Care and Social Services Inspectorate Wales Care Standards Act 2000 Inspection Report Bryn Seiont Newydd Pant Road Caernarfon LL55 2YU Type of Inspection Post Registration - Baseline Date(s) of inspection 23 February 2016 Date of publication 22 April 2016 Welsh Government Crown copyright 2016. 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 email: psi@nationalarchives.gsi.gov.uk You must reproduce our material accurately and not use it in a misleading context.
Summary About the service Bryn Seiont Newydd is situated on the outskirts of Caernarfon. The home provides services for up to 71 people aged 40 and over requiring personal and nursing care relating to dementia. The home is purpose built and was registered on 29 th October 2015; the accommodation is divided into houses for up to eight people in each house. The registered provider is Pendine Park Care Organisation Ltd, and the responsible individual is Gill Hughes. Sandra Evans is the registered manager What type of inspection was carried out? We, Care and Social Services Inspectorate Wales (CSSIW) visited the home on 23rd February 2016 between the hours of 9.30 am and 4.45 pm. This was a scheduled baseline post registration inspection and was unannounced. Two inspectors carried out the inspection. The information for this report was gathered from the following sources: Discussions with the registered manager, the responsible individual, 3 family visitors and 3 staff on duty during our visit. A sample of records in relation to people using the service, staff and the operation of the home. This included the Statement of Purpose and staff training matrix. Five completed staff questionnaires Observation of service users using the Short Observational Framework for Inspection (SOFI 2) tool. The SOFI 2 tool enables inspectors to observe and record life from a service user s perspective; how they spend their time, activities, interactions with others and the type of support received. On the day of our visit there were 64 people living in the home 56 of whom require nursing care. What does the service do well? There is a regular programme of meaningful activities that are designed to enrich the lives of people using the service and provide a balance between stimulating and calming activities and which stimulate different senses. What has improved since the last inspection? Not applicable, as this is the first inspection since the home registered in October 2015. What needs to be done to improve the service? The service is not compliant with Regulation 15(1) of the Care Homes (Wales) 2002. This is in relation to written care plans, as to how the service user s needs are to be met. We found that care plans and risk assessments were not detailed enough. However we did not identify that people were not receiving appropriate care. The responsible individual agreed to address this issue and therefore we have not issued a non compliance notice. Page 3
We will review this at subsequent inspections. We identified areas where practice could be further developed to assist the registered persons in improving the standard of the service provided. The issues identified are: Care plans and reviews have not been signed by the person or family representative, to evidence that they have been involved in the care planning process. Staff support at lunchtimes was not sufficient. People living upstairs do not have free access to outside spaces. In the statement of purpose and service user guide there is a section on Garden Strategy. Currently this does not reflect what is on offer in Bryn Seiont Newydd, and also refers to what happens in other Pendine homes, which could be misleading. This section needs to be reconsidered. Page 4
Quality Of Life Overall we found that there was a friendly atmosphere in the home and observed comfortable relationships between the people using the service and the staff who support them. We saw that people were relaxed and at home in their environment. We found that people were treated with dignity and respect. We saw this through the interactions people had with staff. We saw staff treating people in a considerate manner and using a respectful tone of voice. We observed staff offering people opportunities to discuss their preferences over how to spend their day and what they would like for lunch. People are active, positively occupied and stimulated. We saw that people were engaged in, and enjoying an art session, which was supported by an activity coordinator, a person from the Alzheimer s Society and care staff. We saw evidence that music sessions are held, we saw an organ in one room, and a full sized and smaller portable harp in the home as well as other hand held instruments. We spoke with the visiting hairdresser, who comes twice a week, she told us that hand massages and manicures are also offered. We were also told that people can enjoy baking sessions, and there is a small kitchen that people are supported to use. Care staff told us that people can participate in household activities, such as washing up cups, wiping down tables and laying tables if they wish to. We saw that there is a range of activities that people can engage with, and saw one gentleman playing dominos with a staff member, daily newspapers and books were also available for people to access when they choose. The home encourages/promotes soft toy therapy, we saw a range of dolls and soft toys around for people to pick up and hold. This is evidence of good practice in dementia care. People remain healthy because their needs are anticipated and they are enabled to have access to specialist or medical support. We saw from care files that staff access appropriate advice from primary and secondary health care services. People benefit from a healthy diet and attention