Achvarasdal (Care Home) Care Home Service Adults Reay Thurso KW14 7RR Telephone: 01847 811226
Type of inspection: Unannounced Inspection completed on: 29 July 2014 Inspection report continued
Contents
Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 13 4 Other information 37 5 Summary of grades 38 6 Inspection and grading history 38
Service provided by: Church of Scotland Trading as Crossreach
Service provider number: SP2004005785
Care service number: CS2003008461
If you wish to contact the Care Inspectorate about this inspection report, please call us on 0845 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 3 Adequate Quality of Environment 3 Adequate Quality of Staffing 3 Adequate Quality of Management and Leadership 3 Adequate
What the service does well
• Achvarasdal Care Home provides a welcoming, friendly and homely environment • The home provides opportunities for residents and relatives to be involved in the overall provision of the service • The food for the meals are sourced locally
What the service could do better
• The service was to further develop person centred and meaningul care plans and were to ensure that residents and relatives took part in formal reviews • The service was to review and develop the management of medications • The service was to further develop the overall review of accidents/incidents and falls within the home • The service was to continue to look at ways in which they involved the residents and their relatives in the overall provision of a quality service • The service was to ensure that staff took part in an annual appraisal, that supervision continued to take place and that they were offered and took part in training
Achvarasdal (Care Home), page 3 of 41 Inspection report continued • The provider was to address the recommendations in relation to the development of policies and procedures • The service was to continue to use and develop the methods by which they ensured that they were deilvering a quality service
What the service has done since the last inspection At this inspection we found that not all of the recommendations had been addressed in line with the timescales from their own action plan. Please refer to the body of the report for further information.
Conclusion We found that Achvarasdal Care Home was a place where people were generally happy and content with their overall care and support. Residents and relatives were complimentary about the staff and the management. However, we felt that since the last inspection, not a lot of work had been done to address the recommendations made from the inspection of January 2014. We met with the regional manager to discuss this and how best to support the manager and staff to address the requirements and recommendations that we have made as a result of this inspection.
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1 About the service we inspected
The Care Inspectorate regulates care services in Scotland. Prior to 1 April 2011, this function was carried out by the Care Commission. Information in relation to all care services is available on our website at www.careinspectorate.com.
This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April 2011.
The Care Inspectorate will award grades for services based on findings of inspections. Grades for this service may change after this inspection if we have to take enforcement action to make the service improve, or if we uphold or partially uphold a complaint that we investigate.
Requirements and recommendations
If we are concerned about some aspect of a service, or think it could do more to improve its service, 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 but where failure to do so will not directly result in enforcement.
- A requirement is a statement which sets out what is required of a care service to comply with the Public Services Reforms (Scotland) Act 2010 and Regulations or Orders made under the Act, or a condition of registration. Where there are breaches of the Regulations, Orders or conditions, a requirement must be made. Requirements are legally enforceable at the discretion of the Inspectorate.
The service is provided by Crossreach, formerly Church of Scotland, and is registered to provide a care home service to a maximum of 28 older people.
The service is located in Achvarasdal, a former Victorian shooting lodge, in Caithness.
Based on the findings of this inspection this service has been awarded the following grades:
Quality of Care and Support - Grade 3 - Adequate Quality of Environment - Grade 3 - Adequate Quality of Staffing - Grade 3 - Adequate Quality of Management and Leadership - Grade 3 - Adequate
Achvarasdal (Care Home), page 5 of 41 Inspection report continued This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection.
Grades for this care service may change following other regulatory activity. You can find the most up-to-date grades for this service by visiting our website www.careinspectorate.com or by calling us on 0845 600 9527 or visiting one of our offices.
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2 How we inspected this service
The level of inspection we carried out In this service we carried out a medium 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 We wrote this report following an unannounced inspection. This was carried out by one inspector. The inspection took place on 15 and 16 July 2014 between the hours of 9.30am and 10.00pm.
We gave feedback to the manager and the depute manager on 29 July 2014.
As part of the inspection we took account of the completed annual return and self assessment forms that we asked the provider to complete and submit to us.
We sent ten care standards questionnaires to the manager to distribute to residents. Four sent us completed questionnaires. We also sent ten care standards questionnaires to the manager to distribute to relatives and carers. Relatives and carers returned four before the inspection.
We also asked the manager to give out five questionnaires to staff and we received one completed questionnaire.
During this inspection process, we gathered evidence from various sources, including the following:
We spoke with:
• eight residents • four relatives • the manager • the depute manager • two senior care workers (day and night duty) • four care workers (day and night duty) • the domestic staff member • the cook and the part time cook
We looked at:
Achvarasdal (Care Home), page 7 of 41 Inspection report continued
• the participation strategy, this is the service's plan for how they will involve the people who use the service, their relatives and other stakeholders • minutes of meetings for people who use the service • minutes of staff meetings • the notice boards • care plans/support plans • residents' contracts • how the service managed medications for residents • reviews of care and support needs • risk assessments for people who use the service • evidence of meetings with other health care professionals • accident and incident records • staff training records • the training plan • staff supervision and appraisal records • staff induction records • the staff rota • the environment and equipment • maintenance records • audits that the service had developed and used.
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.
Achvarasdal (Care Home), page 8 of 41 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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What the service has done to meet any recommendations we made at our last inspection Sixteen recommendations were made as a result of the last inspection. These were across all four quality themes and statements that were inspected against at that time. At this inspection, we could see that some had been fully met, whilst others were partially met or not met. We have made reference to this within the body of this report.
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 Care Inspectorate received a fully completed self-assessment document from the provider. We were satisfied with the way the provider completed this and with the relevant information included for each heading that we grade services under.
The provider identified what it thought the service did well, some areas for development and any changes it had planned. The provider told us how the people who used the care service had taken part in the self assessment process.
Taking the views of people using the care service into account For this inspection, we received views from 12 out of the 28 using the service. Four people gave their views via the care standards questionnaires and we spoke with a further eight during the inspection.
We have included further comments and views from people using the service throughout the report.
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Comments from the questionnaires included:
"I am very happy about my care"
"Achvarasdal is a beautiful care home and nicely kept"
"Lovely caring staff. Very happy"
"I am very happy here and well fed and cared for"
Two relatives completed the questionnaire on behalf of the resident and these comments were:
"Overall I am happy with my relative's care. Their main carer is very good with her, as are the rest of the staff and in particular Fiona, the depute manager, who is extremely helpful and caring and keeps us informed on any problems. I do feel there is a shortage of staff though, which is probably difficult to address because of the distance from town and transport availability"
"This is a lovely environment for elderly people and the level of cleanliness had greatly improved in the last year. My relative's room is well maintained and her private possessions are respected. There had been an improvement in the stimulation provided in the home, which helps very much with my mother's mental stimulation".
Taking carers' views into account Feedback about the service varied.
Four relatives returned completed care standards questionnaires. We had the opportunity to speak with a further four relatives individually during our inspection.
Relatives' comments and references to our questionnaires are included throughout the report.
Individual comments made within the care standards questionnaires included:
"I feel that staff should wear name badges for the benefit of the esidentsr and relatives"
One relative commented upon the fact that they had issues with the cleanliness of their relative's room, that they had to ask for toilet paper to be placed in their ensuite and a poor laundry system, with clothes going missing, or the wrong clothes being
Achvarasdal (Care Home), page 11 of 41 Inspection report continued placed in their relative's room. These comments were shared and discussed with the manager and depute at the feedback.
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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: 3 - Adequate
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 At this inspection, we found that the performance of the service was adequate for this statement. We looked at the participation policy, the service's own questionnaires, records of meetings, records of reviews, information posted in the home and spoke with residents and relatives and staff to assess this statement.
Meetings had been held with residents and during these the staff shared information about new staff, training opportunities, health and safety, and menu choice. We could see that when the working together protocol had been further developed that this was discussed and shared. We were told that the minutes of the last meeting were shared so residents knew what had been achieved. At the last meeting held in May 2014, the chairperson of the Friends of Achvarasdal attended and shared information about their role and how any monies were spent. We spoke with some residents who were able to attend these meetings and they said that they found them useful and interesting. One resident told us that on their suggestion they now had venison and local produce from the bakers, which they were enjoying.
There were noticeboards at the main reception area that had a copy of the last report and other relevant information.
We could see when we looked at care plans for the residents that some reviews of care and support had been held. On the second day of the inspection a review was being held with relatives and social work. The care plan was being reviewed at this meeting.
Achvarasdal (Care Home), page 13 of 41 Inspection report continued Some of the care plans that had been further developed were person centred and provided information about choices and preferences.
There was an information leaflet orf prospective residents and this contained key information about the home and the services that were provided.
There was a key worker system in place and we spoke with a key worker who told us that they had spoken with the resident and relatives to develop the care plan.
Crossreach had used their own surveys for staff and residents at the beginning of 2014.
Areas for improvement At this inspection we found that the level of participation and the sharing of information could be further developed. This was to ensure that it was meaningful and was an effective way to involve residents and relatives in assessing and improving the service. Different methods used to involve residents and relatives in their overall care and support, giving their views and the quality of experience within the care home should be explored and developed further. This should include those residents living with dementia and/or who experienced difficulties with their abilities to communicate. The provider was also to ensure that staff were fully aware of the ways that the service worked with residents and relatives, to ensure the above outcomes were achieved. The provider was to further develop the methods of how and when they shared the outcome from meetings and the use of the questionnaires. The use of action plans were to be consistent in providing information to residents and relatives as to how they were going to address any issues/comments or suggestions that were made as part of the meetings and questionnaires. See recommendation 1.
Within their self assessment the service highlighted the following as areas for improvement:
Continued increased involvement of service users and their relatives / carers & advocates.
Investigation of increasing participation at 'carers' / relatives' meetings.
'Further develop evidencing action taken for suggestions via both formal and informal routes.
Further implementation of "pop surveys" for service users and carers.
Increased use of the notice area within the lobby.
Achvarasdal (Care Home), page 14 of 41 Inspection report continued Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 1
Recommendations 1. It is recommended that the provider develops the ways in which they involve the residents and relatives in their overall care and support and life in the care home.
National Care Standards - Care homes for older people Standard 5 - Management and staffing Standard 11 - Expressing your views.
Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths At this inspection, we found that the performance of the service was adequate for this statement. We looked at policies and procedures, residents' care plans, observed staff practice and spoke with residents, relatives and staff to assess this statement.
We looked at five care plans and we could see that some of these were of a person centred nature. There was some good information about how staff could support residents with their individual needs. We could also see that recognition had been taken in regard to choices and preferences and daily routines. There had been some development in life story work and we could see that some relatives had been involved with this. In general, the residents were happy with how their care was being managed.
Assessments of need had been carried out for nutrition (MUST), continence, skin, oral health, mobility and some had assessments for falls risk. Each folder contained information about levels of dependency.
In some care plans where residents had been deemed at risk with their nutrition staff had developed care plans. Staff were carrying out regular weights and where needed these were completed weekly. We could see that staff were contacting the GP and/or dietician for advice, support and treatment. Some residents' intake was being monitored and this was being recorded. We observed lunchtime on the first day of the inspection. There was a whiteboard outside the dining room where the daily menus were written down, there were also pictures of meals that could be used. Staff supported residents in an appropriate manner and it was a relaxed experience. We had a morning cup of tea with some residents. The trolley that came around contained different drinks, home baking and a good array of fresh fruits. Residents
Achvarasdal (Care Home), page 15 of 41 Inspection report continued were given a choice and told us that their tea trolley "was always like this, lots of different things to choose from". We spoke with residents about the food and the majority were happy with the quality and choice. Some told us that they were now having local produce from the bakers and they enjoyed this. However, some felt that the meals could be variable and that the presentation was not always good. One resident said that their plate was 'piled high' and that this put them off. See recommendation 2.
There was evidence that the staff were contacting other healthcare professionals where needed, such as GP, dietician, chiropody, dentist, SALT, community nurses and mental healthcare workers. With regard to tissue viability, staff referred to the Community nursing team who maintained their own care plans. Staff were using some of the paperwork in relation to NHS skin bundles and where a resident was deemed at risk from pressure areas, they were being supported to reposition on a regular basis and this was recorded. We could see that staff referred back to the Community nursing team if there were any issues. We spoke with some residents and they told us that they were happy with the level of care and support. They felt that staff knew about their healthcare needs and that they were able to access other professionals, if this was needed. We also spoke with some relatives and they said that they were kept informed.
Where residents had needs in relation to their mental health and behaviour, staff were using ABC charts to monitor this. This assisted staff to look at setting, time and frequency of behaviours so that the care and support a resident needed could be further developed to suit their needs. Where a resident's medication had been having an impact on their ability to function, we could see that staff had asked for this to be reviewed by the GP.
Since the last inspection, staff had developed the use of a whiteboard that had an overview of residents' healthcare needs. There was information about prior and current weights, use of supplements, antibiotics, skin care regimes, Community nursing visits and dressings and the use of ABC charts. Senior staff were responsible for ensuring that this was kept up to date. We spoke with the cook and they said that they referred to this information when preparing meals.
There was some evidence of reviews and where this was in place there was an outcomes summary.
Some residents chose to self medicate and there was various paperwork in place to support this. This was in line with good practice, the GP and resident had been involved in the decision making process and both had signed the paperwork. There was a review process in place.
Achvarasdal (Care Home), page 16 of 41 Inspection report continued We looked at medication and generally this was of an adequate standard. We looked at the management of CD's and the counts made were all correct. Temperatures were being maintained for fridges and rooms.
There was generally one senior staff who had overall responsibility for medication ordering and receipt. Staff were now using the reverse of the Medication Administration Record (MAR) to record when PRN (as and when needed) medication was given and the effectiveness of the medication given. The medication policy/ protocol had been updated to reflect best practice guidance.
Areas for improvement There was limited evidence of formal reviews in the care plans that were looked at. Therefore, the provider was to ensure that formal reviews took place at least every six months or 'as and when' needed. Reviews were to be recorded and contain information about any unmet needs, how they were to be addressed and indicate whether or not care plans were to be updated. See requirement 1.
We looked at five care plans and found that the content of these was varied. There were some blank care plans in place for a range of needs such as, "if I become ill, "towards the end of my life", "personal care", "daily routine" and some were not dated or signed. Some care plans were only partially completed and contained statements such as "I need full assistance". Therefore, there was limited information for staff as to how to successfully support residents with their needs. The staff had started to use some of the paperwork in relation to the management of falls risk. However, where they had carried out an assessment and residents were deemed as high risk, they were not following the guidance in relation to the development of a care plan and the maintaining of a falls diary. Some of the information from the Single Shared Assessment (SSA) had not been transferred to a care plan. For example, personal hygiene, nutrition, falls, continence, oral hygiene and night time confusion. These care plans were either blank or contained limited information about how to successfully support residents. Where ABC charts were being used, care plans had not been developed.
Therefore, there was no information as to why these were being used or for how long. There was no evidence of the use of these being reviewed. The repositioning charts that were being used were not being adequately completed. There was no information about how often to reposition or settings of the pressure mattresses being used on the charts or the care plans. Therefore the provider was to:
• ensure that care plans and associated documentation were reviewed along with the resident (where able) and their relatives/representatives in order that they were of a person centred nature • ensure that all care plans and associated documentation was fully completed
Achvarasdal (Care Home), page 17 of 41 Inspection report continued • ensure that pertinent information from the SSA was transferred to the care plans following admission, in order to ensure that residents were being cared for in relation to the needs they had been identified as having • ensure that when using the falls assessment paperwork that they followed directions in terms of completing care plans and falls diaries • ensure that they further developed the care plans in relation to skin care and that all pertinent information was within these care plans; such as, the use of repositioning charts and the types and setting of pressure relieving mattresses. They were also to ensure that staff were fully completing the repositioning charts • ensure that if ABC charts were being used that this formed part of a care plan, which detailed residents' mental health care needs, the use of these charts and for how long and then review these on a regular basis
See recommendation 1.
On the first day of the inspection the lunchtime experience was poor. Food was not nicely presented and the food itself was not appealing. This was the view of some residents and some relatives. One resident said that the food was piled onto his plate and that this put them off. They said that they had told staff they wanted smaller portions, but this was not in their care plan. The use of 'show and tell' was poor. This was because only the meat part of the meal was placed on a small saucer, rather than the whole meal on a dinner plate.
The menu board was illegible with several spelling mistakes. We were told that staff should also be posting pictures of the meals, but this was not the case. It was not always the case that the cooks served the meals, or came out to ensure that staff were serving meals in an attractive manner. The lunchtime medication was being administered from the trolley in the dining room, this compromised residents' dignity and privacy. Therefore the provider was to review the mealtime experiences for residents. See recommendation 2.
We made a recommendation at the last inspection about the content of the care plans for respite residents. We also made reference to the provider developing a policy and procedure about how respite residents' care plans were to be developed, in order to support staff (See quality statement 4.4). Neither of these recommendations had been met. We looked at care plans for two respite residents who had identified needs. There were SSA's in place and when we spoke with staff, they had a good understanding of their needs. They also told us that the respite residents had the capacity to tell staff how they would like to be cared for. However, there were no care plans in place to support how staff assisted these residents with their identified needs such as, falls risk, nutrition and personal care. Therefore this recommendation remains in place. See recommendation 3.
Achvarasdal (Care Home), page 18 of 41 Inspection report continued The input charts that were being used to monitor residents' nutrition and fluids were generally of a poor standard. They were not being routinely completed. Some staff did not have a good understanding of the need to ensure that these were to be fully completed over a 24 hour period. The forms used did not highlight a 24 hour approach. There was no information of a target of fluid intake on the charts for staff information. There was no information within the nutrition care plans as to the use of the intake charts, how much fluid a esidentr was to be encouraged to take, how long the input charts were to be used or a review date. Therefore, the provider was to ensure that they reviewed the management of these, in order to ensure that there was a consistent approach from staff in relation to supporting residents with their nutritional status. See recommendation 4.
Care plans for the management of pain had started to be further developed and we could encourage the service to continue with this. However, we felt that the overall management of medication needed to be reviewed in order that it was being managed in line with best practice guidance. This was because we found the following:
• some MAR's were confusing as some medication was highlighted twice within the same month and was being signed for on both MAR • although PRN paracetamol was being recorded on the reverse of the MAR, in some instances this was being given on a regular basis up to four times per day. This meant that staff were recording each time and generating lots of paperwork. Staff should be reviewing the use of PRN as if it is being given as a regular dose this should be amended by the GP. The effectiveness would then be part of the review of the pain management care plan • staff were not always signing when a medicine had been administered • there were still episodes of staff annotating MAR, without dating or signing entries and indicating the prescriber. In some instances the writing was illegible • there were no photographs of residents within the MAR folder • no audits of the overall management of medication had been carried out for some time • the service was to consider the use of transdermal patch records, which were to be maintained alongside the MAR • the service was to make themselves aware of the correct use of the Abbey Pain Scale and ensure that when this is indicated to be used it is done so in line with best practice guidance
See recommendation 5.
The recommendation in relation to developing individual risk assessments with the residents, had not been addressed. At this inspection we saw that the old style
Achvarasdal (Care Home), page 19 of 41 Inspection report continued assessments were being used. They were not person centred and they did not provide enough information as to how staff were to support the residents and manage and therefore, minimise any identified risks. Therefore, this recommendation remains in place. See recommendation 6.
Within their self assessment the service highlighted the following as areas for improvement:
Further implementation of the reviewed care plan format, along with the assessment tools developed to ensure that all services users' specific health care needs are recognised and met.
Individual care plans are being developed for 'as required' medications, including analgesia, to provide full information to staff, and regular reviewing of the medication with the GP.
Development of a respite care plan.
Grade awarded for this statement: 3 - Adequate Number of requirements: 1 Number of recommendations: 6
Requirements 1. It is a requirement that the provider ensures that the care plans for service users were reviewed, so that they set out how the service users' health, welfare and safety needs are to be met.
This is in order to comply with:
Regulation 5(1)(2)(a)(b)(i)(ii)(iii)(c) and (d) of The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 Scottish Statutory Instrument 2011/210)
Timescale for this requirement - 31 December 2014.
Recommendations 1. It is a recommendation that the provider continue to develop the care plans for residents so that they were fully completed and person centred. They were to be set out in a way that the information provided would ensure that they met their needs in an effective way.
Achvarasdal (Care Home), page 20 of 41 Inspection report continued National Care Standards - Care homes for older people Standard 6 - Support arrangements Standard 8 - Making choices.
2. It is a recommendation that the provider review the overall management of mealtimes for residents, in order that there was a consistency of approach from all staff. This was so that the overall experiences for residents was a positive one.
National Care Standards - Care homes for older people Standard 13 - Eating well.
3. It is a recommendation that the provider ensure that each resident who comes to spend a period of respite at the home had a care plan in place, which detailed their needs and how these were to be met by staff.
National Care Standards - Care homes for older people Standard 6 - Support arrangements.
