Care and Social Services Inspectorate Wales Care Standards Act 2000 Inspection Report Llanhennock Cheshire Home Llanhennock NP18 1LT Type of Inspection Baseline Date of inspection Wednesday, 17 August 2016 Date of publication Wednesday, 28 September 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 Llanhennock Cheshire Home is owned and operated by Leonard Cheshire Disability. The home is registered with Care and Social Services Inspectorate Wales (CSSIW) to provide support for up to 34 physically disabled people over the age of 18 years, requiring nursing or personal care needs. At the time of the inspection the home had 33 residents. Kelvin Thomas is the registered manager and is registered with both the Care Council for Wales (CCW) and CSSIW. The home is situated in a rural location on the outskirts of the town of Caerleon in South East Wales, and is set in its own grounds accessed by a short driveway. What type of inspection was carried out? We (CSSIW) carried out an unannounced inspection on the 17 August 2016, in accordance with CSSIW regulatory processes. Analysis of information held by CSSIW in respect of the care home led us to plan a baseline inspection. Information for this report was collected as following: conversations and discussions with 3 residents living at the home conversations with 3 sets of relatives of residents living at the home case tracked 4 people s care from pre-admission assessment through to delivery of care within the home. examination of the Person Centred Planning Audit discussions with and information provided by the registered manager and clinical lead observations of daily life, staff interactions and care practices at the home discussions with 4 members of staff examination of 4 staff personnel files a review of the agency s records relating to staff training and staff supervision (staff meeting on a one to one basis with their line managers) examination of staffing levels and requirements examination of the complaints received by the home since the last inspection visit examination of the homes accident/incident reporting review of the homes Annual Quality Assurance review of the homes Regulation 27 visits review of the homes Statement of Purpose and Service User Guide visual inspection of areas of the home to which residents have access. We reviewed information held by CSSIW about the service including Regulation 38 reports What does the service do well? The registered manager regularly consults residents, their representatives and staff Page 2
working at the home to establish their views of the conduct of the care home. These are reflected in a monthly management report which also details other quality audit findings and action plans required for service improvement. The home also provides a physiotherapy service, enabling a prompt service for people s mobility needs. What has improved since the last inspection? Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) and Deprivation of Liberty Safeguards (DoLS) are now kept at the front of the file, so that they are immediately visible to the reader. Care plans have been reviewed to contain clear details of a persons individual needs and how those needs are to be met. Communications between teams and management have improved and this was evident through team meetings, handovers, nurse meetings and communication via memos and emails. Staff have been provided with notepads, so they may log information as and when needed. What needs to be done to improve the service? The following areas of non-compliance have been identified. On this occasion, we have not issued non-compliance notices in relation to these breaches of Regulations, as we did not identify any evidence of immediate harmful impact to residents. It is the registered provider s responsibility to address these matters and we will follow this up at the next inspection. The registered persons is non compliant with Regulation 15 (2)(c) The registered person shall keep the service user s plan under review. There was an occasion when a service delivery plan had not been reviewed. The registered persons is non compliant with Regulation 18 (2) - The registered person shall ensure that persons working at the care home are appropriately supervised. The registered provider failed to ensure that the persons working within the home supervisions at appropriate intervals. Recommendations for service improvement: To ensure that there is adequate ventilation available whilst decoration to the home is being carried out. To ensure that photos held on the system are placed on individual staff files. Page 3
Quality Of Life Overall, people who live at Llanhennock Cheshire Home enjoy a good quality of life in a warm, friendly and relaxed environment. We saw that people were appropriately dressed and had a good standard of hygiene. On the day of the inspection visit the atmosphere throughout the home was calm and relaxing. We saw that residents were provided with meaningful choices about their lives including making decisions about when they got up, what they ate and daily routines. Staff members we spoke with emphasised the importance of individuals having choice. Residents had a range of choice for breakfast and lunch, and people could decide where they wished to eat their meals. Timing of meals was also flexible and offered residents meals when they wished. We observed respectful and pleasant interactions between staff and residents. Staff used preferred names, and these names were highlighted in individuals care plans. Staff were able to communicate verbally and non-verbally with residents in a skilful manner. We saw one staff member communicate using colours and letters of the alphabet and another staff member was able to understand what the resident wanted via eye movements. We also saw one member of staff explaining to a volunteer how a resident liked to be greeted in a different language. We found that staff were respectful of people s religions and preferred language choice, and demonstrated enthusiasm to extend their knowledge. We observed one resident who became agitated, staff remained calm and had a good level of understanding of their emotional needs and spoke to them in a reassuring and comforting manner. Residents we spoke with who were able to express their views, told us they were comfortable and happy living in the home and confirmed they were treated with respect. Comments included, I like the staff, they are lovely, I like the manager, he looks after me and staff are nice and friendly. One relative told us staff are really wonderful, it s a lovely service and they do an exceptional job. Another relative commented Staff and management are very good.they don t rush and are patient. People are treated with dignity and respect and we saw that staff encouraged people to be independent where appropriate. For example, at breakfast, one person was not eating. We saw staff sit beside the person to take time to encourage the person with an alternative breakfast food option., Staff were also very observant during breakfast, and assisted some people with drinking their tea and fruit juice. Staff approached this in a relaxed manner, with care and sensitivity. Furthermore, on the day of our visit, we observed the lunch service. The food looked nutritious and we observed staff offering a choice of two meals. One resident we spoke to said I like the food and a family member told us that the home catered for their relative s preferred diet choice. Both breakfast and lunch service was carried out in a relaxed and steady manner. Residents were assisted when needed and there was no time frame on how long meal times lasted. In general, we found that people were supported by staff who were knowledgeable and understanding of peoples care needs and their personal preferences. This is because the majority of care plans viewed at this inspection provided sufficient guidance to staff on how to care for a person and were person centred. We examined several people s care plans and risk assessments. Risks associated with the delivery of care had been identified and were detailed in their contents. Upon reviewing care plans, they were Page 4
consistent with the Local Authority care plans. They also advised staff of people s preferences. For example, one care plan outlined the person s preferences in relation to what time they liked to get up and their morning routine. Another plan noted that the person likes to have a selection of clothes to choose from in the morning and what snacks they enjoyed. The care plans also detailed morning, lunch and evening routines. For example, one care plan stated how a resident liked to have a lie down after lunch and another detailed how they liked their door open and light left on at night. The registered manager had also implemented the recommendation from the last inspection to ensure l all Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) and Deprivation of Liberty Safeguards (DoLS) were now kept at the front of the file, and immediately visible to the reader. On the whole, people s changing care needs are monitored. This was evidenced in most of the care plans we examined, which had been updated and reviewed to reflect changes in care needs. For example, one care plan had recently been updated and reviewed after their skin integrity had changed. Another had been updated to reflect their changing epilepsy needs. Staff are now provided with note pads, so they may make a note of any urgent notes at the time of carrying out care, which are then transferred into the main care file. However, we did see a care plan which had not been reviewed. Whilst this was an isolated incident, having clear and up to date guidance for staff is of the utmost importance to promote the safety and well being of residents. In this instance there was the potential for this deficit to place the resident at risk. Therefore, we have deemed the registered person to be non compliant with Regulation 15 (2) (c). We did not issue a notice on this occasion, as we could see from the care file, daily notes and from speaking with staff that this persons needs were being met by the service provided. Referrals to outside teams had also been made and staff had extensive knowledge of the person s condition. An assessment had also recently been carried out by an external agency. The registered manager assured us that the service was in the process of reviewing all care plans and support required, to ensure these reflected current needs. This will be followed up and tested at future inspection. People are provided with support to maintain their physical and mental health needs by referrals, when appropriate, to healthcare professionals. This was confirmed from examining the care files and viewing referrals to Neurology, Weight Management Service, Occupational Therapy, chiropodists and dieticians. The home also operated an in house physiotherapy department which provided daily physiotherapy on an individual basis. The home has their own hydro pool fully equip with hoists, which is used or swimming and physiotherapy sessions. People are provided with opportunities to participate in social and recreational activities. A programme of activities was in place which included arts and crafts, cooking sessions, film days and quizzes. We also saw that trips out to the community are arranged and entertainers came into the home to provide concerts. Religious services are also held to meet resident s spiritual needs. The home also provides 1-1 sessions for those who remain in their room. There is a pleasant dedicated area for activities and on the day of our inspection, we observed residents making bread in this area. We also viewed residents taking part in outside games, walking the grounds and playing with a dog who visits the home on a weekly basis. We also observed volunteers interacting with residents, reading with them and chatting. The home had also purchased a custom made swing, allowing access for wheelchairs. We observed one resident enjoying the swing Page 5
with a member of staff. Page 6
Quality Of Staffing People living at Llanhennock Cheshire Home were cared for by motivated staff which was evident in the warm interactions between staff and residents. Overall, people can be confident that the home employs suitable carers for the role to ensure people are safe. From examining staff files, it was evident that Disclosure and Barring Service (DBS) checks had been undertaken to ensure suitably fit persons were appointed to work at the home. Staff files also contained detailed employment histories, references and appropriate identification for each staff member. However, we noted two files that did not contain a photograph of the staff member. The home had photographs; however these had not been placed on the file. The registered manager assured us that they would be placed on the files within 24 hours. Overall, people using the service can be confident that staff employed are appropriately trained for their role. From speaking with staff we found that they felt equipped and adequately trained to carry out their role. From examining the training matrix, it was evident that all staff had completed the mandatory training in Manual Handling, Fire Safety, Fundamentals of Care, Protection of Vulnerable Adults (PoVA), Infection Control, Food Safety and First Aid training. Staff had also completed further training in Deprivation of Liberty (DoLS), Managing Aggression, Dementia Awareness, Mental Capacity Act, Pressure Care and Safer Medication. All training was completed and up to date. Staff also told us that they felt confident in approaching their manager for additional training when required. This was evident in one supervision record we viewed, whereby a staff member had requested advanced training in areas. The registered manager informed us that they have now reviewed their training on Dignity and Respect. This training is now carried out within the home and a resident living at the home co-ordinates the training. This enables staff to gain a better understanding of the needs for dignity and respect from a service user perspective. This training has been commended by the Local Authority and it s currently been implanted across the whole of Llanhennock Cheshire Disability. People can be generally assured staff are well supported by management. This is because from speaking with staff they informed us that the manager is very supportive, Management are proactive and supportive. Another commented I feel are management approachable. Staff had received regular appraisals from their manager. From examining the individual supervision records, they were detailed and staff were able to raise all issues including training issues, development, personal circumstances, updates on residents and any other business. For the majority of staff, supervisions were carried out on a regular basis. However, from examining the supervision matrix, it was evident that arrangements to supervise staff exceeded the National Minimum Care Standards and that staff were not being appropriately supervised, as some staff had not received supervision for over a 2 month period.. We therefore informed the registered manager that they were non compliant with Regulation 18 (2). We did not issue a notice on this occasion, as staff felt they were well supported and had no concerns. The registered manager assured us that the service was in the process of carrying out all supervisions and we saw evidence of this. Improvements with supervision arrangements for staff will be considered at future inspection. Page 7
At the time of the inspection, the home employed 40 care staff and 6 nurses, of which 39 were permanent members of staff. The home does employ agency staff; however, they are employed on block rotas, in order to maintain continuity of care for people living at the home. This was confirmed by staff we spoke with, who had been employed by the home on an agency basis for over a year period. Page 8
Quality Of Leadership and Management People living at the home can be clear about what the service provides because the Statement of Purpose details information and is compliant with the Care Homes Regulation 2002. In addition, people can be assured that arrangements are in place to review and improve the service provision. This was reflected in the documentation which formed part of the homes annual quality assurance review. We examined the report from October 2015, which overall evidenced that people valued the service the home delivered. The registered manager confirmed that the questionnaires for the next review are due shortly. People living at Llanhennock Cheshire Home can be confident that management are visibly accountable for the management of the home. This is because the registered manager carries out regular monthly reports which focuses on quality of care, interviews with staff and residents and focused on developing the home. The last report dated July 2016 identified the level of sickness which currently stands at 5.7% which has decreased from the previous month. This was a robust report which provided evidence of the registered manager s monitoring of the home and attention to planning for service improvement. Communication between teams and management has improved and this was evident through the implementation of team meetings, handovers, nurse meetings and communication via memos and emails. Staff also commented that the communication and interaction around the home is much improved since the last inspection. We saw evidence that monitoring visits had been undertaken by the responsible individual under Regulation 27 of the Care Home (Wales) Regulations 2002. The last recorded visit had been undertaken in June 2016. These visits demonstrated that interviews had been undertaken with residents and relatives in order to gather their views about the way in which the home is run. The report was comprehensive and had clear action points. From examining the reportable incidents, we found that the service had reported incidents to CSSIW on a regular basis. The registered manager confirmed that they were aware of the incidents that were reported and continued to monitor this. We examined the accidents and incidents folder which contained a monthly audit along with the progress of the accident/incident. This audit provided information about the location of any accidents as well as the action which had been undertaken. The folder also detailed all reportable incidents to CSSIW. It was evident that the home had good reporting systems and all notifications had been reported under Regulation 38. The home also has a robust system for dealing with complaints. The home had received two complaints since the last inspection which had been responded to within a timely manner and followed the complaints policy. One complaint required the intervention of multi-disciplinary teams and this had also been actioned. The home also had audits in place for several areas including medication, DoLS and person centred planning. For example when examining the DoLS documentation, it was evident that the home was making referrals when required and continually updated each Page 9
DoL on an individual basis. Page 10
Quality Of The Environment Overall people can be assured that the home environment is clean, welcoming and pleasant. Upon our arrival, the front electronic access door was open; however, this was due to residents accessing the front garden at the time. However, the front door was monitored by an administrative staff member who sat next to it welcoming visitors. We were asked to sign in and provide identification. The CSSIW registration certificate and liability insurance was visible in the entrance hall. We conducted a visual inspection of the home and areas accessed by the residents.. We saw that the home was clean with no evidence of offensive odours. The home was also well decorated. Residents had a choice of where they wished to spend their time, including a Garden Room, which had views onto the outside gardens and was laid out in a manner which supported positive interactions between people. The home was surrounded by beautiful grounds and gardens for residents to enjoy. We observed volunteers sitting in the garden with the residents reading and enjoying the sunshine. The home also has a wheelchair accessible pathway enabling access around the building and into the garden areas. We also saw a specialist adapted swing erected in the garden for people using wheelchairs to access. We observed residents with their families enjoying sitting outside on the patio area enjoying the sunshine. Residents also had the option to sit at an enclosed area of the front garden, whereby there were benches and oversized outdoor games such as Connect4. There is a swimming pool at the home, where people benefit from hydrotherapy, and there is also a physiotherapy room. In addition, there is an activity room which contains a fully equipped kitchen, a computer, a television, percussion instruments and various arts and craft provisions. Computer stations have now been placed throughout the home for residents to access at any time. The home also provides portable internet appliances enabling internet access for residents and to have Face Time with relatives. Face Time is a real time video feed whereby people can speak via a video link. All residents rooms are now located on the ground floor. This was implemented to ensure safety and easy access for those using wheelchairs. Resident s rooms were seen to contain personal items and were decorated so as to reflect the likes and preferences of them as individuals. Each resident s room included personal items such as televisions, games, sound and lighting equipment. One relative also informed us their loved one residing at the home had been able to choose what wall paper they wanted, the colour and how the room layout should be. Personal and care files were kept secure in locked cabinets behind a lockable door. Copies of personal care files to the individual were kept in their rooms, so they had access to view their care plans at all times. At the time of our visit the registered manager informed us that that there were plans in place to undertake renovation work at the home. Our observations indicated that the home generally appeared in good decorative order, walls had been painted and new carpets had been laid. At the time of the inspection, the home was having maintenance work carried out in the downstairs corridor and bathing room. This caused minimal disruption to the residents living at the home. Also at the time of the inspection, the down stairs communal room was being painted. Although this was a positive improvement for the home, the paint odour was quite pungent on the main corridor later in the afternoon. Page 11
Although this was away from residents bedrooms, we informed the registered manager of the need to provide sufficient ventilation when carrying out any decoration work at the home. The homes administrative team, staff room, activities coordinator and two living-in volunteers are based on a separate floor of the home to ensure that the residents have their own living space. Upon leaving the home at the end of the inspection, the front electronic access door was securely locked and was accessed via a key opening. Overall, we therefore found that the environment was supportive of maintaining the well being and safety of residents. Page 12
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 13