Inspection Report on
Ty Gwynno Care Home
Hafod Lane Hopkinstown Pontypridd CF37 2SD
Date Inspection Completed
03 July 2019 Welsh Government © Crown copyright 2019. 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 Ty Gwynno Care Home offers residential care for adults living with dementia and for those who require support with daily living. Nursing care is also offered for those with more complex medical needs who require the support of registered nurses 24 hours a day. The service can provide accommodation for a maximum of 46 individuals.
Ty Gwynno Care Home is situated in Hopkinstown on the outskirts of Pontypridd within easy reach of local shops and other amenities including public transport. The registered provider is Irvine Care Limited. There is a manager in post who is registered with Social Care Wales and the Responsible Individual (RI) is Dr Claire Royston.
Summary of our findings
1. Overall assessment
People benefit from a service that promotes their well-being. Individuals within the home have opportunities to take part in activities of interest. People are treated with warmth and kindness by friendly staff and appear well cared for and happy. Comprehensive personal plans and risk assessment are in place which reflect individual needs. Medication administration and processes are effectively managed. We found the environment to be well maintained and homely. The manager is approachable and knowledgeable and overall staff feel well supported by the management team.
2. Improvements
This was the first inspection since the service registered under the Regulation and Inspection of Social Care (Wales) Act 2016 (RISCA). Any improvements will be considered as part of the next inspection.
3. Requirements and recommendations
Section five of this report sets out our recommendations to improve the quality of the service. Please refer to section five for further details.
1. Well-being
Page 1 Our findings
People’s physical and emotional well-being is promoted as they are treated with warmth and kindness by friendly staff. People gave positive feedback about the care provided and we saw that residents appeared generally content and occupied. We found individuals were as healthy as they could be because they received proactive care as identified in their personal plans and were referred to appropriate professionals in a timely manner. Staff were knowledgeable about the people they supported and staffing levels were sufficient to ensure that individual needs were met. We conclude that people receive good care and support which enables them to stay happy, healthy and active.
The service offers a safe and suitable environment which supports individual well-being and a sense of belonging. We found people were supported to live in a pleasant and homely environment which was decorated and maintained to a good standard. Bedrooms were personalised to individual tastes and the standard of cleanliness within the home was very good. Policies and procedures were in place to ensure people’s safety was maintained through the use of appropriate security checks, fire safety measures and an ongoing programme of maintenance and repairs. Therefore we can conclude people’s well-being is enhanced by having access to a safe and pleasant space to live.
People are listened to and have influence over the care they receive. We observed throughout the inspection that individuals were treated with dignity and respect and were able to contribute to decisions made in their day to day life. The policies we looked at were comprehensive and legal rights were recognised and supported. We found the service had a good understanding of people’s needs particularly those with a diagnosis of dementia. We found the service actively sought feedback from a number of different sources to ensure they continued to provide effective services. In conclusion we found individual circumstances are considered and people can contribute to decisions related to their care.
People are protected from abuse and neglect. People can be confident that they are cared for by staff whose character and suitability to undertake their roles had been checked prior to the start of their employment. Staff received adequate training relevant to their role which enabled them to understand their responsibilities to safeguard and protect vulnerable adults. Up to date policies and procedures were in place to ensure the service followed national guidance and current legislation. Medical and professional advice was sought in a timely manner and the service was proactive in identifying potential risks. Effective audit tools were in place to support good managerial oversight and ensure best possible outcomes for individuals using the service. Therefore we can conclude that people are safe and protected.
Page 2 2. Care and Support
Our findings
Care files are detailed and reviewed appropriately. We examined four resident files and saw they were well organised and provided up to date clear information on the individual needs. We found pre-admission assessments were carried out by suitably qualified staff. Personal plans in place covered areas such as personal care, diet and nutrition, communication, cognition, behaviour and mobility. We noted one file we examined lacked a behavioural and cognition plan, this was discussed with the manager who agreed to address this as a priority. In addition we found people were supported to complete a ‘living my choices’ booklet which provided an overview of people’s preferences, including how they liked to be supported and what was important to them. Risk assessments and personal plans we looked at were detailed and reviewed on a regular basis and risks were minimised through ongoing monitoring, regular observations and intervention. Best interest and deprivation of liberty decisions were documented to ensure personal plans for those individuals lacking capacity were proportionate and legal. We found that the service had a good understanding of issues related to dementia diagnosis and used specialists tools to assess potential issues around pain management and depression. Daily records we looked at were routinely completed and covered core areas such as safety, medication, diet, continence, personal care and physical well-being however we noted that some daily recordings lacked information on people’s emotional well-being. Therefore we conclude that personal plans are maintained effectively and reflect individual needs however some daily recordings would benefit from documenting peoples emotional wellbeing.
