Care and Social Services Inspectorate Wales Care Standards Act 2000 Inspection Report Brookside Care Home Ty Coch Llangorse Brecon LD3 7UA Type of Inspection Focused Date(s) of inspection Thursday, 2 July 2015 Date of publication Monday, 10 August 2015 Welsh Government Crown copyright 2015. 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. Page 1
Summary About the service Brookside Care Home is situated in the small village of Llangorse, 7 miles to the east of Brecon, Powys. It is registered with the Care and Social Services Inspectorate Wales (CSSIW) to provide care to 31 residents, of whom 20 may have nursing needs and up to 10 people with diagnosis of dementia. The home is a converted house with several extensions providing accommodation over 3 floors. It is run as 2 units, a nursing unit and a unit for people with personal care needs. It has a garden that houses rabbits and chickens. The Registered Provider is Brookside Care Home Ltd, the Responsible Individual is Stephen Vaughan and the Registered Manager is Elizabeth Vaughan. What type of inspection was carried out? We (The Care and Social Services Inspectorate Wales-CSSIW) carried out an unannounced, annual inspection on the 2 July 2015 over a period of 5 hours. It was a focused inspection which mainly considers the experience and quality of life of people using the service, but other areas were also looked at. The following methods were used to gather information: General inspection of the environment Observation of interactions between the people living at the home and staff using the short observational framework for Inspectors (SOFI) tool. The SOFI tool enables inspectors to observe, analyse and make a judgement as to what life is like for people living at Brookside. Discussions with relatives of three people living at the home. Discussions with staff Sampling four care records of people using the service, two on the personal care unit and two on the nursing unit. Sampling staff files Look at where controlled drugs are kept and recorded. What does the service do well? We saw that people living at Brookside were cared for in a relaxed homely atmosphere and that staff were interacting with them in a respectful manner. All the relatives that were spoken with were very satisfied with the service provided. Page 2
What has improved since the last inspection? Four recommendations were made following the previous inspection carried out on the 3 July 2014. We saw evidence that three out of the four had been addressed. From the sample of care records that were seen, we saw evidence that the home is now compliant with Regulation 13 (5). This is because moving and handling risk assessments were in place with clear details to instruct staff on how to transfer people, for example from bed to chair, and equipment to be used. We, CSSIW received notifications of death, accidents or incidents in the last 12 months to comply with Regulation 38, however it was noted that an injury sustained following a fall should also have been sent as a notification. We saw evidence in the care records that were seen that the food and fluid charts are now being completed and totalled every 24hours, and that the home is compliant with Regulation 12 (1)(a). What needs to be done to improve the service? There were no non- compliance notices issued following this inspection but the following four recommendations were made, and we were assured by the Registered Manager that these would be addressed. Ensure that all the care files on the nursing unit are detailed evidencing regular reviewing and action taken when needs have been identified. Ensure that all staff files contain the full and satisfactory information required to comply with Regulation 19 Provide evidence of regular one to one supervision of staff to comply with Regulation 18 (2). We were given an assurance that a rolling supervision and appraisal time table will be implemented and operational by the end of September 2015. Provide CSSIW with notification of injuries to fully comply with Regulation 38 (c) Page 3
Quality Of Life People living at Brookside can be confident that they will be treated with respect in a relaxed homely environment. Examples of the ethos of person centred care can be seen around the home. We saw that considerable effort had been made by staff to make memory pen picture boards that were on the doors of each person s room. People are encouraged to have family photos and items to personalise their rooms. The Deputy Manager told us that this was taken to consideration when redecorating and that people are asked what name they wish to be called when they move to Brookside. When individual rooms are being dusted and tided, the person who occupies the room is always present and is encouraged to actively participate. Both units have a small kitchenette area in the lounge to allow people to make hot drinks at their leisure. Jugs of cold drinks with tumblers were readily available in both lounges. People can be confident that staff interact with the people living at the home in a respectful and thoughtful manner. Using the SOFI 2 tool we observed staff interacting with people when they were having lunch. We observed that attention was immediately given to a person who started coughing, and also when another person shouted. Overall the staff were seen to be using good techniques whilst assisting people with their food and keeping them engaged. Regular activities are held at the home, such as a visiting poet, musician and the children at the local school visit to joint work on an Art Project. Birthdays are being celebrated as was seen on the day of the inspection. The relatives that we spoke to individually praised the activities held and the warm welcome they receive, with one saying it is wonderful. Another relative said that they feel reassured that they would be called immediately if there was any change in the person s health. They commended the food and we observed that people were served a choice of two hot meals, both looked nutritious and appetising. Evidence were seen in one of the care files that staff were to prepare nice atmosphere for when the gentleman s wife comes to have lunch with him, and is assisted to phone her every evening. We saw that breakfast was being made individually throughout the morning at a time suitable to the person getting up. Both care files that were tested on the unit for people with personal care needs were comprehensive and seen to have been reviewed, signed and dated within the last fortnight. There was evidence that visiting health professionals were called when needed, such as the General Practitioner and District Nurse. Body maps were seen to be used appropriately and included in the Accidents and Injury file. One care file that was tested on the nursing units was very detailed with evidence of the care domains being reviewed regularly. The moving and handling procedure was written clearly and the overall file was thorough. However another file that was looked at was not detailed, some of the care plans pertaining to the person s health needs were not completed, and lacked evidence of having been regularly reviewed. There was evidence that the person had lost weight Page 4
but no clear record of action taken, although fortified drinks were given. This was fed back to the Registered Manager following the inspection and we received confirmation that this will be looked at. Prior to our arrival the Registered Nurse had contacted a person s relative to discuss with them the need to apply for authorisation regarding deprivation of the person s liberty. This demonstrates that the home is considering the protection of people s rights. Medication is kept in locked metal cupboards in each person s room along with the medication chart, and also the personal hygiene record. We looked at the medication store room and sampled a controlled drug used at the home and found it to be recorded correctly. Page 5
Quality Of Staffing This inspection focused on the quality of life offered to people living at Brookside Care Home. However, the following observations were made with regards to the quality of staffing. People can be confident that staff will interact in a warm and friendly manner. This is because the outcome of the observation using the SOFI tool was very positive. We carried this out over a lunchtime period where we saw staff speaking in a kind and personal manner and assisting people with their meal with patience. The relatives of three people that were spoken with commended the staff. One relative in particular spends a whole day at the home and said that the friendly approach of the staff is consistent throughout the day and that nothing is too much trouble. The staff that were spoken with told us about the training that they receive every Friday. The training is delivered by an assessor in four sessions, and we were told that it encompasses all relevant training required to work in a care home. We randomly looked at staff files, but some documents such as photo identification were missing from some. and references missing from one. Evidence of regular supervision were not seen, but it was acknowledged that the Registered Manager was not available to direct us to where these might have been kept. Staff that were spoken with said that they did not receive regular one to one supervision but they always have opportunities to approach the Registered Manager. Following the inspection we were given assurance by the Registered Manager that a rolling supervision and appraisal time table will be implemented and operational by the end of September 2015. Staff do not wear uniforms but we observed them wearing protective disposable aprons when appropriate. Page 6
Quality Of Leadership and Management This inspection focused on the quality of life offered to people living at the home and did not include detailed observation of matters relating to leadership and management, as this will be considered at the next baseline inspection. However the following observations were made. Although the Registered Individual and Registered Manager were not at the home during the unannounced inspection, the Registered Manager responded to our feedback and informed us that she has appointed a Deputy Manager to enable her to function at a more detailed level. We met the Deputy Manager during the inspection and she informed us that she was undertaking NVQ level 5 in Management. There is a suitable Statement of Purpose and Service User Guide in place and is available in large print, however some areas need to be reviewed and updated. We were told by relatives and staff that the people living at the home have opportunities to approach the Registered Manager regularly, and that she also undertakes caring duties periodically. The Deputy Manager told us that they have staff meetings with minutes taken, but they are not held regularly. We could not see evidence of regular one to one supervision and this was confirmed by the staff that were spoken with. The Registered Manager agrees that this is lacking and we were given an assurance that a rolling supervision and appraisal time table will be implemented and operational by the end of September 2015. It was evident in conversation with staff that management share their vision for the home with them as they told us in detail about the redecorating plan. We did not see any complaints but the procedure was displayed in the reception area. We noted that a compliment had been written by a relative saying that the staff approach people living at the home with kindness and professionalism and that the home is comfortable and enjoyable. Page 7
Quality Of The Environment This inspection focused on the quality of life offered to people living at Brookside. However, the following observations were made with regards to the quality of the environment. People can be confident that the premises are suitable for the purposes of a care home and that maintenance of equipment used is completed to schedule. We saw that the hoist and stair lift had been serviced on the 29 April 2015. We were told that the home has a programme for redecorating people s rooms and saw two that had already been completed with consideration to personal preference. The beauty salon has been recently relocated within the home and offers hairdressing and nail care. The Deputy Manager showed us where the new sensory room will be located. It is hoped that it will be of benefit to the people living at the home who have a dementia illness. Since the previous inspection new double glazed windows have been fitted in the nursing lounge and a relative commented how well they looked with added benefit of warmth and comfort for people living at the home. The garden is accessible to able bodied people living at the home, and is also accessible to those needing to use a wheelchair. There are raised plant beds for gardening, patio with seating area, hens that roam freely around the garden and rabbits housed with a run. Birds were also encouraged in the garden as hanging feeders were seen in various locations. Page 8
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 9
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