Care and Social Services Inspectorate Wales
Care Standards Act 2000
Inspection Report
Trebanos House Care Home
Trebanos House St. Bernards, The Drive Graig Road, Trebanos Swansea SA8 4BB
Type of Inspection – Baseline Date(s) of inspection – Tuesday, 9 June 2015 Date of publication – Friday, 31 July 2015
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About the service Trebanos House is registered with Care and Social Service Inspectorate Wales (CSSIW) to provide personal care and accommodation for up to ten people aged eighteen to sixty four years for people with a learning disability and one named person with functional mental ill-health within the ten places There were eight people living in the home on the day of the inspection.
The home is situated in large grounds in a quiet residential area in Trebanos, close to Pontardawe town and approximately ten miles from the centre of Swansea city. There are ten single bedrooms and two communal lounge/dining areas.
The registered provider is Care Management Group (CMG) which is a large organisation with care homes in Wales and England that provide support for people with learning disabilities and other conditions. The acting manager Jonathan Melnyk has day to day responsibility for the management of the home.
What type of inspection was carried out? This was a scheduled unannounced baseline inspection focussing on all four themes – the quality of life; quality of staffing; quality of leadership and management and quality of the environment. The methodology used was:-
One unannounced visit by 2 inspectors Reference to previous report Discussion with people living at the home, staff and the acting manager Discussion with care manager Inspection of 3 people’s care records Inspection of 3 staff records Sight of the Statement of Purpose Tour of the building
What does the service do well? This inspection identified that there were no significant areas of outstanding practice that were over and above the regulations and national minimum standards.
What has improved since the last inspection? This inspection identified that there were no areas of improvement since the last inspection.
Page 2 What needs to be done to improve the service? There were no issues of non-compliance identified during the inspection. However, we discussed with the acting manager the issues which need to be addressed:-
The acting manager should complete the application for registered manager for the home and forward it to CSSIW by the end of June 2015. Regulation 8 of the Care Homes (Wales) Regulations 2002.
As the previous inspections have identified, the registered persons must ensure that the home is maintained to a good standard, to ensure the comfort and wellbeing of people living in the home and staff working there. Standard 37.12 of the National Minimum Standards (NMS) for Care Home for Younger Adults.
Page 3 Quality Of Life
People using the service can be confident that staff who support them do so with patience, sensitivity, warmth and kindness, as we observed positive interactions between the people living in the home and staff. People experience enhanced wellbeing because staff are able to recognise gestures and anticipate their needs. Staff display patience and smile at people, which results in a calm and friendly atmosphere.
From listening to people at the home, people can feel confident that staff are person centred in the way care is undertaken, as they are familiar with the people living in the home. Positive comments were made about staff by people living in the home ““staff are very good”, “I’m settled here”, “we are good butties”.
People are treated with dignity and respect, and choices are actively given to people. This is because during our visit we saw staff asking people whether they wished to join in a group or 1:1 activity. With the recent introduction of a new daily diary, we saw a 24 hour account of people’s activities which evidences people’s mood, and choices, all of which contributes to a person centred care plan. Staff are currently positively adapting to this way of recording. Also if required, people can benefit further from the support of a clinical mental health nurse specialist who is employed by CMG and is currently assisting with specific care plans to support people with their individual needs.
People can feel confident that people living at the home are active, positively occupied and stimulated, as people are offered a wide range of different activities within and outside of the home with appropriate levels of support in place for each activity to happen. From discussion with a care manager, we are aware that one of the people living there is benefitting from “better access to the community”. People living there have access to one mini-bus and 2 cars. In the care plans, we saw person centred documents that described people’s preferred activities. On the day of the inspection, we saw that some people were accompanied to local shops as this was a preferred choice, whilst others took advantage of a trip to the Mumbles. On their return, people commented that they “had a good time”. People also told us that they had recently been to a disco and barbeque and the acting manager told us that people living in the home had been included in a recent neighbourhood party, which the home supported by offering extra parking for those attending.
People living at the home are actively encouraged to make full use of the kitchen facilities and can plan and prepare meals by receiving the level of support they require. However, the acting manager feels that meal plans are currently staff led, and has plans for this to be a more inclusive activity for the people living in the home, adding more pictorial aids to ascertain preferences, yet balancing healthy options.
People can feel confident that there are robust monitoring measures in place regarding administration, management and recording of medication as medication is stored appropriately and at the correct temperature and a system is in place for staff to access information provided with the medication regarding possible reactions. Also there has been a recent review by the Boots the chemist (March 2015) which indicated no issues of concern.
Page 4 People can feel confident that finances are managed appropriately, as we saw clear accounting processes in place and observed that the appropriate checks were complete and correct.
Due to a change in the management structure the acting manager acknowledges that a revised Statement of Purpose and Service User Guide is now required. We are informed by the acting manager that there are plans to revise the Service User Guide so that more pictorial information is available in order to aid communication for the benefit of people wishing to live at the home.
Overall the outcomes for people living at Trebanos House care home are positive as staff strive to provide a good quality of life by encouraging and supporting people to be as independent as possible and treat people with courtesy, dignity and respect.
Page 5 Quality Of Staffing
People living at the home can feel confident in the care that they receive, as discussion with staff on duty during the inspection identified that there is a stable staff team who know each other well and also know the people living in the home well.
There are adequate staff on duty to meet the needs of the people living in the home, some of whom are supported on a one to one basis. People’s social and physical needs are met because staff are competent and confident at meeting their particular needs. From discussions with the acting manager he confirms that there are robust cover arrangements to cover any staff shortages as the staff team can accommodate extra shifts; staff from other homes within the company can provide support, or the home has a robust pool of bank staff who are familiar with the people living at the home. From examination of staff files, we saw that there is a robust recruitment process in place in line with Schedule 2 of The Care Homes (Wales) Regulations 2002, and some staff have worked at the home for a number of years. However, we found that qualifications are not always present on file and would recommend that a review of staff files is undertaken to ensure that appropriate documentation is available.
People receive timely support and care and feel listened to, as we observed good interactions between the staff and people living in the home, resulting in a positive atmosphere, with comments from staff such as we are “one big family” and “I love working here”. However a comment was also made regarding being “short staffed”, but following later discussion with the acting manager he confirms that the company has just agreed to recruit a further two staff members.
People can be assured that their wellbeing is promoted and protected as staff receive appropriate training which is relevant and up to date to enable them to provide appropriate care and support for all people living in the home. This is because, we saw the computerised training data base which is managed by the deputy manager, and highlights what training has been undertaken and when training requires updating. From this we saw that staff can access specialist training such as epilepsy management. However, as the bulk of training is undertaken via e learning, we would recommend that access to other training is also considered. Also staff should be encouraged to undertake the relevant NVQ qualifications so that the required staffing ratio of qualified staff is maintained. We were told by a trained mental health nurse specialist who works for the company (CMG) but is based in London, that she is currently supporting the home on a weekly basis and there are plans for “bespoke” mental health training to be delivered to all staff.
People can be confident that staff receive regular supervision and appraisals and information we saw on the training data base system is used within supervision to ensure training is up to date and relevant to support staff to meet the complex needs of people living in the home.
Page 6 Quality Of Leadership and Management
Overall people can be confident that the home is well run. The acting manager is suitably qualified and experienced to care for the people living in the home, having worked for Care Management Group (CMG) since 2005 and has previously been a registered care home manager within the Group. However, he has been in post since 1 June 2015 and has yet to submit an application to CSSIW to become the Registered Manager at Trebanos House. We raised this matter with the acting manager and he agrees that an application will be lodged by the end of June 2015. The provider is also aware that an application is required.
However, it is evident that although this is a recent appointment the acting manager is already making a positive impact on both the people living there and staff. This is because we observed the acting manager speaking with people living in the home and staff on duty are comfortable to approach him and he responds in a warm, friendly and approachable manner. We note that the current registration certificate is not displayed at the Home, but this is being followed up with immediate effect.
The acting manager feels “well supported” by senior managers within the company (CMG) and there is some very detailed information on file in readiness for the next Annual Quality Review Report which is due in May 2015. There is also evidence of regular monthly meetings with people living in the home, with the focus being on their individual preferences in respect of activities and menus, with minutes of the meetings being recorded and signed by the people living at the home.
People can be confident that they are safe because the company ensures that monthly fire drills are undertaken, together with weekly fire checks. However, we note from the documentation that the Fire Alarm risk assessment was last reviewed in December 2013. We therefore recommend that this is followed up as a priority. Several key staffing policies were examined such as safeguarding confidentiality and data protection; grievance procedure and safeguarding adults, all of which have been reviewed in 2015.
Page 7 Quality Of The Environment
People living in the home benefit from an environment which is warm and welcoming, despite the fact that the building needs redecoration and refurbishment. The front lounge is light, airy, and comfortable and we observed many people living in the home making good use of this space. There were no noticeable offensive odours and people were happy to show us their rooms, taking pride in how they have been personalised.
Although at the time of the inspection, the acting manager has only been at the home for a week, he informs us he has tried to make some minor improvements to the lounge and office area. In addition from discussions with staff, it is clear that the building is not fit for purpose and needs to be addressed. The company is still pursuing planning permission to develop the site and following this inspection, the Responsible Individual confirmed that the outcome is anticipated in the next few weeks. This matter has been highlighted in the previous inspection report and at the next inspection we would need to consider if a non-compliance notice is required in respect of the state of the building, if there is no further progress on this matter.
Although it is very positive that some people living in the home undertake their own laundry, we would recommend that a better system of managing the laundry is put in place, as we saw that this is disorganised and cluttered. There is evidence of mould in the shower area of the bathroom, which has yet to be rectified, but we did observe other improvements have already been made to this area and outstanding work has been reported and is due to be undertaken shortly. People can feel confident that there is a robust maintenance system in place, as the deputy manager showed us the home’s data base system which clearly indicates works outstanding and works to be undertaken/completed/high priority. We also had a discussion with the maintenance person who confirmed that “health and safety” issues are given a “high priority” and receive a very “speedy” response.
From evidence within the files, we saw that a Fire Evacuation drill was carried out in April 2015, with no issues identified. However, the home is currently awaiting the outcome of the engineer’s report in respect of the fire panel, as this is not currently fully operational, but as a precautionary measure, smoke alarms are fitted in every room.
Overall people can be confident that the premises are physically safe, as we saw evidence that regular checks are undertaken in the Home e.g. Controlled Waste; shower head sterilization and legionella, all of which were reviewed in 2015, prior to the inspection. Also the infection, prevention and control audit tool has been completed in March 2015 and the kitchen has a 4 star food hygiene rating which was awarded in April 2015.
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.
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