to nutrition and hydration. People have a choice of meals through the day with a choice of two main courses at lunchtime, and it was observed that if this was not liked, alternatives are provided. People have access to a kitchen area, so they can be supported to have drinks and snacks at any time. This is evidence of good practice in dementia care as it promotes independence. People cannot be sure they will receive appropriate responsive care from staff who have an up to date understanding of their individual needs and preferences. We saw that care plans lacked sufficient detail to instruct staff on how support people with their personal care needs. The care plan did not set out in detail the action which is needed to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the person are met. They should describe what good support is for the individual so that care is delivered in a consistent manner. The care plans we saw had not been signed by the persons receiving services or by their family, and on some occasions by the author of the care plan. There was a lack of countersigning and checking of carer reports by nurses, which could lead to important information such as any identified issues highlighted by care staff relating to pressure care being missed. We saw that care plans did not include how to support people with their cognitive difficulties. We saw in one Page 5
person s file that whilst it was acknowledged they were at risk of falling, a falls care plan and risk assessment were not completed until the person had had two falls. The outcome of this is that people s needs may not be met due to a lack of detailed care plans which ensure that staff know how to support people with all their needs. We discussed this with the responsible individual during our visit and they agreed with our findings. Page 6
Quality Of Staffing Overall people are well supported by friendly, competent and welcoming staff. People can feel confident in the care they receive because staff are competent and confident meeting their particular needs. This is because staff have been trained in the approaches and skills needed in caring for people living with dementia, and have accessed/completed modules in advanced dementia awareness/living well with dementia, enriching lives, communicating and an introduction to distress and conflict. This is in addition to the mandatory subjects such as infection control, manual handling and safeguarding. People cannot always be sure of receiving timely support and care. We saw that the care in two lounges was timely and sufficient over the lunch time period. However, in two other lounges we witnessed that there were not enough carers present to support people to have their lunch altogether. We saw that people were not engaged in discussions before and during the meal, which would have made it a pleasurable and sociable experience. We observed one carer for 15 minutes trying to support 4 people to have their lunch; one person fell asleep at the dining table, whilst another was supported to have their soup 10 minutes after it was placed in front of her. In one completed staff questionnaire, a staff member commented that there should be more staff. Staff are supported with their practice. This is because we were told that staff are receiving supervision in line with regulatory requirements and the National Minimum Standards. Staff we spoke with and completed staff questionnaires confirm this and told us they felt valued by management. However, some staff we spoke with said they understood there were recruitment difficulties, but they felt stretched in supporting such a large number of highly dependent people and they were not giving the oversight needed to carer s recordings and observations. People have good interactions with staff and feel enhanced wellbeing as a result. SOFI 2 observations of interactions between staff and people using the service showed people who live at Bryn Seiont Newydd experience warmth and belonging and that staff recognised the importance of such social interaction to the person s wellbeing and strive to provide this. Page 7
Quality Of Leadership and Management People can see visible accountability and know that there are people who are overseeing the service. This is because the registered manager is regularly seen around the home and the responsible individual is a regular visitor to the home. People using the service, working in the service or linked to the service are clear about what it sets out to provide. This is because the statement of purpose is clear about what the home will deliver and what its ethos is. However, we do note that the section on Garden Strategy is not in line with the current provision at Bryn Seiont Newydd and should be given further consideration. We looked at the system in place for recruiting staff. We examined two staff files and found that staff were recruited safely, with all checks being carried out as required by Schedule 2, Care Homes (Wales) Regulations 2002. People can feel confident that staff are supported and valued by the management of the home. Staff we spoke with said they felt valued by management, have regular supervision, and have enough support to carry out their role. Staff told us that they feel supported to develop their skills and knowledge. We were shown training records that demonstrate the registered persons have a strong commitment to the delivery of person centred care. The service had accepted a large number of people within a very short space of time, due to exceptional circumstances in the locality. However, there were issues with staff shortages, resulting in a lack of thorough care planning, and staff feeling stretched. We note that the service is not meeting its stated aims within the statement of purpose and service user guide as they are not ensuring an agreed care plan is completed with the resident and/or family and involving them in reviews. We have spoken with the responsible individual who recognises that admitting such a large number of people in a short space of time was not ideal, and is working with the local health board on learning lessons. The admission of people should be carefully managed so they can be sure that they can meet their diverse needs. People using the service cannot always be confident that the provider will respond positively to feedback and critical incidents. Concerns were raised with us about the way the home had dealt with complaints. We have been told that a person had been given notice to leave the home because their needs can no longer be met in response to concerns about their care being raised. This resulted in considerable distress to the person who raised the concerns. We have been informed by the registered individual that this has now been resolved, and a breakdown in communication has been addressed. Page 8
Quality Of The Environment Overall, we found that Bryn Seiont Newydd provides a stimulating and uplifting environment for people who use the service and visitors are made to feel welcome. People can feel uplifted by the environment they live in. The home has been designed in a thoughtful manner, utilising current research and good practice for people with dementia. People live in small households, of up to 12 people, and each person has a large bedroom with an en-suite wet room. People are encouraged to personalise their own rooms. Wing arm chairs are provided, with footstools, if people would benefit from raising their legs, and reclining chairs are also supplied if the need is identified. Wall decoration is varied, and provides stimulation for people, although some pictures are abstract, and people who live with dementia would benefit from pictures that can stimulate memories and conversation. People are able to meet others and develop relationships in communal areas and have private space should they need it. Corridors are wide and facilitate most people being able to explore the environment freely and benefit from a variety of sitting and recreational areas, including a quiet area to assist in responding to differing needs. Corridors would benefit from having activity items in place, which could include activity boards or sensory areas, so corridors are seen as areas of stimulation. Currently people who are accommodated on the first floor of the home cannot freely access outdoor space if they wish to. This is because the roof garden is not yet ready for use. The downstairs outside spaces would benefit from containing familiar garden objects, such as tools, washing lines, seats and bird tables, to stimulate interest in the outside space. People s well being is promoted because of the range of facilities and equipment provided to meet their particular needs. There are two bathrooms with a bath spa, if people would prefer a bath to a shower. There is also a hairdressing salon which provides a salon experience for people wishing to have their hair done. We observed there were ample hoists to support people who live in the home. People are reassured that they can be safe from strangers entering the premises and that personal belongings are secure and that personal information about them is properly protected. This is because there are receptionists on duty who facilitate entry into the households and identification of visitors is required if they are not known to the care home staff. Information about people is kept locked in appropriate offices, which allows care staff to access them. Page 9
How we inspect and report on services We conduct two types of inspection; baseline and focused. Both consider the experience of people using services. Baseline inspections assess whether the registration of a service is justified and whether the conditions of registration are appropriate. For most services, we carry out these inspections every three years. Exceptions are registered child minders, out of school care, sessional care, crèches and open access provision, which are every four years. At these inspections we check whether the service has a clear, effective Statement of Purpose and whether the service delivers on the commitments set out in its Statement of Purpose. In assessing whether registration is justified inspectors check that the service can demonstrate a history of compliance with regulations. Focused inspections consider the experience of people using services and we will look at compliance with regulations when poor outcomes for people using services are identified. We carry out these inspections in between baseline inspections. Focused inspections will always consider the quality of life of people using services and may look at other areas. Baseline and focused inspections may be scheduled or carried out in response to concerns. Inspectors use a variety of methods to gather information during inspections. These may include; Talking with people who use services and their representatives Talking to staff and the manager Looking at documentation Observation of staff interactions with people and of the environment Comments made within questionnaires returned from people who use services, staff and health and social care professionals We inspect and report our findings under Quality Themes. Those relevant to each type of service are referred to within our inspection reports. Further information about what we do can be found in our leaflet Improving Care and Social Services in Wales. You can download this from our website, Improving Care and Social Services in Wales or ask us to send you a copy by telephoning your local CSSIW regional office. Page 10