Achvarasdal (Care Home) Care Home Service Reay Thurso KW14 7RR Telephone: 01847 811226 Type of inspection: Unannounced Inspection completed on: 20 September 2016 Service provided by: Service provider number: Church of Scotland Trading as SP2004005785 Crossreach Care service number: CS2003008461 Inspection report About the service The inspection focused on standards of care for people living with dementia. We are using a sample of 150 care home services to look in detail at the standards of care for people living with dementia and this service is one of those selected as part of the sample. The areas looked at were informed by the Scottish Government's Promoting Excellence: A framework for health and social care staff working with people with dementia and their carers and the associated dementia standards. It is our intention to publish a national report on some of these standards during 2017. The Care Inspectorate regulates care services in Scotland. Information about 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 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. There were 13 residents living at the home at the time of the inspection. The service is located in Achvarasdal, a former Victorian shooting lodge, in Caithness. Crossreach's mission statement is "In Christ's name we seek to retain and regain the highest quality of life, which each individual is capable of experiencing at any given time." Our aim is to create a homely environment with a welcoming atmosphere, where individuals are supported to do as much for themselves as possible and so promote their independence and fulfilment. The objectives to enable us to deliver our aim include: - To offer an individual, needs' led service to all within our care, regardless of gender, culture, social background or ability. - To maintain a safe and comfortable environment. - To promote choice in all aspects of daily life. - To offer opportunity for fulfilling activities and pastimes. - To maintain dignity and respect privacy. - To promote an individual's independence. What people told us For this inspection, we received views from 11 out of the 13 people using the service. Seven people gave their views via the care standards questionnaires and we spoke with a further four during the inspection. Individual comments from the questionnaires included:- "Staff are very caring and supportive towards me" "Very happy with all care and support and the staff are very good to me" "Very happy with care and support. Sometimes need help through my buzzer, the girls are very busy" Inspection report for Achvarasdal (Care Home) page 2 of 18 Inspection report When we spoke with residents they appeared happy with the level of care and support and said that the staff were very helpful. They enjoyed the meals and said that there was always a choice. Rooms and the rest of the home were kept tidy and clean. Individual comments included:- "I like it that the staff are spoken of in devotions and that they are excellent" "I am worried about my wife as she had a fall and is still quite anxious. The care and support is very good and the staff are helpful" "I have had no issues with the agency staff but I sometimes have to wait too long for the call bell to be responded to" "The food is great and my room is spotless" We were unable to speak to relatives during our inspection as none were visiting at the time. We gained the views of five who completed our questionnaires. Four of the people who responded indicated that they agreed with all of the questions that were asked of them. One felt, overall, that staff did not have the skills to care for their relative. Also they strongly disagreed that there were enough trained and skilled staff on duty at any given time. Individual comments included:- "All the staff are extremely helpful to my relative. Very considerate of her needs and problems and the food is of a good standard with varied menus. I do find it frustrating when we enter and leave that we need to use the bell to summon staff to enter the code for the door. They are busy with residents who require attention. Surely regular family visitors should be allowed access to the number?" (We discussed this at feedback) "The care home desperately needs stability in their senior staff/manager. The inclusion/increase in hours of the activity coordinator has greatly helped in promoting relevant and appropriate activities. The introduction of a memories book for each resident provides an incentive for communication and reminiscence" "We are not particularly happy with the services provided by this care home. Generally speaking the home is in a reasonable state of care and repair. We are also reasonably happy with the care provided by the staff. Having said that it is clearly evident that the staff are demoralised and there is a clear lack of leadership and management. During the years that our relative has been a resident, this home has lurched from one crisis to another and for most if that time there has been no permanent manager, but a host of "stand-ins" from other areas. The problems clearly lies with senior management at head office level who appear to be (quote) 'unsupportive' of their local staff and almost incapable of sourcing a long term management solution" (We discussed this at feedback) Inspection report for Achvarasdal (Care Home) page 3 of 18 Inspection report Self assessment 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. From this inspection we graded this service as: Quality of care and support 3 - Adequate Quality of environment 3 - Adequate Quality of staffing 3 - Adequate Quality of management and leadership 2 - Weak Quality of care and support Findings from the inspection Staff interactions with people using the service were good. There was a high use of agency staff, however at the time of the inspection, all staff seemed to know the people using the service well and included them. Staff were generally supportive and communicated well with people using the service. We found care plans had not been further developed and some people did not have care plans in place, in accordance with the format that was promoted by the provider. It is important for staff and families to have access to accurate information in personal plans about the care and support people need and are to receive. (See requirement 1) Care plans for those people who lived with dementia, or a cognitive impairment, were not person centred and there was a lack of information about how staff could support residents with their stress and distress. The charts that were being used to monitor distress did not result in care plans being updated or staff being supported or guided with their interactions. (See recommendation 1) Staff should develop and encourage a culture of promoting continence rather than managing continence. Staff should develop continence care plans with people, where needed, which support a promoting continence approach. (See recommendation 2) Staff had some good information about people's life history, past, present and future wishes. Staff should continue to gather this information and use it in a way that works for the person in their day-to-day support. The service should use this information to develop activities that are meaningful to individual people using the services. The service should continue to explore and develop community links, to improve a sense of involvement with the local community for people using the service. (See recommendation 3) In most of the care plans we looked, where applicable, appropriate Adults with Incapacity certificates (AWI's) and Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR's) forms were in place. The DNACPR's indicated that Inspection report for Achvarasdal (Care Home) page 4 of 18 Inspection report they should be reviewed; however the GP had stated that these were 'indefinite'. The service should liaise with the GP practices to ensure that these were reviewed accordingly. It was not always clear who held Power of Attorney or Guardianship and the relevant information was not included in the person's care plan. The service was to ensure that staff had this information when assisting people to make decisions. (See recommendation 4) There were no anticipatory care plans in place. Staff should discuss with people using the service, and involve relevant others where appropriate, to develop end of life plans that meet people's previous wishes as much as possible. (See recommendation 5) There was some good information and examples of best practice with regard to the use of covert medications. All relevant parties had been involved and reviews had been held. There was evidence that staff were seeking assistance from the GP between reviews. Overall the management of medication was good and we found that staff were adhering to best practice. There was good provision of activities. The coordinator was very enthusiastic and committed to providing a range of activities for residents to take part in. They had spent time with residents getting to know what they liked. They maintained records of who had taken part and if they had enjoyed their time.