Inspection Report on

Brynhyfryd House Nursing Home

BRYNHYFRYD HOUSE NURSING HOME 36 WEST CROSS LANE WEST CROSS SWANSEA SA3 5LS

Date of Publication

Tuesday, 2 October 2018 Welsh Government © Crown copyright 2018. 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: [email protected] You must reproduce our material accurately and not use it in a misleading context. Description of the service Brynhyfryd House Nursing Home provides care for up to 32 people aged 65 and over. The home can accommodate up to 26 people in a three storey house and up to six people in a separate, two storey cottage. It is set within its own grounds and is located in the West Cross area of Swansea. Plas Newydd Care Limited owns the home, and the responsible individual is Yolanda Jones. There is a manager in place with day to day responsibility for its running.

Summary of our findings

1. Overall assessment

People can be assured that the home is well managed. People receive a good service and are supported by caring, professional staff that know them very well. Both managers and staff are professional, well trained and motivated

The home actively promotes the importance of maintaining people’s health and wellbeing. We saw people are actively engaged in a wide range of activities of their choice. These activities take place both within the home and the wider community. People live in accommodation where they are safe, warm, secure and happy. People also benefit from living in a home which is continually improving.

2. Improvements

Staff recruitment records are now maintained to an appropriate standard and meet legal requirements. We saw improvements in record keeping in relation to the care and support being provided. The health and welfare of people is actively promoted and documentation has improved. Summaries of any accidents and incidents are being recorded, and were made available at inspection.

3. Requirements and recommendations

Section three of this report sets out our recommendations to improve the service and the areas where the home is not meeting legal requirements.

Page 1

1. Well-being

Summary

People are encouraged and supported to do things for themselves and to be as independent as possible.

People can access a wide range of activities of their choice and are actively involved in their communities. People enjoy living an active life in a home that promotes health and well-being.

Our findings

People benefit from living in a home where a healthy diet and lifestyle is actively promoted. We saw good links between the home and external health and social care professionals. This included district nurses, general practitioners (GP), dentists and podiatrists. At the time of the inspection a GP was attending the home to review a person’s medication. In addition we were told nurse assessors attended the home on a regular basis. This was evidenced in the documentation inspected. We saw people’s diet and nutrition was closely observed. Records evidenced all meals and drinks were recorded, and people’s weight was monitored on a regular basis. Both catering staff and care workers were fully aware of the specific dietary needs of people living at the home. People benefit from a varied diet and attention to hydration. We saw menus were varied, healthy and offered plenty of choice. Food choices for the day were displayed on a board in the dining area. The kitchen had achieved a Level 5 rating (very good) awarded by the Food Standards Agency. We observed people eating both breakfast and lunch. Care workers were seen assisting people who required additional support to eat and drink. This was carried out with patience and sensitivity. In addition and throughout the day staff were attentive in ensuring people were hydrated. One person living at the home said “I have been here a number of years, the food is always good”. A relative told us “the diet of x is always closely monitored”.

We saw people were actively promoted to maintain their independence. We saw daily notes of one individual who required support in relation to washing, dressing and grooming. Notes evidenced staff encouraged the person to do as much for themselves as possible, and would assist when required. We saw well documented repositioning charts. We saw nursing staff administered medication in a sensitive and professional manner. They provided us with detailed information on the medication people received and why it was being administered. Medication was stored appropriately and the relevant temperature checks were carried out by nurses on a daily basis. This was to ensure medication was stored at appropriate temperatures. The medication administration record (MAR) charts we saw were accurately completed. This demonstrates that people are supported to be as safe and healthy as they can be.

People are encouraged to be involved in communal/ community activities and have opportunities to socialise with people. We saw people were watching television and listening to music in the communal lounge areas. We were told people were encouraged to access the communal areas whenever possible. The home employed two activity coordinators. They were both care workers who were responsible for activities on a part- time basis. At time of the inspection we had the opportunity to speak to one activity

Page 2 coordinator. It was evident throughout our discussion they were passionate in making a difference to the lives of the people they supported. People, relatives and staff were extremely complimentary on the work they carried out. One person said “they are great”, a relative told us “always things going on” and a staff member said “it’s made a big difference to the home”.

