fordmill care home care home service adults · fordmill care home is a purpose-built home located...

Fordmill Care HomeCare Home Service AdultsBarchester Healthcare Ltd53 Mill StreetMontroseDD10 8NETelephone: 01674 667398

Type of inspection: Unannounced

Inspection completed on: 29 January 2015

ContentsPage No

Summary 31 About the service we inspected 52 How we inspected this service 73 The inspection 114 Other information 215 Summary of grades 226 Inspection and grading history 22

Service provided by:Barchester Healthcare Ltd

Service provider number:SP2003002454

Care service number:CS2007142950

If you wish to contact the Care Inspectorate about this inspection report, please callus on 0345 600 9527 or email us at [email protected]

Inspection report continued

Fordmill Care Home , page 2 of 24

SummaryThis report and grades represent our assessment of the quality of the areas ofperformance which were examined during this inspection.

Grades for this care service may change after this inspection following otherregulatory activity. For example, if we have to take enforcement action to make theservice improve, or if we investigate and agree with a complaint someone makesabout the service.

We gave the service these grades

Quality of Care and Support 4 Good

Quality of Environment 5 Very Good

Quality of Staffing 5 Very Good

Quality of Management and Leadership 5 Very Good

What the service does wellWe found that residents and their staff team had good relationships. Care plans wereseen to be very person-centred and the care and support received by residentsreflected the plans.

Residents told us that they were happy in the home. The home had a very stablestaff team who demonstrated a good understanding of people's needs and workedhard to meet these.

What the service could do betterIt is important that staff ensure that residents receive all prescribed topicalmedications. There were some omissions in the topical medication recording charts.The acting manager planned a full review of all creams and lotions to assess currentskin care needs.

What the service has done since the last inspectionThe provider had introduced a new review system which allowed the service to keepmore detailed records of the outcomes of reviews.



ConclusionOverall, this is a service which is appreciated by residents and their relatives. Peoplewe spoke with told us that they were well looked after. The home was clean and wellmaintained.

The service should ensure that all residents receive their prescribed creams andlotions in order to keep their skin healthy and well hydrated.



1 About the service we inspectedThe Care Inspectorate regulates care services in Scotland. Prior to 1 April 2011, thisfunction was carried out by the Care Commission. Information in relation to all careservices is available on our website at www.careinspectorate.com

This service was previously registered with the Care Commission and transferred itsregistration to the Care Inspectorate on 1 April 2011.

Requirements and Recommendations

If we are concerned about some aspect of a service, or think it could do more toimprove its service, we may make a recommendation or Requirement.

A Recommendation is a statement that sets out actions the care provider shouldtake to improve or develop the quality of the service but where failure to do so willnot directly result in enforcement. Recommendations are based on the National CareStandards, relevant codes of practice and recognised good practice.

A Requirement is a statement which sets out what is required of a care service tocomply with the Public Services Reforms (Scotland) Act 2010 and Regulations orOrders made under the Act, or a condition of registration. Where there are breachesof the Regulations, Orders or conditions, a Requirement must be made.Requirements are legally enforceable at the discretion of the Care Inspectorate.

Fordmill House is owned and managed by Barchester Health Care Ltd. Fordmill Houseis registered to provide nursing care, accommodation and support to a maximum of60 adults including older people, young physically disabled adults and older peoplewith enduring mental health problems.

Fordmill Care Home is a purpose-built home located within the residential area ofMontrose. The service is close to local amenities and transport links. The serviceoperates on two levels, each floor being self-contained with shared accommodation.

A main dining room is located on the lower floor and can be accessed by the lift. Thehome has well maintained landscaped grounds.

The aims and objectives of the service are to provide an environment in which highstandards of care and service can be delivered.

The home brochure states that:



• 'Whether you're a resident, a relative or part of the local community, everyonegets a great reception at Fordmill'.

Based on the findings of this inspection this service has been awarded the followinggrades:

Quality of Care and Support - Grade 4 - GoodQuality of Environment - Grade 5 - Very GoodQuality of Staffing - Grade 5 - Very GoodQuality of Management and Leadership - Grade 5 - Very Good

This report and grades represent our assessment of the quality of the areas ofperformance which were examined during this inspection.

Grades for this care service may change following other regulatory activity. You canfind the most up-to-date grades for this service by visiting our websitewww.careinspectorate.com or by calling us on 0345 600 9527 or visiting one of ouroffices.



2 How we inspected this service

The level of inspection we carried outIn this service we carried out a low intensity inspection. We carry out theseinspections when we are satisfied that services are working hard to provideconsistently high standards of care.

