Peacock Nursing Home Care Home Service - Care Inspectorate
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Peacock Nursing Home Care Home Service Garden Place Eliburn Livingston EH54 6RA Telephone: 01506 417 464 Type of inspection: Unannounced Inspection completed on: 12 February 2018 Service provided by: Service provider number: Peacock Medicare Ltd. SP2003002457 Care service number: CS2003010659
Inspection report
About the service
Peacock Nursing Home is a care home registered to provide care and accommodation for 80 older people,
however there are no longer shared rooms and the maximum occupancy has reduced to 75 older people.
The home comprises of two houses, Peacock (House 1) and Primrose (House 2). Each of the houses has two
floors, the upper floor can be accessed by either a lift or stairs. There are separate dining facilities on the ground
floor of both houses.
All residents' bedrooms have en-suite toilet and washing facilities. There are bathing facilities on both floors.
The home is situated in a residential area and has its own parking and well maintained gardens.
The home is owned by Peacock Medicare Ltd.
What people told us
Prior to our inspection, we sent out 25 questionnaires for staff, residents and relatives to give us their views on
the service. Six were returned to us from residents and staff and five from relatives. During our inspection, we
also had the support of a volunteer. Inspection volunteers have a unique experience of either being a service
user themselves or being a carer for someone who uses or has used services. The volunteer spoke with fourteen
residents and one relative. In addition to this we spoke to an additional two relatives and four residents.
We heard overall, a mixture of views from people we spoke with and the views collated from questionnaires.
Residents who were diabetic stated they would like more choices with snacks and drinks being provided, some
people thought the menu was repetitive but overall people said they enjoyed the food. People told us they could
go to bed and get up in the morning when they wanted, they had choices re bathing or showering and that
there was enough activities provided within the home. People were complimentary regarding the co-ordinator
who made time to chat to people and arrange outings. Both residents and relatives spoke highly of the staff,
however over half of people we spoke to felt there was not enough staff on duty in the evenings and sometimes
were waiting for longer than they would like for staff to attend to them. Relatives told us they were kept
informed of any changes or level of care needed and they were regularly invited to attend meetings within the
home.
Self assessment
We no longer ask services to submit a self-assessment. Instead, we look at the overall development plan that
services use to identify how they will strive to improve the service. This is discussed further under the
Management and Leadership theme.
From this inspection we graded this service as:
Quality of care and support 4 - Good
Quality of environment 4 - Good
Quality of staffing 4 - Good
Quality of management and leadership 5 - Very Good
Inspection report for Peacock Nursing Home
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Quality of care and support
Findings from the inspection
We looked at care plans for people who had a variety of care needs and overall we assessed that people
received a good level of care. We concluded this after observing how care was delivered to residents and
considered what people told us. We spoke to the General Practitioner (GP) who supports the service with weekly
clinics. We heard from the GP that there was good communication with staff and that reviews of medications
for residents were carried out regularly. The GP told us there were good working relationships with other visiting
professionals such as the Community Psychiatric Nurse. This therefore demonstrated continuity of care for
residents. We also heard that people could be added to the list of visits at short notice, for example we heard
how the GP was asked to attend to a resident who had sustained a fall very recently. This was a good example
of how any concerns were being addressed very quickly. We also heard from the GP that end of life care had
improved greatly and that further training had been sourced for the service from another medical practice. We
looked at records relating to nutritional needs, skin care and falls and it was pleasing to see that there were no
concerns highlighted.
We observed a number of meal times, these were efficient and meals looked appetising. People received
support where they needed this in a kind and attentive manner. We suggested that cold drinks be available for
residents with their meal as well as the tea and coffee provision.
Regular meaningful activities were on offer for residents who could enjoy group light exercise, have trips out on
the mini bus or enjoy booked entertainment or visits from local nursery and school children. The co-ordinator
was also supported by volunteers and relatives.