We were shown a number of photograph albums highlighting previous activities. This included attending the theatre, celebrating the royal wedding and an Easter party. They also told us people had enjoyed watching the Swansea air show from the patio area. We found that individual activities were also provided. Example included reminiscence boxes for people living with dementia. These boxes included access to old household items, and historical local information such as the Swansea to Mumbles tram. Another example was providing talking books in Welsh for a person whose first language was Welsh. Care workers told us they made every effort to speak a few words in Welsh to this person on a daily basis. This was observed during the inspection. There was also a one fluent Welsh speaking member of staff. The activity coordinator told us a relative of a person living at the home would be providing poetry reading afternoons. In addition external entertainers regularly visited the home. At the time of the inspection people were seen enjoying a singer in the main lounge. This demonstrates that people can be involved and do things that matter to them.

Page 3 2. Care and Development

Summary

People are cared for by staff that know, understand and are able to meet their individual needs in a respectful way. People can be confident that documentation is person centred and reflects their current situation.

Our findings

People living at the home have developed good relationships with care workers, who genuinely care about their wellbeing. We saw nice interactions between people and care workers throughout the inspection. People living at the home provided us with a range of positive comments. These included “they are great, they really look after me” and “they are very kind”. Relatives were equally complimentary saying “very happy with the care provided, staff work very hard”. Another said “I have excellent communication with staff”. In discussion with care workers we found them to have a good knowledge of the care and support needs of the people they supported. Care workers portrayed people in a positive light and displayed a caring attitude throughout the inspection. We saw a person living at the home become very distressed and agitated. Care workers used a number of different techniques in trying to distract the person and improved their mood. This included sitting with the person holding their hand and providing a number of activities of which they usually enjoyed.

We saw another example where a person had slid to the floor, and required assistance into a chair. Care workers were able to reassure the person throughout the lifting procedure. We heard them explain how they were going to be lifted, whilst carrying out the procedure safely. We heard staff discussing a range of subjects with people, and it was clear they knew the people they supported very well. There were a high number of care workers and nurses that had worked at the home for a significant period of time. We were told that staff turnover was low, and only occasional agency staff used. This appeared to have a positive impact on the home. We observed care workers communicating with people with limited verbal communication. We saw pain identification procedures in place for people who were unable to communicate when in pain. This included the “abbey pain scale”. A relative told us “staff identify and manage x’s pain very well”. People, therefore are treated with warmth, kindness and compassion in their day to day care.

People’s have the right care at the right time in the way that they want it. We saw good pre- admission processes in place and the relevant information about people was being recorded. This included consulting with the person and their relatives. However, there was limited evidence that consultation was taking place, for example during care planning review meetings. We saw important historical information about the person in order to inform staff was being collated. This resulted in a “this is me” document. The care plans covered a range of areas relevant to the individual. Care plans were reviewed at regular intervals and reflected people’s current needs.

Page 4 However, we found two people identified of being at risk of developing pressure areas required additional monitoring. This was discussed at length with the manager. They later confirmed a full review of these individuals would be completed and further safeguarding measures put in place. This included additional monitoring and recording procedures (skin bundle documentation) being implemented at an earlier stage. In addition we found a range of historical documentation that could be removed from people’s files.

We saw care plans were individualised and recorded any potential risks, with adequate measures in place to minimise the risks identified. This included people living at the home assessed as being at higher risk of trips and falls. Such people had safeguarding measures in place, including falls sensor mats and bedrails. At the time of the inspection a bed rail had developed a fault for one person who was being nursed in bed. This was immediately reported and a maintenance engineer rectified the fault. Accidents and incidents were well documented and the relevant information shared with external professionals where appropriate. Therefore, people receive a person centred service which effectively caters for their individual needs.

