Urray House Care Home Service Adults Great Northern Road IV6 7SX

Type of inspection: Unannounced Inspection completed on: 18 November 2014 Inspection report continued

Contents

Page No Summary 3 1 About the service we inspected 6 2 How we inspected this service 8 3 The inspection 14 4 Other information 32 5 Summary of grades 33 6 Inspection and grading history 33

Service provided by: Parklands Ltd

Service provider number: SP2012011901

Care service number: CS2012310891

If you wish to contact the Care Inspectorate about this inspection report, please call us on 0345 600 9527 or email us at [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 5 Very Good Quality of Staffing 4 Good Quality of Management and Leadership 4 Good

What the service does well Urray House is new purpose built care home situated in Muir of Ord. The care home has views across the golf course. There are 34 large spacious bedrooms all with en- suite facilities.

The service users from the original Urray House care home transferred to the new building in June 2014.

Service users and relatives spoken with during the inspection stated that they thought the transfer from the old home to the new one was handled well and that they were kept well informed with the planning of the move.

The staff are friendly, approachable and welcome visitors.

There are good opportunities for residents and relatives to give their views and to be involved in decisions about the day to day running of the home.

The provider and management demonstrated a commitment to making improvements to the quality of the service provided at Urray House.

What the service could do better Care plans need to be reviewed and updated for all service users who are living in the home. These should be a current reflection of service users' individual health and

Urray House, page 3 of 34 Inspection report continued wellbeing needs and how these are to be met with the support of staff. (See statement 1.3)

Every service user should be offered a minimum of two care reviews in each year with family present, where appropriate. (See statement 1.3)

Management and staff practice needs to improve in relation to the dispensing and administering of medications. (See statement 1.3)

Work is needed to improve the documentation in relation to wound management/ pressure care. (See statement 1.3)

The provider needs to look at how meals are served in the dining areas in the home. (See statement 1.3 and 2.2)

Staffing levels in the home need to be maintained at an appropriate level to meet the needs of service users. (See statement 1.3 and 3.2)

The provider should look into ways to improve the environment for those service users who live with dementia. (See statement 1.3)

An appropriate space should be identified orf the storage of moving and handling equipment. (See statement 2.2)

Foot operated bins should be provided for some areas of the home. (See statement 2.2)

Practice needs to improve in relation to the recording of accidents and incidents. (See statement 2.2)

The recruitment process of staff (permanent and volunteers) needs to improve and should follow best practice and the service policy. (See statement 3.2)

Improvements are needed to the system of supervision and appraisal for staff. (See statement 3.3)

Staff should have access to all the service policies. (See statement 3.3 and 4.4)

Improvements are needed in relation to the quality assurance processes in the home. (See statement 4.4)

What the service has done since the last inspection This was the first inspection for this service since they were registered on 15 July 2013

Urray House, page 4 of 34 Inspection report continued Conclusion Urray is a new purpose built care home, which provides comfortable and spacious accommodation for up to 34 residents.

The service welcomes visitors to the home. The manager and staff are friendly and approachable. There are good opportunities for residents and relatives to give their views and to be involved in decisions about the home.

The interaction we saw between the residents and staff was good. We received good feedback about the meals that were provided.

There were several areas where the provider needs to make improvements. Both the provider and management demonstrated a willingness to take appropriate action to make improvements to the quality of service being provided.

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1 About the service we inspected

The Care Inspectorate regulates care services in . Information about all care services is available on our website at www.careinspectorate.com

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

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.

Urray House is a new purpose built care home, which is registered to provide a service to a maximum of 34 older people.

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

The service is provided by Parklands Highland Ltd.

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

Urray House, page 6 of 34 Inspection report continued www.careinspectorate.com or by calling us on 0345 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 after an unannounced inspection that took place on 21 and 22 October 2014 between the hours of 9.30am and 7.30pm. The inspection was carried out by two Inspectors. The inspectors were accompanied by an Inspection Volunteer on the first day of inspection. An Inspection Volunteer is a member of the public who volunteers to work alongside Care Inspectorate Inspectors during the inspection process. Inspection Volunteers have a unique experience of either being a service user themselves, or being a carer for someone who uses, or has used, services. The Inspection Volunteer's role is to speak with people using the service (and potentially their family, carers, friends or representatives) being inspected and gathering their views. In addition, where the Inspection Volunteer makes their own observations from their perspective as a recipient or a carer, these may also be recorded. The Inspection Volunteer spoke with 5 residents and 2 relatives/carers at this inspection. The comments and observations of the Inspection Volunteer have been incorporated in this report.

We gave formal feedback on 18 November 2014. Present at the feedback were the provider, regional manager, manager, one nurse, one senior carer (all Parklands Highland), and 2 representative from NHS contracts.

We issued 15 questionnaires to friends, relatives or carers of people who used the service. Eight completed questionnaires were returned before the inspection.

We issued 15 questionnaires to the service to give to people using the service. Thirteen completed questionnaires were returned before the inspection.

At this inspection we gathered evidence from various sources, including the relevant sections of policies, procedures, records and other documents:

* observing how staff work

* evidence from the service's most recent self assessment

* personal plans of people who use the service

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* training records

* health and safety records

* accident and incident records

* care standard questionnaires that had been completed and returned to us by service users, relatives or carers

* discussions with various people, including:

* relatives and carers of the people who use the service

* the people who use the service

* care staff (including senior carers)

* nurses

* the manager

* the cook

* observation of the environment and equipment.

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.

Urray House, page 9 of 34 Inspection report continued 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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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. The self assessment was completed by the manager and contained good detail of the service strengths and also highlighted areas where the service could improve.

Taking the views of people using the care service into account The Inspection Volunteer spoke with five service users during the inspection. When asked about the care and support they received the following comments were received:

* 'I don't have a care plan that I know of' * 'I don't think I have a care plan

When asked about the quality of care, these were the comments of carers:

* 'The care is generally excellent' * 'We are happy with the care our family member receives'

With regard to food, the Inspection Volunteer received the following comments:

* 'The food is fine' * 'The food is good' * 'The food is not too bad' * 'I don't like semolina' * 'It's good, varied food and you always get a choice'

When asked about activities, service users made the following comments:

Urray House, page 11 of 34 Inspection report continued * 'I'd like to go out to the shinty' * 'I liked seeing the dancers' * 'The exercises sitting down are good'

With regard to their surroundings and the environment of the home, the following comments were made by the service users to the Inspection Volunteer:

* 'I'm happy with the room' * 'It's a comfortable room' * 'The temperature suits me OK' * 'Sometimes it's not warm enough' * 'It's too posh' * 'Yhe rooms are fine' * 'You can bring your own furniture'

When the Inspection volunteer asked service users about the quality of staff in Urray House they gave the following comments:

* 'They are quite alright; I couldn't say a wrong word about them' * 'I don't like telling tales' * 'They are excellent; thoughtful and friendly' * 'They are very short staffed at the moment' * 'They are helpful and will do anything for you; the girls are wonderful' * 'They are alright' * 'There have been a lot of changes'

The following comments were received when service users were asked about the management and leadership of the service:

* 'I think it's well run' * 'The manager is beginning to get on top of the job' * 'I'd speak to one of the nurses if I had a problem or worry' * 'It feels good here'

We received 13 completed Care Standard Questionnaires prior to the inspection. Out of the 13 service users 10 strongly agreed that overall they were happy with the quality of care they received at Urray House and three agreed.

One comments was: "I am very pleased with the staff and care provided. I enjoy all the meals".

Taking carers' views into account When asked about the quality of care, these were the comments of carers:

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* 'The care is generally excellent' * 'We are happy with the care our family member receives' * 'We were involved in a meeting with a social worker about a year ago for our relative' * 'We have had some issues over communication - letting us know when our family member had a visit from the GP'

We received eight completed Care Standard Questionnaires prior to the inspection. The following are some of the comments we received:

"On the whole the home is very well run and good care given. The laundry set up is at times under question" "I cannot fault Urray House for the care and attention my relative receives, and only hope this will continue with Parklands" "The staff are very caring and I commend them"

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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 We found the service's performance to be very good in the areas covered by this Quality Statement. We concluded this after we spoke to the management, staff and people who use the service. We also examined care plans, care and review records, minutes of meetings, and information and feedback from care standard questionnaires.

There was evidence to support that the manager held regular meetings for service users and relatives. There were minutes available and these were displayed in the reception area of the home.

There was a residents' forum meeting held in September 2014 and seven service users attended. These meetings were used to gather suggestions and ideas for the service newsletter and to plan activities and outings.

There was a service newsletter issued in August, September and October 2014.

There was a friends of Urray House and they supported the home by organising some fundraising events, entertainment and some of the parties.

Service users had a care plan in place and there was some evidence of reviews taking place. (This will be discussed further under statement 1.3)

There was a visitors' book which contained some positive comments.

There was a suggestion box at the front reception area of the home.

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There was evidence to support that the service users and their relatives had been kept well informed during the move from the old care home to the new Urray House. Relatives that we spoke with told us that the communication between them and the home was good.

Service users and relatives told us that before moving in to the new home, there had been some involvement with choosing rooms, flooring and some of the soft furnishings. Areas for improvement The manager should give consideration to issuing a questionnaire to service users and relatives now that they have settled in to the new home to gain their views and suggestions on how they think things could improve.

The manager needs to look for various ways in which the people who use the service and their relatives can be involved in assessing and improving the quality of care, environment, staffing and management and leadership.

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

Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths We found the service's performance to be adequate in the areas covered by this Quality Statement.

We concluded this after we spoke with people using the service and relatives, carried out observations in all areas of the home, examined policies and procedures, service users' care plans and other associated care documentation.

The service employed Registered General Nurses (RGN's) and they worked in the home during the day and operated an on call service at night. These nurses attended to any nursing needs for service users who were assessed as requiring nursing care. The responsibility for carrying out nursing tasks with service users who had been assessed as being residential, was still with the community nurses.

There were some polices in place for staff guidance and service provision. (See statement 4.4 for further details)

Urray House, page 15 of 34 Inspection report continued Service users had a care plan in place and some of the 'getting to know me' information supplied by families was very good. (See areas for improvement)

There was some evidence of reviews taking place for service users. (See areas for improvement)

There was some information held in care plans in relation to service users who had been assessed as high risk of developing a pressure ulcer. (See areas for improvement)

Menus were planned in advance and we could see that these included red and white meats, fish, fruit and vegetables. There was good feedback about the meals from service users. We could see that service users could choose to eat in the communal dining areas or in their own rooms if they preferred.

We saw evidence that service users were offered support to eat their meals where necessary. Where support was being offered this was carried out by staff in a dignified and respectful way.

There was evidence of support from other health professionals where necessary, for example, GP's, dietician, community nurses etc.

We looked at the medication system and there was some good practice noted and also areas where improvements were needed. (See areas for improvement)

Staff were noted to be very kind and caring towards service users at all times. Areas for improvement Care plans - We looked at a sample of care plans and found that in all of these some of the information was out of date. Through progress notes we could see that there had been changes to service users' health needs e.g. pressure care, behaviour, restraint issues etc. however care plans had not been updated to reflect any of these changes. When we discussed this with staff they agreed that the current information would be found in the care plan progress notes rather than in the service user's individual care plans. All spoken with stated that this was a time issue and that they had been finding it difficult to keep up with their paperwork since moving to the new home. (See requirement 1)

There was conflicting information in some care plans in relation oral hygiene e.g. whether a service user had their own teeth or dentures. (See requirement 1)

Reviews - We could see evidence that where a new service user had been admitted to the home they had received a review after about six weeks, however for longer term service users there was limited evidence of any recent reviews taking place. We saw no evidence of any six monthly reviews being planned for service users at the

Urray House, page 16 of 34 Inspection report continued time of the inspection. We could see that for some service users their care reviews were long overdue. (See requirement 1)

Tissue viability - The manager had implemented the NHS SSKIN bundle assessment and care plan documentation for staff to use. Some staff had received training in relation to this. It would appear that staff required further training as all of the documentation we looked at was inconsistently completed. In some cases staff were not fully completing the documentation. They were not stating how frequently checks should be made or confirming whether they had checked the pressure relieving equipment.

