Dunjop Nursing Home Care Home Service

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Dunjop Nursing Home

Bridge of Dee

Castle Douglas

DG7 2AE

Telephone: 01556 680 271

Type of inspection: Unannounced

Inspection completed on: 19 February 2018

Service provided by:

Service provider number:

Downing Care Limited

SP2013012042

Care service number:

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About the service we inspected

Dunjop Nursing Home is a care home registered to provide care to a maximum of 20 older people with physical/ sensory impairment and/or memory impairment/dementia.

The service is provided by Downing Care Ltd.

The home is situated in a rural location near Bridge of Dee, Castle Douglas, in Dumfries and Galloway.

Accommodation is over two levels, with stairs, chair lift and a small passenger lift to enable people to access the upper floor. The upper floor has a living room which is used occasionally. A modern shower room and shared toilet facilities. A low fixed height bath is available with bath seat.

All bedrooms are single rooms with a wash basin; three of which have an en suite toilet.

The ground floor has a large conservatory with dining tables. Doors open to a small courtyard area. A small lounge is located off this. There are shared toilet facilities and a bathroom. Discussion took place regarding improving this facility.

At the time of this inspection, 13 people were living in the home, five had contracts for nursing care the remainder were contracted for residential care only. The service employs nurses but also uses district nurses when necessary.

The term used for people who use the service is "residents" and this term is used throughout this report. The aim of the service is 'to be the preferred choice for nursing and residential care in Dumfries and Galloway.' The philosophy of care includes aiming 'to provide a service which promotes independence and gives

encouragement to lead an active life as far as age and health allows.'

How we inspected the service

This unannounced follow-up inspection focussed on the progress made in meeting eight recommendations made in the previous inspection report of 16 August 2017.

During this visit two inspectors spent time talking with residents, relatives and staff. We examined three personal plans in some detail. An lunchtime and evening meal was observed and evening routines. The Manager provided an update on progress being made to develop the service.

Taking the views of people using the service into account

We spoke with two residents who were able to give us their views. Both were contented with the service. One wanted to move on to another service and felt this was taking a long time. The service had been assisting this resident to communicate this to the local authority.

Neither residents had had the opportunity to go out from the care home in recent months and one felt this would have been nice.

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Taking carers' views into account

We spoke with two relatives. Both stated the mud outside the home was a problem and they felt it was hard for the staff to manage as it was constantly trailed into the foyer at the main entrance. This was worse than usual due to ground works taking place. They felt the care was adequate for their relative and had no other issues.

Previous requirements

There are no outstanding requirements.

Previous recommendations

Recommendation 1

The service provider should ensure residents have more meaningful activities to engage with. This will be demonstrated by:

- assessment to establish preferences for social and leisure interests - a plan of how this can be supported

- tailored activities suitable for the individual

- this should include support to keep up relationships, encouragement to use local services and engage with local events.

National Care Standards for Care Homes for Older People, Standard 6.1 - supporting arrangements & Standard 17.1, 17.4, 17.7 - Daily Life

This recommendation was made on 16 August 2017.

Action taken on previous recommendation

There was insufficient action taken to address this recommendation.

Whilst some assessments had been carried out, at the time of the inspection not all service users had had a structured assessment completed to establish preferences and capabilities for meaningful activities There was

What the service has done to meet any requirements we made at

or since the last inspection

What the service has done to meet any recommendations we

made at or since the last inspection

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no day to day plan in place of how this could be supported. Activities took place on an ad hoc basis supported by staff who had not had any recent training in this subject. This meant residents generally experienced a lack of meaningful activity.

The Manager told us staffing was not as they wanted it to be and this had hampered progress. Although "ad hoc" activities can be beneficial to those able to participate this approach did not reflect best practice. Recommendation is not met.

Recommendation 2

The service provider should improve the mealtime experience to help increase residents sense of well-being. This will be demonstrated by:

- a "protected" mealtime approach where disturbance is kept to a minimum - the development of an alternative menu to provide a choice of courses at l

lunchtime lunchtime and evening meals

- the presentation of texture diets to improve in keeping with best practice

- crockery is good quality, homely and recognises the needs of people with dementia. For example by providing a colour contrast.

National Care Standards for Care Homes for Older People, Standard 13.3 & 13.7 Eating Well. This recommendation was made on 16 August 2017.

Although some staff understood the concept of a "protected" mealtime the principles had not all been put in place. The mealtimes we observed were led by the cook and other staff tended to leave the dining area to attend to other residents or other duties. We were told this was the regular routine. This meant the dining

experience was not be managed as well as it could be.

The dining tables were not prepared well in advance of the meal. There had been no changes to the crockery provided. Drinks were provided in plastic "picnic" style beakers. Residents told us they were not provided with a choice of meal. When we asked about this there were other choices available but it was not clear how this was communicated so people with dementia could understand this. No changes had been made to the presentation of texture diets and we were told this was often just all mashed together in a bowl. We observed limited staff interaction with residents during the meals.

Staff were not aware of a mealtime audit and so there was shared understanding of how to improve the mealtime experience. The service have been signposted to the "My home life" programme and mealtime audits are available to assist the service to improve.

Recommendation is not met. Recommendation 3

The personal plan records should be reviewed to ensure they support care needs, outcomes for residents and involvement of agreed representative.

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This will be demonstrated by:

- a review of format and layout to be more outcome focused

- Detail clearly legal status and copies of associated paperwork. For example Adults with Incapacity certificates, Guardianship order, Power of Attorney to ensure clarity of decision-making

- review paperwork to ensure assessments and support plans used are in keeping with best practice with particular reference to tissue viability, nutrition and continence promotion.

National Care Standards for Care Homes for Older People, Standard 5.4 Management & Staffing Arrangements & 6.1 Supporting Arrangements.

We were told personal plans were being reviewed to update the content and layout. The personal plans we viewed was not easy to follow. We saw old documentation which could have been removed and duplication of assessments which had the potential to cause confusion. For example nutritional assessments.

Legal status of residents was recorded but sometimes in three different places and these did not always match. Care plan reviews were taking place but these did not always reflect the involvement of the next of kin or legal representative.

There was still work to be done to ensure best practice was being followed and staff used personal plans to support day to day care. We saw active care notes and some very out of date information in bedroom folders. These should be revised.

The service provider should ensure staff training takes place in dementia care and this includes updates on understanding rights, risks and limits to freedom.

This will be demonstrated by: - training records

- personal plan records show recording of restraint is carried out only as a last resort, agreed and reviewed at regular intervals

- personal plan records detail strategies to be used if a resident is resistant to personal care

- staff interactions are monitored to encourage good practice.

National Care Standards for Care Homes for Older People, Standard 5.4 - Management & Staffing Arrangements & Standard 9.8 - Feeling Safe & Secure.

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Some staff training had taken place on understanding rights, risks and limits to freedom. Restraint records were included within the personal plan documentation. The use of these documents could be streamlined but when used effectively provided a good record of situations of equipment use which may limit a residents freedom. For example lap straps or bed-rails. Staff all told us there was no resident who was resistant to personal care and they were aware that care must never be forced.

Strategies to recognise and reduce stress/ distress could be recorded more clearly and staff could move away from using reference to physical/ verbal aggression to use these more up to date terms. The manager was encouraged to use the training provided by the Ideas team. There was one resident with "as required" sedation medication and the administration of this could have more detail as to what distraction techniques would be used. For example specifics such as playing cards, favourite music or something else pertinent to the individual. This is an area for development and progress will be checked at the next inspection.

Recommendation is met. Recommendation 5

The service provider should develop and implement a plan of improvement to ensure the environment is suitable for older people with dementia.

This will be demonstrated by:

- a review of the internal and external areas to ensure residents can move around easily in the house, access the courtyard more easily and go for walks in the grounds

- a plan to address the issues identified using a recognised audit of the environment - timescales by which actions will be taken.

National Care Standards for Care Homes for Older People, Standard 4.1 - Your Environment. This recommendation was made on 16 August 2017.

There was no change to the ease of use of the courtyard. This remained difficult due to a door lip and the standard of furnishings in the area needed to be upgraded. The external areas of the house were not safe due to lack of maintenance and work men in the back garden. There were potholes on the driveway up to the care home and poor drainage affecting the parking area. This meant there was a lot of mud and rutting which made walking outside difficult.

Although a refurbishment plan had been drawn up it did not address this specific issue or recognise the needs of older people with dementia to gain access to safe outdoor space.

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Recommendation 6

. The service provider should ensure the environment is well maintained and a pleasant place to live.

This will be demonstrated by a refurbishment plan with timescales which takes account of the need to improve: - lighting

- temperature control - reduce excessive noise

- enhance décor and improve homely feel

- furniture with particular reference to vanity cabinets in bedrooms

- increase the choice and suitability of bathing and showering facilities for each floor.

National Care Standards for Care Homes for Older People, Standard 4.3, 4.7 & 4.8 - Your Environment. This recommendation was made on 16 August 2017.

A refurbishment plan had been drawn up but did not address all of the areas listed in this recommendation. Some minor changes to lighting and décor in the lounge, conservatory and some bedrooms had been carried out. However, this did not go far enough to ensure the environment was well maintained and pleasant. We noted many deficits including a fire exit door which had been temporality taken out of use due to

deterioration of the porch behind it. Some bedrooms were very sparse and lacked homely touches. Staff were not aware how they could assist with supporting residents to enhance their rooms. There was a lack of lockable drawers within bedrooms. We saw some equipment with rust damage. We noted the upstairs bathroom to have a lack of hot water from the wash basin tap. This facility was a fixed height bath which would be hard for some residents to use. Both the bath and shower facility were upstairs and this meant residents downstairs had to use the lift to access these. The downstairs facility had not yet been upgraded and the existing bathroom was in poor repair.

Excessive noise was observed from the phone ringer and nurse call systems. Alternatives should be explored as good practice.

Some bedrooms were not fit to be occupied and it was not clear which bedrooms were "out of use". This would have been safer and clearer for staff if these were locked and a notice put up. In order to be clear on this the Care Inspectorate request a notification to be made to make it clear how many bedrooms are fit for use and how many are "out of use".

The service provider should ensure staff follow-up to date infection control procedures with regards to management of dirty linen, commode pots, urinals and mattresses.

National Care Standards for Care Homes for Older People, Standard 4.2 - Your Environment. This recommendation was made on 16 August 2017.

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Staff spoken with were not aware of up to date standard infection control procedures. The service did not have an infection control "champion" and we could not see any audits to check practice and drive up improvement. As with the last inspection we observed poor practice in relation to the management of dirty linen, commode pots, urinals and mattresses.

The service provider should ensure health and safety checks are carried out in keeping with Health and Safety Executive guidance. This should include all hot water outlets, window restrictors and nurse call system. National Care Standards for Care Homes for Older People, Standard 4.2 - Your Environment.

We observed there was one hot water outlet with no water, two had very hot water. We noted water

temperatures had been recorded monthly and actions had been taken to reduce those outlets running too hot. It appeared there could be some fluctuation month by month. Some wash hand basins had an adjustable control which could be easily tampered with. This may need to be reviewed in order to ensure safer hot water controls. We noted one faulty window restrictor in an upstairs bedroom and two downstairs windows without suitable window restrictors in place.

We also noted the laundry room to be left unlocked. Chemicals were stored in this room and posed a risk to residents. We asked for an improved lock to be put in place immediately.

The nurse call system could be used as a call bell or as an alert mat. There were no splitters in use that could enable the system to be used by both. This could be beneficial for some residents.

This recommendation is not met.

Complaints

There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at www.careinspectorate.com.

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Enforcement

No enforcement action has been taken against this care service since the last inspection.

Inspection and grading history

Date Type Gradings

11 Jul 2017 Unannounced Care and support 3 - Adequate

Environment 3 - Adequate

Staffing Not assessed

Management and leadership Not assessed 14 Mar 2017 Unannounced Care and support Not assessed

Environment Not assessed

Management and leadership Not assessed

16 Mar 2017 Re-grade Care and support Not assessed

Environment Not assessed

Management and leadership 3 - Adequate 29 Jun 2016 Unannounced Care and support 3 - Adequate

Staffing 3 - Adequate

Management and leadership 2 - Weak

17 Jun 2015 Unannounced Care and support 4 - Good

Staffing 4 - Good

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To find out more

This inspection report is published by the Care Inspectorate. You can download this report and others from our website.

Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and help services to improve. We also investigate complaints about care services and can take action when things aren't good enough.

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