Page 5 3. Environment

Summary

We found Brynhyfryd House provides a welcoming, homely environment that is well maintained. People can be assured that they are safe and protected from risk by stringent health and safety procedures.

Our findings

People feel uplifted and valued because they are cared for in a comfortable, clean, homely and personalised environment. The manager showed us around both the main home and the smaller cottage. Both were nicely decorated and provided comfortable communal and private space for people to enjoy. The main home had a number of communal areas, which included a dining area, lounges and a large conservatory leading out to a patio and garden. At the time of inspection the garden was not able to be used as it required landscaping. Although we were told the patio continued to be well used in the good weather. Both the conservatory and patio provided pleasant views over Swansea Bay and the Mumbles. The cottage also provided good communal space for people to use. This included a communal lounge where a number of people were seen socialising and watching television. People also used the communal facilities of the main building.

The home was clean and well maintained. There were domestic staff attending to their duties throughout the course of the inspection. People living at the home were very complimentary on where they lived. One person said “I like living here, it’s nice”. Another said “it’s a pleasant place to live, I am well looked after”. Relatives were equally complimentary. One relative told us “I visited a number of homes, and this is by far the best”. Another said “the home is very good; they have good attention to detail”. We saw appropriate toilet and bathing facilities. However, one bathroom was being used as a storage facility for mobility equipment. This was acknowledged by the manager, and a more appropriate location would be arranged. We saw bedrooms varied in size and shape, but all were appropriate, well decorated and reflected the taste of the individual. We saw personal items in bedrooms were encouraged, and included family photographs, paintings, furnishings and a range of personal memorabilia. People, therefore live in a home which meets their individual needs.

People can feel valued by a home that is investing in its environment. We saw the home was in the process of being extended. This was a separate building behind the main home. We were told this would be completed by the end of the year, and would if accepted by CIW provide eleven additional rooms. In addition the surrounding gardens would be landscaped and developed to provide people living at the home a larger garden area to enjoy in the warmer months. Therefore, people can feel valued living in an environment that is constantly improving.

People are cared for in safe, secure, warm and well maintained surroundings. The home could only be entered through the use of an electronic key code system. There was a dedicated office in the reception area of the home. We saw a visitor’s book which we were requested to sign on both days of the inspection. We were provided with a maintenance file that included a range of certificates. This included water, gas, electricity and fire safety

Page 6 certificates. These were all up to date and evidenced regular audits by external professionals. We saw a clear system of work in relation to fire safety. However, fire alarm checks were not being carried out on a consistent basis. Everyone living at the home had a personal evacuation plan specific to their individual support needs. These were held in the individuals file, were regularly reviewed and reflected the changing needs of the individual. We recommended consideration be given to a more accessible location for easy access in the event of a fire for all personal evacuation plans. Therefore, unnecessary risks to be people have been identified and as far as possible eliminated.

Page 7 4. Leadership and Management

Summary

Brynhyfryd House is a well managed home that promotes a positive culture, and continues to invest time in both people living at the home and the staff that support them.

Our findings

People are clear on what the service provides and how they provide it. We saw a detailed statement of purpose and service user guide. They described the values and philosophy of the service. This included respect, dignity, privacy, maintaining high standards of care and professionalism. Throughout the inspection we saw staff demonstrating these values. We saw people and their relatives had opportunities to comment on the running of the home. This was through resident meetings, engagement with relatives, comments book and through the accessibility of the management team. One person living at the home told us “I am often asked if I am happy with the service I receive”. A relative whose partner had recently moved into the home said “It was made very clear to me before x moved in what the home can and can’t do”. Another relative told us “staff are very kind, helpful and respectful”. We inspected a number of policies and procedures. These included safeguarding, medication and the complaints policy. Although, overall the contents were adequate, each required updating. We recommended that all policies and procedures were fully reviewed, and ongoing review arrangements agreed. We found people are supported by a service that is fully committed in upholding its values.

