‘Positive relationships’ at care home despite areas of weakness

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Despite uncovering weaknesses which were cause for ‘serious concern’, an unannounced inspection at Kintyre Care Home on June 11 found residents like living at the facility and have a ‘good relationship’ with staff.

A summary of the Care Inspectorate’s report, which was submitted to the Scottish Parliament on June 25 in accordance with the Coronavirus (Scotland) (No.2) Act 2020, revealed a ‘serious letter of concern’ had been issued to HC-One, owners of the care home, after the inspection uncovered ‘inconsistent use of personal protective equipment (PPE)’ and ‘a lack of understanding from staff of best practice’.

The full report, which has since been published, reveals that despite making improvements on requirements set out by the Care Inspectorate, Kintyre Care Home’s care and support during the Covid-19 pandemic was evaluated as ‘weak’, with a score of two on a six-point scale where one is ‘unsatisfactory’ and six is ‘excellent’.

However, inspectors said residents were supported by care staff who knew them well and were familiar with their individual choices and preferences and with whom they had formed ‘positive relationships’.

‘Although interactions between staff and residents were friendly and respectful, we observed they were mainly task orientated,’ the report reads. ‘Some residents spent a lot of time in their bedrooms to enable sufficient social distancing. Staff told us about their difficulties to provide enough stimulation and physical activity for residents.

‘We were concerned about the provision of social stimulation and meaningful occupation for this group of people.’

The inspection also identified areas of the environment and equipment where ‘immediate attention to the level of cleanliness’ was required, and observed staff practice regarding the prevention and control of infection did not follow current best practice guidance, including ‘inconsistent and incorrect’ use of PPE.

‘Overall, we had serious concerns about the quality of practice we observed which increased the risk of infection for the residents,’ reads the report. ‘To ensure that the provider took immediate remedial action to resolve this, we issued the provider with a letter of serious concern on June 12. We made a requirement which was to start immediately and to be completed within 14 days.

‘The requirement asked the provider to ensure all staff are trained in the donning and doffing of PPE and have the correct type of PPE for the work they are to carry out. It also asked for adequately stocked PPE stations to be placed appropriately within the home for staff to use.’

It continues: ‘The first day of our inspection highlighted significant weaknesses in leadership and management of the service. This led to a lack of confidence in the service’s ability to implement and monitor current guidance and good practice.

‘We found that outcomes from a recent healthcare associated infection audit, carried out by NHS Highland on June 5 2020, had been transferred to an action plan. However, implementation of immediate actions appeared to be slow and ineffective.

‘There was a lack of clear, dynamic and effective quality assurance to evaluate and drive the implementation of guidance and good practice.

‘Although the provider and the local HSCP provided support for the service manager, we did not see sufficient evidence that this led to measurable and sustainable improvements. We found that staff needed clear and consistent management and leadership to ensure that they had the resources, capabilities and confidence to provide safe and effective care.’

The Care Inspectorate made a further requirement via its letter of serious concern, asking HC-One to take action within 14 days to ensure management arrangements were suitable to effectively and urgently improve the quality of the service.

An HC-One spokesperson told the Courier it had taken ‘immediate action’, adding that a new, experienced turnaround home manager from its team would be running the home and that the company’s area director and area quality director had both been working at the home.

Caroline Cherry, head of Adult Services for Older Adults and Community Hospitals, said Argyll and Bute HSCP had been working closely with the Care Inspectorate and HC-One to improve care and support within the home, including temporarily closing the home to admissions, carrying out infection control audits and installing an HSCP manager as a mentor, on a part-time basis.

When a subsequent visit to the home was carried out on June 26, inspectors found these actions had had ‘immediate positive effects’ on the service, adding: ‘There was a sense of control and confidence in working towards sustainable improvements using effective action plans.

‘Staff we met during this second day of our inspection were more confident and able to explain to us how they implemented good practice.’

The report outlined a requirement that Kintyre Care Home must fulfil by October 1 2020 as follows: ‘The home must implement robust quality assurance processes for infection prevention and control, including regular environmental cleanliness audits and cleanliness audits for shared equipment and regular observations of staff practice. The quality assurance process must be dynamic in following the latest available government guidelines and best practice guidance.’