We felt that some of the medication records needed to improve, in particular the recording of cream applications
for residents. This was an issue highlighted in the service audits and in discussion with the manager she is
actively taking steps to address this. We saw on a number of occasions that people were not getting their
medication as they were noted as being asleep, again this is being currently addressed by the service. We did
not see pain assessments in place for some residents who were receiving as required pain medication, however
in discussion with staff and manager they were able to demonstrate they knew the needs of residents well,
however it was accepted that new staff or agency staff would not have this information to hand. We further
discussed improvements that needed to be made with regard to the recording of blood monitoring for residents
who have insulin-dependent diabetes.
We advised the management team that as part of the pre-admission process, it should be evidenced that all
legal processes are followed, and in particular for people who are unable to consent to their admission to care.
Requirements
Number of requirements: 1
1. The service must evidence and document that those residents in receipt of covert medication are regularly
reviewed. In addition, the following must be addressed:
(a) Pain assessments and as required medication protocols are up to date and are easily accessible for all staff
including agency staff;
(b) Residents should not miss essential medication if they are asleep, and should be given this as soon as
practically possible. Consideration should also be made to the timing of administration.
Inspection report for Peacock Nursing Home
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This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements
for Care Services) Regulations, Scottish Statutory Instruments 2011 No 210: Welfare of users 4. - (1) A
provider must - (a) make proper provision for the health, welfare and safety of residents.
Timescale: To be in place by no later than 21 March 2018
Recommendations
Number of recommendations: 3
1. It must be clearly evidenced that residents who require applications of creams and lotions are receiving this
and in accordance with the prescriber's instructions.
This is to meet National Care Standard 15 Care Homes for Older People - Medication
2. It should be clearly evidenced as part of the pre-admission assessment if legal powers are in place, and who is
consenting to long term care arrangements. This should be carried out in partnership with the placing Local
Authority.
This is to meet National Care Standard 1 - Care Homes for Older People - Informing and Deciding
3. Records showing blood monitoring results for those residents with diabetes should also include any actions
taken should readings be outwith the recommended range.
This is to meet National Care Standard 15 - Care Homes for Older People - Medication
Grade: 4 - good
Quality of environment
Findings from the inspection
We found the environment to be clean and fresh. Main lounges were bright and there were areas in corridors for
sitting quietly for those who wanted this. We spoke to some residents in their rooms, most were spacious and
had been personalised with their own furniture and personal effects.
We looked at a variety of documentation and in particular, the statutory checks that require to be in place for
moving equipment, water safety and annual gas safety checks. These were all in order.
We saw that records were kept for general day to day maintenance requests and when these tasks had been
completed. We also checked hazardous substances were locked away and that regular cleaning and steam
cleaning was undertaken in the home.
We noted that the service had made progress with replacing flooring and doors as identified in their action plan
to improve the environment since the last inspection. This work is currently on going. Some areas have also
been decorated and we were advised the remaining areas will be scheduled for the near future. We appreciate
that this has to be carried out with the least disruption to residents.
Inspection report for Peacock Nursing Home
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We discussed with the service to include in the refurbishment works, features that are dementia friendly, such as
pictorial and clear signage. Bathrooms should use contrasting colours, and bedroom doors should be easily
identifiable to residents by using personal effects that are meaningful to them. We also discussed that we found
the nurse call system to be intrusive, in particular at night time. Currently the call system for one floor can be
heard on the remaining floor of each house, and at night we noted this could be for up to 10 minutes at a
time. This meant that both floors could be hearing continuous buzzers over a few hours at a time. We have
asked that this be addressed to ensure that this improves.
Requirements
Number of requirements: 0
Recommendations
Number of recommendations: 3
1. The provider must consider how intrusive noisy nurse call buzzers should be minimised, in particular in the
evenings.
This is to meet National Care Standard 4 - Care Homes for Older People - Your Environment
2. The management team should progress with ensuring the environment is dementia friendly. This should
include clear signage, menus in dining rooms and contrasting bathroom colours.
This is to meet National Care Standard 4 - Care Homes for Older People - Your Environment
3. The provider should progress without further delay, the on-going upgrades of carpets, décor and replacement
doors as identified in the action plan.
This is to meet National Care Standard 4 - Care Homes for Older People - Your Environment
Grade: 4 - good
Quality of staffing
Findings from the inspection
We observed staff over the course of our inspection delivering care to residents. This included meal times,
assistance with mobilising residents and supporting residents who were distressed or agitated. We also took
into account what people told us. We concluded that staff treated residents with respect, kindness and dignity.
We saw reassurance and praise being given to residents who were anxious when being mobilised and also saw
how distraction techniques were used to de-escalate situations. We also saw staff singing and dancing with
residents, reminiscing, and also sitting quietly doing hand massage or nails. We saw that there was staff
attendance at all times in all of the lounges and this was the policy of the home. We felt this presence
contributed to the falls prevention within the home and the low incident reporting as staff were able to
intervene quickly and effectively. This promoted safety and security for the residents and of course, positive
experiences for residents.
Inspection report for Peacock Nursing Home
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We spoke to a large variety of staff across the service including night shift staff. We heard that staff had regular
access to training opportunities and we heard that staff could approach the senior, nurse or management team
at any time should the need arise. We were advised from a new staff member who felt that after the period of
induction had been completed, there was still areas of uncertainty. This period of learning was extended with
the staff member being fully supported to do so. This evidenced a streamlined approach for new staff who were
allowed to learn and develop at their own pace.
We observed the staff working on night shift. We found one staff member was supervising the lounge, another
was assisting a resident in the bathroom leaving it difficult to answer room buzzers. We were advised that this
was not always the case for night shift as there was a shortage of staff on the particular night we undertook our
observation. However, staff on both floors told us that night times could be very busy and they felt understaffed
during this period. Residents we spoke to felt there was not enough staff in the evenings and they were "rushed
off their feet."
Furthermore, in discussion with both day and night staff it was clear to us that tensions were running high
between the teams and that further clarity may be helpful in the distribution of duties to be undertaken by each
shift.
It was disappointing for us to hear that prescribed continence aids had ran out for some residents due to staff
inappropriately using these for other residents. We have discussed this in detail with the manager who assures
us that this will not be repeated. We have also suggested that refresher training be offered to all staff so there
is a thorough understanding of why the products need to be assigned to specific residents.
Staff should also be aware that they should acquaint themselves with the needs of the residents at the start of
their shift if they are working in different areas than they usually do so that any routines are respected.
Finally we found that a very small amount of staff had not undertaken the introductory training for dementia or
moving and handling refreshers, these should be undertaken without delay. We also discussed with the service
the progression of the dementia skilled level of training for the staff who have not yet undertaken this, and that
staff must take ownership of this and bring the necessary work book materials to the work place when
requested to do so. We discussed that it would be beneficial for staff to have training provision on using a
variety of communication methods, this should also be considered for activity staff and volunteers.
We have made a requirement and recommendations below in accordance with our findings.
Requirements
Number of requirements: 1
1. The provider must demonstrate that the level of staffing is adequate to provide the assessed level of support
to service users at all times, in particular in the evenings. The views of residents and staff should also be
considered.
This is in order to comply with: SSI 2011/210 regulation 15 (a) Staffing - Ensure that at all times
suitably qualified and competent persons are working in the care service in such numbers as are
appropriate for the health, welfare and safety of service users.
Timescale: To be evidenced over a three month period and for findings and conclusions to be submitted
to the care inspectorate no later than 30 June 2018
Inspection report for Peacock Nursing Home
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Recommendations
Number of recommendations: 3
1. Staff must ensure that they are aware of the needs and routines of residents they support in all areas they are
required to work.
This is to meet National Care Standard 5 - Care Homes for Older People - Management and Staffing
Arrangements
2. All staff should undertake refresher training with regard to continence. Staff should evidence the importance
of using prescribed products for residents.
This is to meet National Care Standard 5 - Care Homes for Older People - Management and Staffing
Arrangements
3. Staff should ensure they have all relevant training materials when training is being undertaken relating to the
skilled level of dementia. The majority of staff need to ensure they have undertaken this level without further
delays.
This is to meet National Care Standard 5 - Care Homes for Older People - Management and Staffing
Arrangements
Grade: 4 - good
Quality of management and leadership
Findings from the inspection
We found overall that the management team worked very hard to support staff. We heard from staff that we
spoke with that they respected the seniors, nurses and the management team and could approach any of them
at any time regarding concerns they may have. We also noted that staff had regular supervision and it was
pleasing to see that this also included staff values and used a competency framework that considered integrity,
respect and accountability.
Staff told us there was good communication from "the top down" and had opportunities to attend regular
meetings. We also discussed with staff their registration responsibilities with either the NMC (Nursing and
Midwifery Council) and SSSC (Scottish Social Services Council) and we were satisfied that staff were supported
well to obtain any necessary qualifications that was required of them.
The management team evidenced they were keen to promote leadership roles within the home, and we spoke
with staff who had additional responsibility in areas such as oral care, continence, mobility and dementia. In
discussion we felt staff were highly motivated to ensure that these areas of care were delivered and
monitored to the highest standard. We suggested it would be beneficial for the service to have an identified
staff member who has an overview of skin care and prescribed creams for people.
Inspection report for Peacock Nursing Home
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We saw regular audits being undertaken for key areas of service within the home, these included medication,
skin care and nutrition and accidents and incidents. We also saw that areas had been identified for
improvement, for example in the medication audits (also referred to under Care and Support).
We discussed with the management team that the development of audits should include observation of staff
practice, and this should include both day and night shift staff. This also ensures that any areas that require
further training and development are identified. This could also be discussed further in supervision. We also
suggested that regular audits of meal times are undertaken with the views of residents taken into account
regarding the meal time experience,
We saw that there was a development plan in place with regard to the environment and the on going
refurbishment works. The plan should also include wider aspects of the service taking into account the overall
audit findings.
Requirements
Number of requirements: 0
Recommendations
Number of recommendations: 1
1. The management team should progress with the development of audits within the service and demonstrate
from these how an overall development plan will aim to improve and progress with the overall service delivery.
This is to meet National Care Standard 5 - Care Homes for Older People - Management and Staffing
Arrangements
Grade: 5 - very good
What the service has done to meet any requirements we made at
or since the last inspection
Previous requirements
Requirement 1
The provider must take steps to promote and maintain the overall quality of care.
In this respect, the provider must:
Ensure that all issues identified in medication audits are addressed fully, and,
ensure that all necessary information is available in care documentation.
This is in order to comply with SSI 2011/2012, Regulation 4(1) Welfare of users.
Inspection report for Peacock Nursing Home
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To commence upon receipt of this report.
This requirement was made on 7 March 2017.
Action taken on previous requirement
We saw from the medication audits that issues were being identified relating to missed medication and poor
recording of creams. We have addressed this under Care and Support of this report.
We will therefore not repeat this requirement.
Not met
Requirement 2
The provider must make provision for the health, welfare and safety of service users and ensure that the general
home environment, equipment and installations in use are hygienically clean and in working order. In order to
achieve this the provider must ensure that :
a) Cleaning schedules identify the plan of cleaning in place for all areas of the home.
b) Regular audits of the home environment are carried out thoroughly and can identify areas of concern.
c) The Care Inspectorate is provided with a detailed programme of planned improvements. The programme must
be governed by priority of need.
This is to comply with: SSI 2011/210 Regulation 4 (1) (a) Welfare of users, Regulation 10 (c) Fitness of Premises
and , Regulation 14 (b) Facilities in care homes. Consideration should also be given to The National care
standards, Care homes for older people, Standard 4 - Your environment.
To commence on receipt of this report.
This requirement was made on 7 March 2017.
Action taken on previous requirement
We noted that equipment maintenance had been carried out within the statutory timescales.
a) We saw cleaning and steam cleaning schedules in place and these being adhered to.
b) We saw information pertaining to regular audits of the environment.
c) We saw evidence of the improvement plan for the environment and how this was being prioritised. We have
also discussed this further under the Environment section of this
report.
Met - within timescales
Inspection report for Peacock Nursing Home
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What the service has done to meet any recommendations we
made at or since the last inspection
Previous recommendations
There are no outstanding recommendations.
Complaints
There have been no complaints upheld since the last inspection. Details of any older upheld complaints are
published at www.careinspectorate.com.
Enforcement
No enforcement action has been taken against this care service since the last inspection.
Inspection and grading history
Date Type Gradings
7 Mar 2017 Unannounced Care and support 4 - Good
Environment 3 - Adequate
Staffing 5 - Very good
Management and leadership 5 - Very good
23 Feb 2016 Unannounced Care and support 4 - Good
Environment 4 - Good
Staffing 4 - Good
Management and leadership 4 - Good
24 Feb 2015 Unannounced Care and support 4 - Good
Environment 4 - Good
Staffing 4 - Good
Management and leadership 4 - Good
Inspection report for Peacock Nursing Home
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Date Type Gradings
28 Aug 2014 Unannounced Care and support 4 - Good
Environment 4 - Good
Staffing 4 - Good
Management and leadership 4 - Good
14 Jan 2014 Unannounced Care and support 4 - Good
Environment 4 - Good
Staffing 4 - Good
Management and leadership 4 - Good
22 Feb 2013 Unannounced Care and support Not assessed
Environment Not assessed
Staffing 4 - Good
Management and leadership 4 - Good
29 Nov 2012 Unannounced Care and support 4 - Good
Environment 4 - Good
Staffing Not assessed
Management and leadership Not assessed
1 Feb 2012 Unannounced Care and support 4 - Good
Environment 4 - Good
Staffing Not assessed
Management and leadership Not assessed
30 Jun 2011 Unannounced Care and support 4 - Good
Environment 3 - Adequate
Staffing 4 - Good
Management and leadership 4 - Good
4 Nov 2010 Unannounced Care and support 5 - Very good
Environment 4 - Good
Staffing Not assessed
Management and leadership 5 - Very good
23 Jun 2010 Announced Care and support 5 - Very good
Environment 4 - Good
Staffing Not assessed
Management and leadership 5 - Very good
Inspection report for Peacock Nursing Home
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Date Type Gradings
9 Feb 2010 Unannounced Care and support 4 - Good
Environment 3 - Adequate
Staffing 5 - Very good
Management and leadership Not assessed
26 May 2009 Announced Care and support 4 - Good
Environment 3 - Adequate
Staffing 4 - Good
Management and leadership 4 - Good
20 Feb 2009 Unannounced Care and support 4 - Good
Environment 4 - Good
Staffing Not assessed
Management and leadership Not assessed
3 Jul 2008 Announced Care and support 5 - Very good
Environment 4 - Good
Staffing 4 - Good
Management and leadership 4 - Good
Inspection report for Peacock Nursing Home
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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.
Please get in touch with us if you would like more information or have any concerns about a care service.
You can also read more about our work online at www.careinspectorate.com
Contact us
Care Inspectorate
Compass House
11 Riverside Drive
Dundee
DD1 4NY
enquiries@careinspectorate.com
0345 600 9527
Find us on Facebook
Twitter: @careinspect
Other languages and formats
This report is available in other languages and formats on request.
Tha am foillseachadh seo ri fhaighinn ann an cruthannan is cànain eile ma nithear iarrtas.
Inspection report for Peacock Nursing Home
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