People can be assured that staff working in the home have been through a stringent recruitment and induction process. Five staff recruitment files were checked as part of the inspection. The files inspected were well organised and satisfied regulatory requirements. However, we recommended that staff photographs held within personnel files should be dated. In addition long standing members of staff required a more recent photograph to be held on file. Care workers told us they had received a comprehensive induction process and training records confirmed this. However, there was limited documentation held within personnel files to say the induction process had been completed. This was acknowledged by the manager and in discussion we recommended the Social Care Wales induction framework be implemented. Therefore, the safety and well-being of people living in the home is ensured through safe staff recruitment systems. This would be further enhanced by implementing a clear induction framework.

The well-being and on-going support and development of staff is an important ethos within the home. We spoke to a number of staff who told us they felt happy and well supported in their role. One care worker said “I have very good management support and get good feedback from managers”. Another said “the managers are very good”. However, one care worker said “team meetings could be arranged more often”. This was identified as part of our inspection, and a recommendation made for more regular team meetings. Staff told us supervision was being provided, and felt these meetings were beneficial. One care worker told us “supervision is good, I feel listened to”. However, another felt “communication could be improved”. We saw supervision was being provided and overall within the appropriate timescales. However, we saw a small number where the timescales had slightly lapsed. The manager assured us this would be addressed immediately.

Page 8 We saw both nurses and care workers had good access to training. Comments included “so much training, its great”, and “training is discussed in supervision, I am up to date in my training”. We noted all mandatory training was up to date, and more specialist training was also provided. This included pressure sore prevention, dementia awareness, falls awareness and supporting people with diabetes. Therefore, the management team have created a positive ethos and culture whereby people and staff feel valued.

Page 9 5. Improvements required and recommended following this inspection

5.1 Areas of non compliance from previous inspections At the previous inspection, we advised the provider that improvements were needed in relation to the recruitment of staff, and the promoting the health and welfare of people living at the home. Action has been taken to address these areas as we saw documentary evidence that both areas have significantly improved.

5.2 Recommendations for improvement

We made the following recommendations:  Staff photographs held within personnel files to be dated and if required replaced with more recent photographs for longer standing staff members.  Staff supervisions need to be consistently carried out at three monthly intervals.  To consider introducing Social Care Wales induction framework.  To introduce more frequent staff team meetings.  To undertake more frequent checks of the fire alarms. In addition to consider placing personal evacuation plans (PEEPS) in a more accessible location.  To undertake a review of all policies and procedures.  To remove/ archive historical documentation from the files of people living at the home.  To complete reviews of all people at risk of developing pressure sores and introduce additional safeguards (skin bundle documentation) when appropriate.  To evidence people and/ or their relatives are involved in the care plan review process.

Page 10 6. How we undertook this inspection

This was a full inspection undertaken as part of our inspection programme. We made one unannounced, and one announced visits to the home on 25 July 2018 between 09:30 a.m. and 4:30 p.m. and 26 July 2018 between 09:00 a.m. and 12:30 p.m.

The following methods were used:

 We viewed the home’s indoor and outdoor areas.  We spoke with many of the people living in the home and observed their interactions with staff.  We spoke with three relatives and various staff on duty. This included care workers, ancillary staff, the manager, deputy manager and nursing staff.  We viewed four people’s care records and the records of five members of staff, including those related to training, formal supervision and annual appraisals.  We looked at a wide range of other documents, such as the home’s statement of purpose, medication policy, safeguarding policy, complaints policy, accident and incident records and maintenance records.

Further information about what we do can be found on our website: www.careinspectorate.wales

Page 11 About the service

Type of care provided Care Home Service

Registered Manager(s) Christine Bate

Registered maximum number of 32 places

Date of previous Care Inspectorate 14 August 2017 Wales inspection

Dates of this Inspection visit(s) 25 & 26 July 2018

Operating Language of the service English

Does this service provide the Welsh This is a service that is working towards Language active offer? providing an 'Active Offer' of the Welsh language and intends to become a bilingual service or demonstrates a significant effort to promoting the use of the Welsh language and culture.

Additional Information: