Care and Social Services Inspectorate Wales Care Standards Act 2000 Inspection Report The Old Vicarage Llanrwst Road Pandy Tudur Abergele LL22 8UE Type of Inspection – Focused Date(s) of inspection –3 March 2016 Date of publication – 6 April 2016 Welsh Government © Crown copyright 2016. 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. Summary About the service The Old Vicarage is situated in a rural location between LLanrwst and Abergele. The home is set in its own grounds and benefits from views over the surrounding countryside. The home is owned by Chamarel Home Limited and the Responsible Individual on behalf of the company is Mr Krishna Boyrangee. The registered manager is Susan Andelyb Jones who is a qualified registered general nurse with many years of experience of caring for older people. Susan Andelyb Jones has the appropriate management qualification and is registered with the Care Council for Wales. On the day of our visit we were unable to access the home via the normal route as it was closed due to the bridge being unsafe. We accessed the home via another route directed by a staff member; this alternative route is restricted as it is a narrow country lane. We were told by staff the service is experiencing difficulties receiving deliveries and they are concerned that emergency services will have difficulties accessing the home in the event of an emergency. The service has been told by Conwy County Council repair work could take up to 12 months to complete. What type of inspection was carried out? We, Care and Social Services Inspectorate Wales (CSSIW) visited the home on 04/03/16 between the hours of 10:00 am and 13:00 pm. This was an unannounced focussed inspection. Information for this report was gathered from the following sources: Discussions with people using the service and staff on duty, the manager was not present on the day of the visit. A sample of records held at the home. A staff rota covering a two week period Menus We toured the premises and viewed communal areas and some people’s rooms. Our observations during the visit. This included observation using the Short Observational Framework for Inspection (SOFI 2) tool. The SOFI 2 tool enables inspectors to observe and record life from a service user’s perspective; how they spend their time, activities, interactions with others and the type of support received. What does the service do well? The home provides a relaxed, homely atmosphere for people to live in. People who took part in the inspection commented positively on the quality of care offered at The Old Vicarage. What has improved since the last inspection? Refurbishment of the service continues providing an uplifted environment for individuals, We saw some bedrooms have recently been re-decorated. What needs to be done to improve the service? Page 3 No areas of non-compliance were identified during this inspection. National Minimum Standard 20.1 regarding staffing numbers, skill mix, appropriate to the assessed needs of people living at the service. We looked at the most recent staff rotas which showed staffing levels fluctuate from five day care staff to seven on some days. The registered manager must monitor this and ensure enough staff are on duty to meet the needs of the people using the service. Page 4 Quality Of Leadership and Management We did not focus on quality of leadership and management during this visit. This theme will be considered during future inspections. Page 5 Quality Of Life Overall, we found there was a lively and friendly atmosphere within the home with people making their own decisions as to how and where they spent their time. We found that people are treated with dignity and respect. People using the service told us that the staff are caring and respectful towards them. We saw staff approaching people in a polite and friendly manner, knocking on doors before entering bedrooms and discreetly offering assistance with personal care. We noticed that people were wearing freshly laundered clothes with attention paid to personal appearance such as colour coordinated clothing, jewellery, nail care and hairstyle. We heard staff using respectful tone and language when talking with people. There are opportunities for people to be occupied. This is because the staff organise activities for people to take part in if they choose. We were told that the home did not have a planned activities programme, rather that activities were arranged depending on what people wanted to do each day. We saw that people were reading newspapers and magazines, making jigsaws, viewing the television and entertaining visitors during our inspection visit. People told us about the activities that are arranged within the home and mentioned recent, arranged entertainment. We saw records of the activities that people have been involved in over the past six weeks. We also saw evidence to show that people are able to maintain links with the local community and are assisted to attend church services and local functions. For those who are unable to attend religious services, we saw evidence to show that ministers of various denominations visit the home on a regular basis. We found that people’s welfare is monitored and that they have access to medical support. When looking at records we saw evidence that advice, treatment and professional assessment is sought. People told us that prompt action is taken if they become unwell. Service user plans (care plans) were in place which were being reviewed regularly. Risk assessments had been carried out showing areas requiring attention to reduce risk. The plans we saw included people’s preferred routines, what was important to them and how they liked to be cared for. People living at The Old Vicarage benefit from a varied, nutritional diet. The home’s menu was displayed in the dining room and offered people three choice’s at mealtimes. Meals were observed to be attractively presented, appetising, and enjoyed by people living at the home. People requiring assistance with their meals were observed to be supported by staff in a dignified manner. Hot and cold drinks were offered to people throughout our visit. People experience warmth, attachment and belonging. Staff encourage individuals to get together with other people socially and to maintain family relationships. During the inspection we saw that residents had made friends and sat together sociably eating lunch and chatting. One individual we spoke to told us, “I get on with all the residents; X, she comes and sits here and we have all sorts of conversations.” One resident told us, “Even the visitors are very nice- they just waved to me- it makes you feel human.” We observed staff, including those working in the kitchen, interacting with residents in a cheerful, humorous way. Residents spoke highly of staff, “The girls are very nice. If you want any help they will help you.” We also saw that bedrooms were personalised and were homely and cosy. Page 6 Quality Of Staffing We did not look at quality of staffing during this visit. This theme will be considered during future inspections. However the following observations were made with regard to the quality of staffing: People living here cannot expect that staff are employed in numbers adequate to meet their needs. We looked at the most recent staff rotas which showed staffing levels fluctuate from five day care staff to seven on some days. Staff confirmed they struggle when staffing levels fall to five. The registered manager must monitor this and ensure enough staff are on duty to meet the needs of the people using the service. Page 7 Quality Of The Environment This inspection focused on quality of life for people using the service. We did not consider it necessary to look at the quality of the environment in depth on this occasion due to what was observed on the day of the inspection visit. This theme will be considered during future inspections. 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’.