Hogganfield ochL Nursing Home Care Home Service Adults 1791 Royston Rd G33 1AF Telephone: 0141 770 9594

Inspected by: Lawrie Davidson

Type of inspection: Unannounced Inspection completed on: 21 March 2013 Inspection report continued

Contents

Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 6 3 The inspection 18 4 Other information 33 5 Summary of grades 34 6 Inspection and grading history 34

Service provided by: Care In The Community Ltd.

Service provider number: SP2003002362

Care service number: CS2003010467

Contact details for the inspector who inspected this service: Lawrie Davidson Telephone 0131 653 4100 Email [email protected]

Hogganfield Loch Nursing Home, page 2 of 36 Inspection report continued

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 2 Weak Quality of Environment 3 Adequate Quality of Staffing 2 Weak Quality of Management and Leadership 3 Adequate

What the service does well Staff were seen to be gentle and caring towards residents. They worked at a pace that suited residents and offered choice in everyday activities such as at meal times. Care was carried in a respectful and dignified manner. The Manager was clearly committed to working with the provider and staff to make the necessary changes to improve overall care delivery in the home.

What the service could do better Not all aspects of the outstanding requirements or areas that had been brought to the service's attention in June/September 2012 had been met by December 2012. These are noted in the report. Amended requirements have been made to take account of work completed by the time of the inspection in December 2012. While it is noted that work has taken place on care planning over this period this needs to be further developed. This is to ensure that care plans and corresponding documentation accurately reflect the up to date needs of esidentsr and how these needs are to be met. The standard of record keeping, including charts, must improve to ensure the service can evidence that staff practice is informed with up to date information about resident needs and how these will be met. Staff competencies have still to be assessed in certain areas and implementation of some polices and procedures has yet to commence. Detailed feedback was given to both the manager and the provider about the improvements that must be made.

Hogganfield Loch Nursing Home, page 3 of 36 Inspection report continued What the service has done since the last inspection While not fully met, progress has been made with the outstanding requirements and training has taken place in a number of areas, including Dementia and Moving and Handling. There has been some redecoration and refurbishment since November 2011.

Conclusion It was clear that some progress had been made in taking forward work that was improving outcomes for service users. There was good evidence to demonstrate the commitment from the manager and the provider to make improvements in the home. Findings from the inspection evidenced that, while staff were seen to be kind and respectful towards residents, the service could not demonstrate adequately how identified needs could be met, how staff competencies were assessed and how ongoing audits influenced staff practice and care delivery to residents, ensuring that their health and welfare needs were being met.

Who did this inspection Lawrie Davidson

Hogganfield Loch Nursing Home, page 4 of 36 Inspection report continued

1 About the service we inspected

Hogganfield arC e Home is privately owned and provides long term care and respite care and support for up to 50 residents.

The home is situated in the North side of Glasgow and has an outlook over Hogganfield oL ch. Local amenities are reasonably close to the home with transport services to .

Accommodation is provided over two levels with communal lounges situated on the ground floor and a dining area and small sitting area on the upper level.

The home has a well maintained, enclosed garden area which is accessible for residents. A conservatory also provides quiet space for residents or for a small number of residents who choose to have their meals in this area.

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

The aims and objectives of the service state that every service user should be "treated as an individual", and receive "the encouragement to attain a high quality life irrespective of their health needs."

Based on the findings of this inspection this service has been awarded the following grades:

Quality of Care and Support - Grade 2 - Weak Quality of Environment - Grade 3 - Adequate Quality of Staffing - Grade 2 - Weak Quality of Management and Leadership - Grade 3 - Adequate

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.

Hogganfield Loch Nursing Home, page 5 of 36 Inspection report continued

2 How we inspected this service

The level of inspection we carried out In this service we carried out a high intensity inspection. We carry out these inspections where we have assessed the service may need a more intense inspection.

What we did during the inspection This was an extensive inspection over a period of time which looked at a wide range and number of policy and practice areas.

This report on Hogganfield oL ch Nursing Home brings together the regulatory activity spanning the period from November 2011 to March 2013. This period covers prolonged inspection activity and completion of complaint investigations. The period also covers enquiry by City of Glasgow Council under Adult Protection procedures into concerns raised by the Care Inspectorate about the management of service users' personal finances. With regard to further action the finding was that no additional measures were required under Adult Support and Protection procedures.

The regulatory activity took this extended period of time due to a number of factors, including dispute of the findings of inspection activity in the period June - September 2012. As a consequence of this ongoing dispute the Chief Executive of the Care Inspectorate requested further regulatory input to the service in December 2012 to measure the health and welfare outcomes for service users . This additional regulatory work focused solely on the meeting of requirements from November 2011 and requirements from complaints investigation up to, but not including, December 2012.

Apart from the inspection of August 2010 when grades of good were achieved Hogganfield oL ch NH has a regulatory history that reflects grades of adequate or below. This has been since the introduction of grades by the Care Inspectorate's predecessor body the Care Commission in 2008. There appear to be issues for the service sustaining improvement in a number of areas of service provision. This will continue to be a key challenge for the provider and manager as the service moves forward. In August 2012 a new manager was appointed. It is noted that the Certificate of Registration has not been updated to reflect this. This will be an action for the Care Inspectorate. It is noted that the new manager has sought to make improvement within the service.

Hogganfield Loch Nursing Home, page 6 of 36 Inspection report continued

The input by the Care Inspectorate has been considerable in this period and has involved Inspection Managers, Inspectors and Advisors in Health and Finance. This report will not report on previous recommendations made to the service in the course of 2011 - 2012, but will concentrate on issues of compliance that currently affect the health and welfare of service users.

There were 13 requirements made for publicly reported regulatory outcomes for period November 2011 to August 2012. The assessment by the Care Inspectorate of the services progress in meeting these requirements are set out below. The detail of each of the requirements and wider related issues and outcomes are reported under each of the themed headings.

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 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

Hogganfield Loch Nursing Home, page 7 of 36 Inspection report continued

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

The requirement The following requirement was made following the inspection in November 2011.

The provider must implement a system which ensures that medication records can be audited. In order to achieve this, the provider must maintain a complete and accurate record of all prescribed medicines, entering, administered and leaving the care home.

This is in order to comply with: The Social Care and Social Work Improvement (Requirements for care Services) Regulations, Scottish Statutory Instruments 2011 No 210: Welfare of users- 4. - (1) A provider must - (a) make proper provision for the health, welfare and safety of service users. The following guidance was taken into account in relation to this requirement: National Care Standards, Care Homes for Older People: - Standard 5 (12) Management and Staffing - Standard 15 (6), (8) Keeping Well Medication. Nursing & Midwifery Council, Standards for Medicines Management (April 2010). www.nmc-uk.org Timescale: within 8 weeks of receipt of this report.

What the service did to meet the requirement This requirement was not fully met and is reported on in Theme 1 Statement 3. A requirement setting out all aspects of improvement required in relation to medication has been made.

The requirement is: Not Met

The requirement The following requirements were made following a complaint investigation. The outcome of the investigation was sent to the provider on 27 August 2012. The provider must ensure that where a resident is regularly refusing medication the service must explore all options available to resolve the issue; this includes care planning and contact with relevant external professionals. A record of action taken must be maintained.

Hogganfield Loch Nursing Home, page 8 of 36 Inspection report continued

This is to comply with The Social Care and Social Work improvement Scotland (requirements for Care Services) SSI 2011 No 210. Section 4.(1a)

What the service did to meet the requirement This requirement was not fully met and information on medication is reported on in Theme 1 Statement 3. A new requirement noting all aspects of improvement relating to medication has been made.

The requirement is: Not Met

The requirement The provider must ensure that a detailed care plan is in place which identifies the support needs of individual residents. This should reflect the involvement of external professionals, family and representatives.

This is to comply with The Social Care and Social Work improvement Scotland (requirements for Care Services) SSI 2011 No 210. Section 5(2).

What the service did to meet the requirement This requirement was partially met. There was evidence of the involvement of external professionals, family and representatives in care planning however the plans were not detailed enough to evidence fully the support needs of residents. An amended requirement has been made taking account of the improvements.

The requirement is: Not Met

The requirement The provider must ensure that staff have the support, advice and training they need to meet the needs of service users.

This is to comply with The Social Care and Social Work improvement Scotland (requirements for Care Services) SSI 2011 No 210. Section 15 (a) and (b)

Hogganfield Loch Nursing Home, page 9 of 36 Inspection report continued

What the service did to meet the requirement We saw that training had been carried out in a number of areas. The aims and objectives of the training and records of what it consisted of was lacking in some areas. It was therefore difficult to know whether the training provided was tailored to help staff meet the health and welfare needs of residents or whether the training was satisfactory but was not being put into practice by staff. Either way the service could not always demonstrate that training had influenced care. In addition it would also be difficult for management to ensure oversight of practice if they were unaware of the content of the training. A requirement about training has been made. The manager acknowledged that assessing staff competencies remained outstanding. We were told that this was in progress and that a director of the company had responsibility for this. Given the findings from the inspection it is essential that this is prioritised in order to ensure that staff are competent to carry out the tasks needed to ensure that residents' needs are being met.

The requirement is: Not Met

The requirement The provider must ensure that all concerns over an individual's nutritional intake are acted upon appropriately. Detailed care planning, involving relevant external professionals, should be implemented as soon as possible with clear guidance and details on how the service will meet the nutritional needs of those involved.

This is to comply with The Social Care and Social Work improvement Scotland (requirements for Care Services) SSI 2011 No 210. Section 4.(1a) and 5 (1)(b)(i)(ii)

What the service did to meet the requirement Food and fluid charts were not always totalled and we did not find any evidence of evaluation of these charts or how they influenced care planning. In noting this we acknowledge that overall care planning and outcomes for residents in nutrition was good. Feedback on a draft nutrition policy was given to the home manager following the inspection. An amended requirement has been made to take account of the improvements made.

The requirement is: Not Met

The requirement The following requirements were made following a complaint investigation. The outcome of the investigation was sent to the provider on 24 August 2012.

Hogganfield Loch Nursing Home, page 10 of 36 Inspection report continued The provider must ensure that medication is managed in a manner that protects the health and wellbeing of service users. In order to do this the provider must: * Ensure that medicines are administered as instructed by the prescriber * Ensure that medicines are available at the due time of administration * Demonstrate that the service review medication in consultation with the GP, service user or their family where it is evident that the prescribed medication is regularly refused or withheld by staff * Regularly review any trigger to documented challenging behaviour * Maintain accurate record of all prescribed items, administered or not administered and leaving the service * Ensure that a copy of this record is kept on the premises for two years from the last date of medicines use on the record, and be able to produce this record if asked by the Care Inspectorate * Demonstrate that staff follow policy and best practice about retention of medication administration records and documentation * Ensure that staff receive training and refresher training appropriate to the work they perform * Improve liaison with the community pharmacist * Ensure that managers are involved in the audit of medication

This is in order to comply with: SSI 2011/28 regulation 4 - requirement for records all service must keep-keeping and SSI 2011/210 regulation 4(1)(a) - requirement for the health and welfare of service users and regulation 15(b)(i) - requirement about training and regulation 19(3)(j) - a requirement to keep a record of medicines kept on the premises for residents .

What the service did to meet the requirement A new requirement setting out all aspects of improvement relating to medication has been made.

The requirement is: Not Met

The requirement The provider must demonstrate that the service has systems in place to ensure that the health needs of individual service users are adequately assessed and met. In order to do this you must: * Demonstrate that staff will contact a General Practitioner (GP) or other relevant healthcare team member when people who use the service require treatment or their health condition is not improving

Hogganfield Loch Nursing Home, page 11 of 36 Inspection report continued

* Ensure that staff have the necessary skills and experience to work in conjunction with external professionals when people who use the service require investigations or monitoring to be carried out * Ensure that staff have the necessary skills and experience to implement recommendations and advice provided by external healthcare specialists * Ensure that planned support is fully implemented for people with specific health needs including medication, tissue viability, weight loss, under nourishment, dehydration and constipation * Ensure that managers monitor and audit health needs robustly

This is in order to comply with: SSI 2011/210 regulation 4(1)(a) - requirement for the health and welfare of service users and regulation 4(2) - requirement about proper provision of adequate services from any health care professional and regulation 9(2)(b) -requirement about fitness of employees & regulation 15(b)(i) - requirement about training.

What the service did to meet the requirement The requirement was partially met. Areas of the requirement not met will be incorporated into a new requirement.

The requirement is: Not Met

The requirement The provider must ensure that the approach to managing falls is improved to keep service users safe. In order to do this the provider must:

* Ensure that falls risk and care planning is accurate, complete and reflects that appropriate advice is sought from health professionals * Ensure that staff are aware of the information contained in Best Practice guidance "Managing falls and fractures in care homes for older people" * Demonstrate that persons employed in the provision of the care service receive regular training appropriate to the work they perform * Improve liaison with specialist practitioners * Ensure that managers are involved in the monitoring and audit of falls and falls prevention.

This is in order to comply with: SSI 2011/210 regulation 4(1)(a) - requirement for the health and welfare of service users and regulation 4(2) - requirement about proper provision of adequate services from any health care professional and regulation 5(1) - requirement for personal plans and regulation 15(b)(i) - requirement about training.

Hogganfield Loch Nursing Home, page 12 of 36 Inspection report continued What the service did to meet the requirement There was evidence that all but one area of the above requirement was met. A falls register had been devised and implemented however it was not completed satisfactorily and there was no action plan arising. As a result we could not be sure that appropriate action was being taken to minimise the risk of falls for identified individuals.

The falls risk assessment was not completed correctly for one resident which meant that the overall assessment was incorrect. In this case the correct score would have resulted in the individual being at high risk of falls. This would have impacted on the type of intervention needed to minimise the risk. As it was, the risk was assessed as "medium" and there was limited guidance for staff in the plan of care. This resident's vulnerability in relation to falls was not being managed satisfactorily. Best Practice Guidance "Managing falls and fractures in care homes for older people" was available to staff.

The requirement was partially met. An amended requirement has been made taking account of the areas met.

The requirement is: Not Met

Hogganfield Loch Nursing Home, page 13 of 36 Inspection report continued The requirement The provider must demonstrate that personal plans records all risk, health, welfare and safety needs in a coherent manner which identifies how needs are met. In order to do this the provider must:

* Ensure that documentation and records are accurate, sufficiently detailed and reflect the care planned or provided * Provide training so that staff are aware of their responsibility in maintaining accurate records, retaining records and follow best practice including NMC guidance * Provide training about the use of healthcare assessment tools including MUST, challenging behaviour and pressure risk assessments * Ensure that staff know policy and best practice * Demonstrate that managers are involved in monitoring and the audit of records

This is in order to comply with: SSI 2011/210 regulation 4(1)(a) - requirement for the health and welfare of service users regulation 5(1) - requirement for personal plans and regulation 9(2)(b) requirement about fitness of employees and regulation 15(b)(i) requirement about training.

What the service did to meet the requirement The requirement was partially met. Areas of the requirement not met will be incorporated into a new requirement.

The requirement is: Not Met

The requirement The provider must put in place and implement a system to demonstrate that the needs of service users are regularly assessed and adequately met. In order to do this you must:

* Develop and implement clear prevention plans to avoid unplanned weight loss, under nourishment, dehydration and constipation * Develop and implement clear treatment plans when people are identified as under weight, malnourished or constipated * Ensure that there is robust monitoring and audit of prevention and treatment plans * Develop and implement policy guidance for the prevention and management of unplanned weight loss, malnutrition and constipation * Demonstrate that the tool to monitor risk of malnutrition (MUST) is used to develop detailed eating, drinking, hydration and nutritional care plans * Ensure that staff have the necessary skills to identify people at risk of constipation, malnutrition, dehydration and weight loss * Ensure that staff receive appropriate training for their role in care, catering or menu planning

Hogganfield Loch Nursing Home, page 14 of 36 Inspection report continued

This is in order to comply with: SSI 2011/210 regulation 4(1)(a) - requirement for the health and welfare of service users and regulation 5(1) - requirement for personal plans and regulation 15(b)(i) - requirement about training.

The requirement was partially met. Areas of the requirement not met will be incorporated into a new requirement

The requirement is Not Met

The requirement

The provider must undertake a review of menus and the mealtime experience to meet needs and avoid unplanned weight loss, constipation, dehydration or malnutrition. In order to do this you must:

* Ensure sufficient choices of of od to help people meet their fibre needs * Consult people about new menus before implementing them * Demonstrate proper provision for people who require a high calorie diet, a modified food textured diet or the management of constipation * Include the detail of all special diets in the individual personal plan and ensure that information is accurate and up-to-date * Ensure the food and fluid provision is planned using best practice guidance and with reference to "Food in Hospitals, National Catering and Nutrition Specification for Food and Fluid Provision in Hospitals in Scotland" (Scottish Government, 2008)

This is in order to comply with: SSI 2011/210 regulation 4(1)(a) - requirement for the health and welfare of service users and regulation 5(1) - requirement for personal plans. The requirement was partially met. Areas of the requirement not met will be incorporated into a new requirement

The requirement is Not Met

The requirement

The service provider must implement a planned and consistent approach to: skin assessment and care; pressure ulcer prevention; wound assessment and management. In order to achieve this you must: * Update and devise the above policies to include NHS Scotland skin care and tissue viability best practice * Implement these policies to ensure that they reflect best practice in relation to a planned and consistent approach to these areas of care * Ensure all registered nurses and care staff are fully conversant with the above policies.

Hogganfield Loch Nursing Home, page 15 of 36 Inspection report continued * Ensure that risk assessment for pressure ulcer prevention is carried out within the timescales stated in the policy guidance * Identify all residents at risk of pressure ulcer development have appropriate plans of care in place and evaluate these plans within agreed timescales * Demonstrate that accurate and relevant care plans are in place to meet the needs of people who require skin care, pressure ulcer prevention, wound assessment and management needs * Ensure that all staff receive refresher training on skin assessment and care and pressure ulcer prevention * Ensure that registered nurses receive further training on wound assessment, management, dressing choice and identifying wound infection * Ensure that individual residents who are assessed as requiring therapeutic equipment for pressure ulcer prevention or treatment receive this timeously as part of their care and treatment

This is in order to comply with: SSI 2011/210 regulation 4(1)(a) - requirement for the health and welfare of service users and regulation 4(2) - requirement about proper provision of adequate services from any health care professional and regulation 5(1) - requirement for personal plans and regulation 15(b)(i) - requirement about training and regulation 19(3)(j) - a requirement to keep a record of medicines kept on the premises for residents.

What the service did to meet the requirement The requirement was partially met. Areas of the requirement not met will be incorporated into a new requirement.

The requirement is: Not 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. A self assessment was requested of the Provider before the inspection in June 2012. This was not submitted. No self assessment was requested before the December 2012 inspection.

Hogganfield Loch Nursing Home, page 16 of 36 Inspection report continued Taking the views of people using the care service into account We spoke with a number of residents during the inspections of June - September 2012 and December 2012 - March 2013. There were mixed views of the service.

Taking carers' views into account We spoke with one relative of a resident in the home in December 2012 who was keen to make her views known to us. They were very complimentary about both staff and the manager. They thought that communication had improved, that staff were respectful of their relative and that overall care had improved since the arrival of the new manager.

Hogganfield Loch Nursing Home, page 17 of 36 Inspection report continued

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: 2 - Weak

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 The inspections of November 2011 and June - December 2012 indicated that there was opportunity to improve service user involvement in areas such as care planning, environment, staffing and management and leadership. The new manager has been meeting with service users and families, has carried out reviews of all service users. The feedback from these is that service users are satisfied and happy with the service they receive. Areas for improvement The service should seek to involve service users much more in all areas. While service users tell us they are happy with their care, this is not the same as being involved in the decision making that can impact on the care of the group of residents or as individuals. The example we would give for this is the provider signing off documentation for service users who do not have capacity, but have family members, and there being no evidence to to show that there has been discussion or decisions about the provider acting on their behalf. This is a significant area of self determination and independence and opportunity to consider service user involvement.

