Clachan of Campsie House Care Home Service
9 Main Street Lennoxtown Glasgow G66 7HA
Telephone: 01360 312 765
Type of inspection: Unannounced Inspection completed on: 23 May 2018
Service provided by: Service provider number: Care Homes (Scotland) Ltd SP2007008815
Care service number: CS2016347279 Inspection report
About the service
Clachan of Campsie House is a care home for older people that is located in the main street of Lennoxtown in East Dunbartonshire. The home is near to local shops and bus routes. The service is operated by Care Homes (Scotland) Ltd. This service registered with the Care Inspectorate on 29 March 2017 to care for 95 older people, including one respite place. The provider also operates another care home for older people which is located in Glasgow.
The service operates from a two storey building. There are two units on the ground floor and two on the first floor. At the time of the inspection, only two units were occupied. These were Primrose Lane on the ground floor which had 17 residents and Bluebell Boulevard on the first floor which had 16 residents. Primrose Lane was supporting people who were physically frail and had some nursing needs. Bluebell Boulevard was supporting people with a diagnosis of dementia who also had nursing needs.
The provider's published aims and objectives included the following:
"- to provide a quality of life that supports people living here to retain their independence, identity and a sense of value. - to promote each person's physical, mental and emotional health and safeguard individual rights. - to deliver the best possible care and support to everyone who lives in Clachan of Campsie House at all times."
What people told us
For this inspection, we received views from 13 people living in the service. Eight relatives returned completed care standards questionnaires. From the questionnaire responses three people strongly agreed and four people agreed that they were happy with the overall quality of care their relative received from the service. One person strongly disagreed with this statement. We also spoke with six relatives during the inspection.
Residents spoke positively about the care and support they received and the staff that looked after them. Comments included:
"Staff are great. They are polite."
"The food is enjoyable."
"There are activities like exercises and movies."
"Would definitely ecommendr here."
However people who lived in the service also expressed less positive views about lack of staff, use of agency staff and staff turnover. Comments included:
"They are short staffed sometimes"
"There are agency staff at night-time"
"Some staff have left."
Views from relatives about the service provided were mixed. Comments included:
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"The care side is smashing. The management side is not smashing."
"The few excellent staff they do have are over-worked and stretched to the limits."
"The carers are great which, given the management issues the home has had, is quite amazing. They have continued to deliver care with kindness and respect."
"I am pleased with Clachan of Campsie. I visit every day and see the good care given to residents."
"No management presence. Staff retention seems poor."
Self assessment
The service had not been asked to complete a self assessment in advance of the inspection. We looked at their improvement plans and quality assurance paperwork. These demonstrated their priorities for development and how well they were monitoring the quality of the provision within the service.
From this inspection we graded this service as:
Quality of care and support 3 - Adequate Quality of environment 4 - Good Quality of staffing 3 - Adequate Quality of management and leadership 3 - Adequate
Quality of care and support
Findings from the inspection People said that they felt safe living in the service. Residents who lived in the home were generally positive about the overall quality of care and support they received. Comments were "I'm very happy here" and "staff are great". Relatives had mixed views. Comments ranged from "The care is good. Staff are very caring" to "I have sadly witnessed a decline in the overall performance of the home."
A previous area for improvement was the varied quality of information recorded in personal plans. The service was changing the format of plans to make them more person-centred. However gaps and inconsistencies in recording were still evident. Staff using personal plans were at risk of providing support to people that were informed by inaccurate information. This was relevant to all staff but particularly to agency staff that may be less familiar with people's needs. (see requirement 1).
The majority of people we spoke with said that they enjoyed the food, snacks and drinks the service provided. One person told us "there are other choices if you don't like what's on the menu". Another said that breakfast was "lovely". However we had concerns that staff were not consistent in how they assessed people at risk of under-nutrition. Staff's understanding of people's food and fluid needs varied and the quality of ecorr ding about this fluctuated. The visiting dietician was providing additional training on this. (see requirement 2).
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The service had appointed a new activities coordinator since our last inspection. The two previous activity coordinators had left the service. This meant that the service was in a position where it had an enthusiastic but inexperienced person in this key role. We signposted the activities coordinator to a range of useful resources relevant to the role. However this staff member would benefit from specific training, development and peer support.
People described enjoying some activities such as movies, bingo and a celebration of the recent Royal wedding. However opportunities for people to go outside of the home were more limited and often relied on relatives and friends to accompany them.
The service had improved its management of medicines since we last visited the service. This meant that people got their medicines in a safe and correct way. The service was also introducing medicine pods in people's bedrooms which would allow for a more individualised approach.
People were able to access money when they needed it. The service had improved its procedures for recording and safeguarding people's money. However, there was room for further improvement. (See the section of this report headed "What the service has done to meet any requirements made at or since the last inspection." )
Requirements Number of requirements: 2
1. To ensure the quality of personal plans inform correct staff practice the provider must ensure all plans are personalised and accurately written by 31 July 2018.
Personal plans must be routinely reviewed to make sure that they remain accurate and up to date. This should be done by staff who have experience and knowledge of person-centred planning.
The service must always involve service users and/or their representatives in planning and implementing their care and support.
This is to ensure that care and support is consistent with the Health and Social Care Standard 1.5, which states "My personal plan is right for me because it sets out how my needs will be met, as well as my wishes and choices".
It is also necessary to comply with Regulations 5(1) and (2) of the Social Care and Social Work Improvement Scotland Regulations 2011.
2. To ensure the nutritional needs of people who use the service are met in line with best practice the provider must address the following areas by 31 July 2018:
- develop and implement clear prevention plans to avoid significant unplanned weight loss, and/or dehydration.
- develop and implement clear treatment plans when people are identified with significant weight loss and/or when fluid intake is poor.
- develop and implement policy guidance for the prevention and management of significant unplanned weight loss and/or dehydration.
- demonstrate that malnutrition risk screening tools are properly used to fully inform practice.
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- ensure that all staff have a good understanding of people's food and fluid needs including what action to take if they identify people at risk of malnutrition and/or dehydration.
This is to ensure that care and support is consistent with the Health and Social Care Standards:
1.37, which states "My meals and snacks meet my cultural and dietary needs, beliefs and preferences and
1.39, which states "I can drink fresh water at all times"
It is also necessary to comply with Regulations 4(1)(a) and 5(1) of the Social Care and Social Work Improvement Scotland Regulations 2011.
Recommendations Number of recommendations: 0
Grade: 3 - adequate
Quality of environment
Findings from the inspection The quality of the environment inside the building was good. The building used external CCTV for security purposes and the safety of all residents. The home had secure entry systems and everyone coming to the service was required to sign in and out. People told us that they felt safe living in the home.
The home was welcoming, clean and well furnished. People that we spoke with gave us positive feedback about their personal space and other areas of the home. People told us that could personalise their rooms and we saw very good examples of this.
Residents benefited from a good standard of personal and communal living space. The service provided additional facilities such as a cinema room and private dining area. The home had nicely furnished seating areas throughout. This allowed people a good choice of shared or private spaces.
Many of the ground floor bedrooms provided direct access to individual patio areas as well as shared use of a larger garden. This meant that people could use the garden when they chose to whilst remaining in area that was enclosed. Residents could not use exterior balconies on the first floor as they were locked. This meant that people living on the first floor were unable to get fresh air when they wished. This contrasted with the choices for people living on the ground floor.
The garden was untidy and less inviting for people to use. A lack of gardening tools and flowerbeds that were too low meant that residents could not participate in gardening if they wanted to. There were broken flowerpots on exterior balconies which was unattractive.
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Maintenance records that we sampled were satisfactory. This indicated that the service was making appropriate safety checks on the environment and equipment.
We noted that doors from corridors to lounge areas and within lounge areas did not open automatically. It remained difficult for people who used wheelchairs or who had mobility difficulties to open doors independently. Some of these doors were propped open by chairs or other objects. This was an area for improvement at the last inspection. The fire service had also noted this in its fire audit of April 2018.
The temperature in home was very hot on the days that we visited. It took some time for the under-floor heating temperature to rise or fall. Residents could adjust the heating in their bedrooms to suit personal preferences but this did not make much difference to the ambient temperature.
The provider had removed the foyer café to make way for manager's office. eopleP said that the service did not consult them about this change. The provider had installed vending machines as an alternative to the café. This was not well signposted and people could only access via a keypad entry into the ground floor unit.
Requirements Number of requirements: 0
Recommendations Number of recommendations: 1
1. The provider should ensure that everyone can access outdoor areas of the home when they choose to do so.
A plan should be put in place to maintain the garden so that it remains a pleasant and inviting place to for people to use.
If people wish to participate in gardening they should be supported with this and have the appropriate tools to do this. It would be beneficial if flower and plant beds were raised to make them accessible to more people.
This ensures care and support is consistent with the Health and Social Care Standard which states that "if I live in a care home, I can use a private garden." (HSCS 5.23)
Grade: 4 - good
Quality of staffing
Findings from the inspection Overall feedback about the quality of staff was good. People described staff as "polite" and "respectful" and "hard working". However it was also clear that people were concerned about the continued use of agency staff and staff turnover. A relative said "this home is at great risk of losing the young enthusiastic carers". Another person said "staff retention seems poor."
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We sampled staff recruitment records and were satisfied that this ollowedf good practice. The service carried out appropriate background checks in a timely manner. This meant that the service was suitably screening applicants before employing them. There was some evidence of basic induction training for new staff.
Staff that we spoke with indicated that training opportunities were good. It was also clear from our discussions with staff that they wanted to learn more.
The service provided conflicting information about staff training attendance so it was unclear what staff training had been completed. We recommended that training extend to areas more relevant to the needs of residents and the role of staff. For example staff learning with the Promoting Excellence framework in dementia care. Following our inspection the manager provided a forward training plan for the next three months which included training topics beyond basic training. (see requirement 1).
Staff supervision is an opportunity for managers and senior staff to meet regularly with individual or small groups of staff. They can review operational matters, staff learning and development and discuss feedback about individual staff performance. The quality and frequency of staff supervision varied and was not always in line with the service's policy on this. The provider's policy stated that staff should "be supervised as a minimum bi- annually by a named person". We would recommend that new staff, particularly staff with no previous care experience, would benefit from more frequent supervision and guidance. Discussion with staff and examination of records indicated that some staff supervision was taking place. However, the focus of supervision discussions was written mainly from the supervisee's perspective.
Staff could benefit from more feedback about their performance and practice. Staff should also have regular reviews of specific learning and development objectives. (see ecommendationr 1).
Requirements Number of requirements: 1
1. To ensure that people are cared for by skilled and knowledgeable staff the provider must develop and implement a staff training plan by 30 September 2018 that:
- identifies and ecorr ds the training and development needs of every staff member
- provides training to staff in a timely way
- provides training that meets all legal requirements
- trains staff to properly meet the different needs of all the people they support.
This is to ensure that care and support is consistent with the Health and Social Care Standard 3.14, which states "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.".
It is also necessary to comply with Regulation 15 of the Social Care and Social Work Improvement Scotland Regulations 2011.
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Recommendations Number of recommendations: 1
1. The service should increase the frequency of staff supervision and develop the content of supervision discussions to make them more relevant to individual staff practice.
This will support the service's learning and development of a competent and skilled workforce.
Staff should have specific learning objectives that contribute to their professional development.
This ensures care and support is consistent with the Health and Social Care Standard which states that "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."(HSCS 3.14).
Grade: 3 - adequate
Quality of management and leadership
Findings from the inspection The provider appointed a new manager one week before our inspection. It was too soon to assess the manager's impact on the service. The service had lacked a consistent, stable management team since it began operating in 2017. People had mixed views about the effectiveness of the service's previous management arrangements. One relative commented that there had been "too many managers". Another relative said "they are getting things done."
The service continued to rely on the use of agency nurses to cover vacancies for qualified staff. The provider indicated that recruitment of permanent nursing staff was difficult. The provider told us that additional staff had now been recruited, pending background checks. This included a new depute manager who would support the manager. The provider anticipated a reduction in the use of agency staff and that this would improve continuity of care. We have asked the provider to keep us updated on staff recruitment and the use of agency staff. We will also look at this again at the next inspection.
We shared feedback from relatives and staff about the quality of communication from the provider, manager and senior staff. A consistent theme was that communication could be better about changes and developments in the service. Some limited progress had been made with recent relatives meetings taking place and establishing email contacts with relatives and carers to share information. It is important that the service regularly consults and listens to the views of people who use the service. This is a key part of any service development plan.
Some rudimentary quality assurance systems were in place. The service had conducted medication audits. Appropriate records of accidents and incidents were kept. The service also kept records of complaints but these lacked detail in relation to investigations and outcomes. At inspection feedback we discussed the need to review and develop further quality assurance processes to ensure that they were effective and helped improve the service. (see requirement 1).
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Requirements Number of requirements: 1
1. To ensure that people get consistent good quality care and support the provider must further develop and fully implement a quality assurance framework for the service by 31 July 2018.
This must include systems that consistently audit key areas that impact on the care of people who live in the service. Examples include checks on the quality of:
- personal planning
- staff training and practice
- management and leadership
This is not an exhaustive list. The provider should consider any other key performance indicators that may be relevant. Quality assurance systems must be used to improve outcomes for people using the service and for staff working in the service.
This ensures care and support is consistent with the Health and Social Care Standard 4.19 which states "I benefit from a culture of continuous improvement, with the organisation having robust and transparent quality assurance processes".
It also complies with Regulation 4(1)(a) of the Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011.
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 quality of personal plans must improve so they that they are clearly and accurately written, person- centred and inform correct staff practice.
Personal plans must be routinely reviewed to make sure that they remain accurate and up to date. This should be done by staff who have experience and knowledge of person-centred planning.
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The service must involve service users and/or their representatives in planning and implementing their care and support.
This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, (SSI 2011/210), Regulations 5(1) and (2) - a requirement for a provider to prepare a written plan ("the personal plan") which sets out how the service user's health, welfare and safety needs are to be met.
To be completed by 31 July 2017.
This requirement was made on 13 September 2017.
Action taken on previous requirement The service had been changing the format of personal plans so that they were more accurate, informative and person-centred. This work was ongoing and incomplete.
We looked at a sample of personal plans, (both in the old and new formats), and identified some strengths such as the introduction of hospital passports, good evidence of accessing preventative and screening healthcare services such as dentists, opticians and audiology. The service had introduced a "traffic light system" of ecorr ding in care plans to prioritise key areas of support. Some senior staff had received training on how to use plans.
There was some evidence of residents and relatives taking part in care reviews but reviews were not taking place consistently. The quality of record-keeping remained variable. We noted gaps in written information and some plans that had wrong information.
We have repeated this requirement.
Not met
Requirement 2
The provider must develop and implement a staff training plan that:
- identifies and ecorr ds the training and development needs of every staff member
- provides training to staff in a timely way
- provides training that meets all legal requirements
- trains staff to properly meet the needs of the people they support.
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 15 - a requirement that a provider must ensure staff are suitably trained and competent to carry out their work.
To be completed by 31 December 2017.
This requirement was made on 13 September 2017.
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Action taken on previous requirement The service had a training matrix and a three month forward training plan was in place. Staff participation in training was patchy and didn't extend beyond basic training. Staff were not being given opportunities to take part in learning, relevant to the needs of people they were caring for. The service did not have a clear system in place for senior staff to evaluate how staff applied learning to their day-to-day practice.
We have repeated this requirement.
Not met
Requirement 3
The provider must prioritise the development and implementation of a quality assurance framework for the service. This must include systems that consistently audit key areas that impact on the care of people who live in the service. Examples include checks on the quality of:
- personal planning - staff training and practice - medicines management - management and safeguarding of residents money.
This is not an exhaustive list. The provider should consider any other key performance indicators that may be relevant. Quality assurance systems must be used to improve outcomes for people using the service and for staff working in the service.
This is in order to comply with:
The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, Regulation 4(1)(a) - a requirement for a provider to make proper provision for the health, welfare and safety of service users.
To be completed by 30 November 2017.
This requirement was made on 13 September 2017.
Action taken on previous requirement Some quality audits were in place as part of an overall quality assurance framework. We sampled the medication audits and examined medication storage and record keeping. We looked at staff training arrangements and also how the service safeguarded people's money.
As detailed under a previous requirement, some key areas for improvement with personal planning remain. The management team should revisit how they are auditing the quality and effectiveness of personal planning. Plans should be audited more frequently to make sure they are appropriate to the needs of residents and staff.
The new manager had reviewed staff training requirements and identified gaps in training. This is the subject of a separate requirement in this report.
We were satisfied with the way that the service was storing, managing and recording medicines. Following an area for improvement identified at the last inspection the provider had installed an air-conditioning unit in the
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medicine room in Primrose unit. This ensured that medicines were kept in an environment at the correct temperature.
The service had updated and improved its procedures so that records of financial transactions were more clearly recorded. Receipts were used for each financial transaction. However there was room to tighten procedures further by having better records of counter-signatories and regular external checks and reconciliation of residents finances.
We have re-worded this requirement to focus on those areas that remain unmet.
Not met
What the service has done to meet any recommendations we made at or since the last inspection
Previous recommendations
There are no outstanding recommendations.
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 19 Jan 2018 Unannounced Care and support Not assessed Environment Not assessed Staffing Not assessed Management and leadership Not assessed
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Date Type Gradings
13 Sep 2017 Unannounced Care and support 2 - Weak Environment 5 - Very good Staffing 2 - Weak Management and leadership 2 - Weak
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To find out more
This inspection report is published by the Care Inspectorate. You can download this report and others from our website.
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