Inspection Report on

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1 Inspection Report on Rostley Care Home 29 Castle Pill Crescent Steynton Milford Haven SA73 1HD Date of Publication Monday, 4 September 2017 Welsh Government Crown copyright You may use and re-use the information featured in this publication (not including logos) free of charge in any format or medium, under the terms of the Open Government License. You can view the Open Government License, on the National Archives website or you can write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or psi@nationalarchives.gsi.gov.uk You must reproduce our material accurately and not use it in a misleading context. Page 1

2 Description of the service Rostley Care Home is a single storey; domestic style home situated in a residential area of Milford Haven in West Wales, and is registered to provide care and accommodation for up to twelve people over the age of 65 years. The provider of the service is Celtic Residential Ltd and the registered manager is Caroline Davies. Summary of our findings 1. Overall assessment People are supported to make choices and are cared for by staff who understand and anticipate their needs. People and their relatives told us that they like living there and that staff are helpful, listen to their views and are kind and caring. However, we found that the registered manager undertakes other roles within the service and has insufficient time to attend to her managerial duties which has negatively impacted on the standard of record keeping. 2. Improvements No non-compliance issues were noted at the last inspection. Some refurbishment and redecoration had been carried out, in particular the external garden area. 3. Requirements and recommendations Section five of this report sets out the recommendations to improve the service. These are in relation to the following: - Areas relating to record keeping, such as the statement of purpose, risk assessment and care planning. - The time allocated to the registered manager to carry out managerial duties. - External environment in relation to smokers and storage of paints. - Facilities in a shared room. - Health and safety regarding the control of substances hazardous to health (COSHH) Page 2

3 1. Well-being Summary Overall, people experience warmth, kindness and support by staff who clearly know them well, and can anticipate their needs. People are encouraged to express their own opinions are involved in making decisions about their lives. Activities appear to be limited. Our findings People s individual routines and preferences are respected. We saw that people decided where they wanted to sit, in both the privacy of their own bedrooms or in communal areas where they mixed with other people or spoke with the staff. Over a lunch time period, we carried out an observational exercise designed to look at staff interaction with people who had communication difficulties. We observed two people who were not in the dining room. We found that staff ensured the two residents had everything they wanted, and that they could manage. We saw that staff engaged with one of the people assisting them to eat, but also involved the other person in conversation so that they did not feel left out. We also saw that drinks were topped up, and that people were asked what they wanted, and how much. We also noticed that on entry to the room, staff looked at both people, and used eye contact and spoke kindly. People are treated with dignity and given choice and supported to be as independent as possible. People have the opportunity to socialise with others. We spoke with people sitting outside in the small courtyard who were smoking and noted that they also conversed with each other whilst enjoying the sunshine. Some people and their relatives gathered in the small seating area within the kitchen and spoke to the registered manager whilst she cooked and served the lunch time meal. We spoke with one person who preferred to remain in their room, who told us that the staff were kind and they help me. I can t say a bad word about them. The food is nice, too. A relative told us that it was a lovely home we feel really welcome when we visit. However, we did not see a formal list of daily activities, and did not witness any ongoing activities during our inspection. We did not see evidence of any trips or outings from the home. There was no activities organiser in place. The registered manager informed us that there were ongoing activities. They said sometimes time was short, especially if, as occurred on the day of the inspection, people had to be taken by staff to appointments or there were numbers of visitors. We were further told that activities tended to be individual rather than group, and included bingo, cards, skittles, hoopla, a dvd of sit and fit (designed to give armchair aerobics), and singalong sessions. We concluded that people could benefit from being offered more stimulus on a daily basis. People are protected by appropriate referrals under the Mental Health Act. We found that people who lacked the capacity to maintain their own safety were referred to the appropriate organisation for a Deprivation of Liberty Safeguards (DoLS) authorisation. The design and layout of the home meant that people could safely move about and could go outdoors giving them a sense of purpose, but could not leave the boundaries of the premises. We saw that smokers were either discreetly observed if they held their own lighters or were facilitated to smoke on request, by staff, who held the lighters on their behalf. We did not see risk assessments in place for smokers. People s rights and choices are respected, and individual preferences are accepted and facilitated. Page 3

4 2. Care and Support Summary People s health and welfare is promoted. Staff are competent, well trained, and responsive to people s needs. People are referred to health and social care professionals in a timely manner. Risk assessment and care planning documentation requires review and updating. Our findings People can feel safe as they are monitored and referred appropriately to health and social care professionals. We saw during our inspection that people were being taken to hospital appointments and noted in care records viewed that a GP sheet was in place which also recorded other health professionals visits. However, in at least one record viewed, this was not up to date. We saw staff clearly knew each individual well and we heard them asking people how they felt and checking if they wanted or needed anything. We witnessed staff discussing people s conditions with the registered manager in the office, both giving information and receiving advice. It was evident from discussions and records that more knowledge was known about people than appeared in written records. An example of this was a record that stated chest under the heading Important information. We asked the registered manager what this meant and she immediately described an underlying chest condition from which the person suffered. Overall, staff are vigilant, caring and know the processes to take if someone requires anything outside of the usual day to day routine. People are provided with healthy food and drinks. We saw that people were well hydrated and noted that staff frequently offered people drinks such as squash and water. In addition tea and coffee throughout the day. We noted that the lunch time meal, (cooked by the registered manager) was nourishing, with generous portions and saw that people were eagerly anticipating the meal. One relative informed us that the food is exceptional, another told us that their relative had picked up since having regular good, home cooked food. Another stated I would give this place eleven out of ten, wonderful place, wonderful staff, wonderful food. We also saw that people had choice in what they ate, and when. People s lives are enhanced by enjoying choice and provision of good, home cooked food and being kept hydrated at regular intervals. The registered manager and the staff know people s backgrounds and conditions well, but records pertaining to people s care are not well ordered and user friendly and either lack detail and/or contain information that requires archiving. We looked at the records of three people who used the service and found that they were not person centred, lacked detail, and did not contain recent photographs of the person pertaining to the record. We did not see any person centred information such as a pen picture of the person, their previous lives, or family information (other than contacts). We saw that reviews were carried out, but the records were not user friendly, and confusing to read in terms of identifying date and time of the review. We saw that an inappropriate needs assessment form had been used in one record entitled Celtic Residential Care Ltd Domiciliary Care needs assessment. We discussed our findings with the registered manager who acknowledged that the records would benefit from being reviewed and updated. They informed us they intended to seek guidance and re-arrange and archive older information. It was clear that the registered manager and staff knew the people s conditions and backgrounds and what was required to keep them as well as they could be. However Page 4

5 information must be recorded and reviewed in line with government guidelines. Risk assessment and care plans are not detailed or, in some instances, clear and will benefit from being reviewed and updated. People enjoy a good interaction and form happy relationships with staff. We noticed that people approached staff with warmth and there was light, but respectful, banter amongst them. We saw that staff were kind and patient and treated people with respect and dignity. We looked at the records of three staff members and found they had been properly vetted on recruitment. Each one had appropriate references and had undergone an induction process. Staff were properly supervised and had received training appropriate to their work which was recorded in their files. Staff spoken with indicated that they felt well supported by the registered manager and liked working in the service. People feel they matter because staff communicate well with them and take time to understand and assist them. Page 5

6 3. Environment Summary People enjoy the benefits of a one storey building, which is generally well maintained. Externally, there is a recently renovated area, but no shelter for smokers. Attention should be paid to health and safety issues regarding storage. Our findings People benefit from premises that are all on one floor. The home is clean and tidy with no unpleasant odours in any part of the building. Most of the rooms are generally satisfactory with one or two areas requiring some redecoration and/or updating. We found that all parts of the home were warm and well lit. We saw that the small dining room was a little cramped, and required updating. This room also contained a sink, a medicines cabinet and a sharps box which was propped on a ledge and not attached to the wall. The registered manager informed us that this was for visiting health professionals, but moved it to a less precarious place in the office. The presence of the sink and medicines cabinet in the dining room detracted from the dining experience. People had a choice of seating areas and we saw that these were utilised throughout the day, a small seating area attached to the kitchen, the dining room, the lounge, and people s own rooms. We saw that the shared room did not have two sinks, and consideration should be given as to how this may be accommodated. The kitchen was pleasant and clean, and had recently been awarded a Grade 5, (the highest grade possible) by environmental health. People s independence and sense of freedom is enhanced by the layout of the home. People enjoy a pleasant outside space, which has been recently renovated, although the paths are narrow and there is no shelter for smokers. During pleasant weather conditions the one small table just outside the back door was a popular place for smokers to sit in the sun. However, in less clement conditions people could not go outside without getting wet, or wind-blown. The small laundry area was not cordoned off from the passage way to the outside back of the home. We saw that many pots of paint had been placed on a high shelf above the laundry area, which is a health and safety risk. Attention was also required to address the storage of Control of Substances Harmful to Health (COSHH) as we found the cupboard unlocked. We discussed these matters with the registered manager who indicated that they would be referred to the higher management and addressed as soon as possible. People are facilitated to socialise and walk inside and outside of the home freely without danger to themselves, which increases their well-being. Page 6