The grade given reflects the work that needs to be carried out to ensure full implementation and sustainability of actions highlighted and any actions put into place by the manager since appointment in August 2012. See requirement 1.

Grade awarded for this statement: 3 - Adequate Number of requirements: 1 Number of recommendations: 0

Hogganfield Loch Nursing Home, page 18 of 36 Inspection report continued Requirements 1. The Provider must ensure that self determination and independence of residents is maintained as far as possible. In order to achieve this the Provider must demonstrate that there are clear mechanisms for involvement in decision making that can impact on the care of the group of residents or of individuals.

This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations, (Scottish Statutory Instruments) 2011 No 210: Regulation 3. The following guidance was taken into account in relation to this requirement: National Care Standards, Care Homes for Older People: Standard 8, Making choices.

Timescale: within 8 weeks of receipt of this report.

Hogganfield Loch Nursing Home, page 19 of 36 Inspection report continued

Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths A requirement was made about care plans in the inspection report of 29 August 2011. At the inspection of November 2011 it was repeated as it had not been met, but improvement was noted. This requirement was again considered in June - September 2012 and found not to have been met. In August 2012 two complaints were upheld. As a result of each complaint, outcome requirements were made in relation to care planning, covering areas such as medication, nutrition, personal finances, falls and skin care. It was expected that, given the detailed feedback and timescales given, this area would have improved to provide better outcomes for services users. In December 2012 we revisited these requirements and found improvement in some but not all areas. It is concerning that despite the detailed feedback the level of improvement has not been either met or sustained.

In December 2012 we observed good practice in moving and handling. The interaction between staff and service users was also noted to be good, with staff responding appropriately, in particular, supporting dignity and choice.

We considered, along with the manager, previous areas of concern in regard to low weight. We were able to see that the manager, on taking up appointment and acting on previous concerns, had sought immediate input from dieticians to assess and support individuals with their nutritional care needs. The Care Inspectorate consider that sufficient improvement has been made in this area.

Requirements about falls were made following the conclusion of a complaint investigation in August 2012. This was followed up in September 2012 and concerns remained. In December 2012 this area was revisited and the Care Inspectorate found evidence of improvement in this area.

Training for staff had taken place in a number of areas including People Handling, Malnutrition Universal Screening Tool, Dementia, Wound Management and Record Keeping.

In June - September 2012 we identified areas of concern around the management of personal finances. We made referral to Glasgow City Council in accordance with our obligations relating to protection of people. A meeting in December 2012 held by Glasgow City Council under Adult Protection procedures, identified ctioa ns the provider was to take in the area of managing the finances and personal assets of service users but concluded there were no Adult Protection issues to be pursued.

Hogganfield Loch Nursing Home, page 20 of 36 Inspection report continued

The findings of the arC e Inspectorate in December 2012 and February 2013 evidence some areas of improvement and other areas that require further attention and development. Areas for improvement While improvement was seen in some areas of care planning and accompanying documentation this was not always sufficient to demonstrate that the individual needs of residents were being met. See requirement 5.

A requirement about medication was made following the inspection of November 2011. A requirement was made following the conclusion of a complaint investigation in August 2012. These were followed up in September 2012 when the Care Inspectorate found evidence of continued poor medications management in the home. In December 2012 we carried out further audit and found some improvement in some areas, but not all. A new requirement has now been made incorporating all of the outstanding areas. See requirement 1.

Requirements about tissue viability were made following the conclusion of a complaint investigation in August 2012. In December 2012 this area was revisited and the Care Inspectorate found insufficient improvement in this area. Training had been completed, however from review of practice and documentation, we concluded that the training was not always being implemented. We were concerned that trained staff did not know the difference between, and therefore the dangers of, applying different systems to measure risk in this area. A new requirement will now be made addressing together all of the outstanding areas. See requirement 2.

We found in September and December 2012 that there were areas where staff training was being carried out and areas where further attention had to be given to support staff. The provider still had to demonstrate that there had been oversight and supervision of staff to assess that they were competent and able to apply training to practice. A new requirement will be made to support this development area. See requirement 3.

Management of personal finances - the findings of the arC e Inspectorate in December 2012 and February 2013 highlighted areas for further improvement such as consideration of the role of DWP appointee to ensure it is limited to managing benefits only. The care home manager has undertaken to make contact with the Mental Welfare Commission to seek support in areas of capacity and the responsibilities of the care home.

Hogganfield Loch Nursing Home, page 21 of 36 Inspection report continued

The provider has agreed to review recording and practice in several areas including * Recording of cash and cheque receipt into the care home * Personal assets, including equipment and personal belongings * Accumulation of personal money to ensure maximum benefit orf service users, including setting up separate interest bearing acconts. A requirement will be made to address this area. See requirement 4.

While good improvement was seen in relation to falls management, one area of the outstanding requirement was unmet. A falls register had been devised and implemented however it was not completed satisfactorily and there was no action plan arising. As a result we could not be sure that appropriate action was being taken to minimise the risk of falls for identified individuals. See requirement 6.

Grade awarded for this statement: 2 - Weak Number of requirements: 6 Number of recommendations: 0

Requirements 1. The provider of the care service must- a. ensure there is sufficient stock available for all medication currently prescribed for each resident b. ensure medication is administered as instructed by the prescriber and in line with the resident's daily routine c. ensure that all medications kept for the use of service users or administered are currently prescribed d. ensure that dispensed medicines are labelled in accordance with the prescriber's written instruction and that there is no ambiguity around the instruction on the prescription, medication record and dispensing label e. ensure that staff have adequate information to allow them to monitor residents' medication and the condition it has been prescribed for. This might include when a medicine is started, who prescribed it, what it is for, where is has to be applied (ointment, eye drops etc), how long it has to be used for, when it should be reviewed, any tests or monitoring needed or if an accompanying behavioural chart, pain chart is needed f. ensure that staff administer medicines in a way that recognises and respects peoples dignity and privacy taking into consideration that there might be other residents and visitors in communal areas. g. ensure that medicines for the use of service users are stored appropriately and securely, protected from light and at the correct temperature

Hogganfield Loch Nursing Home, page 22 of 36 Inspection report continued

h. ensure that staff are following up-to-date best practice, are fully aware of the home's systems for giving medication, know how to store and administer medicines safely, keep accurate medication records, understand the principles of consent and confidentiality, understand their accountability in terms of monitoring medication and ensuring there is sufficient stock and only give medicines which are prescribed for a current condition. i. ensure there are accurate and current records of medicines (including quantity) for the use of service users which are received, carried over form a previous month, administered, refused, destroyed or transferred out of the service. This is in order to comply with: SSI 2011/210 Regulation 4 (1)(a) and (b) and (2) SSI 2002/114 Regulation 19(3)(j) SSI 2011/210 (b) Regulation 15 (b). SSI 2011/210 Regulation 5(1) Timescale: 30 June 2013 2. The service provider must implement a planned and consistent approach to: skin assessment and care; pressure ulcer prevention; wound assessment and management. In order to achieve this the provider must: * Ensure all registered nurses and care staff are fully conversant with the homes' policies on the above. * Ensure that risk assessment for pressure ulcer prevention is carried out within the timescales stated in the policy guidance. * Identify all residents at risk of pressure ulcer development and have appropriate plans of care in place and evaluate these plans within agreed timescales * Demonstrate that accurate and relevant care plans are in place to meet the needs of people who require skin care, pressure ulcer prevention, wound assessment and management needs * Ensure that registered nurses receive further training on wound assessment and management, dressing choice and identifying wound infection * Ensure that relevant health professionals and families are kept informed of any changes in care and progress and that this is documented * Ensure that individual residents who are assessed as requiring therapeutic equipment for pressure ulcer prevention or treatment receive this timeously as part of their care and treatment * Ensure wound care documentation is clear, complete and an accurate record of care is kept * Ensure that the home maintain a medication system for wound care products that is safe, complete and an accurate record of all prescribed wound products received, used and leaving the service

This is in order to comply with: SSI 2011/210 Regulation 4(1)(a) and (2) Regulation 5(1) and 15(b)(i) Timescale: 30 June 2013

Hogganfield Loch Nursing Home, page 23 of 36 Inspection report continued 3. The provider must review staff training to ensure that all staff who require training to fulfil their oler have received training in: Medication Wound management Care Planning. In addition the provider has to demonstrate that there has been oversight and supervision of staff to assess that they are competent and able to apply training to practice. This is to comply with: SSI 2011/210 Regulation 15 (a) and (b) Timescale: 30 June 2013. 4. The provider must develop an action plan designed to address any issues identified by the Adult Protection meeting on 17 December 2012 and regulatory activity for the period of this report. The action plan should cover how the service will maintain robust systems for: * Recording of cash and cheque receipt into the care home * Recording Personal assets, including equipment and personal belongings * Accumulation of personal money to ensure maximum benefit orf service users, including setting up separate interest bearing accounts. This is in order to comply with: SSI 2011/201 Regulation 3 SSI 2011/210 Regulation 4 (1)(a) National Care Standards, Care Homes for Older People: Standard 5 (12) Management and Staffing Standard 8 Making choices Timescale: 30 June 2013 5. The provider must be able to demonstrate how evaluation of care planned and accompanying documents impact on delivery of care. Therefore the provider must ensure that care plans and accompanying documentation are detailed enough to accurately identify the needs of individuals and how these needs will be met. This should include, but not be limited to, risk assessments and food and fluid charts. This is in order to comply with: SSI 2011/210 Regulation 4 (1)(a) National Care Standards, Care Homes for Older People: Standard 6, Support arrangements. Timescale: 30 June 2013 6. The provider must ensure that the falls register is completed satisfactorily and that, where needed, an action plan is put in place, implemented and evaluated. This is in order to comply with: SSI 2011/210 Regulation 4 (1)(a Timescale: 30 June 2013

Hogganfield Loch Nursing Home, page 24 of 36 Inspection report continued

Quality Theme 2: Quality of Environment Grade awarded for this theme: 3 - Adequate

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 strengths under Quality Theme one, Statement one also apply to this statement. Areas for improvement The areas for improvement noted in Theme one, Statement one also apply to this statement.

Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0

Hogganfield Loch Nursing Home, page 25 of 36 Inspection report continued

Statement 3 The environment allows service users to have as positive a quality of life as possible. Service strengths The Care service had undertaken a programme of decoration in the period September - December 2012. This followed detailed feedback about concerns around the quality of the environment, including clutter, décor and access to outside areas. The inspection of December 2012 did not inspect the environment in detail, but we were satisfied from what areas we had access to that the environment was safe and homely. Areas for improvement The care home should to ensure that all the areas of previous concern have been improved and the improvements sustained. This covers, access to outside areas, infection control, malodour, décor and furnishings.

Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0

Hogganfield Loch Nursing Home, page 26 of 36 Inspection report continued

Quality Theme 3: Quality of Staffing Grade awarded for this theme: 2 - Weak

Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service Strengths The strengths noted under Quality Theme one, Statement one also apply to this statement. Areas for improvement The areas of improvement noted under Quality Theme one, Statement one also apply to this statement.

Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0

Hogganfield Loch Nursing Home, page 27 of 36 Inspection report continued

Statement 2 We are confident that our staff have been recruited, and inducted, in a safe and robust manner to protect service users and staff. Service strengths This area was considered in June - September but not in December 2012. In June - September we noted that the provider had checked Personal Identification Numbers (PIN) numbers with the relevant professional bodies and were recording, for reference purposes, the unique number of received Protection of Vulnerable Groups/ Disclosure information. Areas for improvement In June to September 2012 we noted difficulty on the part of the provider in furnishing the Care Inspectorate with information we requested in relation to safe recruitment of staff. We were unsure of the reason for this but would be concerned that this reflects poor access to important information.

From the information received we had some concerns about recruitment processes including * References not always received before staff commenced employment * Incomplete staff files, including information on qualifications and training

These areas are very important and in December we were evidencing poor knowledge by some staff in relation to key areas of their roles. These areas may have been apparent at point of recruitment if all of the recommended safe recruitment practices had been followed. This would have allowed clarity about development needs including training and risk management. See requirements 1 and 2.

Grade awarded for this statement: 2 - Weak Number of requirements: 2 Number of recommendations: 0

Requirements 1. The provider must ensure that staff have been recruited safely and in line with SSSC Codes of practice ensuring that the following records are kept and easily accessible, detailing:

- The full name, address, date of birth, qualifications, training and experience of each staff member - Date of commencement in post and where applicable date of termination of employment of each staff member

Hogganfield Loch Nursing Home, page 28 of 36 Inspection report continued

- Details of each person employed each day in the provision of the service. This should include detail of their role and responsibility and where they have been deployed in the service. - A record of all persons employed, their role and responsibility and the positions held in the provider's organisation. - Any disciplinary action taken against any member of staff and its outcome. - Details of the type and reference number of Disclosure Scotland/PVG check.- Records of the training needs analysis for each member of staff and details of delivery of training.

This is in order to comply with: SSI 2011/28 Regulation 4 (1)(a) Timescale: 30 June 2013 2. The provider must ensure that all staff are suitably qualified and competent to work in the service. The provider must put in place a staff training plan as a matter of priority. This must include: * Mandatory and role specific training * Training that enables staff to meet the needs of the current resident group * Regular evaluation of staff training and practice * A record of each staff members training.

This is in order to comply with: SSI 2011/210 Regulation 15(a) and (b)(i) Timescale: 30 June 2013

Hogganfield Loch Nursing Home, page 29 of 36 Inspection report continued

Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 3 - Adequate

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 strengths noted under Quality Theme one, Statement one also apply to this statement. Areas for improvement The areas of improvement noted under Quality Theme one, Statement one also apply to this statement.

Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0

Hogganfield Loch Nursing Home, page 30 of 36 Inspection report continued

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 The manager was aware that auditing different aspects of care delivery and having oversight of staff practice could enhance the quality of care provided and help reduce the risk of harm to residents.

The manager was aware, and was working towards, improving the overall practice and processes in the care home. She was aware of the importance of this and had demonstrated using external agents such as dieticians, pharmacist and making linkages with other care home managers in the area which will help improve the service. The provider has made improvement since June - September 2012 in areas concerning * Care of service users personal finances * Resident agreements * Purchasing of equipment * Asset register records Areas for improvement The inspection of November 2011 made a requirement under this statement linked to the administration of medication. This requirement was: The provider must implement a system which ensures that medication records can be audited. In order to achieve this, the provider must maintain a complete and accurate record of all prescribed medicines, entering, administered and leaving the care home. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for care Services) Regulations, Scottish Statutory Instruments 2011 No 210: Welfare of users- 4. - (1) A provider must - (a) make proper provision for the health, welfare and safety of service users. The following guidance was taken into account in relation to this requirement: National Care Standards, Care Homes for Older People: - Standard 5 (12) Management and Staffing - Standard 15 (6), (8) Keeping Well Medication. Nursing & Midwifery Council, Standards for Medicines Management (April 2010). www.nmc-uk.org

This requirement has been incorporated in the medication requirement noted under Theme 1, Statement 3.

Hogganfield Loch Nursing Home, page 31 of 36 Inspection report continued

The inspection in June - September which straddled the appointment of the new manager identified a number of areas of concern, which included a previous requirement being outstanding from the November 2011 inspection. In December 2012 we evidenced the efforts the manager was making to improve the service and outcomes for the people who use the service. This is a journey and its success will be dependent on supporting staff in training and implementation of training. There are concerns about the competency of some staff. The quality assurance systems in place will only be effective if the staff themselves understand good and best practice.

The number of unmet requirements and new requirements is not necessarily reflective of poor quality management and leadership, but reflects ongoing issues in the service that are going to take time to implement and see benefit from.

The manager has been asked, and has agreed too, the identifying of, along with Glasgow City Council and Greater Glasgow Health Board, areas of potential risk for any vulnerable service users while improvement is made. This should allow for increased vigilance by all the agencies responsible for care. The improvements to * Care of service users' personal finances * Resident agreements * Purchasing of equipment * Asset register records have been implemented, but this has not been validated, as the timing of implementation has been post 17 December 2012, despite the issues being raised in September 2012. Until full validation has been concluded the grading will remain "adequate".

Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0

Hogganfield Loch Nursing Home, page 32 of 36 Inspection report continued

4 Other information

Complaints This report highlights the follow up to complaints recorded since November 2011.

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

Additional Information The provider and manager have had detailed feedback on all of the areas referred to in the foregoing report and we expect them to be able to evidence major improvement to the delivery of the professional components of the service at the next inspection. We are satisfied that there is very good interaction between staff and service users and that the provider has invested into the service through a refurbishment programme. We are also satisfied that linkages have been made with the necessary external body, Glasgow City Council and they will support individual service users who may be vulnerable during this period of improvement by the care service. This recognises that the improvement will take some time to be fully implemented.

Grading - this takes account of all aspects of service delivery, including consideration of the very good impact the new manager is making, but also reflecting the need orf evidence of actual and sustained improvement in a number of key areas.

It should be noted though that failure to meet or sustain the requirements repeated and or not met may lead the Care Inspectorate taking enforcement action as the service has had sufficient time to implement these.

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 the Care Inspectorate re-grading a Quality Statement within the Quality of Management and Leadership Theme (or for childminders, Quality of Staffing Theme) as unsatisfactory (1). This will result in the Quality Theme being re-graded as unsatisfactory (1).

Hogganfield Loch Nursing Home, page 33 of 36 Inspection report continued

5 Summary of grades

Quality of Care and Support - 2 - Weak

Statement 1 3 - Adequate

Statement 3 2 - Weak

Quality of Environment - 3 - Adequate

Statement 1 3 - Adequate

Statement 3 3 - Adequate

Quality of Staffing - 2 - eakW

Statement 1 3 - Adequate

Statement 2 2 - Weak

Quality of Management and Leadership - 3 - Adequate

Statement 1 3 - Adequate

Statement 4 3 - Adequate

6 Inspection and grading history

Date Type Gradings

10 Nov 2011 Unannounced Care and support 3 - Adequate Environment Not Assessed Staffing 3 - Adequate Management and Leadership 2 - Weak

29 Aug 2011 Re-grade Care and support 1 - Unsatisfactory Environment Not Assessed Staffing 2 - Weak Management and Leadership Not Assessed

6 Jun 2011 Unannounced Care and support 3 - Adequate Environment 3 - Adequate Staffing 3 - Adequate Management and Leadership 3 - Adequate

Hogganfield Loch Nursing Home, page 34 of 36 Inspection report continued

18 Nov 2010 Unannounced Care and support 3 - Adequate Environment 3 - Adequate Staffing 3 - Adequate Management and Leadership 3 - Adequate

17 Aug 2010 Announced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 3 - Adequate

15 Mar 2010 Announced Care and support 3 - Adequate Environment 3 - Adequate Staffing 3 - Adequate Management and Leadership 3 - Adequate

29 Oct 2009 Unannounced Care and support 2 - Weak Environment 2 - Weak Staffing 2 - Weak Management and Leadership 3 - Adequate

22 Apr 2009 Care and support 2 - Weak Environment 2 - Weak Staffing 3 - Adequate Management and Leadership 3 - Adequate

11 Nov 2008 Care and support 2 - Weak Environment 2 - Weak 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.

Hogganfield Loch Nursing Home, page 35 of 36 Inspection report continued

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

Hogganfield Loch Nursing Home, page 36 of 36