In some of the tissue viability care plans we looked at it stated 'no issues', however we found that they had Waterlow assessments which assessed them as very high risk. This was also the case for one service user who was looked after in bed for some of the day. There were no links between assessments and care plans. (See requirement 2)

Medication - There were some issues noted in relation to the management of some service users' medications and also in relation to some staff practice.

We found the following issues during our sample: a) Staff were not always carrying forward amounts of unblistered medication from one month to the next, therefore there was not a complete audit trail. b) Staff were not always recording appropriately where 'as required' medications were being administered. c) Staff were not always recording whether they had given one or two tablets where a prescription stated they could. d) There were discrepancies in some of the amounts of medications held in the home. e) The Controlled Drug keys were being kept on the same bunch as the main medication keys. (These should always be held separately) f) The recording of controlled drugs did not always follow best practice guidance or the service policy. Some controlled drugs were being signed for in two different controlled drug books. g) The signing of prescribed creams on topical medication administration records (TMAR) was not consistent. h) Medication stock cupboards were not always locked. (See requirement 3)

Staffing - We looked at a sample of the staffing otar s over 31 days. Out of the 31 days there were 12 days where it was highlighted on the rota that the service was short of care staff. This meant that one of the units only had one member of staff caring for ten service users. Staff spoken with all stated that they were not comfortable with this. The manager was making efforts to recruit staff to try and

Urray House, page 17 of 34 Inspection report continued ensure that there would be two staff in each of the three units from 8.00am until 8.00pm.

Out of the 31 days we also noted that on 13 days the service was also short of domestic staff. On some of these days the domestic staff was being moved over to help the care staff.

The manager should carry out regular dependency assessments of all the service users. These assessments should link to the staffing hours to ensure that the staffing in the home reflects the varying needs of the service users in each of the units. (See requirement 4).

We carried out some observations in each of the units on the first day of the inspection. We noted in one of the units that some service users were still being assisted with personal care right up to lunch time. Beds were still unmade when the afternoon staff came on shift. We spoke with staff and some stated that it had been a particularly busy morning and some stated that there were many days where they struggled to get beds made and could still be assisting service users to rise and give personal care up until lunch time. On the second day of inspection the morning appeared to be more organised and more of the service users were in the communal lounges prior to lunch time.

Grade awarded for this statement: 3 - Adequate Number of requirements: 4 Number of recommendations: 0

Requirements 1. It is required that all people using the service have a full, written, personal plan in place within 28 days of receiving a service. These personal plans should reflect service users' needs and choices/preferences in relation to their health, welfare and safety. Each plan should evidence involvement with the service users or their relative/carer where appropriate. The care plan should be reviewed on a regular basis to ensure that all the information remains current.

This is to comply with:

Regulations 4(1)(a) and 5(1) of the Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210).

Timescale for this requirement is one month from receipt of report. 2. It is required that all service users have a skin assessment carried out and documented.

Urray House, page 18 of 34 Inspection report continued Each service user should have a care plan in place, which contains details of their individual skin care needs and any treatment required, for example, creams. Information should include:

* the name of the skin care product / cream / emollient * where this is to be applied * how many times a day it is to be applied * any other information that is relevant to the application of the emollient. For example, short term use, use when required etc.

Where a service user has been assessed as at risk of pressure ulcers, they should have a care plan developed and this should include:

* Level of risk and skin integrity status * Type of mattress in use * Type of chair cushion in use * Frequency of skin checks * Frequency of positional changes / whether turning chart in use * Any prescribed lotions or creams with details of where, how often applied etc. * Any other relevant individual care interventions * The frequency of the care plan review.

