Inspection Report on Cwm Coed Residential Home Aberbeeg Date of Publication Monday, 25 September 2017
Welsh Government Crown copyright 2017. 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.
Description of the service Cwm Coed Residential home is located close to the village of Aberbeeg, South East Wales. The home is registered with the Care and Social Services Inspectorate Wales (CSSIW) to provide accommodation and personal care to four younger adults under 65 years of age with a learning disability. On the day of our visit we were told that four people were in residence at the home and that they had lived at the home for several years. The home is owned and operated by Riverwood Housing Limited. The company has a nominated responsible individual who oversees the management of the home. The registered manager is Lynette Williams. The registered manager was present throughout the inspection visit, and the responsible individual was present for most of the inspection visit. Summary of our findings 1. Overall assessment People living at the home are encouraged and supported to be involved and to participate in life at the home. People living at the home appear to be very settled and content and there is a sense of community at the home. People appear at ease and relaxed with care workers who are dedicated, caring and kind. 2. Improvements There were no non compliance notices issued at the last inspection. Improvements have been made following the identification of areas of non compliance and recommendations for improvement at the last inspection. These include: The floor in the home s wet room has been replaced. The home maintains a record of all fire drills. The home s garden is tidy and suitable for use. The home maintains a record of staff attendance at fire safety training. The home has reviewed its Complaints Procedure. The responsible individual includes the monitoring of complaints in the three monthly monitoring visits and this is contained in the report which follows the monitoring visit. 3. Requirements and recommendations There were no non-compliance notices issued following this inspection. Section five of this report sets out our recommendations to further improve the service. This includes the following: Active Offer : The service should provide an Active offer of the Welsh language. We recommend that the registered provider considers Welsh Government s More Than Just Words follow on strategic guidance for Welsh language in social care. Page 1
1. Well-being Summary The home has a warm, welcoming atmosphere and a sense of community. People have good relationships with the staff that care for them. People are able to make decisions about their everyday life and are encouraged and enabled to make choices about how they spend their time. Our findings We found that people living at the home have good relationships with the staff that support them, and the people they live with. We saw that interactions between care workers and residents were relaxed and positive and residents were consistently treated with dignity and respect. The home had a genuine sense of community and a calm, welcoming and relaxed atmosphere. We saw that people living at the home appeared at ease each other and with staff. Staff told us that the people living at the home have lived together for several years, and generally related well to each other. Some people had limited verbal ability to express themselves however we observed that staff were skilled at communicating with residents to meet their individual communication needs. People living at the home appeared happy, and settled. People are enabled to do things for themselves, and have their individual identities recognised and valued. We observed that people were supervised and supported by staff according to their individual needs. On the day of our visit people were supported by staff to engage in activities within the home and the community. One person was supported to make sandwiches and drinks for themselves, and two people went out, separately, during our visit. Staff we spoke to told us about individual resident s interests and the activities they enjoyed, and we saw that this was reflected in the care records we examined. This included helping with household tasks, massage, attending a local day service, and visits to cafes and shops. One person told us that they were going on holiday soon, an event they were clearly looking forward to. Staff told us that the person was going on holiday with another person that lived at the home accompanied by two members of staff and on their return a third person was going on holiday with two members of staff. We observed through their interaction with people that staff were aware of people s individual interests and that they supported people to be positively occupied either actively or passively throughout our visit. We concluded that people are provided with sufficient opportunities to be involved, to increase their independence in aspects of daily living and have opportunities to participate in social/recreational activities in order to enhance their overall well-being. People are able to exercise some choice and control over their every-day lives. We observed that people moved freely throughout the home, and were able to choose where they wanted to spend their time. We saw that people were involved in making decisions, and care workers asked people how they wished to spend their time. Staff we spoke to told us about the ways they ensured people had a sense of control over their day to day lives by facilitating informed and appropriate decision making. Therefore, people s views and opinions are acknowledged promoting a sense of belonging and value. Page 2
2. Care and Support Summary Care workers have a good understanding of peoples individual needs. People benefit from care that is planned in a person centred manner and delivered by caring and familiar care workers. People are encouraged and supported to get involved in life at the home, and their achievements are recognised. Our findings People are as well as they can be, because their individual needs and preferences are understood and their care needs are anticipated. We examined two people s care files and found updated and recently reviewed documentation on each file. We saw that care files detailed essential information in relation to people s individual preferences, personal care needs, medical conditions and medication requirements. A written plan of care detailed the support staff should provide in order to meet peoples physical, emotional and psychological needs and provided guidance on personal likes and dislikes, social interests and daily routines. For example individual records included detailed information about the level and nature of supervision individuals needed within the home and in the community, the care and support to be provided for a person who had difficulty in swallowing, and individual s preferences for rest and sleep. Staff we spoke to were aware of people s individual care needs, this was consistent with care delivery we observed, and with the information in peoples care files. This told us that care workers had a good