St Fillans Care Home

The provider took immediate action to purchase additional clinical bins, provide plastic wipeable boxes to contain PPE, and confirmed a full programme of cleaning had been completed, including a deep clean of kitchens. Guidance was provided to staff, and spot checks were being carried out to ensure the correct use of PPE, including wearing of masks. Our follow up visit on 30 September 2022 confirmed the above action had been taken to prevent the spread of infection and ensure the premises were clean.

Although the provider had taken immediate action to address the issues above, the governance systems were not always being used effectively to identify and drive the required improvements. The IP&C audit had not identified the issues we found during the inspection. The dementia audit had not identified the issues we found, relating to the complex care unit, Charter. There was no clear direction for staff, and minimal attempts to divert people's behaviours using meaningful activities.

People's care records contained conflicting information which exposed them to the risk of not receiving safe care. Behaviour support plans did not provide sufficient guidance for staff on how to support people to manage times of distress and anxieties.

The service was divided in to four units, St Johns, Castle, Dutch and Charter. Dutch and Charter on the first floor were not decorated consistent with the standard in St Johns and Castle on the ground floor, especially Charter the complex care unit. The environment in Charter did not always promote people's quality of life and help them live well with their dementia.

We have made a recommendation about improving the environment for people living with dementia.

People were not always supported to have choice and control of their lives. People's mealtime experience differed depending on which unit they resided. On Dutch and Castle units' people were supported to choose when, where and what they wanted to eat. In St Johns and Charter people were not always offered a choice of meal or drinks. Staff were observed assisting people to eat from a standing position and getting up and

down during mealtimes doing other tasks. This did not make the mealtime a sociable experience.

We have made a recommendation about staff training on the subject of dementia and improving people's mealtime experience.

People, relatives and staff told us the frequent changes of managers had been unsettling and disruptive but were positive about the new management team. They told us communication and staff morale had improved. Managers and staff worked well with health professionals and other networks, such as Essex FaNs who had supported people to engage in personalised activities.

The service reviewed staffing levels regularly and had recruited new staff, reducing the need to use temporary agency staff. People had good access to healthcare and their medicines were managed safely. Systems were in place to safeguard people from the risk of abuse. Where things had gone wrong, investigations had been used as an opportunity to learn lessons, change practice and drive improvement.