Inspection Report on
Castle Graig Nursing Home
CASTLE GRAIG NURSING HOME 93 SALEM ROAD MORRISTON SWANSEA SA6 8NN
Date of Publication
Wednesday, 10 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 Castle Graig Nursing Home provides nursing and personal care for up to 35 adults, including those with dementia. The service is provided in a detached building within a residential area in Landore, Swansea.
The provider of the service is Navagrace Ltd and the responsible individual is Ranjini Rajakumari Navaratnasingam. A manager is in post and is registered with Social Care Wales.
Summary of our findings
1. Overall assessment Overall we found that people received a good standard of care at Castle Graig Nursing Home and staff worked well as a team to ensure people’s needs were met. Consistency with development of individual staff supervision is required. Improvements to the notification process within the home are needed to ensure legislation requirements are met.
2. Improvements An outdoor area is being developed to further enhance the service provision for those with dementia and cognitive impairment.
3. Requirements and recommendations Section four of this report sets out our recommendations to improve the service and the areas where the care home is not meeting legal requirements. These include the following;
Fire doors: Automatic closures to be considered for doors that are required to remain open; to ensure safety of residents Recruitment files: To contain staff photographs Staff appraisals: To be completed annually Individual supervision: To be consistent and provided three monthly 1. Well-being
Summary
People are treated with dignity and core values such as promoting individuality and choice are evident. Care documentation reflects what is important to people and this is being developed further to ensure it represents real time care and support given.
Our findings
People are treated with dignity and supported with decision making, enabling them to have choice. We saw kind, caring interactions and knowledge of individuals and their needs and preferences was evidenced during these interactions. We observed care such as medications being given by nurses in a sensitive dignified manner with awareness of body language and privacy. We spoke with kitchen staff who knew people’s dietary preferences and choice was incorporated within the menu plan. One person told us “the food is very nice”. There was a particular focus on variety and pleasing presentation for those who required diets to be adjusted to a consistency to suit their needs. We saw that residents meetings were held two monthly and records of these were kept on the main notice board. We conclude that people’s individuality is respected and they are supported to have a voice.
People are supported to be as healthy and active as they can be and receive the right care at the right time. We saw detailed personalised care documentation in place on the electronic care record system and written records ‘About Me’ for long term and respite stay residents. These were appropriately reviewed and involvement of the person and their family/representative was evidenced within the care record. The electronic care record system represented real time care interventions. We looked at care recordings for delivery of personal care, including oral care, continence care and pressure area care. Those seen were all up to date. People looked comfortable and were in clothing that was clean and personalised such as home made blankets and socks. We observed manual handling practice which was completed in a safe, dignified manner. Records of weekly equipment checks were in place. We did note people were in chairs with slings in situ but the manager assured us that the slings were breathable day slings and assessed as suitable for the residents to remain in to ensure comfort for regular position changes. During the inspection a General Practitioner visited a resident to review their care and the details of this visit were promptly recorded and the medication request was made to the pharmacist by the nurse. We were also told of joint working with a dietician and nutrition training that had been arranged for the staff at the home on the day of the inspection. We saw recordings of weight loss; a referral made for dietary advice and confirmation that the home had implemented the appropriate action whilst waiting for the dietician to visit. One member of staff told us “quality of care is the best”. Therefore people receive person centred care with involvement of the right professional at the right time. People are supported to do things that matter to them. We saw an activity time-table in place and were told that an activity co-ordinator was on duty five days a week, typically working 9 till 5 though this was flexible. The co-ordinator was not on duty on the day of the inspection. Events that took place such as weekly visits from a local children’s nursery and day trips to places such as Plantasia and the National Botanic Garden of Wales. During the inspection we saw residents completing individual activities such as colouring and activities were evidenced within daily care recordings. The main notice board had a display of photos of people participating in activities and the time table was also displayed; however this was not up to date due to a problem with the printer. Residents had access to a small enclosed garden and plans were in place to develop a larger outdoor area at the rear of the property. We conclude people are supported to participate in activities and have things to look forward to.
