Care and Social Services Inspectorate Wales Care Standards Act 2000 Inspection report Care homes for younger adults Caewal Road Caewal Road Llandaff Cardiff CF5 2BS Date of publication: 4 July 2011 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
Care and Social Services Inspectorate Wales Mid & South Wales 4-5 Charnwood Court Heol Billingsley Parc Nantgarw Nantgarw CF15 7QZ 01443 848527/28/29 01443 848526 Home: Caewal Road Contact telephone number: 029 20 553 441 Registered provider: Registered manager: Independent Community Living Ltd. Matthew Gray Number of places: 6 Category: Younger adults (under the age of 65), in the categories of learning disability and mental health Dates of this inspection from: 25 May 2011 to: 25 May 2011 Dates of other relevant contact since Registration of Manager last report: 28 October 2010 14 March 2011 Date of previous report publication: 25 June 2010 Inspected by: Elaine Williams Page 1
Introduction Caewal Road is one of a number of small care homes owned by Independent Community Living Limited which is a branch of Craegmoor Healthcare. The home is registered to provide care for adults with learning disabilities and mental ill health. Caewal Road is a converted and extended residential property located on the junction of a busy main road in a suburb of Cardiff. Gardens, high hedges and double glazing protect the home from noise and disturbance associated with the main road. The home itself is not distinguishable from other properties in the street. Caewal Road is managed by Mr Matthew Gray who is registered in this role with CSSIW and holds the appropriate qualification for his post as recommended by the Care Council for Wales. Summary of inspection findings Service users have lived at 8 Caewal for several years. All service users who spoke to the inspector indicated they were happy at the home. Service users are encouraged to be as independent as possible. Staff interviewed by the inspector demonstrated knowledge and skills in working with the service user group. Multidisciplinary healthcare advice is available from within the company. Good links are maintained with external healthcare providers. The home s use of de-escalation techniques in relation to challenging behaviour has reduced the need for physical intervention. Any incidences where reactive strategies are used have been dealt with appropriately by the home s manager and staff. The inspector found evidence of good practice in relation to quality assurance audits which are conducted by the company. The home itself provides a good level of accommodation for service users, with the exception of bathrooms and toilets which require urgent refurbishment. What does the service do well? Service users, visitors and professionals have commented on the homely and relaxed environment at the home. Service users are actively involved in planning their care, running the home and in interviewing potential staff to work at the home. Behaviour plans are kept under review and the home operates a system of reflective practice to consider alternative and highly personalised reactive and de-escalation strategies. Staff spoken to took pride in their work and celebrated individual service user achievements enthusiastically. Staff feel supported by the management of the home. As part of a large organisation the home is able to access dedicated medical and support services. A central training facility is also available. What has improved since the last inspection? Page 1
The kitchen has undergone extensive refurbishment Matthew Gray has now been employed as permanent manager and has been registered by CSSIW in this role What needs to be done to improve the service? a.) priorities No regulatory requirements are made in this report that require priority attention b.) other areas for improvement Tiling in bathrooms was found to be discoloured and peeling. Surfaces in bathrooms and toilets were also peeling. Non porous surfaces can harbour bacteria. The manager assured the inspector that bathrooms and toilets were on the company s refurbishment plan. However, it is noted that this was the same information given at the previous inspection but it had not been addressed in the year between. Given the potential for cross contamination in these areas the inspector suggests these rooms now be given priority in the company s refurbishment programme. Inspection methods Information gathering for the inspection commenced on 14 March 2011 when self assessment of service documentation was sent to the registered provider for completion. This document was returned to CSSIW within prescribed timescales. Analysis of the self assessment documentation, along with consultation with the most recent inspection reports and information held on the home by CSSIW, led the inspector to plan a low intensity inspection. The inspector undertook an unannounced inspection visit to the home on 25 May 2011 between the hours of 3.55pm and 7.10pm. The inspector used the following in her inspection of the home: Analysis of self assessment documentation completed by the registered provider One unannounced inspection visit to the home which included discussions with five service users, the manager, deputy manager, staff and a visiting healthcare professional Detailed examination of one service user file which was case tracked from planning through to delivery of care Examination of the file relating to a recently recruited member of staff which was case tracked from application form to present day Analysis of questionnaires completed by three service users, one relative of a service user, two healthcare professionals who regularly visit the home and two staff members The inspector would like to thank all those who contributed to this report, in particular service users who made her so welcome in their home.
Choice of home Inspector`s findings: Caewal Road publishes a statement of purpose and a service user guide which explains the process for admission into the home. This is available for anyone interested in living at the home and their relatives, in addition to health and social care professionals. The service users living at Caewal Road have done so for many years. The inspector examined the records relating to the most recent admission some five years ago. Files evidenced that the home had conducted a thorough assessment and had full knowledge of the service user s medical conditions, lifestyle and preferences before offering a place, ensuring that the home could meet the service users individual needs. The service user had been fully involved in this process and had contributed to the home s documentation. Out of three questionnaires completed anonymously by service users, all stated that they had received information about the home and been able to visit Caewal Road before moving in. Two people rated their welcome into the home as excellent and one as satisfactory. A relative commented that their family member had settled in very well and stated the best thing about the home was the homely atmosphere. A professional who visits the home on a regular basis stated in a questionnaire that there appears to be a very relaxed environment, which is beneficial to the service users. At the time of inspection Caewal Road was accommodating six service users between the ages of 33 and 48. Requirements made since the last inspection report which have been met: When completed Requirements which remain outstanding: (previous outstanding requirements) Original timescale for completion New requirements from this inspection: Timescale for completion Good practice recommendations: Page 4
Individual needs and choices Inspector`s findings: The service user file examined by the inspector held a copy of their assessment completed by their care manager. This had been developed by the home to include personalised information relating to individual needs and preferences. Staff interviewed by the inspector also showed a high level of awareness of the needs of individual service users. All records relating to service users were locked within secure facilities within a lockable office. The inspector spoke to five service users who were at home during the inspection. All informed the inspector that they were able to participate in a wide range of activities according to their personal interests. Some attended college courses and had obtained qualifications. Two service users do voluntary work within the community. Photographs around the home celebrate individual achievements. A poster containing positive statements was pinned to one service user s bedroom wall to promote self esteem. In another service user s bedroom a poster demonstrating goal achievement was used. The service users told the inspector they had chosen to put these in their bedrooms to motivate themselves. Each service user is allocated a home day where they can choose meals and be involved in domestic tasks, including meal preparation. On the day of inspection a service user had chosen fish, new potatoes and vegetables for the main meal. On this occasion it was cooked by staff. In a completed questionnaire, one staff member was concerned that food purchased was often of poor quality. However, the quality of food provided at the home was rated as excellent by all service users who completed a satisfaction questionnaire. Requirements made since the last inspection report which have been met: When completed Requirements which remain outstanding: (previous outstanding requirements) Original timescale for completion New requirements from this inspection: Timescale for completion Good practice recommendations: Page 5
Lifestyle Inspector`s findings: The inspector observed that service users were relaxed and felt comfortable within their environment. Staff maintained close supervision in an unobtrusive manner. One staff member stated that staff respected the fact that Caewal Road is the service users home, not the staff s. A visiting professional responding to a questionnaire stated that they found the staff to be thoughtful. Each service user has a weekly plan of activities in which they are encouraged but not compelled to participate in. Meals are taken together in the dining room as used as a time of socialisation with other service users. Service users are encouraged to do their own shopping and each has an allocated food storage area. Service users are free to make their own refreshments and meals as required. One service user showed the inspector around his self contained flat within the home. This service user is being supported to move towards independent living within the community. This has been managed in a staged way by the home, in consultation with health care professionals including occupational therapists, psychologists and psychiatrists employed by the provider company. The service user was evidently pleased by his progress and this was echoed by staff who stated that they felt a sense of achievement. Nutritional advice had been sought for one service user who was being supported by the home to maintain a healthy diet. The service user told the inspector that it is hard work but it s worth it. Staff encouraged the service user by celebrating the progress made so far. The home supports service users to have an annual holiday away from the home. One service user had recently returned from a long weekend in Devon. One service user was away visiting family at the time of inspection and another was preparing for a family visit. Family and friends are made welcome at the home. A record of visitors is maintained to ensure the manager is aware of who is on the premises at all times in addition to protecting service users from inappropriate visitors. One service user told the inspector that she had been supported to go to a music concert recently which she had thoroughly enjoyed. The home plans to take service users to more concerts in the near future. The provider company own several homes for younger adults and has established an online social networking site for service users. People living at Caewal Road told the inspector that they enjoyed talking to other service users on this site. One service user explained that he thought this site was safer than traditional networking sites because it was only available to service users. The home evidenced a good awareness of equal opportunities for all service users. In depth work had been undertaken in promoting healthy personal relationships in a sensitive way. All staff undertake training in equality and diversity issues upon employment with the company. Page 6
Requirements made since the last inspection report which have been met: When completed Requirements which remain outstanding: (previous outstanding requirements) Original timescale for completion New requirements from this inspection: Timescale for completion Good practice recommendations: Page 7
Personal and healthcare support Inspector`s findings: Records relating to service users personal and healthcare needs were well maintained. Emergency contacts for GP and next of kin were clearly identifiable within the filing system. Staff and management work as part of a multi disciplinary team which also includes occupational therapy, psychology and psychiatrist services provided within the company in addition to care management and specialist healthcare support available externally. Advice and guidance given by healthcare professionals were held on files and related to care planning and records maintained by staff. The inspector spoke to a visiting occupational therapist who spoke well of the home. She relayed that she had confidence in staff to provide the therapeutic activities as she prescribed. This differed from the perceptions of two visiting professionals who completed a CSSIW questionnaire who stated that the home only demonstrated an average ability to follow instructions relating to therapeutic techniques. However, these people stated that when they had raised a concern, this had been dealt with effectively by the home. Comprehensive documentation developed by the provider company is used to assess all aspects of service user need. Care plans cover such areas as relationships, future planning, nutrition, daily activities, communication, finances and budgeting, mental health, social integration, sexuality and spiritual needs. These were noted in addition to specific healthcare needs. Service users are registered with optical and dental services within the community and are encouraged to attend regular check ups. The home have reported two errors concerning the administration of medication since the last inspection report. Medical advice was sought by the manager at the time with the result that the appropriate action had been taken. Three service users are on phased programmes of self administrating their medication. One service user showed the inspector how he stored and recorded the medication he took each day and staff demonstrated the support they gave to this service user. Risk assessments and plans detailing the stages of competency were in place and included guidance from appropriate healthcare professionals. Medication was observed to be stored securely and appropriately. Requirements made since the last inspection report which have been met: When completed Requirements which remain outstanding: (previous outstanding requirements) Original timescale for completion Page 8
New requirements from this inspection: Timescale for completion Good practice recommendations: Page 9
Staffing Inspector`s findings: Caewal Road employs 13 staff. A hierarchy of staff, including support workers, senior support workers, a deputy manager and registered manager ensure that systems of support are in place at all levels. There was one staff vacancy at the time of inspection. One service user informed the inspector he had interviewed a potential member of staff the previous day. The manager confirmed this person had been offered the post. Service users told the inspector that they like to interview staff so they can see what they are like before they come into their home. The records relating to a recently recruited member of staff were examined. Appropriate checks had been made by the manager of the home to verify the application. Staff are expected to attend a variety of training at the start of their employment and to achieve a qualification related to their post. Mandatory training includes administration of medication, emergency first aid, mental capacity, working with people with learning disabilities, health and safety, manual handling, behaviour management, hygiene and fire safety. A visiting professional stated in their questionnaire response that they felt staff s openness to learning was to be commended. Staff informed the inspector that they felt supported by the management of the home and that the training they received was suitable for their job. Staff talked enthusiastically about their role and how they worked directly with service users. This was found to mirror prescribed tasks in service user care plans. One staff member felt the staff worked well as a team with everyone working towards the same goal. These views were generally reflected within anonymous questionnaires completed by staff. The inspector observed staff having a relaxed and informal relationship with each other, management and with service users. All service users who responded to a CSSIW questionnaire relayed that staff were always caring towards them and they were always treated with respect by staff. The attitude of staff towards service users was rated as very good by a service user s relative. Staff meet on a one-to-one basis with their senior officer on alternate months. This gives staff the opportunity to discuss any work related issues and for management to provide guidance on staff performance. These supervision meetings follow a set agenda covering various aspects of the work expected of staff. Minutes were observed to comprehensive and provided useful comments which staff could incorporate into their work. Requirements made since the last inspection report which have been met: When completed Page 10
Requirements which remain outstanding: (previous outstanding requirements) Original timescale for completion New requirements from this inspection: Timescale for completion Good practice recommendations: Page 11
Conduct and management of the home Inspector`s findings: Caewal Road is managed by Matthew Gray, who has been registered to perform this role by Care and Social Services Inspectorate Wales (CSSIW) since the last inspection took place. Mr Gray holds the relevant qualification for his management post. Staff reported to the inspector that they found Mr Gray to be supportive and approachable. One member of staff informed the inspector that they felt able to talk through any difficulties with Mr Gray and that staff generally felt valued by the management of the home. Service users told the inspector that they liked Mr Gray and it was evident that relationships between management, staff and service users were amicable and relaxed. Caewal Road is owned by Independent Community Living Limited which is a branch of Craegmoor Healthcare. As part of a large organisation the home is able to access dedicated medical and support services. A central training facility is also available. Mr Gray is supported in his management role by a senior officer who has been nominated by the organisation to act in the role of Responsible Individual. An area manager is also available for guidance and assistance and completes monthly audit visits on behalf of the company. This monthly provider report covers areas such as feedback from service users, their relatives and staff, an inspection of the premises, any critical events which have occurred, complaints and conduct of the service. There have been no concerns raised through this method of quality assurance. Money and valuables are stored securely. Where staff support service users with budgeting this is suitably recorded. One service user told the inspector that they do a good job of looking after my money. The registered manager is required to report incidences which affect service users under Regulation 38 of the Care Homes (Wales) Regulations 2002,19 such notifications were received by CSSIW since the last inspection report was published. These mainly related to how the home had responded to incidents of challenging behaviour within the home. Four notifications related to service users leaving the home without notifying staff. On these occasions, the manager had implemented the home s missing persons policy and the service user had returned safely to the home. The home has been deemed to have acted correctly in relation to each of the notifications made. Requirements made since the last inspection report which have been met: When completed Page 12
Requirements which remain outstanding: (previous outstanding requirements) Original timescale for completion New requirements from this inspection: Timescale for completion Good practice recommendations: Page 13
Concerns, complaints and protection Inspector`s findings: Protection Caewal Road has an adult protection policy in place. Staff were able to describe situations which may indicate adult abuse to the inspector and how they would deal with any concerns they had. The registered manager has established good working relationships with the local adult protection team and it is clear that safeguarding service users is given a high priority within the home. A number of service users living at Caewal Road may display challenging or aggressive behaviour. All staff have undertaken training in specialist communication methods in addition to de-escalation techniques using a recognised training programme. Staff informed the inspector that they had seen improvements since using this technique, rather than one which relied on physical restraint. Both the staff and manager informed the inspector that no physical restraint has been used in the home since the de-escalation technique has been employed. The inspector observed staff communicating effectively with service users using a variety of methods. It was clear that staff were aware of changes in service user s mood and reacted accordingly. The inspector witnessed an incident where one service user became agitated. This situation was dealt with and managed effectively as set out in the service user s care plan. One questionnaire completed by staff stated that sometimes they felt there were not enough staff to facilitate new interventions with service users. The strategy used in the above incident, had altered recently, showing that the home keep management plans under review and are willing to consider other ways of working. An occupational therapist visiting the home at the time of inspection stated that she often came to Caewal Road for a reflective practice session. She explained that the home arranged these meetings to discuss particular situations with the multi disciplinary team to evaluate whether they could do things in a more effective way. Complaints and Concerns A communal notice board within the home advertises both the complaint policy and the staff whistle blowing policy in easy to read formats. One complaint regarding the home had been received by CSSIW since the last inspection report was published. As the registered manager was not in post at this time the matter was referred to the Responsible Individual for investigation under Regulation 23B(1). This investigation was not completed within the required timescales and it was necessary to remind the provider company that failure to provide the requested information was in breach of the Care Standards Act. A subsequent investigation found no substance to the complaint. Evidence examined at the time of inspection corroborated this conclusion. Requirements made since the last inspection report which have been met: When completed Page 14
Requirements which remain outstanding: (previous outstanding requirements) Original timescale for completion New requirements from this inspection: Timescale for completion Good practice recommendations: Page 15
The environment Inspector`s findings: Caewal Road is a two storey converted residential property, situated on the junction of a main road in a suburb of Cardiff. It is close to the town centre and to all local community facilities including shops, pubs, leisure centre and parks. Noise of nearby traffic is dampened through double glazing throughout the home and no service users found that traffic noise disturbed them. The home has a small amount of car parking space to the front of the home and a large garden area to the rear. Service users have full use of a greenhouse for growing plants and vegetables in addition to a pleasant lawned area overlooked by a patio. Service users told the inspector that they liked to use the garden when it was warm. Caewal Road has several communal areas, including two lounge areas, a dining room and a conservatory area. One of the small lounges is equipped with soft lighting and music, foot spa and aromatherapy and is used for therapy sessions. In addition to the five bedrooms the home has a self contained flat where independent living skills can be developed. Three service users showed the inspector their bedrooms. They were found to be decorated and furnished according to personal taste. Each service user indicated that they liked their room and viewed it as their personal space. Notices on bedroom doors reminded staff to knock prior to entering which service users confirmed they did. All service users who responded to a questionnaire stated they had a key to their room if they wanted one. Separate facilities are available for staff, including a sleeping area. The home has two bathrooms and three toilets. This meets the national minimum standard for the number of people living there. The inspector found the bathroom and toilet areas to be in need of refurbishment, especially around the tiling which was found to be stained and in a bad state of repair. The manager informed the inspector that the home is undertaking an improvement programme with the kitchen recently being refitted. However, issues relating to the bathrooms were highlighted in the last inspection report. At that time the inspector was assured that the matter would be addressed through the refurbishment programme and it is evident that this has not happened. This is not being made a requirement as the remainder of the home was in a very good state of repair, well decorated and furnished. However, the bathrooms do not look appealing for service users to use and it is strongly recommended that this area now be given priority within the refurbishment programme. Caewal Road has a separate utility room where service users are supported to do their own laundry. This was observed to be clean and all chemical cleaners were securely locked away. The home was observed to be free from trip hazards. Radiators were covered and water sources regulated to ensure service users are not at risk of being scalded. Individual evacuation plans are in place for service users who find it difficult to react in an emergency. All fire safety equipment has been regularly maintained. Two service users have undertaken training in fire safety and take responsibility for ensuring equipment is in working order. One service user showed the inspector where each of the fire exits in the home were located. Page 16
Requirements made since the last inspection report which have been met: When completed Requirements which remain outstanding: (previous outstanding requirements) Original timescale for completion New requirements from this inspection: Timescale for completion Good practice recommendations: Page 17
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 selfassessment, 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 have been required to take in order to remedy a breach of the regulations. The regulated service is also responsible for having in place a clear, effective and fair complaints procedure which promotes local resolution between the parties in a swift and satisfactory manner, wherever possible. The annual inspection report will include a summary of the numbers of complaints dealt with locally and their outcome. Page 18
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 Page 19
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