What we did during the inspectionWe wrote this report following an unannounced inspection. This was carried out byone inspector on 28 January and 29 January 2015. The inspection was concluded andfeedback given to the acting manager on 29 January.

As part of the inspection, we took account of the completed annual return and selfassessment forms that we asked the provider to complete and submit to us.We asked the manager to give out Care Standards Questionnaires (CSQs) to eachresidents and relatives. Three relative CSQs were completed and returned prior to theinspection. The information given was used to inform our inspection report andcomments made have been included in this report.

During the inspection process, we gathered evidence from various sources, includingthe following:

We spoke with:

• ten residents• six family members• acting manager• four care workers• two senior care workers• two nurses.

We looked at:

• care plans and related documentation• evidence of input from outside health professionals• training records• medication records• maintenance records• accident and incident records



• the environment.

Grading the service against quality themes and statementsWe 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'. Undereach quality theme are 'quality statements' which describe what a service should bedoing well for that theme. We grade how the service performs against the qualitythemes 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 ourinspections. These are extra checks we make on top of all the normal ones we makeduring inspection. We do this to gather information about the quality of these aspectsof care on a national basis. Where we have examined an inspection focus area we willclearly identify it under the relevant quality statement.

Fire safety issuesWe do not regulate fire safety. Local fire and rescue services are responsible forchecking services. However, where significant fire safety issues become apparent, wewill alert the relevant fire and rescue services so they may consider what action totake. You can find out more about care services' responsibilities for fire safety atwww.firelawscotland.org



The annual returnEvery year all care services must complete an 'annual return' form to make sure theinformation we hold is up to date. We also use annual returns to decide how we willinspect the service.Annual Return Received: Yes - Electronic

Comments on Self AssessmentEvery year all care services must complete a 'self assessment' form telling us howtheir service is performing. We check to make sure this assessment is accurate.The Care Inspectorate received a fully completed self assessment document from theprovider. We were satisfied with the way the provider completed this and with therelevant information included for each heading that we grade services under.

The provider identified what it thought the service did well, some areas fordevelopment and any changes it had planned. The provider told us how the peoplewho used the care service had taken part in the self assessment.

Taking the views of people using the care service into accountWe spoke with ten residents during the inspection process. All commented favourablyabout the service and their comments have been included within this report.

Nine people returned CSQs which the Care Inspectorate hadissued. Their comments included:

• 'Excellent care and attention A+'.• 'I get all the help I need'.• 'Considering my age and health I could not be in a better place'.

Taking carers' views into accountWe spoke with six relatives during the inspection process. All commented veryfavourably about the service and their comments are included in this report.



Twenty-one relatives returned the CSQs which the Care Inspectorate issued.

Their comments included:

• 'I visit my mother on 3 or 4 occasions every week and the staff keep meinformed about her care and welfare'.

• 'Outstanding care'.• 'I have no issues with service and if any problems do pop up I discuss with

staff immediately'.• 'Sometimes appear short staffed at weekends which means longer time to

wait for assistance for my loved one'.• 'I cannot fault the care home. My relative has been happy there from his date

of admission. I can relax now assured that he is receiving the care andattention he needs'.

• 'The atmosphere in the home is always calm and peaceful. All staff arewelcoming and helpful to me'.

• 'The care has been of a high standard and medical issues have been dealtwith promptly and all information passed to me in a timeous manner withinthis setting. The staff are helpful and there is always someone available totalk to if needed'.

• 'Overall the home is quite good. There have been small issues which havebeen rectified on discussion with staff'.



3 The inspectionWe looked at how the service performs against the following quality themes andstatements. Here are the details of what we found.

Quality Theme 1: Quality of Care and SupportGrade awarded for this theme: 4 - Good

Statement 1We ensure that service users and carers participate in assessing and improving thequality of the care and support provided by the service.

Service strengthsAt this inspection we found that the performance of the service was very good for thisstatement. We reached this conclusion after we spoke with residents, relatives, staffand read care plans.

We examined six care plans at this inspection. These showed that residents had sixmonthly reviews of their care. These were held with both the resident and theirrelatives as appropriate. We saw evidence of discussion and any agreements ofchanges needed to care.

The acting manager told us that the review documentation had been revised sincethe last inspection to allow for a more comprehensive review record to be kept.

We saw that care plans were up-to-date and reflected any changes agreed as theresult of these reviews. Staff we spoke with were able to demonstrate a goodunderstanding of residents' care and support needs.

Residents had access to a range of activities both within the home and in the localcommunity - either going out to attend activities or by inviting groups into the home.

A comments book had been introduced to the reception area. This was in order forresidents or visitors to make any observations. It had not been used to date.

The service continued to produce a monthly newsletter which contained informationabout developments in the home, activities and meetings. We saw that residents had



individual copies of that and the current weeks activity planner in their rooms. Thissupported them to read these and share them with their relatives.

We saw that there were informative noticeboards around the home which providedinformation about how to raise a concern or complaint, advocacy, weekly activitiesand menus.

The social meetings which had been introduced by the last inspection were reportedto be working well.

Residents and relatives told us that staff including ancillary, reception, administrationand care staff were always willing to help them.

People told us that the management team were very approachable and that youcould speak with them with confidence that any issues would be resolved.

Areas for improvementIn their self assessment the provider identified areas for improvement to be involvingnamed carers to be involved in resident reviews and to work with staff and residentsto further develop life story/history books.

Grade awarded for this statement: 5 - Very Good

Number of requirements: 0

Number of recommendations: 0

Statement 3We ensure that service users' health and wellbeing needs are met.

Service strengthsAt this inspection we found that the performance of the service was good for thisstatement. We reached this conclusion after we spoke with residents, relatives, staff,read care plans and associated documentation.

People who used the service had an assessment of needs carried out prior toadmission. This led to the development of a range of risk assessments including riskof falls, nutrition and moving and handling.

Where a risk was identified, a care plan which identified support required wasdeveloped. This included management of health conditions as well as personalpreferences.

For example:



• When they wished support to go to bed or get up.• What people could do for themselves what support they required to take part

in activities.• A plan described how a resident had been consulted about whether they

wished their position changed through the night and how this had beenagreed.

We saw that the care plans had been completed in a very person-centred way whichgave the reader a very good understanding of residents support needs.

All care plans were seen to be reviewed at the regular reviews, and where relevantthese were updated with the involvement of the resident and/or relatives.

Where issues were raised in relation to nutrition, records evidenced that the servicehad taken appropriate action, and had easy access to support from the dietitian. Theservice continued to maintain close links with other local health professionals. Thisincluded GP, podiatry and psychiatric services.

We examined two wound care plans. We were satisfied that the treatment planswere clear and that staff had followed these properly and within identifiedtimescales. We spoke with one nurse regarding these. She was able to demonstratea good knowledge of the residents' needs.

During the first day of the inspection we saw that the lunchtime meal was a relaxedand enjoyable experience for residents. The tables were well presented; the diningarea appeared to have a happy ambience with residents taking their time over theirmeal to chat with each other and staff.

Residents we spoke with were very positive about the range of activities offered. Theytold us that they were encouraged to join in, but did not feel they had to.

Comments from residents included:

• 'It's a nice place to live, everyone is so friendly'.• 'It's a busy home, but this doesn't affect the care I get'.• 'No problems'.• 'Happy with my care'.• 'The food is good, the staff are nice and I like my room'.

Relatives we spoke with also commented very positively on the quality of care andsupport offered. Their comments included:



• 'My mum seems really happy here, she seems well looked after'.• 'No issues, my relative has been here for a couple of years, I've had no reason

to complain'.• 'Staff are friendly and can answer any questions I have'.• 'It's got a good reputation that's why we chose it. It's lived up to it's

reputation'.• 'All good'.

Areas for improvementWe carried out a medication audit. We found overall residents received their tabletson a regular basis and that these were all in stock and signed when given. However,we found gaps in some of the topical application administration records. Staff werenot always signing to evidence that they had given residents prescribed creams andlotions.

Two residents we spoke with told us that they did not always get the creams andlotions that they should. We also found in some residents bathrooms creams whichwere no longer prescribed.

The acting manager agreed that the service would carry out a full review of all topicalapplications with the prescriber to ensure that records were up-to-date and thatagreed prescriptions were being administered appropriately (see Requirement one).

Grade awarded for this statement: 4 - GoodNumber of requirements: 1Number of recommendations: 0

Requirements1. The provider must demonstrate that they have developed and are implementing a

safe and effective system for the management and administration of service usersmedication. Particular reference is made, but not limited to, the use of topicalapplications.

This is in order to comply with The Social Care and Social Work ImprovementScotland (Requirements for Care Services) Regulations 2011. Scottish StatutoryInstrument 210 Regulation 4 (1) (a) Welfare of Users.

Timescale: To commence immediately and be fully implemented by 15 March2015.



Quality Theme 2: Quality of EnvironmentGrade awarded for this theme: 5 - Very Good

Statement 1We ensure that service users and carers participate in assessing and improving thequality of the environment within the service.