The provider has processes in place that keep people safe and protect them from harm. We entered the premises via a foyer; staff then opened the main door with a code. People were asked to sign in and out of the building and our identification was checked on arrival. We saw that where people lacked the capacity to make choices about their own safety Deprivation of Liberty Safeguarding (DoLS) applications for authorisations had been completed. The manager had a comprehensive system in place for monitoring and following up DoLS applications. Care Inspectorate Wales had not been informed of any DoLS applications and had received only three notifications in the past year of any events required to be notified to CIW. It was identified that there were at least 14 notifications that should have been made to CIW. Staff spoken to were aware of Safeguarding processes and felt able to follow these if necessary: however a safeguarding incident was not reported to the safeguarding team and this resulted in a retrospective investigation. As a result of this a non-compliance notice has been issued; further detail is within the non compliance notice. 2. Environment
Summary
This was a focused inspection and the environment section was not included; however improvements are required in relation to a fire door being propped open.
Our findings
A recommendation from the previous inspection was to maintain safety at all times ensuring all internal doors are kept closed as opposed to being propped open. We noted the office door was propped open and this was to ensure staff felt comfortable to approach the manager at any time. The benefits of a magnetic releasing system were discussed in the event of the fire alarm being triggered and the manager agreed to arrange this system for the office door. This system was seen in place for other doors in the home. The manager is aware that this has been identified previously and has plans for measures to be in place as soon as possible to maintain the safety of staff and residents within the home.
On the day of inspection we saw the downstairs carpet area being prepared for cleaning and people were accommodated in other areas of the home of their choice. 3. Leadership and Management
Summary
The manager, though new to the post, is visible and accessible to the team. The manager is proactive responding to issues in a timely manner and ensuring residents, their representatives and staff are involved, as appropriate, in the process. The team within the home know the residents well and this reflects in the management of their care. Staff are supported and able to give care to the best of their ability having received appropriate training: however the provision of individual supervision is to be consistent.
Our findings
A newly appointed manager was in place and their registration with Social Care Wales was confirmed. An updated Statement of Purpose was available and though improvements to this have been recommended these will be followed up at the next inspection due to this inspection being focused. We saw a sample of policies and procedures dated October 2016 that required updating or reviewing. The manager confirmed that these will be reviewed. We saw staff handbooks that contained details of the disciplinary process. We saw records that evidenced application of the disciplinary process; however training needs have been identified to ensure the disciplinary process is followed correctly. We conclude that the service have information available though they are in the process of updating some of this online with the re registration process with RISCA (Regulation and Inspection of Social Care (Wales) Act).
People living at the care home are supported by staff that are recruited appropriately. We looked at four recruitment files and saw that there was a thorough recruitment system in place. Each staff member had a structured file which contained details of employment history, two references and a Disclosure Barring Service check (DBS). Two of the four files viewed did not have recent staff photos. The files were up to date and details of training completed and induction checklists were also in place. All staff spoken to told us that they felt their training needs were met and that they felt confident to complete their role. This evidences that people are protected by thorough recruitment practices; however individual staff files need to have a recent staff photograph in place to ensure regulation compliance.
Staff are supported by the manager, responsible individual and team members; however individual supervision is not consistently provided and annual appraisals are not in place. Staff told us that staffing levels are consistent and they have time to deliver quality care. Staff rotas were seen and evidenced that there was always a qualified nurse on duty and adequate number of care staff as identified by the dependency tool used. Staff told us that they felt their opinion was valued and at times when they have identified a need for additional resources this has been acknowledged and supported. Another member of staff told us “everyone pulls together the team are really good”. One member of staff told us “I wouldn’t stay if I was not happy”. We spoke to an established team of staff. Some nurses and care workers told us that they had regular individual supervision and others could not confirm this: however staff did state that they felt supported and that they could approach the manager; responsible individual and senior staff members when they needed support. Supervision records showed some inconsistency; whilst some staff were supervised within regulatory requirements others were not. We could not evidence staff appraisals took place. The new manager in post is aware and intends to complete these. We conclude that whilst job satisfaction is evident within the team and support is in place, the manager needs to ensure the provision of individual supervision is consistent and that annual appraisals are completed. 4. Improvements required and recommended following this inspection
4.1 Areas of non compliance from previous inspections
At the previous inspection, we advised the provider that improvements were needed in relation to: The manager must be registered with Social Care Wales To maintain people’s safety all internal doors are to be kept closed.
At this inspection we saw a newly appointed manager was in post and we confirmed their registration with Social Care Wales. Improvements were seen with internal doors mostly being closed and an automatic closure system is being arranged to enable the office door to close in the event of the fire alarm being activated.
During this inspection, we identified areas where the registered person is not meeting their legal requirements and this is resulting in potential risk and/or poor outcomes for people using the service. Therefore we have issued a non compliance notice in relation to the following:
Regulation 60 (1) (4): Notifications
Details of the actions required are set out within the non compliance notice.
4.2 Recommendations for improvement
Fire doors: Automatic closures to be considered for doors that are required to remain open; to ensure safety of residents Recruitment files: To contain staff photograph Staff appraisals: To be completed annually Individual supervision: To be consistent and provided three monthly 5. How we undertook this inspection
This was a focused inspection completed due to two concerns received. The concerns were related to the leadership and management of the care home and the overall well-being of the residents. We found no evidence to support the concerns raised however recommendations and non compliance were issued.
One inspector made an unannounced visit to the home on 15 August 2018 between 11:45am and 17:40pm.
The following methods were used:
We spoke to the manager who was present during the inspection.
We spoke to several people living in the home at the time of our visit, and six members of staff working during our visits.
We looked at a range of records including audits of the service, staff rotas, staff training, supervision records, five peoples care records and four staff files.
We considered recent information shared with us by Swansea Safeguarding team.
We gave feedback to the manager on the day of the inspection.
Further information about what we do can be found on our website: www.careinspectorate.wales
About the service
Type of care provided Care Home Service
SCW Registered Manager In post
Registered maximum number of 35 places
Date of previous Care Inspectorate 20/2/2018 Wales inspection
Dates of this Inspection visit(s) 15/08/2018
Operating Language of the service English
Does this service provide the Welsh Working towards Language active offer?
Additional Information: Care Inspectorate Wales
Care Standards Act 2000 Non Compliance Notice
Care Home Service
This notice sets out where your service is not compliant with the regulations. You, as the registered person, are required to take action to ensure compliance is achieved in the timescales specified.
The issuing of this notice is a serious matter. Failure to achieve compliance will result in Care Inspectorate Wales taking action in line with its enforcement policy.
Further advice and information is available on CSSIW’s website www.careinspectorate.wales
Castle Graig Nursing Home
CASTLE GRAIG NURSING HOME 93 SALEM ROAD MORRISTON SWANSEA SA6 8NN
Date of publication: Wednesday, 10 October 2018 Leadership and Management Our Ref: NONCO-00006570-CDVS
Non-compliance identified at this inspection
Timescale for completion 23/01/19
Description of non-compliance/Action to be taken Regulation number
Notifications are not being submitted to CIW nor Safeguarding 60(1) Evidence - The registered person is not compliant with regulation 60 : Notifications: The service provider must notify the service regulator of the events specified in Parts 1 & 2 of Schedule 3. - This is because the service provider has failed to notify the regulator of events as specified in Parts 1 of Schedule 3. Only 3 notifications have been made to CIW since July 2017. - The evidence: Schedule 3 Part 1 - 15. "Any allegation of misconduct of a staff member" - The provider failed to notify CIW and Safeguarding of such an event. This has led to a delay in an investigation and also the subsequent notifying of Disclosure Barring Service (DBS)/another agency did not take place, thereby putting other vulnerable adults at risk Schedule 3 Part 1 - "Serious accident, illness to or illness of an individual" - only 3 such incidents were reported to CIW since April 2017 Schedule 3 Part 1 - 21 - "Death of an individual and the circumstances" - no notifications of deaths have been reported to CIW since April 2017 when in fact at least 14 deaths have occurred (as checked at the inspection). Schedule 3 Part 1 - 22 - "Any request to a supervisory body in relation to the application of the deprivation fo liberty safeguards (DOLS)" - no notifications have been made regarding applications for DOLS despite 21 out of 26 residents having a DOLS application or authorisation in place
- The impact on people using the service is potentially serious due to the fact that notifying CIW of such events can ensure the appropriate agency is involved to safeguard and refer individuals appropriately ensuring overall well-being and safety of vulnerable adults.