Where a service user develops a wound there should be a care plan in place for each wound, with evidence of a wound assessment / treatment chart, record of prescribed wound care products and evidence of on-going evaluation of the wound's progress.

This is in order to comply with:

Regulations 4(1)(a) of the Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 Scottish Statutory Instrument 2011/210).

Timescale for this requirement is one month from receipt of report. 3. It is required that staff follow their own policy and best practice guidance in relation to the administering, dispensing and recording of medications for service users. In order to do this you must:

a) Carry forward amounts of unblistered medication from one month to the next to ensure that there is a complete audit trail of all medications held in the home. b) Appropriately record where 'as required' medications are being administered. c) Record whether one or two tablets have been administered where a prescription states this.

Urray House, page 19 of 34 Inspection report continued e) Keep the keys for the controlled drug cabinet separately from the main bunch. The person in charge of the shift should keep these on their person at all times. f) Follow the service policy and best practice guidance when dispensing and administering controlled drugs. g) Sign for all prescribed creams either on the MAR or the TMAR. h) Ensure that all medication stock cupboards are locked and the keys removed when not being used.

This is in order to comply with:

Regulations 4(1)(a) of the Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 Scottish Statutory Instrument 2011/210).

Timescale for this requirement is from receipt of this report. 4. It is required that the provider carry out regular dependency assessments for service users to ensure that there are the correct amount of staff in each unit on every shift to ensure the health, welfare and safety of service users.

This is in order to comply with:

Regulations 4(1)(a) and 15(a) of the Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (Scottish Statutory Instrument 2011/210).

Timescale for this requirement is one month from receipt of this report.

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Quality Theme 2: Quality of Environment 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 environment within the service. Service strengths We reported how service users and carers participate in assessing and improving the quality of the care and support under Quality Statement 1.1 of this report. We have awarded the same grade for participation under this Quality Theme. See Quality Statement 1.1. Areas for improvement See Quality Theme 1, Statement 1.

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

Statement 2 We make sure that the environment is safe and service users are protected. Service strengths We found this service's overall performance in the areas covered by this statement to be very good. We concluded this after we spoke to the management and staff, undertook a tour of the premises, examined care assessments, accident/incident recording, maintenance records and risk assessments.

Urray House is a new purpose built care home. The rooms were spacious and bright. Every room had private en-suite facilities. There were communal assisted bathrooms and toilets.

Service users were able to use the various communal sitting areas.

The outside space was very attractive and there was a secure garden area. Service users could access this area through one of the small living rooms.

Urray House, page 21 of 34 Inspection report continued There was a key pad on each of the unit doors and a security lock on the front door.

There was a laundry area on the ground floor of the building.

There was a sluice area on the ground floor of the building and this contained a steriliser for the washing of commode pots and urinals etc.

Staff practice in relation to hand washing was noted to be of a satisfactory standard and there was liquid soap, gloves and aprons at points of need throughout the home.

There was a system for the reporting of accidents and incidents.

There was a signing in book at the front reception area of the home.

There was a system in place for the reporting of faults and repairs. There were external contracts in place for the maintenance of gas, oil, fire and moving and handling equipment etc. Areas for improvement Notice boards - The home needs to provide notice boards to give service users and relatives/carers information about daily activities, the weather, entertainment and meetings etc. These should be in each unit and be of an appropriate size/style (to accommodate written/picture information) for all service users to make use of. (progress will be monitored on this at the next inspection.)

Bathrooms - At the time of inspection we noted that the bathrooms were being used as equipment stores. There were hoists and other equipment cluttering up the assisted bathrooms on both floors and posing a risk to service users who may enter these rooms. All equipment should be removed from these areas and placed in an appropriate storage room to ensure the safety of all who use the service. (See recommendation 1)

Signage - We noted that there was no signage around the home to guide and make life easier for those service users who live with dementia. The provider should look to access signage for all areas of the home especially toilets, bathrooms, dining and lounge areas. The manager should also look into appropriate ways to personalise service users' bedroom doors. (See recommendation 2)

Heated food cabinets/lunch time difficulties - Heated food cabinets/trolleys were being stored in dining rooms and were posing a risk to service users. We observed staff asking a service user to move their chair away from it as it was hot. The cabinets were also causing problems for service users trying get past them when sitting down in the dining room. We carried out observations at lunch time in all three units and found that in all units staff were having difficulties trying to serve food in a very small area. The heated trolleys were adding to the difficulties as they were

Urray House, page 22 of 34 Inspection report continued parked in the space where staff needed to be to support service users with their meals. The communal dining areas/lounges in each of the units have a hard floor which is separated from the carpeted lounge area with a curved shaped floor bar. This was causing problems for service users in self propelled wheelchairs as they were getting caught on the bar. These dining areas appeared much too small for the amount of people sitting there and on several occasions service users had to be supported to move to let another service user in to a table. We also noted that staff were having difficulties moving between tables and to get space to sit to support service users with their meals. The provider agreed that there were problems with the size and layout of the dining rooms and stated that they were looking at how this could be improved. (Progress will be monitored on this at the next inspection)

Keypads/locks - should be installed to areas of the home where service users could have access to very hot water or hazardous substances. (See recommendation 3)

Environmental risk assessments - we noted that the environmental risk assessments were generic and not specific to Urray House. These should be reviewed to ensure that they reflect the environment of Urray House and also that they should be reviewed on a regular basis. The risk assessments that we were given had not been reviewed since 2011. (See recommendation 4)

Smoking Shelter - We noted on the first day of inspection that a service user was having to go outside in some very cold, wet and windy weather to have a cigarette. The manager told us that there was a smoking shelter on order however it had not arrived. The provider should look in to this as a matter of priority. (progress will be monitored on this at the next inspection).

Accident/incident reporting/recording - As part of the inspection we tracked four accident/incidents and we could only find accident forms for two. Staff practice needs to improve to ensure that all accidents are reported and recorded. Each accident/incident forms should be signed off by the manager and any follow up investigations needed should be carried out. Risk assessments should be reviewed where necessary and service users' care plans updated with any required changes. (See recommendation 5)

The manager was in the process of implementing falls prevention documentation for service users at the time of inspection. When this is fully implemented the manager should carry out regular audits of falls to ensure that measures are put in place to ensure that risks to service users are reduced where possible. (progress will be monitored on this at the next inspection.)

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

Urray House, page 23 of 34 Inspection report continued Recommendations 1. It is recommended that all moving and handling equipment, for example, hoists, be removed from communal bathrooms and an alternative storage area be found to ensure the safety of all who use the service.

National Care Standards - Care Homes for Older People - Standard 4 : Your environment. 2. It is recommended that the provider look at providing appropriate signage in areas of the home such as toilets, bathrooms, dining rooms and lounge areas etc. to improve life for those service users who live with dementia.

National Care Standards - Care Homes for Older People - Standard 4 : Your environment. 3. It is recommended that a lock be fitted in areas of the home where service users could have access to very hot water or hazardous substances.

National Care Standards - Care Homes for Older People - Standard 4 : Your environment.

4. It is recommended that the provider review the environmental risk assessments for the environment of Urray House and the outside grounds. The risk assessments should be reviewed on a regular basis.

National Care Standards - Care Homes for Older People - Standard 4 : Your environment. 5. It is recommended that the service follow their own policy in relation to the reporting of accidents and incidents.

National Care Standards - Care Homes for Older People - Standard 9 : Feeling safe and secure.

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Quality Theme 3: Quality of Staffing Grade awarded for this theme: 4 - Good

Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service Strengths We reported how service users and carers participate in assessing and improving the quality of the care and support under Quality Statement 1.1 of this report. We have awarded the same grade for participation under this Quality Theme. See Quality Statement 1.1. Areas for improvement See Quality Theme 1, Statement 1.

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

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 We found this service's overall performance in the areas covered by this statement to be adequate. We concluded this after we examined recruitment and induction records, staff rotas and spoke with the provider and manager.

We looked at recruitment and induction records for five new staff. All five had a staff file in place. We could see evidence of application forms being completed and interviews taking place. There was some evidence of an induction programme being carried out with staff although this was limited. (See areas for improvement)

There was a recruitment and volunteer policy in place.

There was evidence to support, through looking at staff rotas that some new staff commenced work in a shadowing capacity.

Urray House, page 25 of 34 Inspection report continued Areas for improvement We looked at recruitment files orf five new members of staff and we could see that all five had commenced work in the home prior to receiving confirmation of a clear PVG check.

Some references received were not from new staff's last employer. This is not in line with best practice or the service's own policy.

Some induction records were very limited and for some staff there was no evidence of any induction taking place. (See requirement)

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

Requirements 1. It is required that the provider follows best practice and their own policy in relation to the recruitment and induction of all staff. When recruiting new staff there should be an interview held of which there should be a written record. There should be two written references gained, one of which should be from the potential employee's last employer. There should be confirmation of a clear PVG check before any new member of staff commences working in the service. A full induction programme should be carried out with each new member of staff.

This is in order to comply with:

Regulations 4(1)(a) of the Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 Scottish Statutory Instrument 2011/210).

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

Timescale for this requirement is from receipt of report.

Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths We found this service's overall performance in the areas covered by this statement to be good. We concluded this after we looked at records of staff training, supervision

Urray House, page 26 of 34 Inspection report continued and appraisal and minutes of meetings. We spoke with service users and relatives/ carers.

Through discussion and observations we could see that staff were very committed to providing a good standard of care to service users. Many were working extra shifts to cover where there were staffing shortages.

The standard of care that we witnessed to service users on both days of the inspection was good.

There was one Registered Nurse working in Urray House. We spoke with the nurse and she stated that she enjoyed working in the home and had developed good working relationships with other health professionals who came in to see service users e.g. GP's, Community Nurses, Dieticians etc.

Staff were encouraged to undertake a Scottish Vocational Qualification (SVQ) at an appropriate level for the work they carried out.

New staff were being encouraged to register with the Scottish Social Services Council (SSSC). Staff who previously worked with Highland Council and now Parklands were already registered.

It was evident that all the staff and management had the best interests of service users at heart and although there were staffing shortages, at no time during the inspection did we feel that care to service users was being compromised.

There was evidence that the manager held meetings with staff. There had been a recent meeting where agenda items were staffing levels, recruitment, staff breaks, staff handovers, laundry and staff not having enough time to read or update care plans.

There was some evidence of training being planned and taking place for staff, however there was no formal training plan for staff at the time of inspection. (See areas for improvement)

There was evidence that some dates for staff supervision had been arranged. (See areas for improvement)

There were policies in place for training and supervision.

Areas for improvement Through talking to staff we felt that morale was low. Many were working extra shifts to cover where there were staffing shortages. Some staff told us that they really enjoyed working in the new Urray House, however due to recent difficulties with

Urray House, page 27 of 34 Inspection report continued staffing shortages they were feeling tired. Staff spoken with stated that they were finding it difficult to complete their paperwork on some days.

There was limited evidence of staff supervision taking place and no evidence of any annual appraisals. The programme of supervision and appraisal should be formalised. The manager should develop a plan, which should identify when staff supervisions are due. Work should continue with this until the programme of supervision covers all levels of staff and becomes established practice. Staff supervision should link to the yearly appraisal and both should link to the staff training plan. (See recommendation 1)

There was no formal training plan for staff. The manager should develop a training plan which should cover both mandatory and non mandatory training for all levels of staff. All training should be evaluated to ensure that practice improves as a result of the training provided. (See recommendation 2)

Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 2

Recommendations 1. It is recommended that the provider establish a programme of supervision and appraisal to provide all staff with support, the opportunity to raise individual issues and as a means of monitoring staff awareness of working practices, effectiveness of induction and training and to identify any further training needs.