Service strengthsPlease see Quality Theme 1, Quality Statement 1 for areas of strength which are alsorelevant to this statement.

Areas for improvementPlease see Quality Theme 1, Quality Statement 1 for areas for improvement which arealso relevant to this statement.

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

Statement 2We make sure that the environment is safe and service users are protected.

Service strengthsThe service was able to provide very good evidence in support of this statement.

We examined the recruitment records of two staff recently employed in the service.The service had sought and received references for each person, carried out aProtecting Vulnerable Groups (PVG) check prior to them commencing their posts andchecked registration with relevant professional bodies.

The manager and staff we spoke with were aware of the need for all care staff tohave applied for registration with the Scottish Social Services Council (SSSC) by 30September 2014. A record of all applications were kept and progress with registrationwere kept by the administrator.

Staff we spoke with demonstrated a good understanding of infection control, theimportance of effective hand washing and the use of aprons and gloves when



carrying out personal care. We observed them using these when supporting peoplewith personal care.

There appeared to be adequate staffing levels within the home. We observed thatstaff whilst busy, were not rushed in their work and had time to spend with residents.Staff, residents and relatives told us that staffing was fine.

Records of accidents and incidents showed that the manager had an overview of allevents in the home and reviewed these taking any actions necessary to reducelikelihood of recurrences.

We found the home to be overall maintained to a high standard. The environmentwas seen to be clean and free of odours. Domestic staff told us that they had enoughcleaning supplies and equipment to keep the home clean.

We found maintenance records to be up-to-date and demonstrated that regularchecks of systems were carried out. This included water safety (temperature testing,water flush through and shower head cleaning). We saw that specialist equipmentwas serviced annually.

Areas for improvementThe acting manager informed us that there was an ongoing programme ofrefurbishment within the home.

We highlighted that in one bathroom, attention was needed to some fixings from anold piece of equipment which should be removed. We also discussed that on oneoccasion two sluice areas were not locked. They may need adjusted to ensure thatthe locks engage when the doors are closed. The acting manager agreed to actionthis immediately and speak with staff to ensure that they check doors are fully lockedafter them.




Quality Theme 3: Quality of StaffingGrade awarded for this theme: 5 - Very Good

Statement 1We ensure that service users and carers participate in assessing and improving thequality of staffing in the service.

Service StrengthsPlease see Quality Theme 1, Quality Statement 1 for areas of strength which are alsorelevant to this statement.

Areas for improvementPlease see Quality Theme 1, Quality Statement 1 for areas for improvement which arealso relevant to this statement.


Statement 3We have a professional, trained and motivated workforce which operates to NationalCare Standards, legislation and best practice.


We examined records of two staff who had recently commenced work in the service.Records showed that they had received initial induction to working with residents, theenvironment and policies. We spoke with one of the newer staff. They told us thatthey had been well supported and spent time working alongside colleagues'shadowing' them whilst working with residents. This was in order to get to know theneeds of residents and gain confidence in working with them.

We examined supervision records of five staff. We saw that supervision offeredopportunities to discuss practice issues and training. Observation of practice sessionswere also taking place. This allowed senior staff to discuss their practice with staffthey supervise and advise them of any improvements needed. This also allowed the



provider to monitor that the training provided was being effective. Staff we spokewith told us that they felt supported in their role.

We saw that a range of training opportunities were available for staff. Staff told usthat they felt that the training provided was appropriate to their post.

Our observations were that the staff treated residents with dignity and respect. Staffhad good knowledge and understanding of individual residents, what they liked andwhat level of support was needed.

They chatted comfortably with residents using their preferred name. Staff memberswere observed to be friendly and supportive towards residents and call bells andrequests were responded to promptly.

Care workers are now in the process of registering with the SSSC. Staff we spokewith were aware of this and progress was being monitored by the management team.

Areas for improvementIn the self assessment, the provider identified an area for improvement to be tocontinue Scottish Vocational Qualification (SVQ) training for staff relevant to theirposts. This will also be required over time for staff registering with the SSSC.




Quality Theme 4: Quality of Management and LeadershipGrade awarded for this theme: 5 - Very Good

Statement 1We ensure that service users and carers participate in assessing and improving thequality of the management and leadership of the service.

Service strengthsPlease see Quality Theme 1, Quality Statement 1 for areas of strength which are alsorelevant to this statement.

Areas for improvementPlease see Quality Theme 1, Quality Statement 1 for areas of strength which are alsorelevant to this statement.


Statement 4We use quality assurance systems and processes which involve service users, carers,staff and stakeholders to assess the quality of service we provide.


The manager reviewed all incidents and accidents and carried out a monthly audit ofthese. This allowed monitoring of any trends and for steps to be taken to minimisethese.

They also used a monitoring tool - the pressure safety cross. This was to monitorand to take appropriate steps to minimise issues with skin conditions for residents.We checked the safety cross on the ground floor and found that there had been nobreakdown of skin during all January.

The service carried out a range of quality audits. These were carried out by themanagement team and head office managers. This included care planning,



environment and accident/incident records. We saw that where there were areas forimprovement needed an action plan was in place.

There was a complaints procedure available and on display. Relatives told us that theywould feel confident to raise any issues and that they would be addressed. We foundthat two concerns raised since the last inspection had been fully investigated. Themanagement team had followed the providers policy and procedure ensuring thatfeedback was given timeously.

Although the service was awaiting the new manager commencing in post, it wasclear that there was a strong management team leading the workforce anddemanding high standards of them. (The deputy manager was temporarily taking onthe manager role and had worked in the service for several years).

This was done in a professional and supportive manner. We evidenced this throughour discussions with staff and checking of records such as; team meetings andsupervision records.

Supervision included observation of practice which assisted the nursing andmanagement team to guide staff to deliver appropriate care.

We concluded that this management support had resulted in good outcomes forresidents.

Staff, residents and relatives we spoke with told us that the manager was alwaysavailable and very involved in all aspects of care delivery.

In assessing this statement we also took into account the findings of Quality Theme1, Quality Statement 1 and Quality Theme 1, Quality Statement 3.

Areas for improvementThe service identified that they planned to continue to make improvements to theservice based on the outcome of audits. Development plans would be implemented.

Based on the findings of Quality Theme 1, Quality Statement 3, this should includeensuring that medication audits particularly focus on administration of topicalapplications.




4 Other information

ComplaintsNo complaints have been upheld, or partially upheld, since the last inspection.

EnforcementsWe have taken no enforcement action against this care service since the lastinspection.

Additional Information

Action PlanFailure to submit an appropriate action plan within the required timescale, includingany agreed extension, where requirements and recommendations have been made,will result in the Care Inspectorate re-grading a Quality Statement within the Qualityof Management and Leadership Theme (or for childminders, Quality of StaffingTheme) as unsatisfactory (1). This will result in the Quality Theme being re-graded asunsatisfactory (1).



5 Summary of grades

Quality of Care and Support - 4 - Good

Statement 1 5 - Very Good

Statement 3 4 - Good

Quality of Environment - 5 - Very Good



Quality of Staffing - 5 - Very Good



Quality of Management and Leadership - 5 - Very Good



6 Inspection and grading history

Date Type Gradings

21 Mar 2014 Unannounced Care and support 5 - Very GoodEnvironment 5 - Very GoodStaffing 5 - Very GoodManagement and Leadership 5 - Very Good

26 Feb 2013 Unannounced Care and support 5 - Very GoodEnvironment 5 - Very GoodStaffing 5 - Very GoodManagement and Leadership 5 - Very Good

29 Dec 2010 Unannounced Care and support 5 - Very GoodEnvironment Not AssessedStaffing Not AssessedManagement and Leadership Not Assessed



29 Jun 2010 Announced Care and support 5 - Very GoodEnvironment Not AssessedStaffing Not AssessedManagement and Leadership 5 - Very Good

19 Mar 2010 Unannounced Care and support 5 - Very GoodEnvironment 5 - Very GoodStaffing 5 - Very GoodManagement and Leadership Not Assessed

1 Sep 2009 Announced Care and support 4 - GoodEnvironment 5 - Very GoodStaffing 5 - Very GoodManagement and Leadership 5 - Very Good

19 Mar 2009 Unannounced Care and support 4 - GoodEnvironment 5 - Very GoodStaffing Not AssessedManagement and Leadership Not Assessed

9 Dec 2008 Announced Care and support 4 - GoodEnvironment 5 - Very GoodStaffing 5 - Very GoodManagement and Leadership 5 - Very Good

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



To find out more about our inspections and inspection reportsRead our leaflet 'How we inspect'. You can download it from our website or ask us tosend you a copy by telephoning us on 0345 600 9527.

This inspection report is published by the Care Inspectorate. You can get more copiesof this report and others by downloading it from our website:www.careinspectorate.com or by telephoning 0345 600 9527.

Translations and alternative formatsThis inspection report is available in other languages and formats on request.

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



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