Meals times are on the whole a positive experience and people’s nutritional needs are being met. We saw meals were attractively presented and people we spoke with were complimentary about the standard of food they received. Comments included; “I had a lovely breakfast,” and “The meals are lovely, plenty of it and lots of choice”. Kitchen staff told us menus were changed regularly to ensure variety and choice. Menu options were discussed during residents meetings to ensure people were happy with the quality and choice of food they received. We also saw kitchen staff had access to a file which provided information on individual food allergies and any specialist diets. We observed staff interactions through the lunch time period and saw people were supported in accordance with their personal plans. On the whole we found staff interacted with people in a sensitive manner, engaging in conversation and offering reassurance. However we also observed other individuals being supported to eat lunch with very little interaction or conversation. Therefore we can conclude people’s dietary needs are understood and met however some interactions during lunch times could be improved.
People are supported to remain healthy and medication is administered and stored effectively. We examined several individual files and saw that timely referrals were made to health and social care professionals including GP’s, dieticians, opticians, advocates, physiotherapists, specialist dementia teams and social workers. We found evidence that
Page 3 care staff monitored diet and fluid intake of those at risk of weight loss or dehydration and people were weighed on a monthly basis or more often if their health required. We examined medication administration records (MAR’s) and found that charts were routinely completed and controlled medication was appropriately stored and accurately recorded. Temperature checks were also carried out on a daily basis in line with regulations. This demonstrates that the service maintains safe medication system and people receive care that maintains their physical and emotional well-being.
People living at the home are positively occupied and receive good quality care. During our visit we observed activities taking place. We saw a weekly activities lists displayed in the reception area of the home which informed people what activities were planned for the forthcoming week. We spoke with the homes activity coordinator who told us that activities such as yoga, tai chi, bingo, exercise classes, gardening activities, music sessions, movement classes and quizzes were organised on a regular basis. Residents living with dementia who were unable to engage in group activities received one to one support which was tailored to meet their specific needs. One individual we spoke with commented, “I enjoy the quizzes and bingo” while another person spoke about their interest in reading and how they benefitted from accessing the library. Photographs displayed in the home showed trips had been taken to Barry Island, Porthcawl, Margam Park and St Fagan’s. We spoke with residents and their relatives and received positive feedback about care provided by staff; comments from people living in the home included, “I love the staff they are very good,” and “anything I need I just ask for it”. Relatives commented: “The carers are lovely”, “I come here a lot and people seem happy”, “The manager is chatty and comes out and talks to people”. Therefore we conclude that individuals are able to engage in activities that interest them and people have positive relationships with the staff.
Page 4 3. Environment
Our findings
The home offers a pleasant environment. On arrival we found the main entrance door was locked via a key pad system and on entry we were required to sign into the visitors’ book. We were shown around the home and saw both the internal and external areas were well maintained. We noted that the home was attractively decorated and had a pleasant look. We found no malodours throughout the property and noted the general level of cleanliness and hygiene appeared very good. We saw people were able to personalise their rooms with photos and keepsakes which promoted a feeling of belonging. Corridors were decorated with activity boards and vintage photographs. The first floor reception area had be given a tea room theme where people were able to chat and request tea and cake. We found each floor had a large communal lounge as well as an additional smaller quiet lounge located on the first floor. People were seen using the communal areas to read, undertake activities, listen to music and watch television. People also had access to a pleasant garden area, on the day of the inspection we saw this space was utilised at lunch time to eat meals, to relax and to engage in gardening activities. Therefore we can be confident that people live in a comfortable homely environment.
People benefit from the home’s commitment to maintain good infection control practices and ensure systems and equipment are regularly serviced. We found that bathrooms were kept clean and tidy with no evidence of communal toiletries being used. Personal protective equipment was readily available for use by staff including gloves and aprons and hand washing facilities. Cleaning substances hazardous to health were safely locked away in store rooms and window restrictors had been fitted to maintain people’s safety. We spoke with the homes maintenance person who advised that repairs were coordinated via a central call centre and that these were undertaken quickly. We were provided with a maintenance file that included a range of certificates, this included water, gas, electricity and fire safety certificates. These were all up to date and evidenced regular audits had been undertaken by external professionals. People living at the home each had a personal evacuation plan specific to their individual support needs and fire drills were undertaken routinely. We noted the Fire Authority had completed a fire safety assessment in late 2018 which had identified areas of improvement to home environment, we were informed by the manager that all recommendations made had been undertaken. Therefore we can be sure that people live in a property that is safe and well maintained.
Page 5 4. Leadership and Management
Our findings
People can be assured staff feel supported and staffing levels are sufficient. Staff we spoke with confirmed they felt valued and had daily access to a management team that was responsive and supportive. Comments included: “I love it here, (the manager) is very supportive”, “The manager is very good we can always ask her anything”, “I love my care home, I’m happy here”, “The manager is good she is professional and by the book”. During the inspection we saw sufficient staff on duty and witnessed people being responded to in a timely manner. Staffing rotas demonstrated that staffing levels remained consistent and call bells were responded to promptly. Staff we spoke with told us staffing levels were ‘good’ and that they had sufficient time to undertake tasks. One staff member told us, “It’s a very friendly home – everybody helps each other” while another stated “staff members were very welcoming when I joined the team”. Overall we can be confident that appropriate levels of staff are in place to support individual needs and staff feel supported by an approachable management team. People can be confident that staff training and supervision is undertaken in line with the statement of purpose. Evidence demonstrated the service offered comprehensive induction training, as well as an initial twelve week probationary period to ensure staff were competent and confident in key areas of practice. The training matrix demonstrated that staff received up to date training in core areas such as medication management, manual handling, deprivation of liberty, first aid and safeguarding; as well as specialist training around dementia, autism and positive behavioural management. We looked at seven supervision records and found evidence that supervision was received on a bi-monthly basis and concentrated on performance, training needs and staff feedback. Overall this evidence indicates that training opportunities ensure staff are both competent and confident in their work and that regular supervision supports good practice and staff development. The service has good auditing tools, policies and procedures in place. We examined a sample of five staff personnel files and found they all contained a record of full employment history, disclosure and barring service checks, photo identification and references. We also found evidence that the service held a variety of meetings to support their oversight, including meetings with heads of department, trained staff, care staff, people living in the home and their relatives. We found comprehensive policies around health and safety, infection control, whistleblowing, safeguarding and medication. We noted some of these policies including the medication and whistleblowing policy were past their scheduled review date however we were informed by the manager that policies were not updated by the home but centrally by the company. The manager advised that she routinely identified a “policy of the month” where a different policy was discussed with staff each month to support their knowledge and understanding. We found evidence that the service used an
Page 6 electronic database to record incidents and accidents, general occurrences and changes in health needs; and this information generated a monthly report which identified trends, triggers and potential training needs. The manager also demonstrated she undertook regular audits of medication, staff engagement, clinical records, personal files and environment. We saw evidence regular visits were undertaken by the RI and feedback had been sought from staff and people living in the home. Therefore we can conclude people receive care from a service that is committed to quality assurance and constant improvement.
Page 7 5. Improvements required and recommended following this inspection
5.1 Areas of non compliance from previous inspections This was the first inspection post RISCA.
5.2 Recommendations for improvement
We have made the following recommendations to promote good practice:
For daily records to include information on peoples emotional well-being. For all staff to support peoples nutrition in a person centred way, ensuring they engage and interact with individuals during meal times. When appropriate people’s files contain behavioural and cognition plans. Policies be updated in line with the scheduled review date. The above recommendations will be followed up during the next inspection.
Page 8 6. How we undertook this inspection
The inspection was completed in accordance with CIW inspection framework and considered the four outcome themes. Our visit to the home was unannounced and took place on 03 July 2019 between the hours of 09:00 and 17:30.
We reviewed information about the service held by CIW. We undertook a SOFI observation. We looked at notifiable events following re-registration. We observed care practices and interactions between staff and residents. We examined MAR charts. We provided questionnaires to staff and relatives. We considered arrangements to review the quality of care provided. We looked at staff rotas. We looked at a sample of policies, and auditing documents. We looked at a sample of minutes from staff meetings and residents’ meetings. We looked at the homes statement of purpose. We looked at recruitment files.
Further information about what we do can be found on our website: www.careinspectorate.wales
Page 9 About the service
Type of care provided Care Home Service
Service Provider Irvine Care Ltd
Responsible Individual Dr Claire Royston
Registered maximum number of 46 places
Date of previous Care Inspectorate This is the first inspection of this service since it Wales inspection was approved under RISCA
Dates of this Inspection visit(s) 03/07/2019
Operating Language of the service Both
Does this service provide the Welsh Yes Language active offer?
Additional Information:
Date Published 27/08/2019