Bothwell Castle Care Home Care Home Service 35 Bothwell Road Uddingston Glasgow G71 7HA Telephone: 01698 622299 Type of inspection: Unannounced Completed on: 19 September 2019 Service provided by: Service provider number: Bothwell Care Limited SP2018013104 Service no: CS2018365959 Inspection report About the service The service has been registered with us since 01 November 2018. This is their first inspection and we have taken into account that they are still a developing service. Bothwell Castle Care Home is registered to provide a care service to a maximum of 75 older people. Bothwell Castle Care Home is a purpose-built care facility, situated on Bothwell Road in Uddingston, Lanarkshire. The Care Home forms part of the Bothwell community set back from the main road, with level access to the entrance and grounds. It is situated close to local shops and is easily accessed for visiting purposes. It is arranged over three floors and offers private, spacious bedrooms each with an en suite wet room. It also provides a choice of lounges and dining rooms, which are decorated to a high specification. Other areas include, a games rooms, reminiscence lounges and a piano bar, as well as, assisted bathrooms. Additional facilities include a cinema, hairdresser with nail bar, a tea room and private dining rooms where families and friends can dine privately with their friends and family. The service sets out it aims and objectives are "To provide a consistently high standard of kind and compassionate care, designed to meet the individual needs and wishes of each resident. This will be achieved through the involvement of the resident and/or relatives in all stages of care planning, delivery and evaluation, to ensure that the personal needs and wishes of the resident are central and are consistently respected. Care and support will be adapted to support changes in resident needs, choices and decisions to ensure that the resident receives the right support and care at the right time. At Bothwell Castle Care Home, we are fully committed to delivering care and support that promotes the National Care Standards Principles of: Dignity and Respect, Compassion, Be Included, Responsive Support and Wellbeing". Inspection report for Bothwell Castle Care Home page 2 of 10 Inspection report What people told us Four residents and 13 relatives returned completed care standards questionnaires, prior to the inspection visit. From these, 17 were overall happy with the care and support provided and one was undecided. We gathered feedback from residents in the service and their families by speaking to people during the inspection. An inspection volunteer was involved in the inspection. An inspection volunteer is a member of the public who volunteers to work alongside the inspectors. Inspection volunteers have a unique experience of either being a service user themselves or being a carer for someone who has used services. The inspection volunteer role is to speak with people using the service being inspected and gathering their views. People told us that the staff were very caring and that they had a good relationship with them. They told us that they enjoyed meals and that there was plenty to choose from. Comments received included: - Bothwell Castle care home is as close as I imagine you could get to care for your loved ones as you would yourself. - I could not praise highly enough the respite care for my relative. - My relative has settled in well, enjoys their time there and engages with others. - There's a good programme of events - I am unsure if there are always enough staff - Absolutely delighted with the care our relative receives - I am happy with the care my relative receives and I can leave knowing they are being well looked after. - The home is beautiful and staff are very caring. - The care and attention given to my relative goes far beyond my expectations. From this inspection we evaluated this service as: In evaluating quality, we use a six point scale where 1 is unsatisfactory and 6 is excellent How well do we support people's wellbeing? 3 - Adequate How good is our leadership? 4 - Good How good is our staffing? 4 - Good How good is our setting? 5 - Very Good How well is our care and support planned? 3 - Adequate Further details on the particular areas inspected are provided at the end of this report. How well do we support people's wellbeing? 3 - Adequate In order to answer this question we considered and evaluated the following Quality Indicators: Inspection report for Bothwell Castle Care Home page 3 of 10 Inspection report 1.1 People experience compassion, dignity and respect - graded as good. 1.2 People have a good quality of life as a result of their care and support - graded as good. 1.3 People's health benefits from their care and support - graded as adequate. It is important that staff across the home treat residents with compassion, dignity and respect. From our observations of staff, we noted them to have a genuine interest in caring for people. We observed staff speaking to people in a respectful manner. Residents and relatives spoke positively about staff and how kind and friendly they were. We found that residents looked neat, tidy and that time had been taken to make sure that they were well presented. A hairdresser and beauty therapist were available throughout the week for people to attend. Residents were given choices of where to sit, when to get up and how to spend their day. There should be a clear process in place for staff, to obtain consents from residents and/or their representative around key areas, including the use of photography and the use of equipment that may be considered as restraint. Their legal status should be clearly documented, to ensure that all staff are aware of this, including if any power of attorney is in place. Please see area for improvement 1. The way people spend their day should promote feelings of purposefulness and wellbeing. There was a weekly activity programme devised by a dedicated activity person. This included in-house activities including, exercise groups, bingo and quizzes. There were visiting activities including arts and crafts, yoga and music therapy, which people told us they enjoyed. The home had links with a local nursery, school and churches which helped keep them part of the community. The home had both a car and a minibus to support people to get out and about. It is important for residents to enjoy a healthy and balanced diet and have access to plenty of drinks throughout the day. We observed a choice of food to be offered each mealtime for people to select from with alternatives available. Snacks and drinks were served between meals. We observed people who required help to be supported by staff, in an unhurried manner. We received many positive comments about the meals and snacks. We found that the monitoring of those at risk of malnutrition or dehydration needed improved. Please see area for improvement under key question 5. We looked at how the home managed falls and found that this was an area that needed improvement. Whilst it is recognised that people living in a care home will have more falls than people living at home, strategies should be looked at to reduce the risk of falling on an individual basis and especially after someone sustains a fall. This especially concerned us, for one resident that we had to highlight to management, during the inspection. Please see requirement 1. We looked at medication management and found that on a day to day basis people could be assured that they were received their medications as prescribed. However, the procedure in place for using 'over the counter' medication, sometimes referred to as 'homely remedies' needed to be improved, as we were not confident that staff had always assured themselves that the medication they administered would not interfere with any existing medicines or medical conditions. Please see area for improvement 2. We acknowledge that there had been many staff changes over the past few months, which meant that many of the staff were either new or recently returned from a period of absence. We found that this was now settling down and staff were working well together, to put systems in place. Requirements 1. To ensure that people who have sustained a fall can be confident that the provider has robust systems in place, then the provider must ensure that by 31 December 2019: Inspection report for Bothwell Castle Care Home page 4 of 10 Inspection report 1. They assess a resident's responsiveness and for any injury (including cuts, bruising, deformities or pain) at the time of the fall. 2. Assess level of injury, provide reassurance and take appropriate action (for example, call ambulance/GP/ NHS 24). 3. Ensure ongoing monitoring of the individual as some injuries may not be apparent at the time of fall. 4. Carry out a post falls analysis of this which takes into account why the fall may have occurred and any lessons learned to reduce the risk of this re-occurring. This ensures that care and support is consistent with the Health and Social Care Standards, which state: 'My care and support meets my needs and is right for me.' (HSCS 1.19). It is also necessary to comply with Regulation 4(1)(a) (welfare of service users) of the Social Care and Social Work Improvement Scotland Regulations 2011. Areas for improvement 1. The service should ensure that a system is in place to demonstrate that residents and/or their legal representative have consented to certain aspects of their care.