National Care Standards - Care Homes for Older People - Standard 5 : Management and staffing arrangements 2. It is recommended that the manager develop a training plan which should cover both mandatory and non mandatory training for all levels of staff. All training should be evaluated to ensure that practice improves as a result of the training provided.

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

Urray House, page 28 of 34 Inspection report continued

Quality Theme 4: Quality of Management and Leadership 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 management and leadership of the service. Service strengths We reported how service users and carers participate in assessing and improving the quality of the care and support under Quality Statement 1.1 of this report. We have awarded the same grade for participation under this Quality Theme. See Quality Statement 1.1. Areas for improvement See Quality Theme 1, Statement 1.

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

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 found this service's overall performance in the areas covered by this statement to be good. We concluded this after we looked at some internal audits, service user review records, service self assessment, and minutes of meetings. We spoke with service users and relatives/carers.

The service had a Quality Assurance policy. (See areas for improvement)

There was a dietetic student on placement in the home at the time of inspection and she had carried out a recent MUST audit and was following up on issues found through this process.

We could see evidence that there had been an annual medication audit carried out by Boots in 2012 and 2013. (See areas for improvement)

Urray House, page 29 of 34 Inspection report continued

There was a complaints policy in place.

The manager completed a regular self assessment for the service when requested by the Care Inspectorate.

There were meetings held for service users. The manager operated an open door policy. There was some evidence of reviews taking place with service users and their relatives/carers. Areas for improvement During the inspection we asked for several of the service policies including the Quality Assurance policy. The manager had to print these off for us, and in some cases we did not get to see them. Policies should be available to staff to give them guidance and for service provision. (See recommendation 1)

There was very limited evidence of any internal audits being carried out. The provider/manager should further develop the system of audits to include, but not be limited to, care plans/reviews, medication, activities, tissue viability, the environment and dining experience. Where any issues are found through the audit process, an action plan should be developed with timescales for the necessary actions to be completed. The provider should have suitable arrangements in place to ensure that action planned to make improvements is carried out and is effective in improving the outcomes for people using the service. (See recommendation 2)

Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 2

Recommendations 1. It is recommended that the service policies are made available to the staff at Urray House. This is to ensure that staff are provided with clear guidance relevant to the work they carry out and service provision.

National Care Standards - Care Homes for Older People - Standard 5 : Management and staffing arrangements 2. It is recommended that the provider ensures there are effective quality assurance systems and processes in place, to assess the quality of service they provide on a regular basis and ensure that all aspects of the service operate at an acceptable standard. This is to ensure that proper provision is made for the health and welfare of service users at all times. In order to do this the provider should:

* Establish a quality assurance programme

Urray House, page 30 of 34 Inspection report continued * Effectively monitor the quality of the service

* Develop action plans with specific actions to be taken and timescales for actions to be completed

* Take appropriate action to make improvements to any areas identified through the internal and external quality assurance processes

* Monitor the effectiveness of actions taken to make improvements.

National Care Standards - Care Homes for Older People - Standard 5 : Management and staffing arrangements and Standard 11 : Expressing your views.

Urray House, page 31 of 34 Inspection report continued

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 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).

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5 Summary of grades

Quality of Care and Support - 4 - Good

Statement 1 5 - Very Good

Statement 3 3 - Adequate

Quality of Environment - 5 - Very Good

Statement 1 5 - Very Good

Statement 2 5 - Very Good

Quality of Staffing - 4 - Good

Statement 1 5 - Very Good

Statement 2 3 - Adequate

Statement 3 4 - Good

Quality of Management and Leadership - 4 - Good

Statement 1 5 - Very Good

Statement 4 3 - Adequate

6 Inspection and grading history

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

Urray House, page 33 of 34 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 0345 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 0345 600 9527.

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Telephone: 0345 600 9527 Email: [email protected] Web: www.careinspectorate.com

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