Bothwell Castle Care Home Care Home Service
35 Bothwell Road Uddingston Glasgow G71 7HA
Telephone: 01698 622299
Type of inspection: Unannounced
Completed on: 19 September 2019
Service provided by: Service provider number: Bothwell Care Limited SP2018013104
Service no: CS2018365959 Inspection report
About the service
The service has been registered with us since 01 November 2018. This is their first inspection and we have taken into account that they are still a developing service.
Bothwell Castle Care Home is registered to provide a care service to a maximum of 75 older people.
Bothwell Castle Care Home is a purpose-built care facility, situated on Bothwell Road in Uddingston, Lanarkshire. The Care Home forms part of the Bothwell community set back from the main road, with level access to the entrance and grounds. It is situated close to local shops and is easily accessed for visiting purposes. It is arranged over three floors and offers private, spacious bedrooms each with an en suite wet room.
It also provides a choice of lounges and dining rooms, which are decorated to a high specification. Other areas include, a games rooms, reminiscence lounges and a piano bar, as well as, assisted bathrooms. Additional facilities include a cinema, hairdresser with nail bar, a tea room and private dining rooms where families and friends can dine privately with their friends and family.
The service sets out it aims and objectives are "To provide a consistently high standard of kind and compassionate care, designed to meet the individual needs and wishes of each resident. This will be achieved through the involvement of the resident and/or relatives in all stages of care planning, delivery and evaluation, to ensure that the personal needs and wishes of the resident are central and are consistently respected. Care and support will be adapted to support changes in resident needs, choices and decisions to ensure that the resident receives the right support and care at the right time. At Bothwell Castle Care Home, we are fully committed to delivering care and support that promotes the National Care Standards Principles of: Dignity and Respect, Compassion, Be Included, Responsive Support and Wellbeing".
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What people told us
Four residents and 13 relatives returned completed care standards questionnaires, prior to the inspection visit. From these, 17 were overall happy with the care and support provided and one was undecided. We gathered feedback from residents in the service and their families by speaking to people during the inspection. An inspection volunteer was involved in the inspection. An inspection volunteer is a member of the public who volunteers to work alongside the inspectors. Inspection volunteers have a unique experience of either being a service user themselves or being a carer for someone who has used services. The inspection volunteer role is to speak with people using the service being inspected and gathering their views.
People told us that the staff were very caring and that they had a good relationship with them. They told us that they enjoyed meals and that there was plenty to choose from. Comments received included:
- Bothwell Castle care home is as close as I imagine you could get to care for your loved ones as you would yourself. - I could not praise highly enough the respite care for my relative. - My relative has settled in well, enjoys their time there and engages with others. - There's a good programme of events - I am unsure if there are always enough staff - Absolutely delighted with the care our relative receives - I am happy with the care my relative receives and I can leave knowing they are being well looked after. - The home is beautiful and staff are very caring. - The care and attention given to my relative goes far beyond my expectations.
From this inspection we evaluated this service as:
In evaluating quality, we use a six point scale where 1 is unsatisfactory and 6 is excellent
How well do we support people's wellbeing? 3 - Adequate
How good is our leadership? 4 - Good
How good is our staffing? 4 - Good
How good is our setting? 5 - Very Good
How well is our care and support planned? 3 - Adequate
Further details on the particular areas inspected are provided at the end of this report.
How well do we support people's wellbeing? 3 - Adequate
In order to answer this question we considered and evaluated the following Quality Indicators:
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1.1 People experience compassion, dignity and respect - graded as good. 1.2 People have a good quality of life as a result of their care and support - graded as good. 1.3 People's health benefits from their care and support - graded as adequate.
It is important that staff across the home treat residents with compassion, dignity and respect. From our observations of staff, we noted them to have a genuine interest in caring for people. We observed staff speaking to people in a respectful manner. Residents and relatives spoke positively about staff and how kind and friendly they were. We found that residents looked neat, tidy and that time had been taken to make sure that they were well presented. A hairdresser and beauty therapist were available throughout the week for people to attend. Residents were given choices of where to sit, when to get up and how to spend their day.
There should be a clear process in place for staff, to obtain consents from residents and/or their representative around key areas, including the use of photography and the use of equipment that may be considered as restraint. Their legal status should be clearly documented, to ensure that all staff are aware of this, including if any power of attorney is in place. Please see area for improvement 1.
The way people spend their day should promote feelings of purposefulness and wellbeing. There was a weekly activity programme devised by a dedicated activity person. This included in-house activities including, exercise groups, bingo and quizzes. There were visiting activities including arts and crafts, yoga and music therapy, which people told us they enjoyed. The home had links with a local nursery, school and churches which helped keep them part of the community. The home had both a car and a minibus to support people to get out and about.
It is important for residents to enjoy a healthy and balanced diet and have access to plenty of drinks throughout the day. We observed a choice of food to be offered each mealtime for people to select from with alternatives available. Snacks and drinks were served between meals. We observed people who required help to be supported by staff, in an unhurried manner. We received many positive comments about the meals and snacks. We found that the monitoring of those at risk of malnutrition or dehydration needed improved. Please see area for improvement under key question 5.
We looked at how the home managed falls and found that this was an area that needed improvement. Whilst it is recognised that people living in a care home will have more falls than people living at home, strategies should be looked at to reduce the risk of falling on an individual basis and especially after someone sustains a fall. This especially concerned us, for one resident that we had to highlight to management, during the inspection. Please see requirement 1.
We looked at medication management and found that on a day to day basis people could be assured that they were received their medications as prescribed. However, the procedure in place for using 'over the counter' medication, sometimes referred to as 'homely remedies' needed to be improved, as we were not confident that staff had always assured themselves that the medication they administered would not interfere with any existing medicines or medical conditions. Please see area for improvement 2.
We acknowledge that there had been many staff changes over the past few months, which meant that many of the staff were either new or recently returned from a period of absence. We found that this was now settling down and staff were working well together, to put systems in place.
Requirements 1. To ensure that people who have sustained a fall can be confident that the provider has robust systems in place, then the provider must ensure that by 31 December 2019:
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1. They assess a resident's responsiveness and for any injury (including cuts, bruising, deformities or pain) at the time of the fall. 2. Assess level of injury, provide reassurance and take appropriate action (for example, call ambulance/GP/ NHS 24). 3. Ensure ongoing monitoring of the individual as some injuries may not be apparent at the time of fall. 4. Carry out a post falls analysis of this which takes into account why the fall may have occurred and any lessons learned to reduce the risk of this re-occurring.
This ensures that care and support is consistent with the Health and Social Care Standards, which state: 'My care and support meets my needs and is right for me.' (HSCS 1.19). It is also necessary to comply with Regulation 4(1)(a) (welfare of service users) of the Social Care and Social Work Improvement Scotland Regulations 2011.
Areas for improvement
1. The service should ensure that a system is in place to demonstrate that residents and/or their legal representative have consented to certain aspects of their care. This should include the taking and use of photographs and the use of any equipment that could be considered as restraint. This ensures care and support is consistent with the Health and Social Care Standards, which state: 'I am fully involved in developing and reviewing my personal plan, which is always available to me' (HSCS 2.17).
2. The service should ensure that people receive any 'over the counter' medications following best practice guidance and their own Homely Remedy Policy.
This ensures care and support is consistent with the Health and Social Care Standards, which state: 'Any treatment or intervention that I experience is safe and effective.' (HSCS 1.24).
How good is our leadership? 4 - Good In order to answer this question we considered and evaluated the following Quality Indicator: 2.2 Quality assurance and improvement is led well - graded as good.
The manager had been in post since February this year and we commended the work that they had carried out, during a time when there had been significant staff changes along with establishing a new service. A new deputy had now been in post for the past 6 weeks.
People using the service should feel assured that the service has a robust quality assurance system. We found that the service had a system that covered all key areas of the service, including nutrition, skin care and falls. It was reassuring to see that the majority of the areas we identified that could be improved during the inspection, were similar to those highlighted by the service. They were now in the process of devising and working through an action plan to address any areas that could be improved.
The manager had devised a service development plan to look at best way to drive the service forward. However, there were no clear detail of how this was going to be achieved. We asked them to look at ensuring that all action plans detailed timescales for actions to be achieved by, who would be responsible for actions and ensure that this was regularly updated to ensure that it was meaningful.
We found that the service had a system in place for managing complaints and concerns. People we spoke with
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told us that the management team were very approachable and that they would feel at ease to go to them with anything they were worried about.
Staff also told us that the senior staff and management were very supportive and approachable.
How good is our staff team? 4 - Good In order to answer this question we considered and evaluated the following Quality Indicators:
3.1 Staff have been recruited well - graded as good. 3.2 Staff have the right knowledge, competence and development to care for and support people - graded as good. 3.3 Staffing levels and mix meet people's needs, with staff working well together - graded as good.
We received lots of positive feedback from residents and relatives about the staff and we observed many lovely interactions between staff and residents.
We sampled the recruitment process and found that staff had been recruited following best practice guidance. There were a few areas that could be tightened up, including the verification of efr erees and ensuring that interview notes are always dated and signed.
We found that there was a training programme in place for staff, which included both elearning and some face to face courses. This covered a range of topics including moving and handling, fire safety and adult protection. We found that training records for staff needed improved in order that they provided a clear record for each staff member, however, we felt assured that training had taken place. Please see area for improvement 1.
People using the service should feel assured that there are enough staff to support them. We found that the service calculated the dependency of residents against staff hours worked. The feedback we received from residents, relatives and staff was that they felt that there were usually enough staff on duty. Occasionally, at times due to last minute sickness, then staffing could be better. We discussed this at feedback and were assured that all attempt were made to cover staff sickness.
We acknowledge that there had been many staff changes over the past few months, which meant that many of the staff were either new or recently returned from a period of absence. Staff supervision and appraisal are important to discuss competencies, training and provide an opportunity for staff to have protected time to speak with senior staff. This had not yet been fully developed, but the service were now in a good place to put this in place. We will review this at the next inspection.
Staff we spoke with told us that although a lot of the staff were very new, they felt that they were forming a culture of good team working and that they enjoyed being here.
Areas for improvement
1. The service should keep records of the training needs analysis of each member of staff and details of delivery of training. This ensures care and support is consistent with the Health and Social Care Standards, which state: 'I have confidence in people because they are trained, competent and skilled, are able to reflect on their practice and follow their professional and organisational codes.' (HSCS 3.14).
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How good is our setting? 5 - Very Good In order to answer this question we considered and evaluated the following Quality Indicator: 4.2 - The setting promotes and enables people's independence - graded as very good.
The home provides a choice of lounges and dining rooms, which are decorated to a high specification. Other areas include, a games rooms, reminiscence lounges and a piano bar, as well as assisted bathrooms. Additional facilities include a cinema, hairdresser with nail bar, a tea room and private dining rooms, where families and friends can dine privately with their friends and family.
We spoke to residents and relatives during the inspection, who told us how they enjoyed using the various areas in the care home.
People using the service should be assured that the environment is kept clean and odour free. We found the home to be overall clean, tidy and free from offensive odours. However, some areas could have been cleaner especially the servery and sluice areas. We discussed these with the manager and felt assured that this would be addressed.
We observed residents to be able to move freely around the service, to use the various areas of the care home. The gardens provide a very good space for people to have a walk round, with plenty of seating and tables. They could be easily accessed from the ground floor lounge/dining area. Residents who live on other floors have access to fresh air too by accessing their balcony area.
We found that people were supported to get out and about by using the home's private car or minibus. There were also some shops within a very short walking distance that residents could visit.
How well is our care and support planned? 3 - Adequate In order to answer this question we considered and evaluated the following Quality Indicator: 5.1 - Assessment and care planning reflects peoples' needs and wishes - graded as adequate.
Residents should be confident that their care plans give clear direction on how to deliver their support and that they are reviewed and updated, when there are any changes in their health or circumstances. We sampled these across the service and found that this was an area that needed significant improvement, to ensure that they contained enough information to guide staff on how best to care and support each person. This is especially important as they currently have many new staff and are using some agency staff who may not know everything about each resident, therefore rely on care plans to provide this. Please see requirement 1.
We looked at six monthly reviews and found that whilst these provided an overview of the person's health, we have asked the service to look at using the review as an opportunity to set goals for the next six months, which may not necessarily be health related, but more related to hobbies and interests.
Each resident had individual supporting documents that had been identified to be completed by staff each day to ensure that all aspects of their care and support were monitored, this included those who were are risk of malnutrition and poor oral hygiene. We also sampled the charts used to record the administration of topical medications, like creams and ointments. We did not find that these were being completed consistently by staff and that there was a lack of monitoring of these on a daily basis. Please see area for improvement 1.
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Requirements
1. To ensure that people are supported with all aspects of their life, the provider must ensure that there are comprehensive personal plans in place, by 31 December 2019, to guide staff on how to care and support each person. This ensures care and support is consistent with the Health and Social Care Standards, which state: "My personal plan (sometimes referred to as a care plan) is right for me because it sets out how my needs will be met, as well as my wishes and choices" (HSCS 1.15). It also complies with Regulation 5(2) of the Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI2011/210).
Areas for improvement
1. The service should ensure that all daily record charts including, but not limited to, TMAR (topical medication administration records), food and fluid charts, are recorded contemporaneously. This ensures that care and support is consistent with the Health and Social Care Standards, which state: 'My care and support meets my needs and is right for me.' (HSCS 1.19).
Complaints
There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at www.careinspectorate.com.
Detailed evaluations
How well do we support people's wellbeing? 3 - Adequate
1.1 People experience compassion, dignity and respect 4 - Good
1.2 People get the most out of life 4 - Good
1.3 People's health benefits from their care and support 3 - Adequate
How good is our leadership? 4 - Good
2.2 Quality assurance and improvement is led well 4 - Good
How good is our staff team? 4 - Good
3.1 Staff have been recruited well 4 - Good
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3.2 Staff have the right knowledge, competence and development to care for 4 - Good and support people
3.3 Staffing levels and mix meet people's needs, with staff working well 4 - Good together
How good is our setting? 5 - Very Good
4.2 The setting promotes and enables people's independence 5 - Very Good
How well is our care and support planned? 3 - Adequate
5.1 Assessment and care planning reflects people's planning needs and 3 - Adequate wishes
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To find out more
This inspection report is published by the Care Inspectorate. You can download this report and others from our website.
Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and help services to improve. We also investigate complaints about care services and can take action when things aren't good enough.
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