Inspection Report on

Inspection Report on

Belmont Court Heywood Lane Tenby SA70 8BN

Date of Publication

Welsh Government © Crown copyright 2017.

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Description of the service

Belmont Court Residential and Nursing Home is located in Tenby and is registered with Care and Social Services Inspectorate Wales (CSSIW) for up to twenty nine people with nursing and personal care needs. One place within the twenty nine is for a younger person aged fifty years and over requiring personal care.

The service is owned by RCH (Wales) Limited, there is a responsible individual in place and the registered manager with day to day responsibility for the management of the home is Gavin Craig Strong.

Summary of our findings

1. Overall assessment

People living in the home can see a service that is led by a dedicated manager and staff team who have a good understanding of their needs and what is important to them. We found people’s choices were respected and their lives enhanced by improved activities and by staff who were professional, well trained and motivated.

2. Improvements

 The manager has registered with CSSIW.

 The activities co-ordinator is continuing to develop and improve the variety of activities for people.

3. Requirements and recommendations

Section five of this report sets out the actions the service provider needs to take to ensure they meet their legal requirements and recommendations to improve the quality of the service provided to people living in the home.

1.

Well-being

People are supported to achieve well-being by being offered opportunities to make choices and be active in an environment that respects their dignity and individual needs and

choices. However, further work is required to ensure that the service better meets people’s communication needs and supports them to communicate in the language of their choice. Our findings

People are encouraged to be involved in activities and have opportunities to socialise and follow interests. The activities co-ordinator told us (CSSIW) that a range of activities and events were held including;

 pampering;

 celebration parties including birthdays and special occasions;  chair exercises;

 arts, crafts and painting;  visiting entertainers;  one to one chats;

 trips within the local community;  gardening;

 music time and  religious services.

During discussions with the activity co-ordinator they showed us photograph scrap books she was in the process of developing. Each person living in the home had a scrap book that held photographs of the individual participating in activities. We were told the aim is for the scrap books to be kept in people’s bedrooms for them to be able to look at and share with their visitors. We also saw photographs of people participating in activities displayed in communal areas of the home.

The activity co-ordinator also showed us ‘activity cards’ provided by a charity to assist in developing meaningful activities with four themes, namely; performing arts, visual aids, music and words. A record of all activities that people participate in is recorded and held in an activity file. The activity co-ordinator spoke enthusiastically about her role, plans for the future and the support she has from the registered manager.

We saw one person being supported to complete bead work on a design and we also saw other designs that had been completed. The person told us “it’s hard work but I quite like

doing this”.

The service does not offer an ‘Active Offer’ of the Welsh Language. At the time of the inspection we were told that no people living in the home spoke Welsh.

Information was not readily available in Welsh, there was no bilingual information or signage within the home nor was the ability of care workers to communicate through the medium of Welsh considered during their recruitment.

Whilst it was recognised no people living in the home speak Welsh at that time, consideration should be given to meet the needs of any people who move into the home in the future who prefer to converse in Welsh. During discussions with the registered manager he gave assurances that the ‘Active Offer’ would be given consideration. This will be followed up in future inspections.

This shows that people are not able to communicate in the language of their choice at this time.

People are encouraged to speak and express themselves. We read the minutes taken from a residents meetings held in June 2017. The minutes identified that people were encouraged to express their views and choices. In the minutes we saw that people had asked about a gardener being employed to help with the preparations for the ‘Tenby in Bloom’ Competition. We saw a written response to this request from the registered manager giving assurances that a gardener would be employed. As a result the home received a ‘Silver Award’ for their garden.

People are supported to raise concerns and complaints about the service. We saw copies of the Service User Guide and Statement of Purpose that provided information on how people can make a complaint; however, the reporting timescales were different in both documents. When we spoke to people they told us they were able to raise concerns if they wanted to; “I’ll let the carers know if there is something wrong”, “I know I can speak to a

member of staff if I am concerned about anything, they are very good” and “This is a nice place, carers are very good, I don’t have any complaints.

It can be concluded that people are encouraged and able to express their views, opinions and concerns.

2.

Care and Support

People are cared for and supported by competent staff who have a good understanding of their needs and treat them with respect and kindness. This would be further enhanced by developing more person centred care plans in conjunction with the person and / or their representative.

Our findings

People are supported by staff who understand them and their health and care needs.

We observed two care workers supporting a person to safely move from their wheelchair to an arm chair. The care workers supported and encouraged the individual and we saw that there were positive interactions between them. When the person had been supported to transfer into an arm chair, the carers made sure the individual was left comfortable with a cold drink at hand. During a conversation with the care workers they told us that they had attended moving and handling training and this was corroborated when we looked at the staff training matrix.

We also observed one person who had become distressed being sensitively supported by two care workers. We saw the care workers, sitting next to the person, holding their hand and speaking to them in a kind and gentle manner. After about five minutes we heard the person tell the care worker “I’m feeling better now, thank you”.

During conversations with care workers, they were able to provide us with details of the people they were the key worker for, how they presented and their personal histories. This was corroborated when we read individual’s care records. Care plans and associated risk assessments were seen to have been reviewed regularly. Whilst the care plans we looked at provided information about the individual and were being reviewed regularly, they were seen to be ‘clinical’ in their detail. Consideration should be given to produce care plans in a more person centred way that better reflects the person’s specific needs and how these are to be met. We noted that there was some evidence of people and / or their representatives involved in the planning and review of their care; this should be further developed wherever possible. We noted that a range of professionals had been, or were involved in people’s care including; GP, district nurse, optician, social worker, dietician, physiotherapist and chiropodist.

We looked at medication documentation, how medicines were stored and how they were administered. We found the documentation was well maintained with no errors noted on the medication recording sheets (MAR), medicines were correctly stored and we observed staff safely administering medication. We saw medication being administered in a sensitive, unrushed way by the registered nurse who spent time listening and explaining what she was doing to people. Consideration should be given for the photographs of people held on their care and medication records to be dated and periodically reviewed to ensure they still resemble the individual.

People are treated with dignity and respect and have their individual identities and routines recognised and catered for. Throughout the period of the inspection we saw care workers positively interacting and supporting people in a kind manner. We also saw care workers knocking on people’s bedroom and communal bathroom doors prior to entering.

Throughout a lunchtime observation we saw care workers supporting and encouraging people to eat and drink in a kind and caring manner. We also saw one care worker spending time with individuals to explain what was for lunch and the choices they wanted to make. We saw a system was in place to capture people’s meals choices, one person told us that “if I don’t like something I can ask for something else”.

This shows that people are treated with respect and have their individual needs and routines recognised and respected.

3.

Environment

Summary

People live in a clean, safe and homely environment which is well maintained with sufficient internal and external space and facilities that are suitable for their needs.

Our findings

People live in a safe and secure environment. On arrival and departure from the home we were required to sign the visitors’ book. A visual check of moving and handling equipment demonstrated they were being serviced within the required timescales, were clean and in working order. Emergency pull cords were seen to be freely hanging and accessible in communal toilets, bathrooms and individual bedrooms. When we activated an emergency alarm in a communal bathroom, we found that it was responded to in a timely manner by a care worker.

We also noted that fire fighting equipment throughout the home had been serviced within the required timescales. Examination of care workers training records demonstrated that they had attended fire safety awareness and moving and handling training. In addition, care workers we spoke to were able to tell us the actions that they would take in the event of a fire emergency within the home.

This shows that equipment and facilities are well maintained and that they support people’s safety.

People live in a comfortable home that is clean, homely and has a personalised environment. During a tour of the home we saw that, where people had chosen, their bedrooms had been personalised with small items of furniture, pictures, paintings and ornaments. A Regulation 27 report completed by the responsible individual in April 2017 also confirmed that ‘residents are encouraged to bring familiar smaller items of furniture and

photographs with them to personalise their private areas’.

We saw that there were a number of communal areas for people to meet. The gardens were well maintained, and had achieved an award in the ‘2017 Tenby in Bloom Competition’. We were advised by the registered manager, which was corroborated in the Regulation 27 report that there is an ongoing refurbishment and redecoration programme in place and that the conservatory flooring had been replaced. One person told us that they liked sitting in the communal lounge because “the views are beautiful and change so many

times during the day”. We noted that the home was well maintained, clean and free from

malodours.

This shows that people are living in a pleasant, clean environment that reflects their individual choices.

4.

Leadership and Management

The leadership and management are demonstrating a commitment to continue to improve the service through a supported, competent and committed staff team.

Our findings

People benefit from a service where staff are well lead, trained and supported. We looked at three care workers personnel files which demonstrated that all the required checks, clearances and information had been conducted and held on the files. The supervision records for the three care workers were also checked and we saw that supervision meetings and appraisals were being held within the required timescales in line with National Minimum Standard 24.3 and 24.6 for Care Homes for Older People.

Care workers told us that they enjoyed working in the home and felt supported by the registered manager. Some of the comments included: “we are like a big family, anything I

need the manager will help”, “the manager has gone out of his way to help me”, I love working here, it’s got a nice atmosphere” and “everyone supported me through my induction”.

All staff had a good understanding of safeguarding the people they care for and confirmed they would report any concerns to a senior member of staff. They were also clear about the service’s Whistle Blowing Policy and confirmed that they felt comfortable in using it. The registered nurse on duty told us the on call manager cover that was available and raised no concerns about the support provided by the on call manager when they used the service. The registered manager told us that they felt they were well supported by the responsible individual who visits the home regularly and is very happy in their role.

We also looked at training records which demonstrated care workers received a range of mandatory and specific training including;

 first aid awareness / basic life support;  health & safety;

 COSHH & RIDDOR;  fire safety awareness;  record keeping;  conflict resolution;  risk assessments;  manual handling;  safeguarding;  food hygiene;  medication training;

 equality, diversity &human rights;  pressure damage;

 hearing care;  end of life care;

 Dementia awareness and  communication.

The care workers we spoke to confirmed they had attended the training and demonstrated a good understanding of the specific needs of the people they were supporting and how best to meet these. People we spoke to positively commented about the care workers and management of the home including; “the manager is good and the girls (care workers) are

kind”.

It can be concluded that people benefit from well trained staff who are competent and supported in their role.

People can see evidence of driving continuous improvement. We read the Regulation 27 monitoring reports produced by the responsible individual following their visits to the home in April, June and August 2017. The reports provided detailed information including service users, service users’ representatives, employees, building and premises, activities and a view of the overall conduct of the home. The findings from the visits are shared with the registered manager so any actions can be addressed.

We were provided with a copy of the Annual Quality Report 2017. The report included details accidents, incidents or untoward events, rights and resident protection, the environment, resident guests and referrals, customer satisfaction, complaints and compliments. At the end of the report was an action plan which identified three key points that were to be addressed. Given the sometimes complex needs of some of the people living in the home, consideration should be given as to how the findings and identified actions are communicated in a format that meet the needs of all those living in the home. We did note that whilst the Service User Guide and Statement of Purpose were detailed they did not provide up to date information in some places and there were contradictions in policy timescales. These were discussed with the registered manager who gave assurances that they would be addressed and copies of the revised documents sent to CSSIW.

People can therefore feel assured they receive care and support from a provider who is committed to ongoing service improvement.

5.

Improvements required and recommended following this inspection

None

5.2 Areas of non compliance identified at this inspection None

5.3 Recommendations for improvement

The following are recommended areas of improvement to promote positive outcomes for people:

 The registered provider should ensure the service better reflects and meets the needs of people who communicate through the medium of Welsh.

 The registered provider should take steps to build on the improvements to care plans by better capturing the individual needs of the person and how these are to be met.  The registered provider should consider how the findings and identified actions in the

Annual Quality Assurance Report are communicated in a format that meet the needs of all those living in the home.

 The registered provider should consider the photographs of people held on their care and medication records are dated and periodically reviewed to ensure they still resemble the individual.

 The registered provider should update the statement of purpose and service user guide to ensure they provide accurate and up to date information.

6.

How we undertook this inspection

This was a full inspection undertaken as part of our inspection programme. An inspector and senior inspector made an unannounced visit to the home on 2 November 2017 between 9:30 a. m and 3 p.m.

The following methodologies were used:

 We spoke to six people living in the home.

 We used the Short Observational Framework for Inspection (SOFI). The SOFI tool enables inspectors to observe and record care to help us understand the experience of people who cannot communicate with us.

 We observed the interactions between staff and people.  We looked at three care files.

 We looked at the minutes from residents meetings.

 We looked at the arrangements for the recording, handling and safe administration of medication including controlled drugs.

 We spoke to six care workers.  We spoke to a registered nurse.

 We spoke to the activities co-ordinator.  We spoke to the registered manager.

 We spoke to members of the catering team.

 We looked at three care staff files and supervision records.

 We looked at the service’s Statement of Purpose and Service User Guide.  We looked at the staff training matrix.

 We looked at Regulation 27 reports produced by the responsible individual.  We looked at the service’s complaints, safeguarding, on call and whistle blowing

policies.

 We looked at moving and handling and fire fighting equipment.  We activated an emergency call alarm.

 We had a tour of the home and grounds.

About the service

Type of care provided Adult Care Home - Older

Registered Person RCH (Wales) Limited

Registered Manager(s) Gavin Craig Strong

Registered maximum number of places

29

Date of previous CSSIW inspection 06/04/2017 Dates of this Inspection visit(s) 02/11/2017 Operating Language of the service English Does this service provide the Welsh

Language active offer?

This is a service that does not provide an 'Active Offer' of the Welsh language. At the time of the inspection no people living in the home

communicated through the medium of Welsh. We recommend that the service provider

considers Welsh Government’s ‘More Than Just

Words follow on strategic guidance for Welsh language in social care’.