and values; Promoting Excellence; health and safety; and person-centred care. Health and Social Care Standards 3.14 I have confidence in people because they are trained, competent and skilled, are able to reflect on their practice and follow professional and organisational codes. 3. Updates to training for staff on best practice guidance and legislative requirements should be made available to improve outcomes for residents. This includes Mental Welfare Commission guidance. Health and Social Care Standards 4.11 I experience high quality care and support based on relevant evidence, guidance and best practice. Grade: 3 - adequate Quality of management and leadership Findings from the inspection Daily meetings supported the manager to promote leadership to the staff team to provide a clear direction and include their involvement in developing and improving the service. Some attempts had been observed and understood for staff to accept their accountability in seeking opportunities to improve their practice learning which continued to be discussed at team meetings. page 6 of 13
To streamline information contained within files would ensure appropriate information was more easily accessible to ensure service users are protected. Improvements in how the service is now run, have been initiated through the manager role modelling and providing direction on providing basic care needs for people experiencing care. Positive comments have been received from people experiencing care, relatives and staff on the benefit of this action in improving standards. Risk assessments were being completed and reviewed timeously to promote the wellbeing of people. Development and implementation in the use of quality assurance processes must be further expanded to monitor and evaluate the effectiveness of support and outcomes and safety for people experiencing care and promoting accountability of staff. (see recommendation 1) Requirements Number of requirements: 0 Recommendations Number of recommendations: 1 1. Continuation on development of a service improvement plan, following evaluation of audits supported by completion of appropriate systems and processes would benefit outcomes for people experiencing care. Health and Social Care Standards Quality Indicator 4.23 Grade: 3 - adequate What the service has done to meet any requirements we made at or since the last inspection Previous requirements There are no outstanding requirements. page 7 of 13
What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 Personal plans should include individual health needs of service users and how these are to be met. National Care Standards, care homes for older people - Standard 6: Support arrangements and Standard 14: Keeping well - healthcare. This recommendation was made on 22 October 2015. Action taken on previous recommendation A new process had been introduced during this inspection which should support identification of resident need and their input into how their needs are to be met. As this is a new project, this recommendation is repeated for monitoring. This recommendation is: not met and will be repeated under Health and Social Care Standard 1.15 My personal plan (sometimes referred to as a care plan) is right for me because it sets out how my needs will be met, as well as my wishes and choices. Recommendation 2 Supervision should be used as a method to enhance and develop the skills of staff through use of reflective practice. National Care Standards, care homes for older people - Standard 5: Management and staffing arrangements. This recommendation was made on 14 June 2016. Action taken on previous recommendation Supervisions had began to be more regular for nursing staff. New processes were being created to support development in the supervision process for care staff, including reflective practice and identification of training needs.. This recommendation is: not met, but will be reworded and repeated for monitoring under Health and Social Care Standard 3.14 I have confidence in people because they are trained, competent and skilled, are able to reflect on their practice and follow their professional and organisational codes. Recommendation 3 To streamline information contained within files would ensure appropriate information was more easily accessible to ensure service users are protected. National Care Standards, care homes for older people - Standard 5: Management and staffing arrangements. This recommendation was made on 14 June 2016. page 8 of 13
Action taken on previous recommendation Review of files and documents contained were reviewed and archived where appropriate. This recommendation is: met. Recommendation 4 The manager should undertake a knowledge and skills audit and devise a development plan to deliver training to address gaps. National Care Standards, care homes for older people - Standard 5: Management and staffing arrangements. This recommendation was made on 19 June 2017. Action taken on previous recommendation Back to basics training was being provided for all staff with all mandatory training being repeated to ensure all staff had necessary fundamental training. Additional training needs were to be monitored through supervision. A training schedule was also available with names and dates for the year. This recommendation is: met. Recommendation 5 An updates to training for staff on best practice guidance and legislative requirements should be made available to improve outcomes for residents. This includes Mental Welfare Commission guidance. National Care Standards, care homes for older people - Standard 5: Management and staffing arrangements. This recommendation was made on 19 June 2017. Action taken on previous recommendation No action had been undertaken as yet to meet this recommendation. This recommendation is: not met and will be repeated under Health and Social Care Standard 4.11 I experience high quality care and support based on relevant evidence, guidance and best 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. page 9 of 13
Inspection and grading history Date Type Gradings 6 Dec 2017 Unannounced Care and support 19 Jun 2017 Unannounced Care and support 10 Jan 2017 Unannounced Care and support 14 Jun 2016 Unannounced Care and support 5 - Very good 22 Oct 2015 Unannounced Care and support 11 Jun 2015 Unannounced Care and support 11 Nov 2014 Unannounced Care and support 24 Jun 2014 Unannounced Care and support page 10 of 13
Date Type Gradings 12 Nov 2013 Unannounced Care and support 12 Apr 2013 Unannounced Care and support 19 Dec 2012 Unannounced Care and support 22 Jun 2012 Unannounced Care and support 23 Jan 2012 Unannounced Care and support 13 Oct 2011 Unannounced Care and support 25 Nov 2010 Announced Care and support 23 Jun 2010 Unannounced Care and support page 11 of 13
Date Type Gradings 9 Mar 2010 Unannounced Care and support 11 May 2009 Announced Care and support 12 Nov 2008 Unannounced Care and support 30 Jun 2008 Announced Care and support 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