Inspection Report on

Transcription

1 Inspection Report on Wrexham Care Centre Nant-y-Gaer Road Llay LL12 0SL Date of Publication 5 December 2017

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3 Description of the service Wrexham Care Centre is a nursing home registered to accommodate 35 people over the age of 65 years who have care needs relating to dementia or mental infirmity, six people under this age may also be included in the registered numbers. Nant-Y-Gaer Hall Ltd is the registered provider. The company has nominated an individual to oversee the service and Care and Social Services Inspectorate Wales (CSSIW) recognise this person as the Responsible Individual (RI). The position of registered manager has been vacant since 28 March The provider has now recruited a person to the position and an application to formally register this person is being processed by CSSIW. The person has been referred to as the manager in the report. Summary of our findings 1. Overall assessment The atmosphere in the service is very different to that of previous visits. It is relaxed and comfortable, staff interaction and engagement with residents is positive and there are more opportunities to involve them in conversation and activity. The improvements made to the operation of the service, identified at the previous inspection have been sustained and remain ongoing. 2. Improvements Staff interaction and engagement with people living in the service has improved. More activities both on a group and individual basis, are being offered. The manager has implemented systems to audit practice. Training for staff in relation to dementia and mental health has been sourced and dates arranged. A registered mental health nurse (RMN) is working in the service three days a week providing support and guidance for staff. The premises are cleaner and a programme of re decoration is in place and being followed. Following the inspection we were provided with an action plan detailing planned improvements and actions that had been completed. 3. Requirements and recommendations At the inspection of 10 April 2017 two non compliance notices were issued due to breaches of Regulation 12.(1) (a) and Regulation 13. (3) of the Care Homes (Wales) Regulations 2002 in relation to the protection of the health and welfare of residents. Page 1

4 The inspection of 25 July 2017 identified further breaches of these regulations. This inspection demonstrated compliance had been achieved in relation to both non compliance notices. Further details can be found in section 5.1 of this report. No requirements were identified at this inspection. The following recommendations have been made to improve practice Evaluate and develop the activity log. Actions for staff to support resident s should contain more detail. Corresponding care and support charts should be fully completed. A copy of the refurbishment programme complete with timescales should be forwarded to CSSIW. Page 2

5 1. Well-being Summary People are treated with kindness and respect and staff take an interest in the residents and find out what is important to them. Although in the early stages, social needs are now being recognised and promoted. The development of a personalised activity plan of interests and evaluation of what is important to each person would evidence this approach. Our findings People are encouraged to be involved in activities that interest them and have opportunities to socialise with each other. The manager told us planning group activities in advance has proven to be challenging. As residents behaviour varied from day to day it was difficult to find an activity that would interest and suit everyone s abilities, the focus is now on smaller groups or one to one engagement. Two members of staff encouraged four residents to join in with an activity which involved holding a brightly coloured sheet, bouncing a ball on it and trying to prevent it from falling off. Initially the residents were a little hesitant, with staff encouragement they quickly became involved moving the sheet to move the ball, laughing and smiling and becoming enthusiastic when they were able to catch it. Two residents were seated next to each other watching what was going on and laughing with the participants when they achieved their goal. Music was playing in the background and two residents began singing to a particular song when it came on. A little later staff started a quiz although only a couple of people joined in, the answers prompted further discussion and sharing of personal anecdotes. Daily records of resident involvement in activities are now being completed; we viewed a sample of charts confirming this. Evaluating and developing these forms may further assist staff in developing individual activity programmes. People are involved, participate make a contribution to the community of the home and feel valued. People experience warmth and attachment and are treated as individuals. The manager recognises every day tasks are important as they encourage independence and allow the person to contribute to day to day life. It is intended daily tasks, if relevant, will form part of individuals activity programme; for example laying tables or turning a bath into a pamper session. One resident had a small guitar and began playing it, staff turned the music down so they could be heard. The person began to sing and became quite animated when people stopped what they were doing to listen. When they had finished a member of staff sat next to them and conversation about their interest in music began. At present one resident enjoys accompanying the manager when they go out shopping and another person spends time with the maintenance person offering advice about painting and decorating. People can do things that matter to them. Food stocks provide more opportunity for choice and variety to an individual s diet. Communication between kitchen staff and management has improved and there are fewer delays in the ordering system. A new cook had been appointed and was reviewing the menus, offering a more traditional selection of meals. Homemade soups were prepared each day and provided a wholesome second choice at mealtimes. At lunch, we noticed staff were aware of people s individual preferences and second helpings were offered. Attention is given to nutrition and hydration to support people to be healthy. Page 3

6 2. Care and Support Summary Observation of practice indicates that care is delivered in a way that respects choice and individuality but this is not always reflected in the care records. Care must be taken to ensure the written record is fully reflective of the care and support provided. Our findings People experience warmth and attachment. This was particularly evident with two residents, observed at previous inspections, who were much calmer and relaxed. One person kept repeating the same questions to staff, who tried different methods of reassurance. They answered by speaking clearly and directly to the person or encouraged involvement in a different activity. Although, each method only helped for short periods of time it was positive to see staff were consistent with these approaches. Another person remained in their room, music was playing and staff kept them company by reading and talking about the magazine articles. Although there was little verbal response, the person was visibly more relaxed than observed on previous occasions. One resident became quite agitated at lunch time. Observation of practice indicated that staff knew the resident and what to do to manage the person s behaviour. They spoke with the person, asking relevant questions and tried to find out why they were behaving in that way. The person remained agitated so staff made the area safe and left, returning at regular intervals to check the person s safety. It was positive to note that a calm approach was generated across the staff group indicating an understanding of individual needs. Care plans contain information relevant to assessed needs but the actions for staff to support individuals could be developed further. Capacity assessments had been completed and the plans viewed contained assessments of needs such as falls, nutrition and continence; these were reviewed monthly. The risk management plans for behaviour contained actions for staff to support the person but would benefit from more detail. For example, one stated the person was wandersome but lacked detail as to how staff could direct or divert the person at these times. Another referred to verbal outbursts but needed further expansion on how staff should cope with these outbursts and a third referred to the use of distraction techniques but lacked details as to what would be the most productive. We noted the ABC (antecedent, behaviour and consequence) chart had not been completed for this person for the last few months despite reference to completion of this chart throughout the care plan. Food and fluid charts were completed following mealtimes but were not being evaluated. Audits had been carried out by the manager to ensure all relevant information was included and dedicated time was now being given to the RMN to ensure the plans contained adequate clinical detail. The examples provided should form part of the clinical audit. Our observations of staff support suggested people s needs are understood and anticipated however, the written record does not always evidence the support given to meet these needs. Page 4

7 3. Environment Summary In April 2017 a non compliance notice was issued in relation to maintenance, repairs and cleanliness of the premises. At this visit we found the service to be clean, bedrooms and communal areas had been decorated and pictures and ornaments provided a more homely welcoming atmosphere. Decoration and refurbishment is ongoing and audits of the premises, maintenance and service records are now in place. Overall the improvements made to the environment indicate the non compliance notice can be removed. Our findings People can now feel reassured that attention is given to the maintenance and décor of the environment. On our arrival the door was opened by the manager. There was a calm, relaxed atmosphere and the only smell was that of fresh paint. The hallway was more welcoming and a notice board contained information about events, staff and the service. Stencils had also been drawn on the lift and pictures hung on the walls. Signs were noted in areas of the service providing direction for people and some of the bedroom doors held a photograph of the resident and details relevant to them; both of these introductions assisted with orientation. The lounge had been decorated and ornaments were in place, making it an inviting area. The majority of bedrooms had been personalised to varying degrees and were based on the person s individual preferences. Bathrooms were clean, pleasantly decorated and provided a comfortable, relaxed ambience for resident s when bathing. A maintenance person has been appointed and is on site five days a week. We were told they completed a daily walk of the premises ensuring escape routes remained uncluttered, light bulbs were in working order and there were no trips, slips or hazards. A checklist was completed and areas for attention addressed at the time. Any issues that required specialist attention were reported to the manager who would refer to external contractors. A plan of decoration was in place and currently two bedrooms a week were being completed. As many of the rooms were currently vacant it was possible to complete this work with little disturbance to residents. We noted two bedrooms currently in use needed attention and it is suggested consideration is given to prioritising these rooms so the residents benefit from the current improvements. There were areas that still required improving. Minor repairs included an exposed wire in one bedroom (currently not in use) and a loose radiator guard. The manager brought these to the attention of the maintenance person for completion on the day. The date of the servicing of the parker bath had passed. Following the inspection the manager informed us a date for the service had been arranged. In addition, a regular contractor had been sourced to carry out servicing of all equipment to ensure its safety and a service file developed as a reminder for staff of the due dates. New domestic staff had been appointed and cleaning schedules were in place and being followed. We could evidence this from our personal observations and completion of the records. Work still needed to be done for example chairs needed replacing but this had been identified by the provider and quotes for replacements were being obtained. The inspection evidenced the registered provider s commitment to improve the standard of the environment to ensure the dignity of people living there is supported. Page 5

8 4. Leadership and Management Summary A manager has been appointed and their application is being processed by the CSSIW registration team. The last inspection in July 2017 identified improvements in the operation of the service. This inspection indicated the improvements have been sustained and remain ongoing. Our findings There is visible accountability and senior management are overseeing the service. The manager had implemented systems to monitor practice and audits identify areas for improvement. Systems have been developed to clean and check the condition of equipment such as slings and wheelchairs and check lists confirmed fire equipment was regularly examined to ensure its safety. Reports around the operation of the service were sent to the RI each week to ensure their awareness of issues that may impact on the service such as staff sickness and how effective actions were being taken to address issues. On the day, we identified areas that required improvement and the manager was more than willing to take on board the comments made. Action plans were forwarded following the inspection describing what had been put in place and a further update was received before completion of the report. This suggests a commitment by the provider to ensure quality assurance and constant improvement of the service. One of the main areas of improvement is the development of the staff group. Staffing levels remain under review. The rotas viewed showed five care staff on duty each day, with ancillary staff and the manager additional to these numbers. Extra staff have been included in the numbers for peak periods such as 12-2 pm. Since August, the deputy manager had been given super numerary hours each week to enable paperwork to be completed including updating care records, making referrals and carrying out audits of clinical aspects of the service operation. As recruiting a RMN was proving difficult and to ensure oversight by a person with experience and relevant skills, the registered provider had approached a nursing agency and secured a block contract of RMN cover for three days each week. Their role will be to oversee practice, offer informal awareness training of mental health issues, update records and provide support for staff. Checks of staff were carried out before they began working at the service to ensure their suitability and the recruitment process had been reviewed. Until the staff group was stable, the manager was looking to appoint staff who had experience in similar settings to enable residents to be provided with care and support by appropriately skilled people. As there were a number of new staff to the service, a list had been developed which summarised individual s health needs, providing details of important points and acting as a signpost for staff to view the care plan in more depth. People benefit from a service where best use is made of resources. The manager is creating a positive ethos and culture by giving staff opportunities to develop their potential. Key worker systems have been introduced giving staff responsibility for supporting residents with personal issues such as developing an individual activity programme, stocking personal toiletries and ensuring wardrobes contained their own belongings. Staff were allocated duties each day which included one to one support and activities; this provided direction for staff. The manager carried out group and individual supervision sessions and we viewed seven supervision records. Page 6

9 The training programme showed all staff had core training, either completed at their previous employment or online when they began working in the service. Refresher training had also been booked. One session to be held on 23 November 2017 will cover fire, COSHH (control of substances hazardous to health), health and safety and infection control. To avoid delays in accessing training the provider had appointed a trainer who will be able to deliver training as it is needed. This will be completed in-house and will identify where further training is required. We have commented in previous inspection reports that training in dementia and mental health issues had been limited. In order to address this, the manager is accessing training for staff from a variety of sources. A resource file for staff of fact sheets for specific conditions presented by existing residents has been implemented. These will be discussed with the RMN at group supervision sessions in order to increase staff awareness. Information was being accessed online and from specialist forums. An optician had been contacted and is to organise training for staff which links poor eyesight and falls and provides guidance and information for staff to minimise risk to health and safety. The manager had also contacted the mental health charity MIND, the local university and the community health team to source training. Mental health training was completed on 27 October 2017 and part of this training included the correct use of ABC charts. The management of difficult behaviour training had been booked for 26 November and a further session in January The manager had also registered to become a dementia friend and would be attending the course to formalise this in November. People benefit from a service where the well being of staff is given priority and staff are well lead supported and trained. Page 7

10 5. Improvements required and recommended following this inspection 5.1 Areas of non compliance from previous inspections The registered provider should provide evidence that the health and welfare of people living in the service is met consistently and safely. The registered provider must ensure that the premises are cleaned to a standard that minimise the risk of infection and respects the dignity of people living in the service. At the inspection of 10 April 2017 we issued a non compliance notice to Nant-Y- Gaer Hall Ltd because they did not meet their legal requirements in relation to: Regulation (a) as the number and experience of staff and the way in which staffing is organised did not always ensure that people were safe, fulfilled emotionally and socially or cared for in a manner that reduced unnecessary risk to their safety. At this inspection we were satisfied that arrangements are now in place to monitor and review staffing to ensure peoples mental, emotional and physical needs are receiving appropriate time, care and support. At the inspection of 10 April 2017 we issued a non compliance notice to Nant-Y- Gaer Hall Ltd because they did not meet their legal requirements in relation to Regulation 13. (3) as domestic hours and the systems for ensuring cleanliness of the premises were not sufficient. At this inspection we were satisfied that arrangements are now in place to ensure cleanliness of the premises. Page 8

11 5.2 Areas of non compliance identified at this inspection None. 5.3 Recommendations for improvement Evaluate the activity logs. Maintaining a recording of each person s participation in the activity and how they felt would be beneficial for staff, enabling them to keep a record of progress and plan future activities which are specifically tailored to each individual. Blanket statements in the care plans such as divert/ direct should be expanded upon. They should provide clear direction for staff as to how they will provide the appropriate care support and care to meet people s needs. ABC charts must be completed as incidents occur. They provide details of what triggers incidents and when evaluated, enable staff to put actions in place or adapt the current actions to minimise the risk of further incidents. Food/fluid charts should be evaluated daily to evidence a good diet and that sufficient fluids have been taken. A copy of the refurbishment programme complete with timescales should be forwarded to CSSIW for information, this can then be reviewed at the next inspection. Page 9

12 6. How we undertook this inspection We, Care and Social Services Inspectorate Wales (CSSIW) carried out an unannounced inspection on the 19 October 2017 between the hours of 9.05 and The visit was to determine progress made in addressing the non compliance notices issued at the inspection of 10 April We also received a concern around the lack of training provision for ancillary staff. Comments have been made in the four sections of the report. There were 14 people resident on the day of the inspection. We based our findings on Observing staff interaction with people living in the service. These observations were formalised through the use of the Short Observational Framework for Inspection (SOFI2) tool. The SOFI2 tool enables inspectors to observe and record life from the perspective of the person using the service; how they spend their time, activities, interactions with others and the type of support received. Conversations with staff and the manager. Viewing communal areas and 33 bedrooms. Reading three care plans and corresponding charts, chosen at random. Reading a staff file and staff rotas from week beginning 2 16 October Copies of the menus and handover sheets were also provided for information. Additional information was forwarded following the inspection this included: Samples of staff allocation sheets, This is me documentation and details of resident s daily participation in activities. Cleaning schedules, details of slings and slide sheets purchased by the provider. Maintenance audits and checklists for the premises. The management report from 18 September The five quality assurance questionnaires completed and returned by relatives. Samples of care plans audited on 27 September Seven staff supervision records. Evidence of the super numerary hours given to the deputy to complete audits. Further information about what we do can be found on our website Page 10

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14 About the service Type of care provided Registered Person Adult Care Home - Older Nant-Y-Gaer Hall Ltd Registered Manager(s) Vacant position since 28 March 2017 Registered maximum number of places 35 Date of previous CSSIW inspection 25 July 2017 Dates of this Inspection visit(s) 19 October 2017 Operating Language of the service Does this service provide the Welsh Language active offer? English No Additional Information:

15 No noncompliance records found in Open status.