Tigh-a-Rudha Residential Home Care Home Service
Scarinish Isle of Tiree PA77 6UH
Telephone: 01879 220407
Type of inspection: Unannounced
Completed on: 17 August 2020
Service provided by: Service provider number: Argyll and Bute Council SP2003003373
Service no: CS2003000462 Inspection report
About the service
The Care Inspectorate regulates care services in Scotland. Information about all care services can be found on our website at www.careinspectorate.com
The service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April 2011.
Tigh-a-Rudha Residential Home is owned and managed by Argyll and Bute Council. It is located in the village of Scarinish on Tiree and has very attractive views of the sea towards Mull.
The home is located close to the local shop and the island has a 'dial-a-bus' service for anyone wishing to travel.
The home provides a care service to 12 older people, including respite accommodation. All accommodation is on the ground level and all bedrooms are for single occupancy. Residents have easy access to a well designed and dementia friendly sensory garden for recreation and activity.
The philosophy of the service is: "To provide a caring, comfortable and homely environment where older residents are encouraged, through appropriate support and stimulation to maximise their physical, intellectual, emotional and social potential."
This was a focussed inspection to evaluate how well people were being supported during the COVID-19 pandemic. We evaluated the service based on key areas that are vital to the support and wellbeing of people experiencing care during the pandemic. This inspection was carried out by inspectors from the Care Inspectorate.
What people told us
As part of our inspection we spoke to several relatives and residents as well as external health professionals.
The feedback we received for the service was very good. People were particularly happy with the good relationships between residents and staff and families and felt generally confident about the standard of care.
Comments included: 'Staff are very good at keeping in touch'. 'They are very caring and there is very good communication'. 'I feel very confident that staff know my mum. There is a real warmth about the place'. 'Staff have been tremendous through COVID'.
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 good is our care and support during the 3 - Adequate COVID-19 pandemic?
Further details on the particular areas inspected are provided at the end of this report.
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How good is our care and support during the 3 - Adequate COVID-19 pandemic? 7.1 - People's health and wellbeing are supported and safeguarded during the COVID-19 pandemic.
People who use care services should feel confident their health and wellbeing will be supported and safeguarded during the COVID-19 pandemic. During this inspection we found some strengths that had a positive impact on people's experiences and outcomes and outweighed any areas for improvement.
We saw that staff interacted with residents in a warm and compassionate manner. Residents we spoke to felt safe and relaxed. People told us about the good relationships between staff, residents and families. They also felt confident that staff knew each esidentr very well. We saw several examples of staff using their knowledge of people's life history and preferences to facilitate good outcomes for them. This meant that residents experienced person-centred care in a familiar and homely environment.
Residents benefitted from very good connections with family and friends. Staff found creative ways to support people to stay in touch. This included the use of innovative technology as well as adapting traditional ways to communicate, for example by laminating letters. Families told us that they were kept well informed of the impact of COVID-19 on their relatives in a caring and sensitive manner.
Despite having to spend most of the time in their bedrooms to enable appropriate social distancing, people were regularly engaged and interacted with by staff. Staff also enabled individual residents to make use of the communal spaces whilst ensuring social distancing. Safe garden visits were taking place and the service was also prepared to facilitate individually risk assessed indoor visits in line with current guidance.
Staff were able to demonstrate a good understanding of symptoms associated to COVID-19. The service had very good links with external healthcare professionals. Examples showed that staff responded quickly to individuals' changing healthcare needs, including symptoms associated with COVID-19. People could therefore be confident that COVID-19 symptoms would be identified and appropriate health professionals would be involved to facilitate testing and treatment as needed.
Since our last inspection, the new management team made progress in ensuring that people's personal risk assessments were complete and up to date. This work was based on detailed and regularly updated action plans. However, care plans did not yet always contain regularly evaluated descriptions of people's current support needs and clearly defined personal outcomes. This meant care and support may not be provided in a consistent, outcome focussed way that enabled regular, evidence-based evaluations of the care provided. To support their ongoing improvement work we encouraged managers to develop and implement new and improved quality assurance tools and processes. (See area for improvement 1.)
People should be confident that they will experience very good care in the last days of their life and that their individual preferences were understood and respected. To ensure this we would expect residents to have anticipatory care plans (ACP) in place that contain their individual wishes, needs and preferences. We saw that the service had no ACP in place which meant that people could not be assured of care that reflects their needs and wishes at the end of life. (See area for improvement 2.)
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7.2 - Infection control practices support a safe environment for both people experiencing care and staff.
We evaluated how well infection control practices support a safe environment for people experiencing care and staff. We concluded that there were several important strengths that had a positive impact on people's outcomes, with some areas to consider improving.
We found that the service was clean and tidy. An effective enhanced cleaning schedule was in place and all staff worked together to carry out necessary cleaning and disinfection tasks. This included the cleaning of frequently touched areas at least four times daily and regular deep cleaning of communal areas. Sharing of care equipment was minimised and any shared equipment, like hoists, was cleaned immediately after each use. These infection control practices supported a safe environment for people experiencing care and for staff.
There was appropriate and sufficient ersonalP Protective Equipment (PPE) available. Staff were competent in the use of wearing PPE in accordance with guidance which helped to keep everyone safe. An appropriate number of PPE stations were placed at key locations throughout the service. This made PPE, alcohol-based handrub and waste bins easily available near to the point of use.
Handwashing facilities were available in each bedroom and there was a clearly marked handwashing station in a communal toilet. Staff supported residents with regular hand hygiene. We observed staff undertaking hand- hygiene in line with best-practice during this inspection, helping to reduce the risk of cross contamination. Managers supported this by implementing and encouraging regular peer observations of practice.
There was appropriate separation of clinical and domestic waste. Staff knew what went where and the importance of securing potentially infectious waste, helping to keep everyone safe. Managers had started to make further improvements to the disposal and management of clinical waste prior to our inspection. This meant that the service was in the process of implementing improved, pedal operated clinical waste bins throughout the service.
Regular COVID-19 testing was in place and staff understood the guidance on accessing tests for COVID-19, both for themselves, and those who live in the home.
Staff were routinely wearing their own clothes when working in the service, but also had access to uniforms. We found that the service's approach to wearing and laundering uniforms or staff's own clothes lacked clarity and that this was potentially creating a risk of contamination. We discussed this with managers and encouraged them to clarify and strengthen their policies.
7.3 - Staffing arrangements are responsive to the changing needs of people experiencing care.
Our focus in this inspection area was to evaluate if staff were competent, skilled and knowledgeable to support people in relation to COVID-19. We concluded that there were several important strengths that had a positive impact on people's outcomes, with some areas to consider improving.
It was positive to see that training and guidance in relation to COVID-19 was readily available for staff. Staff told us that they were routinely updated with any changes to guidance and that they felt well informed. We found staff to be very competent and highly motivated to use their knowledge and skills to keep people safe.
Staff demonstrated a high degree of resilience and motivation in the face of the challenges they encountered during the pandemic. This collective effort helped to maintain a high degree of staff continuity which created a
Inspection report for Tigh-a-Rudha Residential Home page 4 of 10 Inspection report safe and familiar environment for people during these unsettling times. Staff told us that they felt well supported by managers.
We found staffing levels were sufficient to meet people's needs. However, the extra demands put on staff by the COVID-19 measures meant that resources were at times stretched. This observation was matched by the managers own assessment. A recruitment process for staff was therefore ongoing. Managers also worked on improved assessment processes for staffing levels, in particular to ensure that there were sufficient esourr ces for social stimulation and activities. Despite the pressures on staff, we found some very good examples of staff using their excellent knowledge of the residents to provide meaningful and person-centred stimulation and activities.
The service had a good track record of effectively working with the provider and other organisations to ensure safe staffing levels. However, we found that the development of formalised contingency plans could still be improved. Managers agreed with the importance of this work, due to the remote location of the service, and aimed to address this as soon as possible.
Areas for improvement
1. The provider should improve the quality assurance systems for care and support plans and other resident related documentation. This should include, but not be limited to:
- The development of effective and responsive audit and measuring tools. - The regular monitoring and analysis of audit results and measurements, leading to regularly evaluated action plans. - The appropriate involvement and engagement of all staff groups and levels with the auditing and measuring processes, outcomes and action plans. - The transparent sharing of key quality assurance data with staff, residents and families. - The appropriate participation of residents, families and external professionals in the quality assurance processes of the service.
This is to ensure 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 implement complete and up to date Anticipatory Care Plans for residents in place that reflects their wishes and where appropriate, those of their representatives.
This is to ensure that care and support is consistent with the Health and Social Care Standards which state that: 'I am supported to discuss significant changes in my life, including death and dying, and this is handled sensitively.' (HSCS 1.7) and '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. (HSCS 1.15)
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What the service has done to meet any requirements we made at or since the last inspection
Requirements
Requirement 1
To ensure stability of care and support the service must be well led and managed. By the 31 December 2019, the provider must ensure sufficient support is put in place to implement the service development plan and provide consistent leadership. This should include, but not be limited to:
- ensuring consistency of leadership; and - ensuring support with the consistent implementation of an agreed service development plan.
This is to ensure care and support is consistent with the Health and Social Care Standards which state that: 'I use a service and organisation that are well led and managed. (HSCS 4.23) and 'I experience stability in my care and support from people who know my needs, choices and wishes, even if there changes in the service or organisation. (HSCS 4.15) and in order to comply with Regulation 3 (Principles) of the Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011.
This requirement was made on 20 December 2019.
Action taken on previous requirement Over recent months the provider made effective and positive changes to the management and leadership of the service to meet this requirement. There was significant and supportive involvement of senior managers that helped to assess the management and leadership needs of the service.
Throughout this process managers engaged positively with staff to ensure their participation and recognise their contribution. The new leadership team worked very effectively together and communicated well with families and external stakeholders.
The implementation of a local operational manager brought regular and consistent leadership presence. Detailed action plans for the development of the service were in place. The new leadership team also had a significant positive impact on the performance of the service during the COVID-19 pandemic and the overall positive outcome of this COVID-19 focussed inspection, we decided to evaluate this requirement and found that it was met.
Met - outwith timescales
Requirement 2
The provider must put in place an effective process to determine staffing decisions including the skill mix, numbers and deployment of staff. The system must demonstrate that needs are met. This should include, but is not limited to:
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- The implementation of a recognised dependency tool which takes into account fluctuating numbers, espiter and medical care needs. - The dependency tools must consider other relevant factors, including feedback, quality assurance data and the mix of staff skills and experience. - The system should be transparent to allow service users and staff to understand the process and to meaningfully participate in it.
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 'I can be meaningfully involved in how the organisations that support and care for me work and develop.' (HSCS 4.6) and in order to comply with Regulation 15 (a) (Staffing) of the Social arC e and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011.
This requirement was made on 20 December 2019.
Action taken on previous requirement The provider has made progress with addressing this requirement and a detailed action plan was in place. This included the assessment of staffing levels. Recruitment too was ongoing to increase resilience and staff continuity and to allow for staffing levels to be more adjustable to individual needs. We did not fully assess this requirement as part of this COVID-19 inspection and will instead follow it up at the next inspection.
Not assessed at this inspection
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 improve the approach to mealtimes in the service. This should include, but not be limited to:
- a review of how the dining room is set up during mealtimes, including table setting and menus, with the aim to make it an attractive and obvious destination point at mealtimes; and - a review of the current staffing arrangements at mealtimes, including available number of staff and deployment during mealtimes.
This is to ensure care and support is consistent with the Health and Social Care Standards which state that: 'If I wish, I can share snacks and meals alongside other people using and working in the service if appropriate. (HSCS 1.36) and 'I can enjoy unhurried snack and meal times in as relaxed an atmosphere as possible.' (HSCS 1.35).
This area for improvement was made on 20 December 2019.
Action taken since then Not assessed at this inspection.
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Previous area for improvement 2
The provider should ensure that residents can access the new secure garden area as independently as possible according to their individual abilities. This should include, but not be limited to:
- ensuring that there are no trip hazards at the garden entrance door; - ensuring that possible solutions for existing trip hazards do not affect the aim of as independent as possible access to the secure garden area; and - ensuring that a handrail is provided at the garden entrance area.
This is to ensure care and support is consistent with the Health and Social Care Standards which state that: 'I can independently access the parts of the premises I use and the environment has been designed to promote this.' (HSCS 5.11) and 'The premises have been adapted, equipped and furnished to meet my needs and wishes.' (HSCS 5.16) and 'If I live in a care home, I can use a private garden.' (HSCS 5.23)
This area for improvement was made on 20 December 2019.
Action taken since then The provider removed the trip hazard at the garden access door. The garden access was easy and safe. We assessed this area for improvement as part of this COVID-19 focussed inspection, because access to the outside, including for garden visits, is essential during the pandemic.
This area for improvement was met.
Previous area for improvement 3
The provider should make improvements to the current care plans and risk assessments. This should include, but not be limited to:
- ensuring that all required risk assessments are completed as scheduled; - defining person-centred outcomes for each plan; and - ensuring that all care plans are regularly evaluated in a meaningful way.
This is to ensure care and support is consistent with the Health and Social Care Standards which state that: 'My personal plan is right for me because it sets out how my needs will be met, as well as my wishes and choices.' (HSCS 1.15) and 'My needs, as agreed in my personal plan, are fully met, and my wishes and choices respected.' (HSCS 1.23)
This area for improvement was made on 20 December 2019.
Action taken since then The provider made progress with improving the care plans and risk assessments. Personal risk assessments were now completed and up to date. This helped to ensure people's safety and to enable staff to produce up to date and responsive care plans that met people's needs. Work on ensuring that all care plans were complete, up to date, outcome focused and regularly evaluated was ongoing and not yet complete.
This area for Improvement was not met and will continue.
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Detailed evaluations
How good is our care and support during the COVID-19 pandemic? 3 - Adequate
7.1 People's health and well being are supported and safeguarded during 3 - Adequate the COVID-19 pandemic
7.2 Infection control practices support a safe environment for people 4 - Good experiencing care and staff
7.3 Staffing arrangements are responsive to the changing needs of 4 - Good people experiencing care
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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.
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.
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Tha am foillseachadh seo ri fhaighinn ann an cruthannan is cànain eile ma nithear iarrtas.
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