Care and Social Services Inspectorate Wales

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1 Care and Social Services Inspectorate Wales Care Standards Act 2000 Inspection Report Brynawel Rehab Care Home Llanharry Road Llanharan Pontyclun CF72 9RN Type of Inspection Baseline Date of inspection 3 December 2013 Date of publication 26 December 2013 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 Please contact CSSIW National Office for further information Tel:

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3 Summary About the service Brynawel Rehab Centre is located just outside the village of Llanharry in Pontyclun. The home is owned and operated by Brynawel House Alcohol and Drug Rehabilitation Centre Limited. The Board of Trustees have nominated a Responsible Individual to oversee the running of Brynawel Rehab Centre. The home is managed by Jacqueline Wood. Ms Wood is registered with both the Care Council for Wales and Care and Social Services Inspectorate Wales (CSSIW) to act in the capacity of manager. Brynawel Rehab Centre is registered to accommodate a maximum of 16 adults who require support with personal care due to needs associated with alcohol and substance misuse. At the time of our inspection 14 service users were accommodated. What type of inspection was carried out? We (CSSIW) visited the home on an unannounced basis on 3 December 2013 between the hours of 9.05 am and 3.05 pm. We planned to undertake a baseline inspection which considered all four quality themes in this report. During our inspection we considered the following: Self Assessment of Service completed by the registered persons Two service user files which were case tracked from admission planning through to delivery of care The home s records relating to accidents and incidents Observation of medication administration Files relating to two members of staff and one volunteer. Our evaluation focussed on recruitment, staff training and support given to them to enable them to do their work Discussions with service users, staff and management at the home What does the service do well? Service users described their stay at Brynawel Rehab Centre as being rewarding and fulfilling. What has improved since the last inspection? There were no areas for improvement noted at our last inspection. What needs to be done to improve the service? No non compliance notices have been issued at this time. However we notified the registered persons that they were not compliant with the following regulation (specific details are outlined in this report): Regulation 19(2)(d) Schedule 2(4) states that where a person has previously worked in a position whose duties involved work with children or vulnerable adults, so far as reasonably practicable, verification of the reason why the employment or position ended must be sought It is expected that the registered persons will take responsibility for addressing the above area by undertaking whatever necessary actions are required to achieve compliance. The above areas of non compliance will be the focus of the next inspection. 3

4 Quality of life Brynawel Rehab Care Home is a facility that offers care and therapy services for people who have undergone detoxification from drugs and / or alcohol. As such, routines in the home are in place to enable people to build structure into their lives. Residents are not able to leave the home within the first ten weeks of a 16 week programme and daily living at the home is not as autonomous as we would expect in a care home environment. However, we noted that service users had signed contracts at the beginning of their rehabilitation programme to consent to the restrictions placed on their liberty. People staying at Brynawel Rehab Care Home have opportunities for people to learn, be active, positively occupied and stimulated. This is because we observed people spending time playing games and reading. We saw that a computer suite was available for those who wished to use online services. Although all service users had been registered with a local gymnasium, there was also a small gym available in the home. Staff showed us various art work that had been completed by current and previous service users. An activities rota provided to us included additional recreation activities available such as swimming, cooking competitions and indoor climbing at a nearby centre. People experience well being and a sense of achievement. This was demonstrated through care planning documentation which set short, medium and long term goals for service users. We also noted that the efforts of service users was recognised and celebrated by staff and management. One such example was an initiative set up by service users to raise money for a disaster fund. Appreciative and encouraging notes had been attached to posters from staff and the management team. People are supported with difficult feelings and are supported to develop coping strategies. People undergoing rehabilitation at the home are required to spend time in group and one to one therapy sessions. All staff have attended training in substance misuse and were able to explain to us the issues that service users may face. Staff we talked to said they enjoyed seeing people develop new coping skills. Peer mentorship is also available for people undergoing rehabilitation and a group of ex service users visited the home on a weekly basis to encourage them. We talked to one service user who explained how they felt more positive about the future following their stay at Brynawel Rehab Care Home. People s rights are protected and they experience being treated with dignity and respect. We observed that service users were treated with respect by staff at all times. Daily records completed by staff were factual and non judgemental in nature. People s spiritual needs are acknowledged and supported. The Positive Quotes Tree in the reception area held a number of biblical encouragements for people to whom faith was important. We saw a bible was available for those wishing to read it and staff told us about the links made with two churches in the local area. We were advised that links to other religions would be made upon any request made by a service user. People are supported to maintain healthy nutrition. We observed that there was fresh fruit available throughout the home. The chef told us about people who had specialist 4

5 dietary needs and was knowledgeable in how to meet these. The home had been awarded the highest level of the All Wales Healthy Options Award indicating that they use fresh and good quality ingredients. We observed people having a mixed grill for lunch. Portion sizes were generous and service users told us the food here is excellent. 5

6 Quality of staffing People experience good communication and engagement with staff. We observed that conversations were relaxed and informal. Service users told us that the staff were understanding and very good. People felt that staff had time to listen to them and there was always someone around to talk to. People can have confidence that they are cared for by motivated staff who want to make a positive difference to people s lives. We spoke to several members of staff who demonstrated a commitment to, and a deep understanding of, the needs of people who have misused alcohol or substances. One staff members described how privileged she felt to work with the service users and how she also told us I still get excited every time someone tries something new. People can have some confidence that safe recruitment methods ensure that suitable staff are employed to work at the home. Although the recruitment process was overall sound, we brought to the attention of the registered persons that, where a potential staff member has previously worked for a care provider, those employers must be contacted to ascertain the candidate s suitability to work in care. The registered persons assured us that these areas would be addressed. People can generally be assured that staff have received training which enables them to provide care in complex situations. We found that staff had access to a variety of training courses and that specialist training in alcohol dependence and substance misuse was in line with Drug and Alcohol National Occupational Standards. However, we had concerns regarding the induction training given to new members of staff. We examined two personnel files for staff recently employed at the home. These showed that the recommended Care Council for Wales Social Care Induction Framework was used for new staff. However, the Induction Framework should be completed over the first twelve weeks of employment. We found that new staff had visited the home two weeks prior to starting work at the home and had covered all topics in the framework within one day. We discuss this with the registered persons who agreed that this brevity did not provide a solid and supportive induction and this will be addressed. We will consider progress made in this area at our next inspection. People benefit from receiving care from staff who are supported by their line management. We saw evidence that staff had had opportunity to meet with their line manager on a regular basis to discuss their work and training needs. Staff files examined showed evidence of an annual appraisal system where longer term goals were agreed. Staff meetings had been held on a monthly basis to ensure that all staff members were up to date with current practice within the home. 6

7 Quality of leadership and management Brynawel Rehab Centre is owned and operated by Brynawel House Alcohol and Drug Rehabilitation Centre Limited. The Board of Trustees have nominated the Chief Executive Officer to act in the role of Responsible Individual in overseeing the running of Brynawel Rehab Centre. The home is managed by Jacqueline Wood. People can have confidence that the business is well run, with due care and attention to minimum standards and regulations. Although the registered manager only works part time, specific plans are in place for the management of the service in her absence. Communication methods had also been developed to ensure the manager was kept informed of everything that occurred within the home when she was not on the premises. People experience a consistent, responsive service based upon quality improvement and a sound financial platform. This is because a staged Strategic Plan had been put in place which aimed to develop Brynawel Rehab Care Home into a centre of excellence by We also examined the minutes of financial audit meetings and found that plans to ensure the quality of the service could be maintained should occupancy levels and income fall. People s expectations about that the service says it provides is matched by the experience they receive. This is because the home had developed a Statement of Purpose which set out the aims and objectives of the service. Service users were also asked to sign a contract where the responsibilities of both the resident and the home were clearly set out. People can have confidence that the service will respond positively to feedback and critical incidents. We examined the home s accident and incident records and found that appropriate action had been taken on each occasion. Critical events had been audited in order to identify any trends or themes. The complaints policy was on visible display within the home and daily records maintained by staff demonstrated action taken when a service user was dissatisfied with the service. In addition to this a suggestion box was available in the foyer where anonymous concerns could be brought to the attention of management. 7

8 Quality of environment People using the rehabilitation service at Brynawel benefit from accommodation which is set in stimulating and well maintained environment. Brynawel House is an old manor house type building which has been adapted and extended. We found the building to be in a good state of repair. Internally the home was domestically decorated to provide a sense of familiarity. People can feel uplifted by the environment. We found the premises to be light, airy, fresh and clean. Clear signposting ensured that people new to the building were enabled to find their way around. The buildings were located within their own grounds where smoking shelters were available for those who smoked. The gardens also contained a vegetable patch and a chicken coup, which had been maintained by service users. Eggs produced by the chickens, and produce from the vegetable patch had been used at the home. People using the service can have private space or choose to spend time with others. This is because each person is allocated a bedroom with en suite facilities. Bedrooms had been furnished in line with National Minimum Standards and included a television. Bedrooms were available on the ground floor for people with limited mobility and these rooms also had wheelchair accessible showering facilities. All service users are given keys so they may lock their rooms. One service user told us the bedrooms are not just comfortable they are very comfortable! Communal areas include a selection of lounge areas and a communal dining room. We observed that service users felt relaxed in choosing where to spend their time in the home. We saw that communal areas were used to meet friends, read the day s newspapers or play games. The environment is used to celebrate service users achievements and demonstrates a sense of personal value of service users. This is because we saw that art work completed by former service users decorated the walls of communal lounge areas and hallways. Staff were able to tell us about the service users who had completed the art work. The foyer to one of the buildings had a Positive Comments Tree, which had been built by service users and decorated with wooden ornaments holding encouraging words. These had been made by ex service users to encourage the people currently living at the home. People are enabled to be as independent as possible as facilities are in place to meet their needs. In addition to the main kitchen, the premises had two smaller kitchens where service users could make snacks as and when they wanted. There were also two laundry rooms which service users were encouraged to use on a regular basis. We observed that the kitchen was well stocked and in a hygienic condition. The kitchen had retained its five star rating from the Food Standards Agency. People cannot always be assured that personal information held about them is protected at the home. This is because we observed several occasions when the office was left unattended and unsecured. This was brought to the registered persons attention for rectification. 8

9 How we inspect and report on services We conduct two types of inspection; baseline and focussed. 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. Focussed 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. Focussed inspections will always consider the quality of life of people using services and may look at other areas. Baseline and focussed 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. Those relevant to each type of service are referred to within our inspection reports. Further information about what we do can be found in our leaflet Improving Care and Social Services in Wales. You can download this from our website, Improving Care and Social Services in Wales or ask us to send you a copy by telephoning your local CSSIW regional office. 9

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