understanding of individual people s needs. We concluded that people receive person centred care focused on individual needs. People are supported to maintain their health and well-being. We saw from individual care records that people were referred to health professionals for specialist assessment and treatment when required such as dental and psychiatry services. We saw that people had access to health screening programmes such as a bowel cancer screening. We therefore concluded that people receive the right care at the right time. Some people need protection under the Deprivation of Safeguards (DoLs) because of their vulnerabilities and potential risks they face. DoLs is a level of protection for people when all or parts of their freedoms are deprived because of their health condition. Care files we examined evidenced that applications for DoLs authorisations had been submitted to the relevant local authorities for those whose freedom had been restricted. Therefore people s rights are respected. People are treated with warmth and compassion in their day to day lives. We observed positive interactions between staff and people living at the home. Throughout our visit we observed that staff consistently responded to peoples care needs in a kind and caring manner. Care workers facilitated people in the pursuit of daily activities and recognised and celebrated their achievements. We observed that interactions between care workers and people were friendly and relaxed. We observed care workers interacting and communicating with people in a manner appropriate to people s individual needs. We concluded that people have good relationships with care workers who are caring and familiar to them. Page 3
We found that peoples medication is managed safely. We reviewed peoples medication administration records (MARs) and saw that they had been completed correctly, and show that staff follow safe medication administration practice. We saw that tablet counts are undertaken daily for each medication. We were told that medications audits are undertaken regularly and saw that this is a matter considered in the registered providers quarterly monitoring visits. We saw that medications are stored securely. We concluded that overall people are safeguarded by the home s medication procedures. People are offered healthy nutritious meals. The home has a weekly menu plan which we were told is changed periodically. We saw that at lunchtime some people chose what they wanted to eat and prepared their meal with the support of care workers. One person had difficulty in swallowing and we saw that staff prepared a lunch time meal suitable to their individual needs. Care workers shop for food supplies accompanied by people living at the home if they wish. We saw from training records we examined that care workers had undertaken the necessary food handling training. The home had been inspected by the Food Standards Agency in March 2015. We saw that the report which followed the inspection did not identify any areas for improvement and that the home was compliant with regulations. We concluded overall that peoples nutritional needs are being met. Page 4
3. Environment Summary People live in a home which meets their needs and is clean and generally well maintained. The general ambience of the home is welcoming and the décor is homely. There is access to an outside area which is tidy and generally safe and suitable for use. People are safeguarded by the health and safety checks and measures at the home. Our findings People are supported within a safe, clean and secure environment, the layout of which enables them to easily spend time privately or communally. We saw that the home had a lounge, a large conservatory, a separate kitchen and dining area. The décor in the communal areas was homely and welcoming, and the home appeared generally well maintained. The conservatory had patio doors which led to a garden which had a swing which we were told one person living at the home enjoyed using. The garden was tidy and generally suitable for use although the paving was slightly uneven and was awaiting repair. People living at the home have their own bedrooms, most of which were decorated in themes they had chosen. We saw there were sufficient bathing and toileting facilities for the people that live and work at the home. The flooring in the home s wet room had been replaced since the last inspection and was suitable and safe for use. General housekeeping and cleaning was undertaken by the home s care workers with some help from people living at the home. We found the home to be clean and tidy. We observed, during the inspection, that people were using the environment safely and freely, spending time both in private and communally as they wished. People using the service therefore have access to a clean, tidy and safe indoor and outdoor living environment. People are protected and their safety is maintained. We found the entrance to the home was secure and visitor identity was checked before entering the property along with signing of the visitor book. We saw medications were stored securely in a locked cabinet in the home s office. We saw that all health and safety checks and measures in relation to fire certificates, electricity, and PAT testing were satisfactory and up to date. We saw that a record was maintained of fire drills which were undertaken regularly. We saw that safety checks of manual handling equipment, such as the hoist and an airflow pressure relieving mattress, were undertaken. All confidential files including care and staff files were stored securely. People s right to privacy is therefore respected within a secure environment. Page 5
4. Leadership and Management Summary The home has stable and consistent leadership from an established registered manager which benefits residents and staff. Care is provided by sufficient number of skilled and competent staff who appear committed to working at the home. The home has effective systems in place to promote safe practice, and to assess the quality of the service provided. Our findings People living and working at the home benefit from the stability provided by an experienced and well established registered manager who has a visible presence. Staff spoke positively about the support they received from the registered manager. We observed that interactions between registered manager, residents, and staff were relaxed and friendly, and that people appeared able approach the registered manager and members of the management team with ease. We concluded that the management of the home is visible and approachable. People are supported by a stable and dedicated care team. Staff we spoke to demonstrated job satisfaction and a commitment to working at the home and made comments such as I love it here, love the diversity and I love working here, a lovely job I can give 1:1. Staff told us that they felt supported and that they had sufficient staff to meet peoples needs both inside the home and in the community. We observed that care was provided in a calm unrushed manner. We saw that staff spent their time with people participating in activities, or chatting. We were told that any