Care and Social Services Inspectorate Wales Pen-y-Garth EMI Residential & Residential Home Pleasant Lane, Brymbo LL11 5DH Tel: 01978 753323 Home: Pen-Y-Garth Residental and Residential Home Contact Telephone: 01978 753323 Registered Provider: Registered Manager: Pen-Y-Garth Homes Limited M. Roberts Number of places: 44 Category: Care Home - Older Adults Date of Inspection: August 2010 to September 2010 Dates of previous report publication: December 2009 Inspected by: John Edwards
Introduction Pen-y-Garth is situated in its own grounds in the village of Brymbo and is convenient for the Wrexham and Chester areas. There is good car parking space for staff and visitors. The registered provider is Pen-Y-Garth Care Homes Limited, the responsible individual being Mr K. Symms. The egistered manager is Mrs M. Roberts. The home is registered to accommodate 44 service users over 65 years of age, including 5 service users under 65 years of age, who need personal care due to physical or mental infirmity (dementia) Summary of inspection findings What does the service do well The home provides good information to service users and their relatives in the forms of a statement of purpose and a service user guide. The manager ensures that assessments are undertaken to ensure that the home can meet service users needs. Relatives and staff can contribute ideas to the care given. Service users are offered choices. Staff are courteous and respectful. Staff treat service users as individuals. Service users are happy with the quantity and quality of food being provided. Staff group is well qualified and various training courses are offered. Service users are protected by the home having good recruitment procedures. Manager is approachable and well thought of by service users and staff. What has improved since the last inspection? Priorities No formal requirement notices have been issued during this inspection episode. Other areas for improvement The laundry is situated in an outbuilding and although functional could do with refurbishment. The home s self-assessment form mentions that some improvements could be made to the landscaping around the home and the installation of safe pathways for service users.
Inspection methods The information contained in this report was gathered in the following ways: Prior to this unannounced inspection the manager completed a self-assessment form confirming policies and procedures in place and giving information about all aspects of the home s operation. Care and Social Services Inspectorate Wales questionnaires were distributed to 5 service users, 5 service users relatives and 5 members of staff. Of these, 4, 4 and 1 were returned respectively. An unannounced inspection visit was carried out on 2nd September 2010. Three service users were case tracked and their files inspected. Staff treat service users as individuals. The rooms of 10 service users were inspected. Two members of staff were spoken with in private and a further 4 members of staff were spoken with during the inspection process. A thematic inspection on infection control standards was undertaken during this inspection. A separate section for the report on this thematic inspection will be found at the end of the report headed Infection Control.
Planning for individual needs and preferences All three service user files inspected had detailed care plans in place and there was evidence that these are regularly reviewed. Relatives confirm that they are able to contribute ideas to the care given to the person living in the home and two members of staff spoken with separately and in private during the inspection also confirmed that the manager listened to their suggestions and hese were acted upon. Staff are responsible for writing daily case notes on service users files and these can contribute to care planning when significant changes have been noted. The home keeps the necessary records in place, some in the office and some in an alarmed out-building. Requirements made since the last inspection report which have been met: Requirements which remain outstanding: Action required (previous outstanding requirements) Original timescale for completion Regulation number New requirements from this inspection:
Quality of life The two members of staff spoken with confirmed that service users are given choices in all areas of daily living, including bedtime routines, meals and activities. Service users are encouraged to bring personal possessions into the home and this was apparent in all the 10 service user rooms seen during the inspection. This is the second inspection visit that the inspector has undertaken to the home and again the atmosphere was found to be calm and non-confrontational. Service users were seen to be content and well-presented. Members of staff were observed to be interacting with service users in a friendly and professional manner and visitors to the home were seen to be made welcome by the staff group. All 5 returned relative questionnaires confirmed that visiting arrangements are good and that staff are welcoming. Staff spoken with said that some activities are made available by them every afternoon of the week and the home also employs an OT for 2 hours on 4 afternoons a week. This is in addition to various entertainers coming into the home. The manager informed the inspector that members of staff continue to fund-raise for the home and service users and commendably do so in their own time. Staff are aware of the need to respect service users confidentiality and this is covered as part of their induction and NVQ training. Requirements made since the last inspection report which have been met: Requirements which remain outstanding: Action required (previous outstanding requirements) Original timescale for completion Regulation number New requirements from this inspection:
Quality of care and treatment Staff were seen to treat service users with courtesy and respect and are aware of privacy and dignity issues when giving personal care. Staff spoken with were aware of the importance of treating service users as individuals with differing needs and one relative s questionnaire mentioned the fact that staff had learnt to deal with and diffuse a service user s difficult behaviour. The manager acknowledges that the provision of care can only be undertaken by staff who have had the appropriate checks and the appropriate training. The files of the service users case tracked clearly evidenced that health services are accessed appropriately and good written notes kept of contacts. Tissue viability is assessed and the community nursing services are involved in dealing with any breakdown. During the inspection the beds of 10 service users were examined and it was noted that of the 10 beds inspected, 3 had specialist mattresses to reduce the risk of pressure damage. As part of this inspection the home completed a medication checklist confirming good practices in place. The home s medication practices are reviewed annually by their pharmacist. During the inspection the home s food provision to service users was looked at in detail and findings mirror those in a recent monitoring report by Wrexham Borough County Council. Returned service user questionnaires rated the food being provided highly. Four out of 5 returned relatives questionnaires rated the choice of food being provided as very good and one as average. All 5 questionnaires rated the quantity of food being provided as very good (4) and good (1). Staff spoken with confirmed that choices are available at all times and that the menus are varied. The lunch being served on the day of the unannounced inspection looked appetising and there was sufficient food being provided. As part of the inspection food stocks were looked at and these were found to be adequate. The manager and cook are happy with the budget being provided for food and good quality leading brand foodstuffs were evident. On the day of inspection there was a cook and kitchen assistant on duty. Rotas show that a cook is on duty from 8:00am until 6:00pm every day of the week and the cook is supported by a kitchen assistant from 8:00am until 2:00pm every day of the week. The service users and staff members health and safety are protected by policies and procedures in place. Staff also receive training in the mandatory areas, including moving and handling, first aid, infection control and fire safety. It was noted during the inspection that the handyman has been known to transport staff and service users in his car. The inspector is in favour of this as it gives service users in particular opportunities to go into the community and perhaps do some personal shopping for example. However, on enquiry it became evident that the handyman s insurance did not cover him for business use and the manager was informed of this. The manager arranged this cover immediately and a copy certificate was forwarded to CSSIW shortly after the inspection. A requirement is therefore not being made as the matter has been resolved quickly. The manager confirmed that the handyman has a current CRB check in place. The manager has attended a falls awareness training course and records and explores possible reasons for falling and safeguards that can be put in place to prevent further falls. The home s self-assessment form confirms that fire, electrical, lifting and heating systems are regularly inspected and certified by appropriate suitably qualified contractors.
Requirements made since the last inspection report which have been met: Quality of care and treatment Requirements which remain outstanding: Action required (previous outstanding requirements) Original timescale for completion Regulation number New requirements from this inspection:
Staffing Rotas supplied by the home prior to the inspection show that there are 6 care staff on duty to meet the needs of service users during the mornings, and 5 care staff on duty during the afternoons and 4 on duty at night. On the day of inspection the home was seen to run smoothly at this level of staffing. Domestic and laundry hours are also provided. It was noted that the handyman did not appear on the rota and this is contrary to the National Minimum Standard 20.2 which clearly states that A written staff rota is kept showing which staff are on duty at any time during the day and night and in what capacity. The issue of staff breaks were discussed with the manager and she confirmed that there were clear guidelines in place to ensure that breaks do not impinge on the quality of care being provided to service users. Information provided by home shows that as at 10th August 2010, apart from the manager and her deputy, the home employed 37 care staff, and of these 20 held NVQ 2 or higher, and 11 were enrolled or awaiting verification of NVQ 2. This exceeds the standard. Commendably the deputy manager holds NVQ 4 and a senior carer is also working towards this award. Recruitment was looked at in some detail during the previous inspection and procedures were seen to be thorough. The home s self-assessment form confirms that CRB checks are being undertaken and renewed every 3 years. Recruitment was not looked at during this inspection. The home provided details of staff training prior to the inspection and training and updates are ongoing. The 2 members of staff spoken with confirmed that their training was up to date and one said that there were always opportunities to go on a course, and training was not limited to just the statutory training. They also confirmed that they were receiving one to one supervision. The home does not use volunteers or agency staff. Requirements made since the last inspection report which have been met: Requirements which remain outstanding: Action required (previous outstanding requirements) Original timescale for completion Regulation number New requirements from this inspection: The rota should include the hours worked by the handyman.
Concerns, complaints and protection The home has a complaints procedure which service users and their relatives are made aware of before the service user enters the home. The policy is detailed and gives clear information of the options open to the complainant. There is also a Complaints Procedure at a glance which is in the form of a flow chart and is written in large font. The home has had one formal complaint during the year, and this is being dealt with in line with the home s complaints procedure. The home has had 3 POVA (Protection of Vulnerable Adults) referrals during the year, 2 having been resolved and the home exonerated. The third is in the process of investigation and CSSIW is involved. Requirements made since the last inspection report which have been met: Requirements which remain outstanding: Action required (previous outstanding requirements) Original timescale for completion Regulation number New requirements from this inspection:
The physical environment Pen-y-Garth is situated in its own grounds in the village of Brymbo and is convenient for the Wrexham and Chester areas. There is good car parking space for staff and visitors. The home has a rolling programme of refurbishment and there is a maintenance/repairs book listing jobs needing attention from the home s handyman. These jobs were usually seen to be completed promptly. The home has 20 single bedrooms and 12 shared bedrooms. Single rooms make up 46% of places which is below the national minimum standard. The rooms of 10 service users were inspected during the inspection and the rooms were found to be clean, homely, adequately furnished and comfortable. All rooms had been personalised to some extent by the service user concerned. The communal areas of the home were also homely and comfortable. The manager confirmed that all radiators now had safe covers and following advice given during the last inspection all bathing outlets are now supplied with bath thermometers which staff are expected to use to ensure that hot water used is at safe temperatures. Hot water supplies are also protected by appropriate valves. All communal areas of the home were inspected and the manager agreed to arrange for more appropriate lighting in one of the downstairs toilets. All areas seen were clean and free from offensive odours. Requirements made since the last inspection report which have been met: Requirements which remain outstanding: Action required (previous outstanding requirements) Original timescale for completion Regulation number New requirements from this inspection:
A note on CSSIW s inspection and report process This report has been compiled following an inspection of the service undertaken by Care and Social Services Inspectorate for Wales (CSSIW) under the provisions of the Care Standards Act 2000 and associated Regulations. The primary focus of the report is to comment on the quality of life and quality of care experienced by service users. The report contains information on how we inspect and what we find. It is divided into distinct parts mirroring the broad areas of the National Minimum Standards. CSSIW's inspectors are authorised to enter and inspect regulated services at any time. Inspection enables CSSIW to satisfy itself that continued registration is justified. It also ensures compliance with: Care Standards Act 2000 and associated Regulations whilst taking into account the National Minimum Standards. The service s own statement of purpose. At each inspection episode or period there are visit/s to the service during which CSSIW may adopt a range of different methods in its attempt to capture service users' and their relatives'/ epresentatives' experiences. Such methods may for example include self-assessment, discussion groups, and the use of questionnaires. At any other time throughout the year visits may also be made to the service to investigate complaints and to respond to any changes in the service. Readers must be aware that a CSSIW report is intended to reflect the findings of the inspector at a specific period in time. Readers should not conclude that the circumstances of the service will be the same at all times. The registered person(s) is responsible for ensuring that the service operates in a way which complies with the regulations. CSSIW will comment in the general text of the inspection report on their compliance. Those Regulations which CSSIW believes to be key in bringing about change in the particular service will be separately and clearly identified in the requirement section. As well as listing these key requirements from the current inspection, requirements made by CSSIW during the year, since the last inspection, which have been met and those which remain outstanding are included in this report. The reader should note that requirements made in last year's report which are not listed as outstanding have been appropriately complied with. Where key requirements have been identified, the provider is required under Regulation 25B Compliance Notification) to advise CSSIW of the completion of any action that they have been required to take in order to remedy a breach of the regulations. The regulated service is also responsible for having in place a clear, effective and fair complaints procedure which promotes local resolution between the parties in a swift and satisfactory manner, wherever possible. The annual inspection report will include a summary of the numbers of complaints dealt with locally and their outcome.
CSSIW may also be involved in the investigation of a complaint. Where this is the case CSSIW makes publicly available a summary of that complaint. CSSIW will also include within the annual inspection report a summary of any matters it has been involved in together with any action taken by CSSIW. Should you have concerns about anything arising from the inspector's findings, you may discuss these with CSSIW or with the registered person. Care and Social Services Inspectorate Wales is required to make reports on regulated services available to the public. The reports are public documents and will be available on the CSSIW web site: www.cssiw.org.uk
Thematic Inspection: Infection Control Summary of inspection of infection control findings What does the service do well? There is a colour coded cleaning regime. The current staffing levels are keeping the home to a good standard of hygiene. There is a laundry routine in place. The manager has ensured the provision of training in infection control for all staff. What needs to be done to improve the service? Priorities There have been no requirements made as a result of this infection control inspection. Other areas for improvement Upstairs bathroom would benefit from refurbishment. Bedpan washer awaiting repair. Inspection methods Reading the information included within the self-assessment form completed by the registered manager. Discussions with the manager and staff. Inspection of service users rooms and mattresses. Inspection of all communal toilets, bathrooms and sluices.
Quality of care and treatment As part of this inspection 5 service users were chosen at random from both sides of the home and these included 5 males and 5 females. The service users beds were stripped with the assistance of the manager and her deputy and the mattresses examined. All mattresses seen were clean and in good condition and had impermeable coverings. Staff spoken with confirmed that mattresses are regularly checked and cleaned. The home has a colour coded system in place where cloths/mops of a certain colour are only used in the appropriate areas, and notices are available to advise staff. Requirements from this inspection: Action required Timescale for completion Regulation number Staffing The home employs a cook and a kitchen assistant every day of the week, the cook working an 8:00 to 6:00 shift and the assistant 8:00 to 2:00. The kitchen was observed to be clean and hygienic during the inspection. The kitchen received 4 stars following a Food Safety inspection in October 2008. There are 2 domestics on duty from 8:00 to 2:00 and there is also a laundry person on duty from 8:00 to 3:00 six days a week. There are routines in place to transport dirty linen and clothes to the laundry. The home was found to be clean and hygienic during this unannounced visit. Requirements from this inspection: Action required Timescale for completion Regulation number
Conduct and management of the home The manager confirms that there have been no outbreaks of infection in the home since the last inspection and there is a policy in place which has been written following reference to the current approved literature, including DH Prevention and Control of Infection in Care Homes. Commendably the manager, domestic staff and all but 4 care staff have undergone infection control training during 2010. During the inspection it was noted that there were sufficient stocks of protective clothing on the premises. Requirements from this inspection: Action required Timescale for completion Regulation number Concerns, complaints and protection At the time of this report there is a complaint being investigated by CSSIW. There was an element of the complaint concerning infection control issues but this current inspection activity has not upheld this element of the complaint. Requirements from this inspection: Action required Timescale for completion Regulation number
The physical environment All bathrooms, toilets and sluice areas were inspected. It was noted that the bedpan cleaner was not operational and was awaiting repair. The manager had put in an alternative routine in place. Bathrooms and toilets seen were clean but one upstairs bathroom suite was dated and should be placed in line for refurbishment. The manager informed the inspector that this bathroom was rarely used, so complete refurbishment should not be unduly disruptive. The bedrooms of 10 service users were seen, and all communal areas. These were found to be clean, hygienic and free from offensive odours. Requirements from this inspection: Action required Timescale for completion Regulation number