Care home under close scrutiny after poor report

The Viewforth House care home in Lerwick for people with dementia is under close council scrutiny after it received poor reports in two recent inspections.

The council-run premises was subject to two unannounced visits from the Care Inspectorate during the last year, one last December and another in May.

In December it received the low grading of two – the second to low­est grading – in all four categories assessed. These comprised the qual­ity of care and support, environment, staffing and leadership and manage­ment.

Any score below three is consid­ered unacceptable, and by May this had not improved. As a result a “comprehensive action plan” has been drawn up to ensure that improve­ments are made.

The findings emerged at a meet­ing of the council’s social services committee on Wednesday, when interim director of community care Simon Bokor-Ingram said View­forth’s performance had been rated as “weak”. However, this had not affected the care of the clients.

Mr Bokor-Ingram, who was not in post at the time of the inspections, said: “There were no issues about hands-on care or the interaction between staff and clients. They [the issues] were about the documentation process. The Care Inspectorate’s job is to reduce risk by making sure standards are maintained, and some of the documentation was not evident for them to see.”

In December the inspection report made five requirements for the 20-bed care home – “require­ments” being stronger than “recom­mend­ations”.

These centred on staffing ratios, safe practices, the provision of interests and activities and the need for an audit system.

The requirements stated Viewforth must:

● Make sure staff understand their roles and responsibilities and ensure safe practices;

● Make appropriate provision for the promotion of interests and activites. In order to achieve this the provider must undertake a review of the pres­ent medication procedures, training, staff practices, the provision of interests and activities and audit systems to ensure they are fit for purpose;

● Ensure staffing ratios detailed on the condition registration are upheld and maintained at all times;

● Have in place an audit system which reviews the maintenance and Health and Safety provision at Viewforth House;

● Have in place an audit system, which reviews the service provided and is inclusive of keyworker and staff practice and staffing training.

The inspectors observed that monitoring of care plans were of poor quality with some sections not signed, some care agreements were out of date, personal “significant events” such as birthdays were not always recorded, some charts and personal inventories were incomp­lete, personal items for safe keeping were not always recorded and some items, whose owners were unknown, were found in a cupboard.

Inspectors spoke to staff about promoting interests and activities, and were told by some they they did not have “the staff or the time”. Their time was impacted on by hav­ing to cover safety checks, including of the boiler, as the maintenance man only “popped in” from time to time.

A bath on the ground floor had not been repaired, or removed, between December and May, and deep cleaning was not adequately recorded. Items such as broken photocopiers had been dumped in a lounge, meaning it could not be used by clients. These shortcomings have now or are in the process of being rectified.

However, inspectors found many positives, including that accidents were reported well, and, crucially, that relatives were happy with the care of their loved ones and felt involved with this care. The unit also had good support from GPs and district nurses.

At Wednesday’s meeting, the problems of Viewforth were raised by councillor Allan Wishart, who wanted to know the situation in the “bad report” was now under control.

He was assured by chief social work officer Hughina Leslie that an action plan is now in place, following a meeting of community care managers and the Care Inspectorate.

Mr Bokor-Ingram said: “The score in both reports was really disappointing. Very little progress was made since December and it wasn’t implemented fast enough to raise the score. It’s certainly disappointing that the early warning wasn’t progressed between December and May.

“There is now a very comprehensive action plan in place to make sure the standards set by the Care Inspectorate are being set.” Weekly reports are now being sent to him and Mrs Leslie – among other things these will “evidence” activities being carried out.

Mr Bokor-Ingram said there had been no staff shortages at Viewforth, but said that the old premises were “more challenging” to work in than an new purpose-built unit.

Chairman of the social services committee Cecil Smith said he was “disappointed” with the report but a “robust plan” was now in place. He said the poor performance was a “one-off” and the care of residents had not been affected.

Vice chairman Allison Duncan said: “I was extremely disappointed when I read the full report, and took immediate action to ask questions. I am happy there are now to be weekly reports and the situation will be monitored. On the positive side, all our other care homes got excellent marks.”

Although people with a diagnosis of dementia are cared for in the community as far as possible, there has to be accommodation such as Viewforth for the few people for whom this, or a standard care centre, would be unsuitable.

According to the agenda of the social services committee: “All Shetland’s care homes will continue to support people with dementia as required. Future building works are scheduled in Lerwick that could provide a semi-secure environment to replace the existing Viewforth resource.”

Viewforth is due to be replaced by a more modern unit, the plans for which should be in place by April. Mr Bokor-Ingram said the building work currently going on to link Lerwick’s two care centres, Edward Thomason House and Taing House, could create more bedrooms. But, he said, he would like to do “something better” for particularly challenging behaviour. This provision could be within the exisiting buildings or “somewhere else”.