St Fillans provides residential and nursing care for up to 71 adults and older people. The service is supporting people with a range of needs which includes; people living with dementia and those who have a physical disability or require palliative care. The service is separated into four units. Two specialist dementia units, one nursing unit and one residential unit. There were 52 people living in the service when we inspected on 19 December 2017. This was an unannounced inspection.

There was a manager in post who had applied to become registered. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last inspection in September 2016, we found a breach of regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to care plans not always reflecting people’s needs.

At this inspection we found that there had been improvements in this and people were receiving personalised care that was responsive to their needs. Care plans were written in a person centred manner and reflected the care and support each person required and preferred to meet their assessed physical and emotional needs. Further work was still needed to ensure that daily records were an accurate record of care being provided.

Staffing levels had improved since our last inspection although some people raised concerns that there were times when deployment of staff could be improved further on the Dutch unit, and we have received assurances that this will be monitored closely to ensure deployment of staff is effective to meet people’s needs at all times.

There was a positive, open and inclusive culture in the service. The atmosphere in the service was warm and welcoming. There were systems in place to minimise risks to people and to keep them safe. Staff were trained and supported to meet people’s needs effectively.

Staff understood the importance of gaining people’s consent and were compassionate, attentive and caring in their interactions with people. They understood people’s preferred routines, likes and dislikes and what mattered to them.

The management team and staff understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People presented as relaxed and at ease in their surroundings and told us that they felt safe. Procedures were in place which safeguarded the people who used the service from the potential risk of abuse. People knew how to raise concerns and were confident that any concerns would be listened and responded to.

People were complimentary about the way staff interacted with them. Independence, privacy and dignity was promoted and respected. Staff took account of people’s individual needs and preferences and people were encouraged to be involved in making decisions about their care.

People’s nutritional needs were assessed and professional advice and support was obtained for people when needed. They were supported to maintain good health and had access to appropriate services which ensured they received ongoing healthcare support.

People were provided with their medicines in a safe manner. They were prompted, encouraged and reassured as they took their medicines and given the time they needed.

The service had improved their quality assurance systems. These were used to identify shortfalls and to drive improvement. As a result the quality of the service was continually improving. This helped to ensure that p

This inspection took place on 20 September 2016 and was unannounced.

The service provides nursing care and support for up to 71 people. On the day of our inspection there were 58 people living in the service.

The service is separated into four units. Two specialist dementia units, one nursing unit and one residential unit. There is free access between the units. If people’s needs change they are not moved unnecessarily.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Care plans did not always reflect the care and support people required. Some care plans did not contain sufficient information to ensure people received the care and support they required. Information in some care plans was contradictory. Where care plans did contain information about how people wanted to receive their care and support this was not always followed.

People were not always supported to remain active and lead meaningful lives. Activities in the service were limited. A new activities co-ordinator had been recruited who was developing this aspect of care. We have made a recommendation about developing relationships between care staff and developing a community environment within the service.

The service had a quality assurance system in place which was used to identify shortfalls. However, this was not always effective and was not consistently used to drive improvement.

People did not feel there were sufficient staff to meet their needs. This was reflected in comments by people about how much time staff had to interact with them and build relationships. The service was addressing this and was recruiting more staff and developing a stable staffing team.

Staff received regular support and training. They knew how to minimise risks and provide people with safe care. Procedures were in place which safeguarded the people who used the service from the potential risk of abuse.

People were supported to make day to day decisions and interactions we observed were caring, but some people did not always feel the service was caring toward them; we have made a recommendation regarding developing relationships between care staff and developing a community environment within the service.

You can see what action we told the provider to take at the back of the full version of the report

St Fillans Care Centre is a care service for up to 71 older people who may be elderly, have nursing needs or be living with dementia. At the time of our inspection there were 51 people who lived in four separate units over two floors.

At the time of our inspection there was a manager in post who had applied to be registered. That process has been completed and the manager is now registered. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection of the service on 28 May 2013 there was a breach of Regulation 9 of the Health and Social care Act 2008 (Regulated Activities) Regulations, relating to the care and welfare of people who used the service. This was judged to have a moderate impact on people. There was also a breach of Regulation 22 of the Health and Social care Act 2008 (Regulated Activities) Regulations, relating to staffing levels. This was judged to have a minor impact on people. The provider sent us an action plan to say what they were going to do to improve and improvements had been made.

People had their needs assessed and received safe care that met their assessed needs. Where risks were identified to people’s health or wellbeing they were supported in ways that reduced the risk without placing undue restrictions on the person’s freedom. There were procedures in place to support people to take their prescribed medicines safely.

There were sufficient staff with the knowledge and skills necessary to provide people with correct care and support. There were processes in place to manage staff’s training and support needs so that they received the information they needed to meet people’s diverse and changing needs. Staff morale was high and they felt valued.

CQC monitors the operation of the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS), and to report on what we find. DoLS are a code of practice to supplement the Mental Capacity Act 2005. These safeguards protect the rights of adults by ensuring that if there are restrictions on their freedom and liberty these are assessed by appropriately trained professionals. The service was meeting the requirements of the DoLS. The manager had a good understanding and up-to-date information about MCA and DoLS legislation. Where people did not have the capacity to make a particular decision correct procedures were followed to make a decision in the person’s best interests.

People were treated with care and compassion and staff understood the things that people enjoyed or disliked. Staff treated people with respect and protected their dignity when providing care and support. Communication between staff and people who lived in the service was good. When people were unable to use make their views known verbally, staff understood the different ways that they communicated their needs and feelings and supported them in ways that reduced their anxieties.

People were encouraged to take part in activities that interested them and were supported to maintain contacts with the local community so that they could enjoy social activities outside the service.

The manager demonstrated the qualities of good leadership and encouraged staff to feel empowered; staff morale was high and they felt valued.

There was an open culture and the manager and staff provided people with opportunities to express their concerns and did what they were able to reduce people’s anxiety. People understood how to make a complaint and were confident that actions would be taken to address their concerns.

The provider had systems in place to assess and monitor the quality of the service. The manager implemented a system of checks and audits and took relevant actions to drive up the quality of the service. Systems were in place to gain the views of people, their relatives and health or social care professionals. This feedback was used to make improvements and develop the service.

We spoke with three people who used the service, six relatives, and one visiting professional and interviewed three staff. We looked at four people's care records. Other records viewed included policies and procedures, medication administration records, staff rosters, staff training matrix, supervision records, audit and quality checks, satisfaction questionnaires completed by people who used the service and relatives, minutes of relative and staff meetings and we toured most of the communal areas of the service. We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

Is the service safe?

We found that risk assessments to keep people safe when moving and handling people were detailed and contained all the information needed for staff to follow, detailing equipment to use and therefore keeping all concerned safe. We observed good practice in using the hoist on two occasions.

In the case of one person we concluded that their needs may not have been adequately assessed or suitable equipment provided, which meant that care and treatment was not planned and delivered in line with their individual care plan. A pressure sore had developed that could have been preventable. In the case of a second person we found that the nursing intervention was working and this person’s skin was healing from a pressure sore. Therefore we concluded that the service was not consistent in keeping people safe from developing sore skin.

We examined the medication systems in use and found that these protected people as they were being followed and staff were trained to use them.

There have been no applications made under the Mental Capacity Act (MCA) 2005 in relation to a Deprivation of Liberty Safeguards (DoLS).We saw that there was a policy and procedure in place and that staff had received training. However we saw evidence that three people may be being deprived of their liberty unlawfully and requested this be explored and appropriately referred. This demonstrated that staff at the service were unaware of the legislation and may not know how to protect people and uphold their rights by appropriately using this legislation.

Is the service effective?

Care at St Fillians was effective because we saw systems in place to listen to people that used the service, their relatives and staff. We believe there was an open culture of listening to people. There were some systems in place to audit medication, care plans and infections control. To make this more effective the organisation should consider systems to capture and analyse other risks relating to falls and infections.

There was an effective roll out of training for staff with regular updates and high uptake in professional qualifications for care staff. There was evidence to show that staff were regularly supported in their role through meetings and supervision.

We found that the food was of good quality and well presented.

Is the service caring?

We saw that the staff interacted with people living in the service in a caring, respectful and professional manner. People using the service told us staff were caring. One person told us, “I like the staff that look after me”. A relative said that they felt their family member was well cared for and that the staff were kind and thoughtful.

Two different relatives told us that they had been involved in their relatives care plan and were confident they knew what was written down on how best to care for their relative.

Is the service responsive?

We found evidence from people using the service, relatives and documentation that showed the service had not been responsive to people’s needs with regards to personal care and support to eat meals. There had been occasions when the service had run with gaps in staffing. One relative said, “There is not always enough staff”.

The service had a complaints procedure and whistle blowing procedure in place. Complaints had been raised and we saw evidence that the procedure was working as matters were investigated and generally put right to people’s satisfaction. We left one matter with the managers to follow up that was brought to our attention during the inspection. People's experience and care records showed that they had access to a whole range of health professionals. This included seeking support and guidance from health care professionals, including falls prevention specialists. We met a professional at the service who was advising on pain control at the end of a person’s life. They confirmed that the service had responded and referred people to them appropriately.

Is the service well-led?

The service did not have a registered manager in place, but steps had been taken to appoint a suitable person and in the meantime appropriate arrangements were in place to support the service with a temporary manager in situ. The service worked well with other agencies and services such as health and social care professionals to make sure people received their care in a joined up way.

The service had quality assurance systems, audits and records seen by us that showed identified shortfalls were addressed promptly. As a result the quality of the service was continuingly striving to improve.

This was the first inspection of this new service. The service had taken a group of people from a local care home that had urgently closed. This influx of people had been a challenge but at the time of our inspection matters had resolved and the use of agency staff had begun to decrease. We spoke with staff who said things had improved. We spoke to people who used the service and relatives. One person told us that their relatives had improved since being at St Fillians and they were pleased that they had moved into the service. Another relative told us that there were some good carers employed, who knew the people living at the service very well. They had also been concerned about use of agency staff. One person living at the service told us “Overall it is reasonably good care.”

We found that there was sufficient staff employed and on duty that were appropriately trained to meet peoples needs. We found care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare. We found that timely referrals were made to other agencies to maintain the welfare and health of people at the service.

A new manager has been appointed and we await their application to become registered.