4. It is a recommendation that the provider review the paperwork that was in place in relation to monitoring the nutritional and fluid intake of esidents.r They were to cover a 24 hour period, inform staff as to the fluids needed by each individual resident and then form part of the care plan. They were to ensure that these were fully completed by staff.
National Care Standards - Care homes for older people Standard 6 - Support arrangements Standard 13 - Eating well.
5. It is a recommendation that the provider review the overall management of medications within the home. This was so that staff were adhering to best practice guidance.
National Care Standards - Care homes for older people Standard 5 - Management and staffing Standard 6 - Support arrangements Standard 14 - Keeping well - medication
6.
It is a recommendation that the provider further develop the individual risk assessments for residents so that they contained relevant and up to date information about how staff were to manage and reduce potential risks.
National Care Standards - Care homes for older people
Achvarasdal (Care Home), page 21 of 41 Inspection report continued Standard 6 - Support arrangements Standard 9 - Feeling safe and secure.
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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 that have been identified within statement 1.1 are also relevant here, please refer to that statement for further information.
In addition, the service had carried out some redecoration and refurbishment of some of the communal areas and residents were involved in choosing colour schemes.
Residents and relatives were actively encouraged to personalise their bedrooms and we could see that they were homely and comfortable. Some residents had brought in their own furniture.
Areas for improvement The areas of development that have been identified within statement 1.1 are also relevant here, please refer to that statement for further information.
Within their self assessment the service highlighted the following as areas for improvement:
Continued improvement to the external and internal environment of the home.
Redecoration of individual rooms and dining room.
Continued involvement of all stakeholders within that.
Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0
Statement 2
Achvarasdal (Care Home), page 23 of 41 Inspection report continued We make sure that the environment is safe and service users are protected. Service strengths At this inspection, we found that the performance of the service was adequate for this statement. We looked at policies and procedures, residents' care plans, accidents and incident records, risk assessments, maintainance records and observed the environment. We also spoke with residents, relatives and staff to assess this statement.
Records of accidents and incidents continued to be maintained. A protocol had been developed since the last inspection for staff guidance, in relation to the management and recording of accidents and incidents. There was a folder in place which contained information about monthly reviews, including a falls overview and some of these stated the outcome and action that was needed to be carried out.
The service had started to use the paperwork in relation to Falls Risk Management in care homes.
Water testing continued to be carried out routinely and recorded. Where hot water temperatures exceeded the expected temperature, this was highlighted within the records that were maintained. There was a risk assessment of water systems in place and there was evidence of regular testing in relation to the management of legionella. There was an up to date certificate with egarr d to legionella.
There was a maintenance book in place and staff knew how to report any issues and these were attended to by the maintenance staff member. Equipment was maintained regularly by outside contractors and certificates were maintained.
Environmental risk assessments were in place and a matrix was used to develop the level of risk. There was evidence of a review of some of these assessments where works pattern had changed.
Fire training had recently been carried out for staff. We could see that, where staff had expressed their lack of knowledge, they had attended this training. We spoke with night staff and they told us that they felt comfortable with their roles and knew what they had to do in the event of a fire.
We spoke with night staff about their housekeeping duties and in the main, they felt that this was achievable. They said that if there was a resident who needed extra support, that housekeeping would have to wait. We spoke with those residents who were able to give an informed opinion of their care at night and they felt that call bells were answered appropriately. This was the subject of a recommendation at the last inspection, which we feel has now been addressed. However, the service was to continue to review the overall staffing at night to ensure that residents' needs were met at all times.
Achvarasdal (Care Home), page 24 of 41 Inspection report continued
A dependency assessment had been carried out for all residents and it was the intention of Crossreach to further develop the use of these.
Cleaning and food hygiene records were maintained and completed regularly. Some relatives' commented on the cleanliness of the home and felt that it was of a better standard of late. During the inspection we spoke with the domestic staff. They had a good understanding of their role. They told us that they had adequate equipment and cleaning materials. They had also attended infection control training. On the days of the inspection the home was clean and there were no odours present.
The service was in the process of advertising and recruiting staff to existing vacant posts. We spoke with some residents and relatives during the inspection and they felt that there were enough staff on duty at any time to meet needs. The shift patterns for staff had recently been changed and this had resulted in more staff being made available at tea time and early evening. This had been identified as a time where more staff were needed.
Contracts were seen to be in place for residents and the ones that were viewed were dated and signed.
The questionnaires that were forwarded to us prior to the inspection indicated that people felt safe and secure in the home. They also indicated that they did not have any issues in relation to the staffing levels in the home.
Areas for improvement The overall management of accidents/incidents and falls could be better. For example, the folder that contained the monthly review was only completed up to February 2014. Not all of the accidents and incidents that were still attached to the book that was used, were signed off by the manager, therefore, this suggests that these have not been reviewed by the manager. Some of the actions stated in the monthly reviews simply stated "circumstances to be looked into", or they were left blank. The post falls incident form was not being used routinely as indicated to us. Therefore, the provider was to review the overall management of any accident/ incident/fall. They were to ensure that they carried out regular reviews which clearly stated what action was to be taken to minimise any further episodes. The provider was to continue to develop and use the tools within the 'Managing Falls and Fractures in care homes'. See recommendation 1.
We could not see how the service came to the conclusion as to the safe use of bedrails. The service should make themselves aware of and then use the tool within the 'Managing Falls and Fractures in care homes' pack, which was about clinical decision making processes in relation to bedrails. They were to ensure that residents and relatives were involved with this and that their consent was gained. Some of the
Achvarasdal (Care Home), page 25 of 41 Inspection report continued residents had 'wander mats' in place, which were used for their safety. However, we could find no informed consent from residents or relatives for the use of these. See recommendation 2.
At the last inspection we were told that the provision of grab rails to corridors was going to be addressed by May 2014. This had been made the subject of a previous recommendation. However, this had not been carried out. Therefore, this recommendation remains in place. We would point out that the service will be receiving a second inspection in this inspection year of 2014/15. The expectation is that this will be addressed by the provider. See recommendation 3.
The service was to ensure that where the temperatures of hot water exceeded the identified temperature, that they evidenced what they had done to address this.
Although the service carried out dependency assessments for all residents, we could not see how this effectively influenced the staffing levels in the home, or where the staff were to be deployed. However, we could see that the service themselves had looked at shift patterns, so that there were more staff on duty at key points of the day. We were told that Crossreach were in the process of looking to develop a tool where this would be addressed. We would encourage the use of a tool whereby there was a regular review of staffing levels in the home. In order that they reflected the needs of the residents on a regular an on-going basis.
Within their self assessment the service highlighted the following as areas for improvement:
Handrails to be fitted within the main corridors.
Continued development of the Falls and Incidents Audits to support in prevention.
Continued review of residents' safety in the outbreak of a fire.
Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 3
Recommendations 1. It is a recommendation that the provider carry out an effective review of accidents/ incidents/falls so that patterns, triggers or other factors might be highlighted, which could assist in the effective management and minimisation of such incidents.
National Care Standards - Care homes for older people
Achvarasdal (Care Home), page 26 of 41 Inspection report continued Standard 5 - Management and staffing Standard 9 - Feeling safe and secure.
2. It is a recommendation that the provider ensure that the decision making process in the use of bedrails followed best practice guidance In addition the provider was to ensure that consent was gained from residents and/or relatives in the use of safety equipment such as bedrails and wander mats.
National Care Standards - Care homes for older people Standard 5 - Management and staffing Standard 9 - Feeling safe and secure.
3. It is a recommendation that the provider address the provision of grab rails/ handrails in communal corridors.
National Care Standards - Care homes for older people Standard 5 - Management and staffing Standard 9 - Feeling safe and secure.
Achvarasdal (Care Home), page 27 of 41 Inspection report continued
Quality Theme 3: Quality of Staffing Grade awarded for this theme: 3 - Adequate
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 that have been identified within statement 1.1 are also relevant here, please refer to that statement for further information.
Achvarasdal (Care Home), page 28 of 41 Inspection report continued Areas for improvement The areas of development that have been identified within statement 1.1 are also relevant here, please refer to that statement for further information.
As part of the service's own self development, they had highlighted that they would like to further develop the participation of residents with the recruitment of staff. This is seen as a good way to develop the involvement of residents. However, the service must take account of the methods they were going to use and whether the involvement was formal or informal. To start off this process, the service could gain the views of those who wanted to take part and in what capacity. If residents wanted to be involved in the interview stage, the service should develop a protocol that identified olesr and responsibilities and how the views of residents influenced the decision making process. Confidentiality was also to be considered. Once this protocol was developed, it was then to be shared with all concerned for their comments and suggestions. If residents took part in any area of recruitment, it would be good practice to maintain records of who took part and how. This could then feed into the overall methods used to ensure a quality service as stated within quality statement.
Within their self assessment the service highlighted the following as areas for improvement:
Encourage more participation from service users in recruitment of staff, including participation within the interviews.
Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0
Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths At this inspection, we found that the performance of the service was adequate for this statement. We looked at policies and procedures, staff training records, supervision and appraisal records and spoke with residents and relatives and staff to assess this statement.
Crossreach have an employee development officer. eW were told that they were carrying out training as a precursor to staff completing their Professional Development Award (PDA)/Scottish Vocational Qualification (SVQ) in the
Achvarasdal (Care Home), page 29 of 41 Inspection report continued management of medication. Crossreach also have two dementia specialists and at the time of the inspection, the service was waiting for dates for staff training.
The depute manager had completed their PDA in dementia studies. They told us that they were going to be supporting staff to carry out the informed level of the Promoting Excellence in Dementia.
The depute was also developing a staff training matrix, which would show past, present and future training for all staff. This would then enable training to be planned to meet timescales and needs. We were informed that the home was trying to develop reflective accounts following any training that staff had undertaken. We would encourage this development and also for it to form part of the supervision process. There had been training for staff since the last inspection such as:
• moving and handling (16 staff) • medication (2 staff) • safeguarding (7 staff) • continence products (5 staff) • palliative care in dementia (1 staff) • skilled level dementia (4 staff) • fire training (majority of staff)
There had been some meetings with staff and this included meetings for night staff. Various aspects of the service were discussed at these meetings. We spoke with some staff and they told us that they attended meetings and found them useful.
Staff took part in an induction, which included an orientation for their first shift, they then went on to complete a PDA, which was role specific. Each staff had a mentor who was a senior member of the care team.
Staff supervision has commenced and there were allocated supervisors for all staff. At the most recent sessions policies and procedures were handed out to staff, one being about the appraisal process. The manager and depute were going to receive training in relation to the management of appraisals and this was planned for September 2014.
We spoke with residents and relatives about the staff within the home. They were very complimentary about staff and told us that they were happy with how they looked after and cared for them. They said that staff were approachable and helpful. One resident felt that staff were "marvellous". Within the questionnaires that were returned to us both residents and relatives indicated that they felt that the staff had the necessary skills and knowledge to provide the care and support.
Achvarasdal (Care Home), page 30 of 41 Inspection report continued Areas for improvement The recommendation made at the last inspection and which was about ensuring that staff took part in regular appraisals, had not been met. Therefore this recommendation remains in place. See recommendation 1.
Although supervision sessions for staff had commenced, we felt that this could be further developed. This was because when we looked at some supervision records, there was not a consistent approach to what was discussed, as there were blank spaces on the documentation. A timescale for a review to take place had been highlighted in one supervision session, but we could not evidence that this had taken place. Therefore, the provider was to ensure that they followed their own policy and procedure and supervision contracts. See recommendation 2.
Although there had been some staff meetings, these had only taken place twice since the last inspection (January and February 2014). The minutes for the staff meeting in February had not yet been typed up or shared with staff. Action plans had not been used to inform developments and how, or who, was responsible for any issues that needed to be addressed. Therefore, the provider was to ensure that staff had the opportunity to attend regular meetings. This was so that they were able to discuss issues, share best practice and be able to participate in the developments and improvements that needed to be achieved. Action plans were to be used to address and monitor the outcomes from these meetings. See recommendation 3.
The recommendation in relation to having key members of staff with up to date, first aid training, had not been addressed. Therefore this remains in place. See recommendation 4.
Given that we have made requirements and recommendations within this report across all quality themes, the provider was to ensure that staff training continued. This was to include, but not be exclusive to the areas that we have highlighted in this report. We would encourage the further development of the yearly staff training plan. We would also encourage the use of reflective accounts following any training that has been attended. This was so that any learning could then be used to develop the care and support needs of the residents. See recommendation 5.
Within their self assessment the service highlighted the following as areas for improvement:
Ensure all staff take part in an annual appraisal.
Completion of First Aid training for staff.
Grade awarded for this statement: 3 - Adequate
Achvarasdal (Care Home), page 31 of 41 Inspection report continued Number of requirements: 0 Number of recommendations: 5
Recommendations 1. It is a recommendation that the provider ensure that all staff took part in an annual appraisal.
National Care Standards - Care homes for older people Standard 5 - Management and staffing.
2. It is a recommendation that the provider ensure that all staff took part in regular supervision sessions. They were also to ensure that there was a consistent approach to the documentation of this. When reviews were highlighted these were then to be carried out.
National Care Standards - Care homes for older people Standard 5 - Management and staffing.
3. It is a recommendation that the provider ensure that all staff had the opportunity to attend staff meetings. This was so that there was a formal way for staff to discuss issues, share best practice and be able to participate in the developments and improvements that needed to be achieved.
National Care Standards - Care homes for older people Standard 5 - Management and staffing.
4. It is a recommendation that the provider ensure that the key staff that had been identified took part in First Aid training.
National Care Standards - Care homes for older people Standard 5 - Management and staffing.
5. It is a recommendation that the provider ensure that all staff took part training in relation to their roles and responsibilities. The provider was to take account of the requirements and recommendations that have been made as a result of this inspection form part of, but not exclusive to, the training plan.
National Care Standards - Care homes for older people Standard 5 - Management and staffing.
Achvarasdal (Care Home), page 32 of 41 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 that have been identified within statement 1.1 are also relevant here, please refer to that statement for further information.
Areas for improvement The areas of development that have been identified within statement 1.1 are also relevant here, please refer to that statement for further information.
Within their self assessment the service highlighted the following as areas for improvement:
Improve In-house Survey for service users to include easy read format.
Grade awarded for this statement: 3 - Adequate 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 At this inspection, we found that the performance of the service was adequate for this quality statement. We looked at how the service shared information with residents and their relatives, policies and procedures, the use of audits and quality assurance methods. We also spoke with residents, relatives and staff to assess this statement.
Achvarasdal (Care Home), page 33 of 41 Inspection report continued The strengths that have been identified within this eportr under the other quality statements, including the participation statements, also have a bearing on this statement. For example, the use of questionnaires with all stakeholders, including other healthcare professionals; and meetings for staff, residents and relatives is a method by which the service could assess the quality of the provision of the service.
The service had a quality assurance policy in place, which was aimed at enabling a culture of quality service provision, leading to continuous improvement in practice and service delivery. This included the use of an in-house quality audit from which the manager was to develop a quality improvement plan. This covered all aspects of living in and working in the care home.
The manager had developed their own audits or were using the Care Inspectorate's inspection trigger tools, and these were in relation to:
• dementia care • nutrition • continence • infection control • content of care plans
Once completed an action plan was used to highlight where the service needed to address any shortfalls.
There was a system in place to enable staff supervision.
There was a comments and suggestions book.
The service had held reviews for some residents and these reviews had information about how happy the residents and their relatives were with the level of care and support. (However, please refer to quality statement 1.3, requirement 1)
The service had submitted a self assessment document as requested by us.
The service had ensured that they had completed action plans from the last inspection and the recent complaint that had been made. These action plans quite clearly stated what the service was going to do to improve upon current practice. The service had address the requirement from the complaint, which was about ensuring that staff had the appropriate information about who and when to contact, should there be any issues with the care of the residents.
When we spoke with the manager they told us that they walked around the building each day. This was so that they could observe staff practice and address any issues
Achvarasdal (Care Home), page 34 of 41 Inspection report continued that may arise. The manager also worked on the floor alongside the staff, so that they could gain a good understanding of the management of the care and support offered.
When we spoke with residents and relatives they all felt that the quality of the overall service was good. However, some relatives felt that the communication could be better. They told us that staff were approachable, as was the manager and depute. We spoke with residents who were able to participate in the meetings and they were positive about these. They said that they could talk about any aspect of the home and make suggestions.
Within the questionnaires that were returned to us by residents and relatives, prior to the inspection, all indicated that they were either very happy, or happy, with the overall service.
Areas for improvement We had reminded the provider about their responsibilities with regard to notification reporting. We again found at this inspection that the service were still not notifying the Care Inspectorate. In this instance it was in relation to four residents' deaths. See requirement 1.
The service was to ensure that they continued to use the audit tools to ensure that they were providing a quality service. Action plans were to be used to identify shortfalls and who and by when, these were to be addressed. We found that the care plan audits remained the same format as at the last inspection. They did not look at the content of recording, or the fact that care plans were to be person centred. The audits did not identify the key worker, nor did they identify a timescale by which shortfalls were to be addressed. Therefore, there was very little evidence from the audit as to what work had been carried out. See recommendation 1.
The recommendation made from the last inspection, in relation to Crossreach providing staff with a policy and procedure about effective care planning for respite residents, had not been addressed. At this inspection we again found that some respite residents did not have a care plan in place. Therefore, this recommendation remains in place. See recommendation 2.
Within their self assessment the service highlighted the following as areas for improvement:
Further involve staff, service users and carers and other stakeholders in the Quality Improvement plan through discussion of analysis and outcomes.
Continue Quality Assurance, and complete QIP.
Develop protocol for the use of respite care planning documentation.
Achvarasdal (Care Home), page 35 of 41 Inspection report continued
Full implementation of Care Plan audits.
Grade awarded for this statement: 3 - Adequate Number of requirements: 1 Number of recommendations: 2
Requirements 1. It is a requirement that the provider should notify the Care Inspectorate of certain events, including serious accidents. Information about the notifications that must be made can be found on our website.
This is in order to comply with:-
Public Services Reform Act 2010 sect 58 (6), which states that the Care Inspectorate may require anyone providing a care service to supply information that it considers necessary.
Timescale for this requirement - 29 July 2014.
Recommendations 1. It is a recommendation that the provider continue with the quality audits and that they were fit orf purpose.
National Care Standards - Care homes for older people Standard 5 - Management and staffing.
2. It is a recommendation that the provider develop a policy and procedure in relation to the admission and care planning process for respite residents. Once developed this was to be shared with staff.
National Care Standards - Care homes for older people Standard 5 - Management and staffing.
Achvarasdal (Care Home), page 36 of 41 Inspection report continued
4 Other information
Complaints The complaint that was made resulted in one element being upheld and this was made the subject of a requirement. Please refer to quality statement 4.4 for further information. This requirement has been met.
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).
Achvarasdal (Care Home), page 37 of 41 Inspection report continued
5 Summary of grades
Quality of Care and Support - 3 - Adequate
Statement 1 3 - Adequate
Statement 3 3 - Adequate
Quality of Environment - 3 - Adequate
Statement 1 3 - Adequate
Statement 2 3 - Adequate
Quality of Staffing - 3 - Adequate
Statement 1 3 - Adequate
Statement 3 3 - Adequate
Quality of Management and Leadership - 3 - Adequate
Statement 1 3 - Adequate
Statement 4 3 - Adequate
6 Inspection and grading history
Date Type Gradings
29 Jan 2014 Unannounced Care and support 3 - Adequate Environment 3 - Adequate Staffing 3 - Adequate Management and Leadership 3 - Adequate
5 Sep 2013 Unannounced Care and support 3 - Adequate Environment 3 - Adequate Staffing 3 - Adequate Management and Leadership 3 - Adequate
15 Nov 2012 Unannounced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 3 - Adequate
Achvarasdal (Care Home), page 38 of 41 Inspection report continued
17 Apr 2012 Unannounced Care and support 1 - Unsatisfactory Environment Not Assessed Staffing 2 - Weak Management and Leadership Not Assessed
22 Feb 2012 Unannounced Care and support 2 - Weak Environment Not Assessed Staffing 3 - Adequate Management and Leadership Not Assessed
4 Nov 2011 Unannounced Care and support 3 - Adequate Environment Not Assessed Staffing 3 - Adequate Management and Leadership Not Assessed
4 Oct 2010 Unannounced Care and support 5 - Very Good Environment Not Assessed Staffing Not Assessed Management and Leadership Not Assessed
14 May 2010 Announced Care and support 5 - Very Good Environment 5 - Very Good Staffing Not Assessed Management and Leadership Not Assessed
3 Feb 2010 Unannounced Care and support 5 - Very Good Environment Not Assessed Staffing 5 - Very Good Management and Leadership Not Assessed
1 Sep 2009 Announced Care and support 5 - Very Good Environment 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good
17 Feb 2009 Unannounced Care and support 5 - Very Good Environment 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good
Achvarasdal (Care Home), page 39 of 41 Inspection report continued
4 Jun 2008 Announced Care and support 5 - Very Good Environment 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good
All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission.
Achvarasdal (Care Home), page 40 of 41 Inspection report continued
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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.
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