Urray House Care Home Service

Tarradale Gardens Muir of Ord IV6 7SJ

Telephone: 01463 870516

Type of inspection: Unannounced

Completed on: 17 January 2019

Service provided by: Service provider number: Parklands Highland Ltd SP2012011901

Service no: CS2012310891 Inspection report

About the service

This service registered with the Care Inspectorate on 15 July 2013.

Urray House is a new purpose built care home, which is registered to provide a service to a maximum of 40 older people.

The service is situated in the town of Muir of Ord in Ross-shire. All bedrooms are spacious, bright and have private ensuite facilities.

The service is provided by Parklands Highland Ltd

What people told us

The inspection volunteer spoke with four people who used the service and three relatives/carers during the inspection. We also spoke with four people and four relatives/carers. Some of the comments from our discussions were as follows:

- 'It's a lovely home, clean and no smells. I am happy here its a good place to be.' - 'Everything is fine, I have no complaints.' - 'I won't say I enjoy the food, but its adequate.' - 'Staff don't have the time to sit with you.' - 'I am very happy living here and the staff are very kind and caring.' - 'We are well looked after, but the staff are very busy.'

Some comments from relatives/carers were as follows:

- 'It was a lovely place when my relative first came in, but I eelf it has gone down hill lately.' - 'My relative eats well and does get a choice.' - 'I always find my elativer happy and content when I visit.' - 'It is very difficult to get through to the home on the phone. It quite often doesn't get answered.' (This was being dealt with at the time of the inspection).

Other comments from our discussions are included in the body of this report.

From this inspection we evaluated this service as:

In evaluating quality, we use a six point scale where 1 is unsatisfactory and 6 is excellent

How well do we support people's wellbeing? 3 - Adequate

How good is our leadership? 3 - Adequate

How good is our staffing? 3 - Adequate

How good is our setting? 5 - Very Good

Inspection report for Urray House page 2 of 17 Inspection report

How well is our care and support planned? 3 - Adequate

Further details on the particular areas inspected are provided at the end of this report.

How well do we support people's wellbeing? 3 - Adequate

We found that in relation to this key question there were some strengths which just outweighed weaknesses.

People who use the service should experience care and support where they are respected and valued.

People who use the service told us that; 'The staff are all very nice and friendly. They will do anything for you. They don't have time to sit and chat with you as they are too busy, but they always tend to your needs.' Another person told us; 'I can get up and go to bed when I want.' Another person told us; 'I am happy here, its a good place to be. I have made friends here.'

During our observations we noted that staff treated people who used the service with respect. They knocked on people's bedroom doors before entering and where people required support with their personal care needs, this was carried out in a compassionate and dignified manner. Some staff had worked in the home for a long time and you could tell that they knew people's needs well.

Staff should have the time to support and care for people and to speak with them.

During one observation we noted that there were three staff in one of the lounges and four people who used the service. During the 45 minutes of our observation it was only one member of staff who was noted to be interacting with the four people. Although the other two members of staff were in the room and were busy completing paperwork they did not participate in any of the conversations with people.

People should be able to choose to have an active life and participate in a range of recreational, social, creative, physical and learning activities every day, both indoors and out.

There were two activities co-ordinators employed in the service. We observed some activities that took place during the inspection. On the first day of the inspection people who used the service and some of their relatives/friends enjoyed an afternoon of musical entertainment. We saw some evidence that activities were planned. There was an activities board in each of the units. Some days activities were displayed on these boards, however, we noted that the boards were not always updated. This meant that people who used the service would have to rely on staff to let them know what was going on in the home each day. We found that the quality of some of the activities could be better. Staff need to ensure that the activities provided are age appropriate and meaningful to those people who are taking part. (See area for improvement 1)

People should be supported to participate as a citizen in their local community in the way that they want.

We saw evidence to support that the local school and nursery came in to the home on a regular basis. We were told that there was not always transport available to support people who use the service to keep links with their local community. Staff felt that people who use the service could make very good use of the local hub if transport arrangements were better. We fed this back to the provider who agreed to look in to how this could be improved.

Inspection report for Urray House page 3 of 17 Inspection report

People who use the service should be able to choose suitably presented and healthy meals and snacks, including fresh fruit and vegetables and participate in menu planning.

The feedback about the quality of the food was mixed. Some people told us it was good and there was always a choice and others told us it was just 'adequate'. Other people we spoke with told us that the menu was 'a bit depressing' and that there should be a lot more fruit and vegetables on offer. There had been a complaint made to the Care Inspectorate since the last inspection in relation to how meals were presented and the choice for those who required their meals to be in a pureed form. We noted that the service had carried out some work in this area and were able to confirm that people were being offered a choice of main course in pureed form. We saw that the food was pureed separately, for example, potatoes, vegetables and mince.

We spent time in the dining rooms in all of the units during the inspection. We found that things ran much more smoothly on the second day of inspection. On the first day there were no menus, no show and tell (visual choice of meal) and no recording of food temperatures before the food was served. This was much improved on the second day of the inspection. However, people who use the service should receive a consistent level of support to ensure that their meal time experience is pleasant and enjoyable. (See area for improvement 2).

We also looked at the food /fluid records for those people who had been assessed as having nutritional and hydration needs. We found that on some days these were very poorly completed. Through observations we noted that people were being offered regular drinks and plenty of support to eat their meals so we felt that this was more a recording issue rather than poor care. (See area for improvement 2 under key question 5 how well is our care and support planned.)

Although we found that some improvements were needed in relation to the dining experience we did observe that the atmosphere in the dining rooms was relaxed and people were supported well to eat their meals. There was no one being rushed and we observed some nice interactions between staff and people who used the service.

People's needs are met by the right number of people

There had been some issues since the last inspection in relation to the staffing levels in the home. We looked at the staffing otasr and we could see many occasions where the shifts were running short of the full compliment of staff. The provider had made efforts to cover shifts with staff from the other Parklands homes, however there were still times where the home was running with less staff than they had assessed as necessary to comfortably meet people's needs. Discussions with relatives/carers confirmed that there were times where there had not been enough staff and people told us that they felt this combined with new staff who lacked experience sometimes impacted on the level of care that was provided to their family member. When we interviewed staff they told us that over the past few months things had been difficult due to being short staffed and they stated that at times they had to prioritise people's care needs over having time to sit and chat or comfort people. People told us that things were now getting better and over the last couple of weeks the staffing levels had improved. The provider had been successful in recruiting carers, nurses and domestic staff. There was a nurse on induction days during the inspection.

A complaint was made to the Care Inspectorate in relation to staffing levels in the home since the last inspection. Although there was evidence to support that there had been some improvement we found that this requirement was still to be fully addressed. (See requirement 1)

People's care and support should meet their needs and be right for them.

Inspection report for Urray House page 4 of 17 Inspection report

There was evidence to support that people who used the service had access to health professionals, for example, GP's, community nurses, dieticians and dentists. We could see that where health professional advice had been sought this was taken on board by the nurses and senior staff and appropriate action taken to support improved outcomes for people.

We looked at the way the service stored, dispensed and recorded medications for those people who were not able to manage their own. We found that there were improvements needed to ensure that any interventions or treatment that people received was safe and effective. (See area for improvement 3)

Requirements 1. By 31 May 2019 the provider must ensure that the individual needs and preferences of people using the service are met in a person centred way. To ensure this the provider must, having regard to the size and nature of the care service, the stated of aims and objectives and the number and needs of service users:- a) ensure that at all times suitably qualified and competent persons are working in the care service in such numbers as are appropriate for the health, welfare and safety of service users. b) ensure that staffing levels take account of the physical, social, psychological and ecrr eational needs and choices in relation to the delivery of care for all individuals, also taking into account the physical layout of the building, staff training and staff supervision needs.

This is in order to ensure that care and support is consistent with the Health and Social Care Standards which states 'My needs are met by the right number of people' (HSCS 3.15) and 'People have time to support and care for me and to speak with me' (HSCS 3.16) and in order to comply with Regulation 4(1)(a) (welfare of service users) of the Social Care and Social Work Improvement Scotland Regulations 2011.

Areas for improvement

1. The provider should involve people, relatives and staff to self evaluate how well the service supports people to achieve their potential. From the self evaluation the provider should plan how they can make improvements, to ensure that people are enabled to experience a range of meaningful activities and opportunities, which promote their wellbeing.

