Drumry House Care Home Service Adults 40 Kinfauns Drive G15 7TS Telephone: 0141 276 1814

Inspected by: Julia Bowditch Type of inspection: Unannounced Inspection completed on: 30 July 2012 Inspection report continued

Contents

Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 12 4 Other information 28 5 Summary of grades 29 6 Inspection and grading history 29

Service provided by:

Service provider number: SP2003003390

Care service number: CS2003001030

Contact details for the inspector who inspected this service: Julia Bowditch Telephone 0141 843 6840 Email [email protected]

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Summary

This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection.

Grades for this care service may change after this inspection following other regulatory activity. For example, if we have to take enforcement action to make the service improve, or if we investigate and agree with a complaint someone makes about the service.

We gave the service these grades Quality of Care and Support 4 Good Quality of Environment 4 Good Quality of Staffing 5 Very Good Quality of Management and Leadership 5 Very Good

What the service does well People who use this service and their carers are happy with the standard of care and speak highly of the staff who provide it. Staff are motivated and skilled and committed to providing good care to each service user. They know service users and their needs well and support them in a friendly and caring way.

There are good systems in place to monitor quality in all areas of the service.

What the service could do better The room for storing medicines must be kept at an appropriate temperature.

The service needs to continue to consider ways to make the environment more suitable for people with dementia.

What the service has done since the last inspection The service has worked to improve its approach to service user and carer participation since the last inspection. Regular service user and carers meetings are now being held.

Staff are continuing to develop the new care plans introduced by the provider for all service users.

Drumry House, page 3 of 31 Inspection report continued A new medication system has recently been introduced.

Some improvements have been made to the garden and grounds of the home and funding has been secured to develop this further.

Conclusion The changes that the temporary manager has made in this service since the last inspection have been positive for both staff and service users. Staff we spoke to feel that they are now being given more responsibility and more opportunities to develop professionally.

Who did this inspection Julia Bowditch

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1 About the service we inspected

The Care Inspectorate regulates care services in . Prior to 1 April 2011, this function was carried out by the Care Commission. Information in relation to all care services is available on our website at www.scswis.com. This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April 2011.

Requirements and recommendations If we are concerned about some aspect of a service, or think it needs to do more to improve, we may make a recommendation or requirement.

- A recommendation is a statement that sets out actions the care service provider should take to improve or develop the quality of the service based on best practice or the National Care Standards.

- A requirement is a statement which sets out what is required of a care service to comply with the Public Services Reform (Scotland) Act 2010 ("the Act") and secondary legislation made under the Act, or a condition of registration. Where there are breaches of Regulations, Orders or conditions, a requirement may be made. Requirements are legally enforceable at the discretion of the Care Inspectorate.

Drumry House is a care home for older people. The service is provided by Glasgow City Council and provides care to a maximum of 41 frail older people and also houses a unit for up to 11 older people with dementia, three of whom are respite service users. During the inspection there were 48 people using the service.

Accommodation is on two levels with a lift or stairs to access the upper floor and is purpose built as a care home. Service users have access to a large dining room, two small lounges, a smoking room, a patio area and a large garden. Smaller seating areas are located throughout the building. The dementia unit has a lounge with a small dining area situated just off the main lounge.

The service aims, "to provide quality, personalised care in a warm homely environment, which promotes privacy, dignity, independence and choice".

Before 1 April 2011 this service was registered with the Care Commission. On this date the new scrutiny body, Social Care and Social Work Improvement Scotland (Care Inspectorate), took over the work of the Care Commission, including the registration of care services. This means that from 1 April this service continued its registration under the new body, Care Inspectorate.

Drumry House, page 5 of 31 Inspection report continued Based on the findings of this inspection this service has been awarded the following grades:

Quality of Care and Support - Grade 4 - Good Quality of Environment - Grade 4 - Good Quality of Staffing - Grade 5 - Very Good Quality of Management and Leadership - Grade 5 - Very Good

This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection.

Grades for this care service may change following other regulatory activity. You can find the most up-to-date grades for this service by visiting our website www.careinspectorate.com or by calling us on 0845 600 9527 or visiting one of our offices.

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2 How we inspected this service

The level of inspection we carried out In this service we carried out a low intensity inspection. We carry out these inspections when we are satisfied that services are working hard to provide consistently high standards of care.

What we did during the inspection We wrote this report following an unannounced inspection. The inspection was carried out by one Inspector Julia Bowditch and was started on 4 July 2012 between the hours of 9:45 am and 4:00 pm. We visited between 7:00 pm and 11:40 pm on 17 July to meet night staff and completed the inspection on 26 July between 10:00 am and 4:30 pm. Feedback was given to the Manager and a Senior Social Care Worker on the final day. This report is a summary of the findings.

As requested by us, the care service sent us an annual return. The manager also sent us a self assessment form during this inspection.

In this inspection we gathered information from a number of sources, including the relevant sections of policies, procedures, records and other documents, including:

* the service's most recent self assessment * care plans of people who use the service * minutes of reviews * minutes of service user meetings * minutes of carers' meetings * medication records * accident/incident records * complaints records * minutes of staff meetings * staff training records * quality assurance information * observation of the environment * discussions with various people including the manager, senior social care workers, social care workers, social care assistants, people who use the service and their relatives.

Grading the service against quality themes and statements We inspect and grade elements of care that we call 'quality themes'. For example, one of the quality themes we might look at is 'Quality of care and support'. Under

Drumry House, page 7 of 31 Inspection report continued each quality theme are 'quality statements' which describe what a service should be doing well for that theme. We grade how the service performs against the quality themes and statements.

Details of what we found are in Section 3: The inspection

Inspection Focus Areas (IFAs) In any year we may decide on specific aspects of care to focus on during our inspections. These are extra checks we make on top of all the normal ones we make during inspection. We do this to gather information about the quality of these aspects of care on a national basis. Where we have examined an inspection focus area we will clearly identify it under the relevant quality statement.

Fire safety issues We do not regulate fire safety. Local fire and rescue services are responsible for checking services. However, where significant fire safety issues become apparent, we will alert the relevant fire and rescue services so they may consider what action to take. You can find out more about care services' responsibilities for fire safety at www.firelawscotland.org

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

The requirement The provider must ensure that the temperature of rooms in the home is monitored to ensure that they are adequately heated at all times. This is to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, SSI 2011/210 Regulation 10(2) (c), a requirement whereby a provider must not use premises for the provision of care unless they are fit so to be used.Timescale: Immediately.

What the service did to meet the requirement Improvements have been made to the heating system and the home is now a comfortable temperature. Room temperatures throughout the home are now being continually monitored.

The requirement is: Met

The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: Yes - Electronic

Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. Every year all care services must complete a self assessment form telling us how their service is performing. We check to make sure this assessment is accurate.

We did not receive this self assessment before the inspection began but on our prompting it was submitted before our second visit. There had been an improvement in the quality of information in the self assessment since last year. It contained a range of information most of which reflected what we found on our visits. The service identified what they thought they did well, some areas for development and any changes they planned. The self assessment contained some examples of where strengths have led to positive outcomes for service users and what the service does to bring about improvements or change in people's lives.

Drumry House, page 9 of 31 Inspection report continued Ongoing work on self assessment ought to show more clearly how grades are reached by involving people through the home's participation methods.

Taking the views of people using the care service into account During the inspection we spoke with six people who use this service. We also received 15 completed questionnaires which we had sent out before the inspection. People were generally complimentary about the care they received and the staff who looked after them. Here are some of their comments:-

"I like it here."

"The staff are lovely."

"I hope we get out when the weather's better."

"Need bigger locks on doors as they are too small to turn."

"I am happy with the overall service I receive within the care home. Staff are always kind and considerate to me at all times."

"If I didn't like it here I wouldn't keep coming back."

"The food's lovely. But sometimes we get too much fruit."

Taking carers' views into account During the inspection we spoke with three relatives of people who use this service. We also received four completed questionnaires which we had sent out before the inspection. These are some of the comments we received:

"I have been impressed at the level of care afforded to her (relative). The staff have been great at helping her through, what for her has been, a difficult transition from her own home to hospital to residential care."

"The staff at Drumry House are a great team and my relative's keyworker is an asset worth holding on to. She is good natured, friendly, and knows just how to handle my relative's behaviour."

"Since being refurbished the home is much brighter and more welcoming. It could still do with some work in certain areas."

"Access to the garden is limited due to health and safety reasons - this would be nice to utilise in the summer months."

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"Overall, whilst the building is dated and the décor tired in places, the dedicated staff at Drumry House more than compensate. They are positive, friendly, informative, organised and caring. I wouldn't have my relative anywhere else."

"The staff are fantastic. They keep us informed."

"My wife is settled here."

"My relative has been here about a month and is happy living here."

"I have been to visit on different days and at different times and have yet to see any activities taking place amongst clients. On occasions there are several members of staff sitting in the lounge watching television, when I'm sure they could be interacting with clients."

"Not enough care taken with clients' clothing. Clothes are not always returned to the proper people even although they have their name and room number on them."

"It would be nice to have a garden to sit out in, reason being the care home has not got anywhere suitable for my mother and visitors to sit out and enjoy the good weather."

"There is a lack of organisation with clothes and on numerous occasions people have been seen walking around with my relative's clothes on."

The issues raised by relatives about the garden, activities and laundry were raised at this inspection, and as discussed elsewhere in this report we found that the garden would soon be landscaped, activities had improved and a new laundry system had recently been put in place.

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3 The inspection We looked at how the service performs against the following quality themes and statements. Here are the details of what we found.

Quality Theme 1: Quality of Care and Support Grade awarded for this theme: 4 - Good

Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths Under this statement we gathered evidence relating to participation, for example, people's involvement in their support plans, opportunities for service users and carers to be involved in decisions about how the service is delivered and how staff spoke to and interacted with service users. From the evidence we considered, we found performance by this service to be very good.

The service has worked hard to improve its approach to service user and carer participation since the last inspection. The participation policy had been updated to better reflect how the home involved service users and carers and was displayed in each unit. We had asked the service to do more to encourage participation and saw that there was now a wider range of ways in which people could have their say. These included:

* At a basic level service users had choices in their everyday lives such as when to get up and go to bed, when to have a bath or shower and which of the sitting areas around the home to use. They were free to wander around the unit or stay in their own rooms. Some could leave the unit independently to visit local shops.

* Staff knew service users well and listened to and acknowledged any requests they made and spoke to them in a respectful manner.

* Each unit in the home held its own meetings for service users. This meant that people were encouraged to give their views in a small group by staff who worked with them regularly and knew them well. We saw from the minutes of meetings that people had commented on changes that had been made to the home, for example the small upstairs dining room was now being used and people said that it was quieter and meals were more enjoyable. They were consulted on new furniture and

Drumry House, page 12 of 31 Inspection report continued furnishings. We saw that outings suggested by service users had taken place. People felt that there was a lot more going on around the home.

* Full service user meetings were held monthly and we saw that at a recent meeting people were told about fire procedures and the new care plans, asked for suggestions for outings, and asked for their views on the new menus.

* A social committee of service users, staff and a carer had recently been set up to discuss activities and social events

* Carers meetings were being held regularly and the most recent one was very well attended. We saw from minutes that there was discussion on a range of topics including care, staff training, the environment and health and safety. The manager also informed them of the different ways to make a complaint. Minutes from meetings were on display in the service.

* The service had issued questionnaires to relatives based on the quality themes care and support, environment, staffing and management and leadership. We saw responses from 10 relatives who were very complimentary about all areas of the service.

* Suggestion boxes asking for information to be included in the next newsletter were available throughout the home.

* When service users made comments about the food staff recorded them on menu comments sheets that went to the cook. The cook attended service user meetings to hear what they had to say about the food. He also attended staff meetings to raise any issues about food. We saw that some changes had been made to the menu as a result of people's feedback.

* Information on how to complain was displayed in each unit and in communal areas.

* Service users and carers were involved in developing their own care plans and risk assessments. New care plans developed by the provider for all care homes were currently being introduced. Service users and carers were told about them at their meetings and how they could be involved in ensuring that information in them was person centred and met their needs.

* Six-monthly reviews were planned for each service user. This gave them and their representative the opportunity to regularly discuss their care plan, any concerns they may have and plans for future care. Preparation for reviews was very good - 'residential assessments' completed with service users gave them the chance to give their views and raise any concerns on a one to one basis with their keyworker before the meeting.

Drumry House, page 13 of 31 Inspection report continued Areas for improvement We saw that the opportunities for people to give feedback on the service had led to improvements for service users. Although minutes of service user and carers meetings were displayed on communication boards in each of the units of the home we thought that the service could do more to give them feedback in a format that they could better understand. (See Recommendation 1 under this statement)

We asked the manager to include a date on carers' questionnaires to show when they had been completed.

Feedback from several carers was that there were frequent issues with laundry, for example clothes going missing and service users wearing others' clothes. We raised this with the manager who said that there was a new laundry system which had just been put in place which she hoped would address these issues. We will look at the laundry system more closely at the next inspection.

Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1

Recommendations 1. The provider should look at ways of making information for service users easier to read and understand. National Care Standards Care Homes for Older People, Standard 11: Expressing your views

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Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths Under this statement we focused on the home's approach to the management of medicines, aspects of nutrition and activities that supported people's wellbeing. From this, we found the home overall to have a good performance.

We found that there was good information in care plans about people's health needs. We saw that staff involved a range of healthcare professionals such as GP, district nurse, optician, dentist, chiropodist and dietician to maintain people's health or where there were concerns.

The home had recently changed to a new system for managing medication. Staff received training from the local pharmacy that supplied them with medicines. We found that the home was following good practice in relation to the management of medication. Examples of this included:

* staff checked and photocopied prescriptions before being sent to the pharmacy * Medicine Administration Record (MAR) charts were checked at the end of each shift to ensure that signatures were in place. Changes to MAR charts were recorded with the date and signature of the person making the change * daily checks were made on medication stocks against MAR charts and any discrepancies reported * fridge temperature checks were carried out * Controlled Drugs had dedicated separate lockable storage

In addition to this the manager had begun contacting GPs to discuss annual reviews of medication for each service user, had introduced a system for checking staff competencies in administering medication, and was about to introduce 'protected meal times' which meant that medicines would be given outwith meal times so that people could have their meals undisturbed.

We saw that Adults with Incapacity (AWI), Part 5 Certificates were in place. These are needed to support appropriate decision making for people who have been assessed to lack capacity on health treatments. However associated treatment plans were not in place. (See Areas for improvement below)

Plenty of food and drinks were available during the day including between meals. Fridges in food serving areas were well stocked. People we spoke to told us that they enjoyed the food on offer and could let the cook know if there was anything they didn't like. New menus had recently been introduced which generally offered a good range of options including plenty of fruit and vegetables. These were still being adapted to suit people's preferences. Specialised and fortified diets were provided for

Drumry House, page 15 of 31 Inspection report continued people who required them, for example smooth textured foods for people at risk of choking or high calorie foods for people who needed to put on weight. When we asked some staff about specific service users we found they knew a lot about their individual dietary needs.

There were good systems in place to regularly monitor each person's weight and body mass index (BMI). We found service users were assessed and identified orf the risk of under nutrition using the Malnutrition Universal Screening Tool (MUST). A member of staff within the home had been identified as a MUST champion to take forward the use of the tool with other staff. A MUST nutrition assessment was carried out within 48 hours of each person being admitted to the home. Where there were concerns a nutrition plan was put in place to direct staff on how to meet people's nutrition needs. The service worked closely with the dietician and GP where there were concerns about a person's weight. There was good communication with the kitchen. The cook had a copy of MUST assessments and nutrition plans and provided individual or modified diets where required.

The service had made good efforts to ensure that people had more to do during the day. One television had been removed from part of the lounge so that there was an area for quieter activities like reading and board games. Service users now had their morning, afternoon and evening snacks in the dining room. The manager said that this got people moving instead of sitting all day. People told us they liked it as they could sit and have a chat. One member of staff had been identified as the entertainments organiser and arranged social events including the bus runs that some people had been on. We observed a bar night that was held twice a week where service users appeared to be enjoying singing, dancing and interacting with staff. Cream teas, film nights and bingo nights were also held frequently. The overall impression was that people were kept quite busy and joined in activities if they wished to. Areas for improvement The medical room where medication was stored was very warm. There were no records to show that temperatures were being monitored. (See Requirement 1 under this statement)

Although staff had received training in medication from the provider not all had been trained in the new medication system. (See Recommendation 1 under this statement)

It was good that there were medication care plans in place which listed the medication people took, the dose and how it was to be administered but in the ones we looked at there was information missing such as side effects, the date the medicine was started and a date for review. These details should be included so that staff have all the information they need to support people with their medication. (See Recommendation 2 under this statement)

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We highlighted the need to have associated treatment plans to support medical treatments for individuals as part of AWI (Part 5). Information on this can be accessed on the Mental Welfare Commission for Scotland website. The manager had begun to follow this up with GPs.

Since the last inspection night staff had begun administering evening medication at the start of their shift at 10pm. We were told that sometimes they had to waken service users to give them their medicine. The manager recognised the need to look at the needs of each individual and to ensure that people who went to bed early received their medication earlier. There had been discussions about lockable space for medication in individual rooms which would help with this. Also, during the inspection we observed one or two service users asleep in chairs in the lounge area late at night and wondered if they would have preferred to go to bed earlier if assistance had been offered had night staff not been busy administering medication. We have asked the manager to monitor this to ensure that night time duties are not affecting people's preferred bed times. (See Recommendation 3 under this statement)

Although a MUST champion had been identified orf the home and could talk knowledgeably about the MUST nutritional screening tool they had not yet received formal training in its use. (See Recommendation 4 under this statement)

We discussed with the manager ways of keeping service users occupied further by involving them in everyday living tasks such as folding laundry and setting tables for meals.

Grade awarded for this statement: 4 - Good Number of requirements: 1 Number of recommendations: 4

Requirements 1. The provider must ensure that the temperature of the medical room where medication is stored is monitored to ensure that it is suitable for the storage of medication.

This is to comply with SSI 2011/210 Regulation 10(2) (c), a requirement whereby a provider must not use premises for the provision of care unless they have adequate and suitable ventilation, heating and lighting.

Timescale: Immediately on receiving the final eportr

Recommendations 1. All staff who administer medication should receive training in the system recently introduced into the service.

Drumry House, page 17 of 31 Inspection report continued National Care Standards Care Homes for Older People, Standard 5: Management and Staffing Arrangements 2. Medication care plans should be completed in full. National Care Standards Care Homes for Older People, Standard 5: Management and Staffing Arrangements 3. The manager should review medication times for all service users to ensure that they meet individual needs. National Care Standards Care Homes for Older People, Standard 5: Management and Staffing Arrangements 4. Staff should receive training in the use of the Malnutrition Universal Screening Tool (MUST). National Care Standards Care Homes for Older People, Standard 5: Management and Staffing Arrangements

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Quality Theme 2: Quality of Environment Grade awarded for this theme: 4 - Good

Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the environment within the service. Service strengths The performance for service user involvement under this statement was found to be very good. The evidence relating to this has been included under Quality Theme 1, Statement 1.

Also, at a recent carers' meeting carers had been updated on plans for the garden. A donation had been received that meant the grounds could be landscaped to make a sensory garden for service users and their carers to sit in. Areas for improvement Areas for improvement under Quality theme 1, Statement 1 in this report, also apply to this statement.

Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0

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Statement 2 We make sure that the environment is safe and service users are protected. Service strengths We found performance by this service to be good in the areas we looked at under this statement which included the requirement we made at the last inspection.

The home had a secure door entry system that allowed staff to control who had access to the building. Staff now had identity cards and visitors to the home had to sign in. There was a CCTV system which had recently been updated where staff could see the grounds and who was approaching the home.

Service users' bedrooms were clean and fresh and contained personal items of their own choice. On our walkround of the home we found that the general cleanliness was good and the home was warm. The problems with the heating identified at the last inspection had been resolved. The requirement we made has now been met. The manager continued to meet regularly with domestic staff and their supervisor so that the cleanliness of the home would be regularly monitored.

We saw that the provider had introduced a Safeguarding Plan in its Older People and Physical Disability services "to learn to manage challenges safely and provide a quality service which supports vulnerable people". The manager had recently completed a questionnaire under topics such as Adult Support and Protection, complaints, staff practices, falls, policies and procedures, residents' finances and staff training, which had been compiled into a Safeguarding Plan for the service where issues were identified and an action plan to address them was developed.

All staff had received training in Adult Support and Protection and those we spoke to were confident about what to do if they suspected abuse.

The service kept a record of any significant occurrences, for example incidents and accidents, and we saw that there was good follow-up which was also recorded, for example updated care plans and risk assessments. This helped to make staff aware of the actions that had been taken and therefore minimise the risk of them happening again.

The person responsible for maintenance in the home showed us the system for identifying, recording and ensuring that repairs were carried out. To help to keep the home in good repair there was a daily, weekly and monthly schedule of checks to be carried out including fire checks, water temperatures, premises and equipment checks (for example hoists).

Personal risk assessments and fire risk assessments were in place for each service user and reviewed regularly.

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There were some good adaptations to the environment to make it more suitable for people with dementia. Signage had been improved and there was good orientation around the time of day by setting tables for meals. We saw that different coloured table cloths were used for lunch and dinner in the dementia unit to give visual clues of the time of day. In all dining areas there were menus on tables and information on the date and activities that were planned for that day to remind people what was available. It was good that these were pictorial and used large print. Also in the kitchen area in the dementia unit there were glass doors on cupboards and fridge so that people could see the contents. There were plans to use photographs on bedroom doors to help people identify their own rooms. Areas for improvement While we saw that the service had made some improvements that benefited people with dementia we thought that more could be done especially outwith the dementia unit as we were told that there were service users in other units who also had varying levels of dementia. We therefore recommend that the manager carry out an audit of the environment using a dementia audit tool such as the one from Stirling University on all areas of the home that people with dementia use. (See Recommendation 1 under this statement)

Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1

Recommendations 1. An audit of the environment should be carried out to ensure that all units are in line with best practice for dementia care environments. An example of guidance on a tool for this can be found at: http://dementia.stir.ac.uk/ consultancy_design_audit. In addition the manager and staff should become familiar with 'Promoting Excellence: A framework for all health and social services staff working with people with dementia, their families and carers' and 'Standards of Care for Dementia in Scotland' (found at http://www.scotland.gov.uk). National Care Standards Care Homes for Older People, Standard 4: Your environment

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Quality Theme 3: Quality of Staffing Grade awarded for this theme: 5 - Very Good

Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service Strengths The performance for service user and carer involvement under this statement was found to be very good. The evidence relating to this has been included under Quality Theme 1, Statement 1.

In addition to this we saw that the home had a system where concerns raised by carers were addressed with staff in supervision or additional development meetings. Areas for improvement Areas for improvement made under Quality Theme 1, Statement 1 in this report also apply to this statement.

Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0

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Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths We considered the performance of the service to be very good in the areas we looked at under this statement. We looked at evidence relating to the quality of staff training, supervision and team meetings. We also observed staff practices and spoke to staff about their work.

We observed motivated and skilled staff working in the home. There was good interaction between staff and service users and this provided service users with a relaxed and supportive environment. Service users and carers spoke positively of the staff who provided the care they or their relative received. (See sections on service users' and carers' views in this report)

We saw that staff received regular one to one supervision with their line manager where they could discuss and reflect on any service user and practice issues. The service had begun to use behavioural competencies within a Personal Development Plan (PDP) to assess staff performance on areas such as communication, influencing and initiative. Staff were required to carry out a self assessment and reflect on an area of their own practice. The use of competencies within staff supervision and appraisal processes is relatively new and is recognised as being effective in promoting professional development.

Team meetings and management meetings were held regularly. We saw from minutes of these meetings that good information sharing and discussions on work matters took place. Staff were clearly given opportunities to have their say on the topics discussed. We saw that unit specific staff meetings erw e also being held which gave good opportunities for staff to discuss particular service users and practice issues in each unit.

An annual training plan was in place for care staff. Examples of training available were care planning, Adult Support and Protection, medication and PDP. All staff were up to date with mandatory training including fire safety, moving and assisting and managing health and safety. Good progress was being made on staff obtaining qualifications suitable for registration with the Scottish Social Services Council (SSSC), the body responsible for registering staff who work in social services and regulating their education and training. The majority of staff had completed SVQ level 3 and managers had commenced or completed SVQ4 and where appropriate the Registered Managers Award. Staff had received packs to complete applications to register with the SSSC.

A strength in this service was that they had a member of staff trained as a trainer for

Drumry House, page 23 of 31 Inspection report continued dementia. Also four staff had so far completed the distance learning dementia awareness course run by the Dementia Unit at Stirling University and two were currently working on it. This showed a commitment by the provider to ensure that staff in this service were appropriately skilled to support people with dementia.

As described elsewhere in this report individual staff were given responsibility for areas of practice such as activities, nutrition and dementia which was positive for the service as well as their own development.

We observed a staff handover and heard very good person-centred information about service users being passed from one shift to the next. Handovers ensured that all staff were kept up to date with service and service user issues. Areas for improvement Although team meetings were held regularly minutes did not include 'matters arising' from the previous meeting or an action plan to evidence how issues that had been identified were taken forward. (See Recommendation 1 under this statement)

It would be helpful for staff development for there to be a resource of best practice documents available to staff to easily access information that would help them in their work. This should include the documents on good practice in dementia such as the publications on dementia - 'Promoting Excellence: A framework for all health and social services staff working with people with dementia, their families and carers' and 'Standards of Care for Dementia in Scotland' (found at http://www.scotland.gov.uk).

Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1

Recommendations 1. An action plan should be developed showing what has been decided at staff meetings. Also matters arising from the previous meeting should be identified and recorded in the minutes. National Care Standards Care homes for older people Standard 5: Management and staffing arrangements

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Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 5 - Very Good

Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the management and leadership of the service. Service strengths The performance for service user and carer involvement under this statement was found to be very good. The evidence relating to this has been included under Quality Theme 1, Statement 1.

We saw from the minutes of a carers' meeting that the Head of Services would be invited to attend the next meeting to answer any questions about plans for the new care homes being developed by the provider. Areas for improvement The areas for improvement we made under Quality Theme 1, Statement 1 also apply to this statement.

Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0

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Statement 4 We use quality assurance systems and processes which involve service users, carers, staff and stakeholders to assess the quality of service we provide. Service strengths We considered the performance of the service to be very good in the areas of quality monitoring, audit and associated reporting.

Methods of participation highlighted elsewhere in this report have resulted in service users and carers being involved in assessing the quality of service, for example through reviews, questionnaires and regular service user and carers meetings. Staff performance was audited through regular one to one supervision and Personal Development Plans (PDPs). (See Quality theme 3, statement 3 for more information on this)

The manager and senior care workers were visible in this service to observe and monitor staff practice. We saw that practice issues they had identified were raised with staff in supervision. Staff told us that the new temporary manager had made many changes to the service which they considered to be positive. They felt that they received good support from management and that staff morale was good.

At a local level audits were carried out by the manager and senior care workers. These included audits of care plans, medication, finances and the environment. The Safeguarding Plan described in Quality theme 2, statement 2 above was an overall audit of how the service kept people safe.

An external manager had carried out recent audits of care plans, complaints and participation. The manager of this service was making good progress on the points raised in the action plans from these audits. Other areas of the service were to be audited over the course of the year.

Performance Reviews were carried out by external management to monitor and report on aspects of the service. In this service activities, staff supervision and PDPs were the areas that had been reviewed so far.

The manager and senior staff had completed a new computer based management workbook which the provider had introduced as an ongoing monitoring and audit tool. This was a useful tool as it included key information about service users such as risk of falls and weight loss and monitored staff information such as rotas, leave and sickness absence. It also covered staff training to help identify when key training was due. Information in this tool was monitored by the Head of Services who had met with the manager and seniors from this service to discuss it.

The temporary manager had been in this service for a relatively short time and had a

Drumry House, page 26 of 31 Inspection report continued very positive approach to improving the service. It was clear that she and the staff team had worked hard to make the many improvements we have seen since the last inspection.

We spoke to a visiting care manager who was happy with the care provided to people she placed in the home. Areas for improvement We would like to see feedback from external stakeholders, such as visiting care managers and healthcare professionals, on all aspects of the service so that further improvements can be made. (See Recommendation 1 under this statement)

Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1

Recommendations 1. The manager should consider giving external stakeholders, such as visiting care managers and healthcare professionals, the opportunity to feed back on the service. National Care Standards Care Homes for Older People Standard 11: Expressing your views

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4 Other information

Complaints No complaints have been upheld, or partially upheld, since the last inspection.

Enforcements We have taken no enforcement action against this care service since the last inspection.

Additional Information

Action Plan Failure to submit an appropriate action plan within the required timescale, including any agreed extension, where requirements and recommendations have been made, will result in SCSWIS re-grading the Quality Statement within the Management and Leadership Theme as unsatisfactory (1). This will result in the Quality Theme for Management and Leadership being re-graded as Unsatisfactory (1).

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5 Summary of grades

Quality of Care and Support - 4 - Good

Statement 1 5 - Very Good

Statement 3 4 - Good

Quality of Environment - 4 - Good

Statement 1 5 - Very Good

Statement 2 4 - Good

Quality of Staffing - 5 - eryV Good

Statement 1 5 - Very Good

Statement 3 5 - Very Good

Quality of Management and Leadership - 5 - Very Good

Statement 1 5 - Very Good

Statement 4 5 - Very Good

6 Inspection and grading history

Date Type Gradings

8 Feb 2012 Unannounced Care and support 3 - Adequate Environment 3 - Adequate Staffing Not Assessed Management and Leadership Not Assessed

18 Aug 2011 Unannounced Care and support 4 - Good Environment 4 - Good Staffing Not Assessed Management and Leadership Not Assessed

13 Dec 2010 Unannounced Care and support 4 - Good Environment Not Assessed Staffing Not Assessed Management and Leadership Not Assessed

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21 Jun 2010 Announced Care and support 4 - Good Environment Not Assessed Staffing 4 - Good Management and Leadership Not Assessed

21 Jan 2010 Unannounced Care and support 4 - Good Environment 3 - Adequate Staffing 4 - Good Management and Leadership Not Assessed

29 May 2009 Announced Care and support 4 - Good Environment 3 - Adequate Staffing 4 - Good Management and Leadership 4 - Good

11 Nov 2008 Unannounced Care and support 4 - Good Environment 3 - Adequate Staffing Not Assessed Management and Leadership 3 - Adequate

30 May 2008 Unannounced Care and support 4 - Good Environment 3 - Adequate Staffing 3 - Adequate Management and Leadership 3 - Adequate

All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission.

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To find out more about our inspections and inspection reports Read our leaflet 'How we inspect'. You can download it from our website or ask us to send you a copy by telephoning us on 0845 600 9527.

This inspection report is published by the Care Inspectorate. You can get more copies of this report and others by downloading it from our website: www.careinspectorate.com or by telephoning 0845 600 9527.

Translations and alternative formats This inspection report is available in other languages and formats on request.

Telephone: 0845 600 9527 Email: [email protected] Web: www.careinspectorate.com

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