7 4. Leadership and Management Summary Overall, the home is well run and people benefit from the accessibility and visibility of the registered manager. However, the registered manager undertakes duties within the service which has detracted from her managerial role. Our findings People may not be aware of the most current information when consulting the statement of purpose and service users guide. We examined the statement of purpose and found a number of anomalies such as the amount of people who could be accommodated at the service, and omissions such as room sizes, and the position regarding a service in the Welsh language. The document did not appear to have been reviewed for some time. Discussions with the registered manager indicated that this would be given priority and an updated and current statement of purpose would be sent to CSSIW by 30 June, We also found that policies and procedures required updating and review. People cannot currently depend on the information contained within the statement of purpose as being accurate. The corporate certificate is not displayed. We saw that the registered manager s certificate was prominently displayed, and found that the registered address for the company had changed. Checks made with CSSIW revealed that no change of address notification had been received and the corporate certificate had been sent to the address already held. We discussed with the registered manager that an urgent change of address notification must be sent to CSSIW at the earliest opportunity. People are not directly adversely affected by this, but the service must be compliant with legislation to maintain their registration. People can be assured that the registered manager is knowledgeable about how to best ensure their welfare. Discussions with the registered manager revealed that she had a sound knowledge of people s conditions and ensured that they were assessed prior to admission in order to ensure that the service could meet their needs. We saw that the registered manager directed and advised other staff, and spoke with relatives regarding any anxieties they had regarding their relation. However, this was not always documented. It was clear that both relatives and the people using the service held her in high regard. We saw that the staff also approached the registered manager with ease, and that there was a good rapport between them. Staff turnover was low. Staff spoken with indicated that they felt supported and were given good training opportunities. Overall, people are properly assessed before admission, to ensure that the service can meet their needs. They also benefit from interested and committed management and staff who work as a team to ensure the best outcome for each individual. The registered manager undertakes other roles which negatively impacts on time needed for office duties. We found that the registered manager was also the cook. We saw that at meal times she assisted people to feed themselves, and cleared up, whilst also attending to telephone calls, people coming to the door, (both visitors and health and social care professionals), as well as attending to managerial office duties. We found the systems and available hardware used within the office would have benefitted from being updated such as the laptop being used which became alarmingly hot shortly after being switched on. We heard the fan speedily and loudly humming, and we discussed that this might be a fire Page 7

8 hazard and should be professionally examined or replaced at the earliest opportunity. Our observations were that the registered manager needed more dedicated office time and/or an administrative assistant to review and update documentation and bring order to the office systems and documentation, generally. In addition, cooking duties should be delegated in order to release her from the daily task and allow more time for managerial duties. Dedicated office time and delegation and/or assistance with some duties will allow the registered manager more time to attend to necessary documentation which will ultimately benefit the service as a whole. People can be assured that all safety checks within the home are carried out regularly. We saw that gas and electrical appliance testing was on a rolling contract as were the hoists. We saw evidence of receipts and documentation from appointed and accredited companies who carried out the checks regularly. People s lives are enhanced by being confident that they can safely use the available facilities and services. Page 8

9 5. Improvements required and recommended following this inspection 5.1 Areas of non compliance from previous inspections None 5.2 Areas of non compliance identified at this inspection None 5.3 Recommendations for improvement Care and Support: 1. Risk assessments and care planning require review and update. They lack detail and require a more person centred approach, such as a pen picture and information about the individual. 2. People s records must contain recent photographs, and should be archived so that current and relevant information is easily accessed. 3. People s medication administration charts should contain a recent photograph for safe identification. Environment: 1. We recommend that an external shelter is provided for smokers. 2. We recommend that pots of paints are removed as soon as possible from their current position and an alternative place which complies with health and safety recommendations is identified and utilised at the earliest opportunity. 3. The shared room should have two wash hand basins. 4. The COSHH cupboard door must be kept locked at all times. 5. The dining room should not contain a free standing sharps box. This room would benefit from upgrading and removal of the sink and medicines trolley. Leadership and Management: 1. The statement of purpose and service users guide require review and updating to address the anomalies found during the inspection, such as the numbers of people the service is registered to accommodate. This should be completed by 30 June, The registered manager should ensure that she has dedicated office time and delegate some roles in order to attend to managerial duties. The addition of an administrative assistant could enhance and accelerate updating of the documentation. 3. An early notification of the change of address of the service s business address should be sent to CSSIW. It is an offence not to display the corporate certificate in addition to the managerial certificate. 6. How we undertook this inspection Page 9

10 This was a full inspection undertaken as part of our inspection programme. We made an unannounced visit to the home on 05 May 2017 between am and pm. The following methods were used: We spoke with three relatives of people who used the service We spoke with four people who used the service We spoke with two staff members We used the Short Observational Framework for Inspection tool (SOFI) which is designed to record interactions between staff and people who have communication difficulties We examined the records of three people who used the service We examined the records of three staff, including training and supervision We examined a range of documentation including: - The statement of purpose - Registration certificates - Gas and electricity safety testing - Hoist maintenance checks We toured the building and the grounds Further information about what we do can be found on our website Page 10

11 About the service Type of care provided Registered Person Registered Manager(s) Adult Care Home - Older Celtic Residential Care Ltd Caroline Davies Registered maximum number of places 12 Date of previous CSSIW inspection 28 July 2016 Dates of this Inspection visit(s) 06/05/2017 Operating Language of the service Does this service provide the Welsh Language active offer? English No Additional Information: