Focussed visit summary: Visits to older people in care homes
Number of visits 9
Number of recommendations 38
Recurring themes and areas for improvement
1.Compliance with incapacity legislation
Many of the people we visited lacked capacity to make decisions about their welfare, treatment or finances. We wanted to ensure they were being treated in accordance with the Adults with Incapacity (Scotland) Act 2000. We made recommendations if they were not. Areas of recommendation addressed:
- Poor compliance with part 5 of the 2000 Act (medical treatment)
- Inadequate recording of the powers of attorneys and guardians
- Poorstaff knowledge of relevant legislation
Example of improvements following our visit:
Our recommendation where we found that care homes did not have good records of attorneys and guardians. Staff seemed unaware of the importance of this and had limited knowledge of the legislation.
The contact sheet for each resident should clearly document the status of Power of Attorney and Welfare Guardian. The powers held under Part 2 and 6 of the Act should be carefully recorded and discussion regarding the management and possible delegation of the powers discussed with the manager of each unit. Private Guardian and local authority supervisors contact details should be recorded and updated. Consideration should be given to using the MWC checklist.
The care home's response:
Tracker put in place for all clients who have a Power of Attorney/Guardianship. Record identifies Power of Attorney/Guardian. Copy of MWC checklist and good practice guidance being used. Training sessions and workshops for staff to be developed.
2.Management of "challenging behaviour"
Under incapacity legislation, any intervention must be of benefit and must restrict the person's freedom as little as possible. We visited people with dementia whose behaviour appeared to be a problem. Sometimes, we thought that staff could have managed this better. Our recommendations addressed:
- The importance of reviewing sedative medication on a regular basis
- Care plans that did not appear to have an appropriate range of interventions
- Staff knowledge and training
Example of improvements following our visit:
Our recommendation where we found care plans that did not provide individualised approaches to challenging behaviour and where staff appeared to be struggling to manage some residents. In this case, the care home manager put a lot of effort into making improvements and did more than we actually recommended.
The Mental health and Challenging Behaviour component of the residents care plan should be reviewed and more personal details should be added where required.
The care home's response:
Care Plans to be reviewed in relation to mental health and challenging behaviour for individuals. Staff to attend Challenging Behaviour training to enhance staff members' understanding of mental health component/best practice in relation to medication. Trackers to be compiled in relation to psychoactive medication to identify areas for improvement/staff who require support
3.Activity
Keeping active is an important part of everyone's life. We wanted to see interventions that were of benefit to residents and took account of their wishes and preferences. This was an important message in our joint report with the Care Commission, Remember, I'm Still Me." We made recommendations about:
- The use of life stories to guide provision of activity
- The range of activities available and a record of benefit
- The creative use of people's individual money to provide extra outings and activity that would improve quality of life.
Example of improvements following our visit
Our recommendation where we found care plans that included a section on "keeping active" that did not appear to provide a good record of activity.
The "keeping active" part of the care plan should be reviewed by each unit manager and activity coordinator and updated with more information included where required.Activities should also be part of the six monthly care plan and it should be recorded which activities the person enjoys participating in and those which the person has been encouraged to take part in but declined.
The care home's response:
All personal plans in regards to "keeping active" are reviewedby named nurse /key worker. At all 6 monthly reviews, activitiesare discussed with patient /family advocate. Updated monthly or on patient request.