This is to ensure that care and support is consistent with the Health and Social Care Standards which states that, '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.' (HSCS 1.24).

2. The manager should ensure that people who use the service are supported to enjoy their meals in a consistent manner. People should be supported to make a choice in relation to their meal in a way that is appropriate for their individual needs. Where records need to be kept, for example, recording of food temperatures, staff should ensure that they complete these accurately and consistently at each meal time.

This is to ensure that care and support is consistent with the Health and Social Care Standards which state that, 'I can choose suitably presented and healthy meals and snacks, including fresh fruit and vegetables, and participate in menu planning. (HSCS 1.33).

Inspection report for Urray House page 5 of 17 Inspection report

3. The provider must ensure that people are appropriately supported with their medication needs. In particular you must:

a) ensure that people receive their medication as prescribed by their GP. For example, where a medication has been prescribed as being given three times a day, staff should not change this to 'as required' without GP instruction.

b) ensure that where a person has been prescribed 'as required' medication for pain that staff regularly evaluate each medication to ensure that it remains effective.

c) ensure that where staff are administering pain relief medication, in the form of a patch, that they use the recording sheet appropriately and detail where the patch has been sited. This will ensure that the patch does not get sited on the same area within the stated time.

d) ensure that they keep a complete audit trail of all medications stored in the home.

This is to ensure that care and support is consistent with the Health and Social Care Standards which state that, 'Any treatment or intervention that I experience is safe and effective. (HSCS 1.24)

How good is our leadership? 3 - Adequate There were some strengths but these just outweighed weaknesses. Improvements must be made by building on strengths while addressing those elements that are not contributing to positive outcomes for people.

People should be able to use a service and organisation that is well led and managed. There was a new manager in place since the last inspection. There were some mixed views on this change. One person who used the service told us; 'I don't know who the new manager is but the place seems to be well run.' Some of the relatives we spoke with told us that they didn't often see the new manager.

People should benefit from a culture of continuous improvement, with the organisation having robust and transparent quality assurance processes.

We were able to see that some audits had been carried out since the last inspection, however, these were very basic and lacked any evidence of improvements to outcomes for people. The manager told us that she wanted to change the audit template to make them more specific. Through discussion we suggested that the manager should look at improving the audits by looking more at people's experiences, rather than carrying out compliance type audits. (See area for improvement 1)

The manager had been involved in developing an improvement plan for the service. Although we found that this was of good quality and took into account the new Health and Social Care Standards, it was obvious that a lot of the actions had not yet happened. We suggested that the improvement plan should be a 'live' document, specifically orf Urray House and should be regularly evaluated to accurately reflect the service's progress in each of the identified areas. (See area for improvement 2)

We were shown limited evidence of residents, relatives and staff meetings since the last inspection. There had been a meet and greet meeting with the new manager in October 2018, however, there were no minutes available from this.

Inspection report for Urray House page 6 of 17 Inspection report

There had been two staff meetings since August 2018. At both of these meetings there were a lot of issues raised by staff. We were unable to see any follow up to the issues raised. (See area for improvement 3)

Although there appeared to be a lot of issues raised by staff, we were unable to see any evidence of any regular supervision/appraisals being carried out with staff. The provider had carried out an annual review with each member of staff, which they told us they had found very beneficial and that they had felt listened to. The manager needs to progress work to develop and implement a system of supervision and appraisal for all levels of staff in the home. (See area for improvement 4)

Areas for improvement

1. The provider should ensure that work continues to progress the quality assurance systems and processes in the service.

To support continuous improvement the service could look at moving away from visual check list type audits and look more at other aspects of people's experiences.

This is to ensure people's care and support is consistent with the Health and Social Care Standards which state that, 'I benefit from a culture of continuous improvement, with the organisation having robust and transparent quality assurance processes.' (HSCS 4.19)

2. The provider should self-evaluate the quality of the service against the Health and Social Care Standards in order to make and implement a plan which improves outcomes and experiences for people.

3. The provider/manager should ensure that the programme of meetings for people who use the service, their relatives/carers and staff is fully re-instated. This will ensure that all those involved with the service have an opportunity to meet and give their views and feedback on all aspects of the service provided. There should be a written minute of all meetings and where issues are raised, these should be followed up and where appropriate, actions taken.

This is to ensure that care and support is consistent with the Health and Social Care Standards which state that, 'I benefit from a culture of continuous improvement, with the organisation having robust and transparent quality assurance processes.' (HSCS 4.19) and 'I am supported to give regular feedback on how I experience my care and support and the organisation uses learning from this to improve.' (HSCS 4.8)

4. The manager should continue to develop and implement a structured system of supervision and appraisal to support staff's learning and development.

This is to ensure that care and support is consistent with the Health and Social Care Standards 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.' (HSCS 3.14)

How good is our staff team? 3 - Adequate

Inspection report for Urray House page 7 of 17 Inspection report

There were some strengths but these just outweighed weaknesses. Improvements must be made by building on strengths while addressing those elements that are not contributing to positive outcomes for people.

People who use the service should 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.

There was a system of training and development for staff. Some training was through an electronic system (evo learning) and some was face to face training. Staff we spoke with told us that they thought some of the training was very good, however, other courses were of little benefit to them. Staff were asked to write a reflective account after each electronic course to evidence their learning, however, we found that these were very limited in detail and there was no evidence of any evaluation by the management. Further work needs to be carried out in relation to this, to ensure that where training has been provided, there is evidence to support that it has been of benefit to the staff and has improved their practice in all areas of their work. This will support staff to continue to provide a good level of care to people who use the service. (See area for improvement 1)

People's needs should be met by the right number of staff and they should have time to support and care for people and to speak with them.

People we spoke with during the inspection told us that the staff were kind and caring towards their family members. Some relatives/carers told us that they thought that, at times, the home was short staffed and that staff did not have enough time to spend with people.

The service had been through a difficult time since the last inspection and there had been problems with having sufficient staff to cover shifts. The provider had made efforts to organise staff from other homes to help until further recruitment of staff had been completed. Staff told us at this inspection that things were starting to get better and that the provider had changed the staffing structure in the home to include more care hours, where this had been assessed as necessary. There was a requirement made as a result of a complaint since the last inspection and although there was some improvement noted, this was very recent. This requirement will remain in place to allow progress to be monitored in this area. (See requirement 1 under Key Question 1)

Areas for improvement

1. The provider/manager should ensure that where training is being provided for staff that there is an effective system in place to evaluate each training course. This will support staff in their learning and help management to identify both strengths and further areas for improvement in staff practice and ensure that people who use the service continue to receive care that is right for them.

This is to ensure people's care and support is consistent with the Health and Social Care Standards which state 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)

How good is our setting? 5 - Very Good There were some major strengths which supported positive outcomes for people.

People should be able to use an appropriate mix of private and communal areas, including accessible outdoor space, because the premises have been designed or adapted for high quality care and support.

Inspection report for Urray House page 8 of 17 Inspection report

Urray House is a purpose built care home that benefits from three units, which promote small group living. Each unit has its own dining room/lounge area and small server type kitchen. There is a large communal area at the front reception area of the home, where people gather for group entertainment and some activities. There was some very lively musical enterainment on during the inspection and people who used the service and some visitors to the home were noted to be enjoying this.

People who live in a care home should be able to decide on the decoration, furnishing and layout of their bedroom, including bringing their own furniture and fittings where possible.

We saw that people had large bedrooms with pieces of their own furniture and personal items around them. The rooms were large and people could have some say in the choice of soft furnishings.

People who live in a care home should be able to control their lighting, ventilation, heating and security of their bedroom.

There were controls for the lighting in people's rooms at their bedside. Large windows in bedrooms were at an appropriate height that people could open them for fresh air within the limits of the restrictors.

People who live in a care home should be able to access and use a private garden.

There was a large secure garden, which people in one of the units had independent access to. The other ground level unit had a small garden area, which could be accessed from patio doors in the dining area. When weather permitted people were encouraged to use the garden areas of the home. Relatives/carers we spoke with told us that they thought the garden areas of the home were lovely and safe for their family members to make use of when the weather was good.

How well is our care and support planned? 3 - Adequate There were some strengths but these just outweighed weaknesses. Improvements must be made by building on strengths while addressing those elements that are not contributing to positive outcomes for people.

People's needs should be assessed by a qualified person, including other health and social work professionals if required.

When people were admitted into the home the nurses carried out health related assessments. These included mobility, tissue viability, incontinence and nutritional needs. These assessments were mostly very good quality, however the information gathered through these assessments was not always used to develop a person centred care plan.

People's personal plans (sometimes referred to as a care plan) should be right for them as it sets our how their needs will be met, as well as their wishes and choices

We found that most of the care plans we looked at lacked detail in relation to people's preferences, likes and dislikes in some areas of their care needs, especially in relation to personal care, continence management and eating and drinking. We could also see that, for some people, their needs had changed, however, their care plan had not been updated to reflect the changes. We take on board that staffing shortages had impacted on the staff's abilities to complete paperwork, however, everyone agreed that information needed to be current in order for staff to provide care to people at the correct level. There was an area for improvement made in relation to this at the last inspection and it will be repeated in this report. (See area for improvement 1)

Inspection report for Urray House page 9 of 17 Inspection report

We looked at care documents including repositioning charts, food and fluid and records for recording when people had support to apply prescription creams (Tmars). These needed further work as staff were still not consistently completing them. There was an area for improvement made in relation to this at the last inspection and this will be repeated in this report. (See area for improvement 2)

We looked at whether people who used the service received a regular review of their care plan. The manager told us that it was 'a work in progress'.

In the sample of care plans we looked at we could see that some people had a recent review with their family present. The manager needs to develop a review planner, which would show at a glance when people have had, or were due, a review of their care plan. The manager and senior staff need to ensure that when a review takes place, any actions required as an outcome of the review are taken forward.

People's care plans should be updated as a result of the review taking place. This will help to ensure that people continue to receive the appropriate level of care. There was an area for improvement made in relation to this at the last inspection and it will be repeated in this report to allow progress to be monitored in this area. (See area for improvement 3)

Areas for improvement

1. The provider should ensure that work continues on care plans for people who use the service. This is to ensure that each care plan is a current reflection of people's health and wellbeing needs. Care plans should be evaluated regularly, or as necessary where there have been changes to people's health. This will ensure that care plans remain current and people receive care at a level that is right for them.

This is to ensure people's care and support is consistent with the Health and Social Care Standards which state that, 'My personal plan (sometimes referred to as a care plan) is right for me because it sets our how my needs will be met, as well as my wishes and choices.' (HSCS 1.15)

2. The manager and staff should ensure that where someone has been assessed as requiring support to take adequate food and fluids, change their position in bed or apply their prescription creams, that all records in relation to this are completed accurately and consistently in line with the person's planned care.

3. The provider should ensure that people who use the service be offered a regular review of their care plan. Each person should be offered a minimum of two reviews in each year. People who use the service and their relatives/carers should be fully involved in this process where appropriate. Any issues highlighted at the review should be taken forward and the person's care plan updated to reflect any changes.

This is to ensure people's care and support is consistent with the Health and Social Care Standards which state that, 'I am fully involved in developing and reviewing my personal plan, which is always available to me.' (HSCS 2.17)

Inspection report for Urray House page 10 of 17 Inspection report

What the service has done to meet any requirements we made at or since the last inspection

Requirements

Requirement 1

In order to ensure that the individual needs and preferences of people using the service are met in a person centred way, the service provider must, having regard to the size and nature of the care service, the stated aims and objectives and the number and needs of service users:- a) ensure that at all times suitably qualified and competent persons are working in the care service in such numbers as are appropriate for the health, welfare and safety of service users. b) ensure that staffing levels take in to account the physical, social, psychological, ecrr eational choices in relation to the delivery of care for all individuals, also taking in to account the physical layout of the building, staff training and supervision needs.

This is to ensure that care and support is consistent with the Health and Social Care Standards which state that, 'My needs are met by the right number of people.' (HSCS 3.15) and 'People have the time to support and care for me and to speak to me.' (HSCS 3.16) and in order to comply with Regulation 4(1)(a) (welfare of service users) of the Social Car and Social Work Improvement Scotland Regulations 2011.

Timescale for this requirement is 31 October 2018.

This requirement was made on 7 August 2018.

Action taken on previous requirement This requirement was made as the result of a complaint made to the Care Inspectorate in August 2018. The home had been through a period of change since then and recruiting and retaining staff had been difficult. At times, staff from other Parklands homes had been covering shifts. Staff sickness and other staff absences had also had an effect on this. At this inspection we found that things were getting better, however, there were still times where the home was running with less staff than the provider had assessed as necessary to meet people's needs. The manager had been successful in recruiting more staff and some were completing their period of induction, or waiting for the necessary checks to come back prior to starting work.

Not met

Inspection report for Urray House page 11 of 17 Inspection report

What the service has done to meet any areas for improvement we made at or since the last inspection

Areas for improvement

Previous area for improvement 1

The provider should ensure that work continues on care plans for people who use the service. This is to ensure that each care plan is a current reflection of people's health and wellbeing needs. There should be evidence to support that people who use the service, or their families/carers, are fully involved in this process. Care plans should be evaluated regularly, or as necessary, where there have been changes to people's health. this will ensure that each care plan remains the most up to date information and the people receive a level of care that is right for them.

National Care Standards Care Homes for Older People. Standard 6: Support arrangements.

This area for improvement was made on 14 September 2018.

Action taken since then The service was continuing to work on people's care plans. Staff told us that the staff shortages had impacted on their ability to keep the information current in each person's care plan. Where people had health issues, for example, diabetes, pressure ulcers or acute illness, the nursing staff had developed care plans and these were of a good standard. However, we found that a lot of the information, in relation to general pressure prevention, eating and drinking, continence and personal care, was not very person centred and was limited in detail. Work needs to continue in this area to ensure that people's care plans reflect their needs and wishes. This will ensure that they receive the level of care that is right for them. This area for improvement has not been met and will be repeated in this report.

Previous area for improvement 2

The provider should ensure that they re-instate the regular programme of care reviews for people who use the service. Each person should be offered a minimum of two reviews in each year. People who use the service and their relatives/carers should be fully involved in this process where appropriate. Any issues highlighted at the review should be taken forward. Care plans should always be updated as a result of the review taking place.

National Care Standards Care Homes for Older People. Standard 6: Support arrangements.

This area for improvement was made on 14 September 2018.

Action taken since then Some work had been carried out in relation to this area for improvement. We were able to see evidence of some reviews taking place at this inspection. The manager told us it was a work in progress, that they were looking at developing a review planner to record when reviews had taken place and to ensure that plans were made to organise the next one, within the appropriate time scales. This area for improvement has not been fully met and will be repeated in this report.

Previous area for improvement 3

The provider should ensure that care documentation, for example, SSKIN bundles and TMARS's are consistently and accurately kept, in line with people's planned care. There should be a system in place to monitor staff's

Inspection report for Urray House page 12 of 17 Inspection report recording, to enable appropriate action to be taken, where this is assessed as necessary. This is to ensure that people's care needs continue to be met.

National Care Standards Care Homes for Older People. Standard 6: Support arrangements.

This area for improvement was made on 14 September 2018.

Action taken since then We looked at the electronic recordings in relation to people's SSKIN care, for example where they needed support to change their position in bed. We found that these recordings were not consistent and did not reflect people's planned care. Staff need to ensure that where someone's prescription for topical medications (creams) are being copied on to the electronic system, that they input the full details. This will ensure that carers have the full details of what the cream is called, where it is to be applied and how often. This information was not always there in the sample we looked at.

Food and fluid charts were still in written form. On the first day of inspection we looked at these orf the previous week and found them to be of a very varied standard. It looked as if some people's intake was very poor on certain days. This is not what we evidenced when we carried out our observations. We found that this was more of a recording issue rather than a lack of care. Staff need to make improvements in all three of these areas. This area of improvement has not been met and will be repeated in this report.

Previous area for improvement 4

The provider should ensure that staff are given further training/guidance on how to use a pain assessment tool. This will ensure that people with dementia, or communication difficulties and are unable to verbalise that they are in pain, receive appropriate pain relief and will enable staff to evaluate whether it has been effective.

National Care Standards Care Homes for Older People. Standard 15: Keeping well - medication.

This area for improvement was made on 14 September 2018.

Action taken since then We could see that people had a care plan in place for pain and that the Abbey pain scale was was detailed as being used to assess people's pain levels. When we looked at the medication records we were not able to see it being used in practice. This area of improvement has not been met at this inspection and will be repeated in this report.

Previous area for improvement 5

The provider/manager should give consideration to making improvements to the way they provide information to the people who use the service, about the activity provision. The provider/manager should give consideration to providing information about activities in various formats, for example both words and pictures. This would make life easier for those people who live with dementia or have communication difficulties.

National Care Standards Care Homes for Older People. Standard 12: Lifestyle - social, cultural and religious belief or faith.

This area for improvement was made on 14 September 2018.

Action taken since then There were notice boards in all units of the home, which detailed the day's activities and also a weekly activity planner. We did notice that on one day of the inspection the boards were not updated. Staff need to ensure

Inspection report for Urray House page 13 of 17 Inspection report

that the information for people who use the service is up to date so that they can make choices about how they would like to spend their day. This area of improvement has been met.

Previous area for improvement 6

The provider/manager should continue to work through the programme of training for staff. Training should be provided to staff in the following areas. - first aid, fire awareness, tissue viability, recording and palliative care.

All training should be evaluated to ensure that staff practice improves as a result of the training provided.

National Care Standards Care Homes for Older People. Standard 5: Management and staffing arrangements.

This area for improvement was made on 14 September 2018.

Action taken since then Further work was needed to meet this area of improvement. See further details under Key Question 3 - How good is our staff team.

Previous area for improvement 7

The manager should ensure they continue to work on the system of supervison and appraisal. The system should progress until there is a programme in place for all members of staff. Staff should be given the opportunity to meet with their line manager/senior member of staff on a regular basis. Supervision meetings should take account of the staff member's training and development needs within the role they are employed to do and inform the service training plan. A record should be maintained of each and every supervision meeting.

This will support management to identify where staff may need further training or assistance. This will ensure that each staff member is skilled and competent in the work that they do and carry out safe and effective practice.

National Care Standards Care Homes for Older People. Standard 5: Management and staffing arrangements.

This area for improvement was made on 14 September 2018.

Action taken since then This area for improvement had not been met at this inspection. Please see Key Question 2 - How good is our leadership for further details.

Previous area for improvement 8

The provider/manager should continue to develop and implement a quality assurance system to monitor all aspects of the service. It should identify what is working well and what could be done better and should inform improvement plans and improve the quality of experience for people using the service. The provider and manager should continue to work on the identified improvements. This will ensure the health and well being of people using the care service is protected and enhance.

National care Standards Care Homes for Older People. Standard 5: Management and staffing arrangements.

This area for improvement was made on 14 September 2018.

Action taken since then Some work had been carried out in relation to this area for improvement, however there was a lot more improvements to be made. Please see Key Question 2 - How good is our leadership for further details.

Inspection report for Urray House page 14 of 17 Inspection report

Complaints

Please see Care Inspectorate website (www.careinspectorate.com) for details of complaints about the service which have been upheld.

Detailed evaluations

How well do we support people's wellbeing? 3 - Adequate

1.1 People experience compassion, dignity and respect 4 - Good

1.2 People get the most out of life 3 - Adequate

1.3 People's health benefits from their care and support 3 - Adequate

How good is our leadership? 3 - Adequate

2.2 Quality assurance and improvement is led well 3 - Adequate

2.3 Staff are led well 3 - Adequate

How good is our staff team? 3 - Adequate

3.2 Staff have the right knowledge, competence and development to care for 3 - Adequate and support people

3.3 Staffing levels and mix meet people's needs, with staff working well 3 - Adequate together

How good is our setting? 5 - Very Good

4.2 The setting promotes and enables people's independence 5 - Very Good

How well is our care and support planned? 3 - Adequate

5.1 Assessment and care planning reflects people's planning needs and 3 - Adequate wishes

Inspection report for Urray House page 15 of 17 Inspection report

Inspection report for Urray House page 16 of 17 Inspection report

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

Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY [email protected]

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.

Inspection report for Urray House page 17 of 17