CAERPHILLY COUNTY BOROUGH COUNCIL, DIRECTORATE OF SOCIAL SERVICES
COMMISSIOING TEAM
Contract Monitoring Report
Name/Address of provider: Bargoed Care Home
Date/Time of visit: 14 September 2017 & 15 November 2017
Visiting Officer(s): Caroline Roberts, Contract Monitoring Officer
Present: Kevin Michael, Home Manager Karen O’Shea, Deputy Manager
1 Background
1.1 Bargoed Care Home is situated in Bargoed and is registered to provide residential and nursing care to 41 people aged 65 or over. The home is owned by Four Seasons Healthcare (FSHC), along with another home within the Caerphilly borough.
1.2 At the time of the visit, there were 38 people living within the home, with 2 new individual’s preparing to take up residence.
1.3 The last full monitoring visit was conducted in April 2016 and the report outlined 7 corrective actions and 4 development actions for the Managers appropriate attention.
1.4 In August 2017, a new Manager was appointed due to the previous Manager’s retirement.
1.5 Since the appointment, the new Manager, advised the Monitoring Officer that a list of actions had been identified, which the home is currently working towards implementing i.e. staff supervision which at the time of the visit was not being undertaken.
1.6 The visiting officer employs a variety of monitoring systems to gather and interpret data as part of monitoring visits, including observations of practice at the home, examination of documentation and conversations with staff, service users and relatives where possible.
1.7 Dependant on the findings within the report, corrective and developmental actions may be given to the provider to complete. Corrective actions are those which must be completed as governed by regulations such as the National Minimum Standards (NMS) and developmental actions are good practice recommendations.
2 Previous Recommendations
2.1 Corrective actions
2.1.1 The home should ensure that all residents are engaged and provided with stimulation as much as possible. People in their rooms could benefit from talking 1
books, music or television, as well as the visits they receive from staff.
2.1.2 Service Plans and Risk Assessments to be reviewed monthly.
2.1.3 All staff are instructed during induction on how to treat services users with dignity and respect at all times.
2.1.4 DNACPR forms to be on file and completed for all residents.
2.1.5 Service users’ records are kept up to date and correctly, and reviews of documentation are to be completed monthly.
2.1.6 Staff files to contain a photo ID.
2.1.7 Home to be free from odours.
2.2 Developmental actions
2.2.1 The home should work on developing life histories or similar which enables staff both to have a greater understanding of the person before living within the care home and also gives a range of conversation topics to use.
2.2.2 Consideration to be given to having an agreement in place with relatives that states what level of notifications, and when, they would like about their loved ones in relation to accidents, incidents etc.
2.2.3 A record of interview to be kept on file to evidence a robust recruitment procedure.
2.2.4 Bedroom signage for people should be permanent and not makeshift, so that it is evident that the home values its residents and takes pride in keeping their home tidy and welcoming.
3 Findings
3.1.1 Documentation
3.1.2 As part of the monitoring process, 2 resident’s files are normally viewed. During this visit, 1 file was viewed.
3.1.3 The Service Plan viewed did not reflect that the individual had been involved in compiling the information nor was there evidence that a family representative had been involved. It was also noted that the Service Plan had not been written in the first person, which evidences that the information is not being conveyed by the resident.
3.1.4 Four Seasons reviews are split into sections i.e. Urinary/Continence/Bowel Needs, Mobility, Nutritional Needs, Rights, Consent and Capacity Needs.
3.1.5 Whilst viewing the daily records, it was evident that more detail was required i.e. the recording of an individual’s mood, behaviour. However, it was positive to note that the records evidence that staff are knowledgeable in respect of what appropriate professionals should be contacted should the need arise i.e. Optician, Speech and Language Therapy (SALT), Community Nurse, Community Psychiatric Nurse. 2
3.1.6 There was no indication that an agreement had been put in place with relatives, should an incident occur.
3.1.7 On the file viewed by the visiting officer, there was no Do Not Attempt Cardiopulmonary Resuscitation (DNACPR). Whilst it is a very sensitive topic of discussion, it is important that such information is retained on an individuals file.
3.1.8 The file contained no life history about the individual and therefore, you did not have the sense of knowing the individual. However, the visiting officer had been advised that the individual did not wish to discuss their life prior to admission to the home.
3.2 Activities
3.2.1 At the time of the visit the Activities Co-ordinator was not present. Whilst observing the three floors of the home, the Monitoring Officer observed care staff verbally interacting with residents; unfortunately, no pre-arranged activity was taking place. Some residents were observed to be sat in the lounge area, with the T.V. on. However, it appeared the residents were not watching the television and a few were observed to be sleeping.
3.2.2 The Manager advised that the Activity Co-ordinator currently works 40 hours per week. At the time of the visit, the Activity Co-ordinator was not working 7 days per week; however, the Manager was working toward changing this.
3.2.3 Whilst not observed by the visiting officer, the Manager advised that the residents have enjoyed making sock puppets, crocheting, taking part in making hanging baskets, re-furnishing garden furniture etc.
3.2.4 Bargoed Care Home also has 2 budgies, Sunshine and Sparkle which the residents enjoy!
3.3 Staffing
3.3.1 At the time of the visit, due to the Manager being new in post, staff supervisions were not taking place. However, this was an area that had been highlighted and acknowledged.
3.3.2 During the day the home had 2 nurses on duty from 7:30 am. – 7:30 p.m. and 8 carers from 7:30 a.m. – 1:30 p.m. During the afternoon, 2 nurses are on duty along with 7 carers. Night shifts consist of 1 nurse and 4 carers.
3.3.3 During the initial visit, the Manager advised that they were in the process of recruiting nurses. However, the Monitoring Officer has subsequently been informed that the home now has a full compliment of nursing staff.
3.3.4 As part of the monitoring process, the visiting officer viewed 2 care staff files. One from when the previous manager recruited and 1member of staff recruited by the current Manager.
3.3.5 1 file consisted of 1 professional reference and 2 character references, whilst the other had 1 professional and 1 character reference. Both files held up-to-date Disclosure Barring Service (DBS) checks. 3
3.3.6 Whilst interview records were present on file, there was no evidence of a scoring system being used to appoint appropriate staff. The visiting officer was informed that a scoring system is only used should there be more than 1 candidate.
3.3.7 The 1 file, whereby the staff member had been recruited by the previous Manager, did not contain a full application form; therefore, all appropriate information was not evident. However, whilst viewing the second file; a full application had been retained on file.
3.3.8 Both files contained a current photograph of the member of staff; however, only 1 contained a signed contract of employment.
3.3.9 The earlier file did not contain training certificates, whereas certificates for the newly appointed member were observed i.e. Level 2 Food Safety in Catering 2016, Level 3 HABC Health & Social Care (adults for England 2017).
3.4 Quality Assurance
3.4.1 At the time of the visit, the Manager advised whilst an annual survey is expected to be undertaken there was not one available for the visiting officer to view. This is a matter that the Manager will address in order to gather the views and opinions from the residents, relatives/friends, staff and stakeholders. The feedback obtained from completed surveys, will provide valuable information upon which the home can build on the level of care provided to its residents.
3.4.2 Flash Meetings are held, which provides the Manager and the Deputy Manager with an opportunity to receive invaluable information from care staff, nurses and domestic staff.
3.4.3 At the time of the visit, the Monitoring Officer was informed that no resident meetings had been held since the Manager’s appointment. This is something that the Manager wishes to re-introduce, combined with a relatives meeting. This will allow some residents to have support to express their wishes/feeling, opinions and views.
3.4.4 Staff handover is attended by nurses and carers and is led by the Clinical Lead (nurse) during the change in shift. Medical issues are discussed, such as needs of the residents, food/fluid intake, sleep etc. A handover document is used as a prompt and allows the handover to be more succinct.
3.4.5 A summary of information is also made available to assist agency staff employed at the home.
3.4.6 All information shared during the handover is documented.
3.4.7 Advocacy services are accessible, should an individual require support. The home sometimes uses Disability Can Do, an organisation that promotes and encourages inclusion, independence and choice. Leaflets are on display and the visiting officer was advised that when advocacy is involved, it is mostly to offer/provide support with financial issues.
3.4.9 When the Manager was asked what action would be taken should it be felt that an individual may no longer require a specific medication, the Manager responded by advising a medical review would be requested. Whilst the GP usually undertakes a 4
review as and when required, 6 monthly medical reviews are requested as good practice.
3.5 Discussion with staff and residents
3.5.1 As part of the monitoring process, the visiting officer spoke with a member of staff and asked a few questions in respect of health and safety, risk assessments, the emotional needs of individuals, the Manager of the home and the advice, support and leadership that is offered.
3.5.2 The member of staff stated that she felt Bargoed Care Home has good management and described the Manager as being “brilliant!”
3.5.3 When asked what would be done should an individual be found to be emotionally upset or anxious, the member of staff explained what actions she would undertake in order to offer reassurance and comfort to the individual. The member of staff also advised the visiting officer, that there can not be too much emphasis on health and safety or risk assessments.
3.5.4 Prior to speaking with the member of staff, the visiting officer had spent some time talking with residents and therefore, chose one individual at random to discuss with the member of staff. The member of staff demonstrated a good knowledge and understanding of the individual and was able to evidence that personal information was known and that there was awareness of the individual’s likes/dislikes.
3.5.5 Communication was discussed and for those individuals who had communication difficulties, the visiting officer was informed that white boards and flash cards are sometimes used. This was evidenced as one gentleman sat in close proximity to the visiting officer and was using a white board as a means of communication.
3.5.6 Unfortunately; due to the amount of paperwork that staff are required to complete, the member of staff felt that staff are not always in a position to just sit and chat with the residents.
3.5.7 The member of staff was asked what action would be taken should bad practice be observed. The response was to inform the Manager straight away. This would provide the Manager with the opportunity of alerting the Local Authority and/or Health Board of any possible safeguarding issues.
3.5.8 It was positive to hear that staff feel encouraged to offer suggestions to the Manager, in respect of improving the quality of life for the residents that reside at Bargoed Care Home. The member of staff stated that the Manager is very good with engaging with staff and the residents.
3.5.9 The visiting officer also had an opportunity to speak with a resident and also a relative. The visiting officer was informed that the resident enjoys par-taking in crafts and at the time of the visit, most residents were in the process of making Christmas cards. The resident enjoys playing bingo and also likes to spend time in their room, watching T.V.
3.5.10 The resident described living at the care home as being “great” and that she does not feel like a number. The care staff were also described as “great” and there was no one at the home the resident did not like. The resident advised that she enjoys 5
chatting to the staff and that they chat about everything.
3.5.11 The visiting officer was informed that when calling for assistance, the carers answer straight away and they stay for as long as required. The resident also stated that she wanted to nominate one specific individual for the Pride of Britain award!
3.5.12 When speaking with a relative, the visiting officer was informed that the home always makes visitors feel welcome.
3.5.13 The atmosphere at the home was described as being “good” and the gentleman explained that his wife is really settled. When asked if either attend resident/relatives meetings, both advised the visiting officer that they had previously been invited to such meetings; however, they do not wish to attend.
3.5.14 Arrangements are in place for the resident’s husband to be contacted should hospital admission be required or if there are any identified changes in health or medication.
3.5.15 The relative explained that he is comfortable in approaching the Manager with regard to any minor issue or concerns he may have.
3.5.16 It was positive to hear that the relative feels that the home has been successful in providing a good quality of life to his relative and stated that it is a “good home that will do anything”.
3.6 Training
3.6.1 Staff undertake training via e-learning and also class room based training should they access a training course via the Local Authority’s Workforce Development Team i.e. pressure care.
3.6.2 Training is identified during supervision and is then observed in practice. Team Leaders will provide feedback to the Manager, whether it is positive or negative.
3.6.3 At the time of the vising officer’s second meeting, the visiting officer was advised that the staff training percentage was at 95%, evidencing that the Manager is committed to having fully trained staff working with the residents at the home.
3.7 General
3.7.1 Whilst entering the reception area of the home, works were being undertaken which did not appear to have an affect on the residents.
3.7.2 A gentleman was observed to be returning to the home after a period of time in hospital. Immediately, a carer approached the resident and offered reassurance. The carer then assisted the gentleman to his room, offering to make him comfortable and a hot drink.
3.7.3 There was no malodour during the time of the visit and the home was found to be clean, tidy and hazard free.
3.7.4 The staff approached the Manager and suggested that the conservatory area of the home be cleared, in order to make additional space for the residents and their 6
visitors. This was agreed and the space allows a more private area, should individuals wish to sit quietly, whilst in the company of others.
3.7.5 The Manager undertakes a daily walk around the home, observing and electronically recording his findings. The Regional Manager also undertakes a monthly walk around the home, talking with residents and relatives and observing daily practice. Any identified issues are raised with the Team Leaders.
3.7.6 Weekly menus are in place and vegetarian options are also available.
3.7.7 There are menu choices available for the residents and discussions are held with the residents in order to ascertain their choice. Some residents choose to eat in the dinning area, engaging in conversation with carers and fellow residents. Whist other individuals, choose to dine in their room.
3.7.8 Whilst speaking with a member of staff, the visiting officer was informed that residents are encouraged to eat at their own pace and that support is provided as and when an individual would like to return to their room.
3.7.9 The Manager has plans for improvements to be made at the home, which include décor (artwork, new light fittings etc.) and facilities for relatives visiting loved ones. This will allow the home to have more of a homely feel.
3.7.10 Whilst observing, the visiting officer noticed that the doors for the residents rooms did not have permanent name plaques, instead the doors had card attached to the door. This was disappointing to see, as this matter had been raised and discussed with the previous manager during a monitoring visit undertaken in 2016. A permanent name plaque demonstrates to residents that they are important/valued. It is important that a positive message is conveyed to the people who reside at the home.
3.7.11 Whilst observing the 3rd floor, it was observed that a few people were sitting in chairs, sleeping; whilst, 4 individuals were sat around the dinning table, with very little conversation taking place.
3.7.12 The rooms were found to be personal, with items such as trinkets, ornaments, photographs being observed.
3.7.13 The wet room was found to be clean with no hazards and a few pictures were on display, which provides a more homely feel to the room.
3.7.14 The Statement of Purpose was located on the 3rd floor; however, information contained within the document was found to be out of date.
3.7.15 The Service User Evacuation Regulations were found to be out dated and this was raised with the Manager during the visiting officer’s feedback.
3.7.16 Whilst providing feedback to the Manager, it was acknowledged that what had been identified during the monitoring visit had already been identified and formed a part of the Action Plan.
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4 Corrective and Developmental Actions
4.1 Corrective
4.1.2 Whist viewing two staff files, it was noted that they did not contain a full employment history as gaps were identified. (NMS 22.2) Timescale: Immediately and ongoing This matter was discussed with the Manager who advised that audits are currently being undertaken.
4.1.3 Documentation to be completed appropriately, detailing information and ensuring accountability/responsibility is taken by signing and dating documentation. (NMS 7.1) Timescale: Immediately and ongoing
4.1.4 Service Plans and Risk Assessments to be reviewed monthly (NMS 6.4) Timescale: Immediately and ongoing.
4.1.5 Individual’s to have the opportunity to contribute to the completion of their Service Plans (NMS 6.5) Timescale: Immediately and ongoing
4.1.6 DNACPR plans to be retained on file (NMS 19.3 & 19.4) Timescale: Immediately and ongoing
4.1.7 Effective quality assurance and monitoring to be undertaken to obtain feedback from residents/relatives, staff and stakeholders (NMS 28) Timescale: Immediately and ongoing
4.1.8 Supervision to take place on a regular basis (NMS 24.2 & 24.3) Timescale: Within 2 months of this report.
4.1.9 For an up-to-date Statement of Purpose to be made readily available to all residents (NMS 1.1) Timescale: Within 3 months of this report.
4.2 Developmental actions
4.2.1 Bedroom signage for people should be made permanent and not makeshift, in order to ensure that the residents feel valued.
5 Conclusion
5.1 Since the arrival of the new Manager, it is evident that all members of staff are being encouraged to work as a team and to put forward any ideas that may benefit the service provided.
5.2 Individuals spoken to whilst undertaking observations, spoke with warmth about the home and with positivity. The residents spoken to, stated that they were happy residing at the home and spoke positively about the carers.
5.3 Monitoring visits are usually undertaken in partnership with a Health; however, in this instance, a solo visit was undertaken by the Monitoring Officer but future visits will be undertaken jointly with Health.
5.4 Routine monitoring will continue, and the Contract Monitoring Officer would like to thank all involved for the time and information that was given to complete the visits. 8
Author: Caroline Roberts
Designation: Contract Monitoring Officer
Date: 5 January 2018
N.B. This report will be made available via Caerphilly County Borough Council’s Internet site. Hard copies of the report will also be made available to prospective residents and/or their families should they ask to see them.
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