shortfall in staffing numbers was covered from within the staffing team and that the home does not use agency workers. This ensured that people were cared for by familiar staff. We examined three of the home s weekly staff rotas and found that staffing numbers were consistent with the needs of people living at the home. We concluded that staff have sufficient time to spend with people to ensure their emotional and psychological needs are met as well as physical care needs. People consistently receive care and support from staff who are appropriately appointed, trained, and supported. We examined two staff employment files which contained the required information to confirm their suitability and fitness. Staff we spoke to told us that they had sufficient training to undertake their role competently. The staff files we examined showed that staff received training appropriate to the role they perform such as safeguarding, mental capacity act, positive behaviour management, medication administration, fire safety training and emergency first aid in the workplace. We saw that staff had regular supervisions with the registered manager, and an annual appraisal which reviewed their work over the previous year. We saw that the home had regular staff meetings where information is shared. We concluded that there is a robust process in place which ensures staff are recruited, and sufficiently vetted, and trained and supported in a way that improves outcomes for people. People can be sure that there are robust, transparent systems in place to assess the quality of the service they receive. We saw that the home had undertaken a review of the quality of care provided at the home, and that a report had been prepared in October 2016 concerning that review. We saw that the home had received generally positive feedback through the completed questionnaires from people living at the home and staff. We saw that three monthly quality monitoring visits were undertaken by the responsible individual, and Page 6
we saw that a report followed each visit. The reports demonstrated that the opinion of people living and working at the home was sought with regard to the standard of care provided at the home in accordance with regulatory requirements Therefore, people are provided with opportunities to be consulted about the service, and are actively involved in the development of the service in order for them to feel valued and listened to. We found that the home has effective administrative systems. We saw that policies were available to support practice at the home. We reviewed three of the homes policy documents, Complaints Procedure, Safeguarding Policy and Medication Administration Policy and found that each document had been reviewed and updated and contained the necessary information. We concluded that people can be sure that there are systems in place to promote safe practices. We were informed that there were no Welsh speakers currently living in the home. We were told that there were no staff working within the home who spoke Welsh but that there was a member of management in the company who spoke Welsh fluently and could translate if necessary. The home had not considered the Welsh Government s More Than Just Words follow on strategic guidance for Welsh language in social care. The home did not provide an Active Offer of the Welsh language. It did not anticipate, identify or meet the Welsh language needs of the people who may intend to use their service. We concluded that people who may use the service could not be confident that their service could be provided in the Welsh language. The home s statement of purpose, and service user guide meet regulatory requirements. These are important documents which should be kept under review. The home s statement of purpose should provide people with information about the service, including the facilities available at the home. We saw the home s statement of purpose had been reviewed in October 2016, and that it contained all the required information. We saw that the values and principles of care provided were clearly documented, and that the document had been provided to individuals living at the home. We saw that people living at the home have access to a pictorial version of the service user guide. We concluded that people are generally informed of their rights and services available to them. Page 7
5. Improvements required and recommended following this inspection 5.1 Areas of non compliance from previous inspections There were no noncompliance notices issued at the last inspection. At the last inspection the registered provider was advised that they were not compliant in the following area: Regulation 13 (4)(a) of the Care Homes (Wales) Regulations (2002) - the floor in the wet room was a tripping hazard. The floor in the wet room has been replaced. Regulation 17(2) Schedule 4.14 - a record of fire drills was not maintained. The home maintains a record of fire drills. 5.2 Areas of non compliance identified at this inspection There were no areas of non compliance identified at this inspection. 5.3 Recommendations for improvement Active Offer : The service should provide an Active offer of the Welsh language. We recommend that the registered provider considers Welsh Government s More Than Just Words follow on strategic guidance for Welsh language in social care. Page 8
6. How we undertook this inspection This was a full inspection undertaken as part of our inspection programme. We made an unannounced visit to the home on 23 August 2017 between 11:25 and 15:50. Discussion with two members of staff, the registered manager, and the responsible individual. We used the Short Observational Framework for Inspection (SOFI). The SOFI tool enables inspectors to observe and record care to help us understand the experience of people who cannot communicate with us. Observation of interactions between residents and staff Examination of the care documentation relating to two residents. Examination of the personnel files of two members of staff, in order to consider the recruitment process in place. Visual inspection of the building s interior. Consideration of the home s quality assurance systems. Review of staff training provision. Review of three of the home s weekly staff rotas. Review of the previous inspection report. Review of the home s Statement of Purpose. Further information about what we do can be found on our website www.cssiw.org.uk Page 9
About the service Type of care provided Registered Person Registered Manager(s) Adult Care Home Younger Riverwood Housing Ltd Lynette Williams Registered maximum number of places 4 Date of previous CSSIW inspection 29 July 2016 Dates of this Inspection visit(s) 23/08/2017 Operating Language of the service Does this service provide the Welsh Language active offer? English This is a service that does not provide an Active offer of the Welsh language. It does not anticipate, identify or meet the Welsh language needs of the people who use, or who intend to use their service. We recommend that the service considers Welsh Government s More Than Just Words follow on strategic guidance for Welsh language in social care Additional Information: