Care and Social Services Inspectorate Wales

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Care Standards Act 2000

Inspection report Care homes for older people

Bryn Marl Nursing Home

Marl Drive Llandudno Junction

LL31 9YX

Date of publication – 31 March 2012

You may reproduce this Report in its entirety. You may not reproduce it in part or in any abridged form and may only quote from it with the consent in writing of Welsh Ministers

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Care and Social Services Inspectorate Wales

North Wales Region Government Offices Sarn Mynach Llandudno Junction Conwy LL31 9RZ 03000625609 03000625030

Home: Bryn Marl Nursing Home Contact telephone number: 01492 581191

Registered provider: Bryn Marl Limited Registered manager: Gillian Roberts Number of places: 40

Category: Care Home Nursing - Older Dates of this inspection episode from: 11 February 2012 to: Dates of other relevant contact since

last report:

Date of previous report publication:

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Introduction

Bryn Marl Care Home is situated in a residential area in Llandudno Junction. It is registered to provide personal and nursing care for up to 40 older persons. The registered provider is a company, Bryn Marl Ltd and the approved responsible individual is John Haydon.

The manager is Gillian Roberts who has worked at the home as a registered nurse for many years. She was registered as the manager in April 2009. Ms Roberts holds the Registered Mananger’s Award and is registered with the Care Council For Wales.

Summary of inspection findings

What does the service do well

Service users reported that they receive a high standard of care from staff who are caring and respectful.

What has improved since the last inspection?

There has been an improvement in the numbers of registered nurses rostered on duty each day and an improvement in the décor and gardens of the home.

What needs to be done to improve the service?

a.) priorities

The registered persons must ensure that updated mandatory training in manual handling and fire safety is provided to all staff who require it.

b.) other areas for improvement

The manager is reminded that all care plans must be reviewed and updated at least once per month in line with the regulations.

It was recommended in the previous inspection that an individual social assessment should be undertaken for each service user and a care plan developed detailing how social leisure needs will be met. This has not yet been actioned and remains a recommendation for good practice.

There remains some members of staff who have not yet had POVA training despite a recommendation being made in the previous annual inspection. This remains a

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A copy of the most recent report compiled by the Responsible Individual, as required by Regulation 27, was supplied to the Inspector. The document needs to be more specific about the how effectively the home is being managed and what action is required to be taken by the manager, if any, to meet the regulations and to improve and develop the service.

Inspection methods

 A self assessment form was completed by the registered person. This requires them to assess how well they consider their service is operating and also provide written evidence of their compliance with the Regulations and National Minimum Standards This document is submitted to CSSIW prior to the inspection.

 An unannounced inspection visit was undertaken on 21st_{February between}

10.00am and 16.30pm.

 During the visit to the home the Inspector held discussions with the manager, staff, service users and relatives. The Inspector also viewed documentation and had a tour of the premises.

 Four service users were case tracked during this visit. This included looking at their admission to the home, information held in respect of them, the care planning process and their personal accommodation.

 CSSIW issued questionnaires to 10 service users, 10 relatives and 10 staff and visiting professionals from the Health Board and Social Services.

 The experiences of service users were gathered through completed questionnaires and discussions with service users during the inspection visit.

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Choice of home Inspector`s findings:

The home has a statement of purpose and service user guide which is updated annually. The manager stated that copies of the documents are provided to all prospective service users and/or their families. This was confirmed by 6 out of 8 relatives who responded to questionnaires prior to the visit. Copies of the documents were also seen displayed in the entrance hall to the home as recommended in the previous inspection. Two service users also confirmed that they had been able to visit the home prior to moving in. They

described their welcome as excellent/good.

Admission to the home is dependent upon an assessment of need to ensure that the home is suitable for the individual. The home has an assessment tool which is used to undertake a pre-admission assessment to determine the needs of the prospective service user. Once admitted the service user/ relative is provided with a contract including a statement of terms and conditions of residence. The Inspector found evidence that these processes had been followed during the case tracking of service users’ records.

Requirements made since the last inspection report which have been met: Action

required

When completed Regulation number

Requirements which remain outstanding: Action required

(previous outstanding requirements)

Original timescale

for completion Regulation number

New requirements from this inspection:

Action required Timescale for

completion Regulation number

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Planning for individual needs and preferences Inspector`s findings:

Four service users were case tracked as part of the inspection visit. All had a care plan in place. There was evidence in the care plans of a pre-admission assessment and ongoing reviews by the funding authorities. The care plans used were comprehensive and detailed the action required by staff to meet the needs of the individual service users. Risk

assessments were in place for nutrition, pressure sore risk, falls and manual handling. Where high risks have been identified a care plan was in place with the action required by staff to minimise the risk. The 4 care plans had been reviewed monthly. In one care plan there had been a gap of 4 months where no review had taken place in the latter part of 2011. The manager is reminded that all care plans must be reviewed and updated at least once per month in line with the regulations.

Where possible service users are involved in the development of their care plan. Where this is not possible, relatives are involved. Relatives confirmed in their questionnaire responses that they are able to contribute their ideas to the care provided and stated that the staff are good at keeping them informed about their family member’s condition.

All personal information is stored securely and staff are aware of the importance of confidentiality.

Requirements made since the last inspection report which have been met:

Action required When completed Regulation number

Good practice recommendations:

The manager is reminded that all care plans must be reviewed and updated at least once per month in line with the regulations.

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Quality of life

Inspector`s findings:

The level of activities offered by the home was explored during this visit. In the pre-inspection information provided by the manager it was reported that the home holds an activity session one afternoon per week but not all service users attend as they prefer to stay in their own rooms. Other activities are offered on a one to one basis in service users’ own rooms. Relatives who responded to questionnaire responses rated the activities on offer as very good/good/average. Two service users stated that they would like to see more activities. The manager reported that staff will continue to offer

opportunities for activities to service users. It was recommended in the previous

inspection that an individual social assessment should be undertaken for each service user and a care plan developed detailing how social leisure needs will be met. This has not yet been actioned and remains a recommendation for good practice.

Comments in questionnaire responses from service users and relatives reported the staff attitude towards service users is very good / good. It was reported that staff are always willing to spend time chatting with and listening to service users. Another relative reported that staff are respectful to service users and have genuine interest in the service users’ welfare.

The manager reported that staff try to maintain flexibility to allow for service users’

individual life style preferences. Service users reported that they can choose when to get and go to bed and where they spend their time, either in the communal lounge areas or in their own room.

Four service users spoke to the Inspector during the visit. All were highly complimentary of the service they receive at the home and expressed satisfaction with their

accommodation, the quality and quantity of meals and the way in which they are treated by staff.

Requirements which remain outstanding: Action required (previous outstanding requirements) Original timescale for completion Regulation number

completion

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It was recommended in the previous inspection that an individual social assessment should be undertaken for each service user and a care plan developed detailing how social leisure needs will be met. This has not yet been actioned and remains a recommendation for good practice.

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Quality of care and treatment Inspector`s findings:

Bryn Marl is registered to provide general nursing care for up to forty older persons. On the day of the inspection visit there were 31 service users accommodated at the home. Risk assessments are undertaken for individual service users in tissue viability, manual handling, falls, and nutrition. Where any high risk was identified there was a care plan in place with the action required by staff to minimise these risks. The home has a supply of pressure relieving equipment and where necessary, specialist tissue viability nurses are involved in the care of service users.

Service users are registered with local GP surgeries and are assisted to see the GP in private whenever necessary. There was evidence in the care plans seen that other healthcare professionals such as physiotherapist, district nurse, continence advisor, dietician and other specialist nurses had been accessed appropriately. Service users are also assisted to attend hospital appointments as required.

There is a medication policy in place and records are kept of the ordering, receipt,

administration and disposal of medications in the home. A recommendation was made in the previous inspection for a medicines audit to be introduced in the home. The manager reported that this has been actioned.

The home utilises the MUST tool to monitor the nutritional status of service users.

Training has been provided to all staff in the use of the tool. Service users are weighed on a monthly basis and the dietician is involved where necessary in the care of service

users.

Four weekly menus are produced and choices are offered at each mealtime. Service users who responded to questionnaires and those who spoke to the Inspector confirmed that there is a varied choice of food. Service users who spoke to the Inspector also confirmed that they are able to have snacks and hot drinks throughout the day and night. There is a dining room where service users may take their meals and this was observed during the visit. Service users may also take their meals in their rooms if they prefer. The kitchen and food storage areas were not inspected during this visit. The

Environmental Health Officer last visited the home in October 2009. The manager reported that there are no outstanding requirements from that visit.

North Wales Fire and Rescue Service conducted an inspection visit to the home on 26th October 2011. Requirements were imposed as a result of the inspection. The manager reported that the requirements have been actioned or are in the process of being actioned.

Information provided in the pre inspection self assessment form evidenced that checks are maintained on equipment in the home. The manager confirmed that the home has a fire risk assessment and that this is kept under review by a competent person.

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completion

Regulation number

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Staffing

Inspector`s findings:

On the day of the visit staffing levels were discussed with the manager. The staffing levels are as follows:

AM 2 nurses + 6 carers

PM 2 nurses + 5 carers – 1 additional carer is employed between 6pm and 10pm daily. Night 1 nurse + 2 carers – increasing to 3 carers when service user needs increase. The manager is additional to the rota and she works Monday to Friday until 4.30pm. Staff files were checked as part of the inspection visit. A robust, recruitment procedure is followed and evidence was seen that checks are undertaken with the Criminal Records Bureau prior to staff taking up their roles. All files seen contained the information required by the regulations. Nursing registrations are checked annually with the Nursing and Midwifery Council and evidence of this was seen in staff files.

Staff supervision was discussed during this visit as this was a requirement in the previous inspection. The manager reported that supervision of staff has commenced but not all staff have received supervision to date. However, arrangements have been made with the trained nurses to assist with supervision of care staff and the manager will be responsible for undertaking annual appraisals. It remains a priority to ensure all staff receive supervision on a one to one basis as least once in every 8 weeks.

Training was also discussed as this was a requirement in the previous inspection. Evidence in staff files show that staff have an individual training plan. There remains some members of staff who have not yet had POVA training despite a recommendation being made in the previous annual inspection. This remains a recommendation for good practice.

Updated training in manual handling and fires safety is also required. The registered persons must ensure that updated mandatory training in manual handling and fire safety is provided to all staff who require it. The registered persons are required to inform CSSIW that this training has been arranged.

There was evidence in staff files of updated clinical training for the registered nurses since the previous annual inspection.

NVQ training is also ongoing through local colleges. The number of NVQ trained staff meets the requirement for a minimum of 50% of staff to hold the award. Two members of trained nursing staff hold an NVQ 4 in addition to the manager.

Relatives and service users who responded to questionnaires or who spoke to the

Inspector during the visit, spoke highly of the staff and were very complimentary about the way in which staff carry out their duties.

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The registered persons must ensure that updated mandatory training in manual handling and fire safety is provided to all staff who require it. The registered persons are required to inform CSSIW that this training has been arranged.

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There remains some members of staff who have not yet had POVA training despite a recommendation being made in the previous annual inspection. This remains a recommendation for good practice.

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Conduct and management of the home Inspector`s findings:

The registered provider of the home is Bryn Marl Ltd. Mr John Haydon is the approved responsible individual for the company and visits the home regularly.

Mrs Gillian Roberts has worked at the home for over 17 years and was registered as the manager in 2009. She is a registered nurse and holds a recognised management

qualification. Ms Roberts holds the Registered Manager’s Award and is registered with the Care Council For Wales as required by the regulations.

Under the regulations the registered persons are responsible for monitoring the quality of the service they are providing and must produce an annual quality of care monitoring report. An assessment of the service was provided as part of the pre-inspection

information by the registered providers prior to the inspection. The information provided was lacking in detail. As stated in the previous inspection report, the quality report should detail the methods used for monitoring the service (such as the audits undertaken, staff supervision/meetings, questionnaires, Regulation 27 visits by the provider) the findings and actions taken or planned as a result.

A copy of the most recent report compiled by the Responsible Individual, as required by Regulation 27, was supplied to the Inspector. The document needs to be more specific about the how effectively the home is being managed and what action is required to be taken by the manager, if any, to meet the regulations and to improve and develop the service.

Original timescale for completion

A copy of the most recent report compiled by the Responsible Individual, as required by Regulation 27, was supplied to the Inspector. The document needs to be more specific

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Concerns, complaints and protection Inspector`s findings:

The procedure to follow in order to make a complaint or raise a concern is made available to all service users and their relatives. There has been one formal complaint made to CSSIW since the previous inspection. No requirements were imposed as a result of the complaint investigation. Service users confirmed that they are aware of how to make a complaint and stated that they would feel able to do so.

A policy and procedure for protection of service users from abuse is in place and staff are provided with training in this area. Staff are checked against the ISA Barred List before commencing work. At the time of the visit there had been no investigations under the procedures for the protection of vulnerable adults since the previous inspection. Some members of staff have received training in the protection of adults from abuse. As stated elsewhere in this report it is a recommendation that training is provided to the remainder of staff who have not received it.

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The physical environment Inspector`s findings:

Bryn Marl is situated in a residential area of Llandudno Junction. Single rooms make up 90% of places which exceeds the National Minimum Standard. Double bedroom

accommodation is available for those who wish to share. Eighteen of the bedrooms have en-suite toilet facilities. Adapted bathrooms and toilets are situated around the building. The communal areas available consist of 2 lounges, a conservatory and a dining room. During the visit, the Inspector was given a tour of the premises. The home was clean and warm and free from undesirable odours. There was evidence of ongoing redecoration and refurbishment. Individual bedrooms were viewed by the Inspector and were seen to have been personalised with the possessions of service users. Service users who spoke with the Inspector expressed satisfaction with their accommodation.

The accommodation is provided on two floors. Service users have access to all parts of the communal and private accommodation through the provision of a passenger lift. In addition there are aids and equipment to promote service users’ independence and mobility such as mobile hoists and handrails in corridors and toilet areas. There was evidence that recommendations made in a previous inspection relating to infection control measures had been actioned. In one upstairs toilet, the surrounding rail was rusting and the manager was advised to replace this to prevent spread of infection.

Regulation number

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A note on CSSIW’s inspection and report process

This report has been compiled following an inspection of the service undertaken by Care and Social Services Inspectorate for Wales (CSSIW) under the provisions of the Care Standards Act 2000 and associated Regulations.

The primary focus of the report is to comment on the quality of life and quality of care experienced by service users.

The report contains information on how we inspect and what we find. It is divided into distinct parts mirroring the broad areas of the National Minimum Standards.

CSSIW`s inspectors are authorised to enter and inspect regulated services at any time. Inspection enables CSSIW to satisfy itself that continued registration is justified. It also ensures compliance with:

 Care Standards Act 2000 and associated Regulations whilst taking into account the National Minimum Standards.

 The service`s own statement of purpose.

At each inspection episode or period there are visit/s to the service during which CSSIW may adopt a range of different methods in its attempt to capture service users` and their relatives`/representatives` experiences. Such methods may for example include self-assessment, discussion groups, and the use of questionnaires. At any other time

throughout the year visits may also be made to the service to investigate complaints and to respond to any changes in the service.

Readers must be aware that a CSSIW report is intended to reflect the findings of the inspector at a specific period in time. Readers should not conclude that the circumstances of the service will be the same at all times.

The registered person(s) is responsible for ensuring that the service operates in a way which complies with the regulations. CSSIW will comment in the general text of the

inspection report on their compliance. Those Regulations which CSSIW believes to be key in bringing about change in the particular service will be separately and clearly identified in the requirement section.

As well as listing these key requirements from the current inspection, requirements made by CSSIW during the year, since the last inspection, which have been met and those which remain outstanding are included in this report. The reader should note that requirements made in last year`s report which are not listed as outstanding have been appropriately complied with.

Where key requirements have been identified, the provider is required under Regulation 25B (Compliance Notification) to advise CSSIW of the completion of any action that they

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CSSIW may also be involved in the investigation of a complaint. Where this is the case CSSIW makes publicly available a summary of that complaint. CSSIW will also include within the annual inspection report a summary of any matters it has been involved in together with any action taken by CSSIW.

Should you have concerns about anything arising from the inspector`s findings, you may discuss these with CSSIW or with the registered person.

Care and Social Services Inspectorate Wales is required to make reports on regulated services available to the public. The reports are public documents and will be available on the CSSIW web site: www.cssiw.org.uk

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