Hill view care home, aberbargoed - contract monitoring report
Name Of Provider: Hill View Care Home, Aberbargoed
Date(s) of Visit: Thursday 2 March, 2023, 12 noon – 4.00 p.m / Wednesday 5 April, 2023, 11.30 a.m. – 2.45 p.m.
Visiting Officer: Andrea Crahart, Contract Monitoring Officer, Caerphilly Commissioning Team
Present: Sarah Roach, Registered Manager
Background
Hill View Care Home is situated in Aberbargoed and is close to local amenities (shops, schools, church etc.). The home is able to provide care and support to 34 people who have dementia residential needs and at the time of the visit the home had 6 bed vacancies.
The home is large and split on 3 levels. People are carefully matched to live on floors at a similar point in their experience of living with a dementia, in order to reduce any stress experienced and encourage a sense of well being.
The Manager is registered with Social Care Wales (workforce regulatory body).
The manager of the home regularly communicates any issues to the Caerphilly Commissioning Team in terms of any concerns (including safeguarding concerns, infectious outbreaks, concerns with residents, the building etc.) and informs the Care Inspectorate Wales (CIW) also.
The CIW (Care Inspectorate Wales) undertook an inspection in November 2019 which at the time had made reference to a number of areas for improvement and there were recommendations to meet legal requirements. Contract monitoring visits from Caerphilly Commissioning Team had also taken place in August/September 2019 and May 2022.
Dependent on the findings within the report, corrective and developmental actions will be given to the provider to complete. Corrective actions are those that must be completed (as governed by legislation); developmental actions are good practice recommendations.
Previous monitoring visit
Corrective actions
Quality Assurance (Quality of Care Review) to include further analysis of the Home (e.g. lessons learnt, outcomes of inspection reports etc.) Timescale: Immediately and ongoing. (RISCA Reg. 80). To be monitored further. (Action from visit in 2019)
Developmental
Personal Care checklist to be developed to include space for carers to record when oral care is being undertaken more than once a day. Alternatively, ABuHB Oral Care Monitoring forms to be used to capture this information. Timescale: Within 2 months. To be checked.
Records to be maintained of each shower head that has been cleaned within the Home so that it is easily identifiable which have been cleaned. Timescale: Within 2 months and ongoing. To be checked.
Responsible individual
The Responsible Individual (RI) continues to provide good support to the Registered Manager/ staff team and has an oversight of the service and its quality on an ongoing basis.
The Home’s Statement of Purpose had been revised in March 2023 and provides a comprehensive overview of what the care home delivers.
The monitoring officer did not have sight of the home’s Service User’s Guide as part of the monitoring process.
If the RI and Registered Manager are unavailable to manage the service, the contingency plan would be for the Deputy Manager to cover in their absence.
The Home’s Policies and Procedures were requested and received from the manager. These included e.g. Safeguarding, complaints, medication, staff supervision/appraisal etc. The majority of policies had been updated in August 2022, therefore were current, however some were undated at the time of the visit.
Registered manager
The Care Home operates a CCTV system (surveillance system) which covers all communal areas (lounges, hallways) only. The manager has sought to gain consent from relatives through signed consent forms.
The temperature in individual bedrooms is able to be adjusted via the radiator thermostats to ensure that people do not become too warm or too cold. In addition, during times of hot weather electric fans and air conditioning units are used.
The manager continues to submit Regulation 60 notifications which are a mechanism to report incidences that have occurred e.g. outbreaks of infectious diseases, falls experienced etc., and these are submitted in a timely way to the relevant professionals e.g. Care Inspectorate Wales (CIW), Caerphilly Commissioning Team, Environmental Health, Public Health Wales etc.
The manager continues to forward Duty to Reports (DTR)’s to the Safeguarding Team when situations have arisen that require support/guidance and possibly further investigation concerning individual residents.
The home continue to receive good support from health professionals i.e. GP, Community Psychiatric Nurse and District Nursing Team, who ensure people’s health needs are met.
Training
Hill View Care Home provide a large range of training courses for staff to access. Training providers who are utilised to provide training include Langford’s, New Directions, Aneurin Bevan University Health Board, the Caerphilly Mental Health Team and Blaenau Gwent/Caerphilly Workforce Development Team.
The manager has a training matrix to record all the training being delivered which was produced in a way that was clear to understand. It was evident that many staff were up to date with mandatory/key training, such as manual handling, first aid/CPR/stroke awareness, dementia, safeguarding/deprivation of liberty safeguards/mental capacity act, health and safety/COSHH, falls training. However, there were some gaps in respect of infection control and food safety.
‘The Active Offer – More than Just Words’ (revised Welsh Language Act) requires providers of social care to provide communication in Welsh without the person asking for this. Hill View has taken the decision recently not to implement this at the present time, however would be willing to introduce it if they are able to recruit staff who can speak the language.
Staff have either achieved an NVQ/QCF Level 2, 3 or 5 in Health and Social Care or are in the process of working towards a qualification.
Staffing
There were plenty of staff on duty during the monitoring visits and staff were actively supporting people when they were having their lunch in the downstairs lounge. The carers were very friendly and showed patience and empathy at all times. The service continues to have difficulties in recruiting and retaining staff due to the shortages of carers in the care sector and any absences are covered by the existing staff team as far as possible, although agency staff are utilised when required.
Two staff member files were examined to determine if robust recruitment processes are in place. The staff files were very organised and included information such as a detailed application form, 2 references, interview records, a photograph of the staff member and identification. Only 1 Contract of Employment was present on the person’s file as the other is due to be negotiated with the person concerned. Disclosure and Barring Service (DBS) certificates are kept on a separate file and although 1 was present the other needed to be downloaded from the electronic system, however it had been processed and was present. Training certificates were present for some courses only and references had not been adequately verified with the referee.
A supervision matrix which was made available on the day of the visit confirmed that the vast majority of staff had received a supervision in January 2023. The matrix is set up so that these can be planned for in advance every three months, as per CIW regulations. The supervision proforma covers e.g. personal achievements since the previous session, challenges/difficulties experienced, learning and development, targets to be sent etc. The manager confirmed that appraisals would need to be a focus going forward.
File and documentation audit
The 2 files viewed included relevant documentation from Caerphilly Social Services e.g recent Integrated Assessments and Care & Support Plans, which would be used to inform the home’s Personal Plans (Care and Support Plans) for each area of need.
Two resident’s files were viewed which were orderly, and included an index, basic details about the person and a photograph of the person. A ‘This is me’ document was present which was very informative and provides staff with a very good understanding of the person, and would have assisted with populating their Personal Plans. (This document was produced by the Alzheimer’s Society and includes information such as, the person’s family background, important life events, people/places, preferences, routines and personality; the aim of which is to aid staff in supporting people to reduce any distress and meet their needs).
Personal Plans (Care and Support Plans) had been written in a detailed way and in a person centred manner to reflect the person’s needs and wishes. These had also been reviewed in recent weeks and typically provided information regarding how to best support the person in terms of e.g. their personal care, oral care needs, foot care, skin integrity, mobility/transfers, meals/drinks, wishes upon death etc.
Daily Records which are used to record the care and support given were detailed and had been signed/dated by the staff member.
The Professional visit log for one of the files indicated that the GP had been involved in the person’s care from their admission to the home, that the social worker had visited and the Mental Health Team were involved also.
Deprivation of Liberty Safeguarding (DoLs) documentation was available and up to date for the individuals in the home who required this information.
Quality assurance
There was evidence that the RI had undertaken quarterly visits to the home which had been documented. These included detail regarding key areas e.g. incidents/accidents, any complaints, direct feedback from a resident, family member and staff member. There was also reference to environmental improvements that had been undertaken, with some actions to take forward.
A recent staff meeting had been held in February 2023 and made reference to many areas that were discussed e.g. induction process, rotas, changes to residents needs etc. The manager also stated that meetings are recorded and made available via the home’s WhatsApp group so that staff can hear the meeting and be up to date with information if they were unable to be present.
The manager confirmed that residents and relative’s meeting would be re-starting in a few weeks time so that individuals have the opportunity to communicate anything their wish.
Six monthly quality assurance reports are required to be compiled by the RI and the most recent report was made available to view. This illustrated that many areas of the service had been analysed in detail, highlighting areas that are working well and identifying where improvements are required. It was also positive to see that residents and their families are consulted when improvements/changes are being considered.
Home maintenance
The RI employs a caretaker who undertakes regular checks throughout the home.
The contract monitoring officer was made aware that the Fire Service had recommended that new fire doors are fitted throughout the home, and agreement has been reached that these will be fitted on a phased approach. Other improvements to the environment have included new flooring to various bedrooms and a wet room has had a change of purpose to a dining room on the third floor.
Fire safety/health and safety
The home’s most recent Fire Risk Assessment was carried out in March 2023 by the Tower Fire Group. A number of areas were identified for rectifying/improvement which had been prioritised from priority 1 to 4. It was evident from the risk assessment that the home is acting upon the recommendations, with quotes having been requested for a number of areas identified, and some had already been completed.
Fire drills continue to be held on a regular monthly basis with good records being captured as to the detail of the drill e.g. the number of staff who have attended including a de-brief. The most recent fire drill took place in March, 2023.
Managing people’s money
The records for 2 people were viewed which showed that the person’s income and expenditure had been recorded. When funds were received and taken out there were always two signatures for these transactions, and receipts were in place for miscellaneous expenses that had been purchased for the person. The contract monitoring officer was informed that the home manages funds on behalf of all the residents.
Residents’/relatives’ feedback
A relative was spoken to during the visit who said that he had nothing but praise for the staff at Hillview. He said that he always feels welcome, he enjoys meals with his wife at the home and there is always some activity taking place.
Observations
Areas of the Home were clean, smelt very fresh and were tidy at the time of the monitoring visits.
The interaction between staff and people cared for was warm, friendly and people looked well cared for. The home has a dedicated hair salon which is a well equipped and pleasant space for people to have their hair and nails done.
There is an Events page that is made available each month for the benefit of residents, relatives/friends letting people know what is taking place in the home. This provides a clear overview of what is being held e.g. on the day of the visit (5 April) residents would be able to celebrate National Pizza day, and the page also included when people’s birthday’s were so that everyone is aware.
Visitors receive a very warm welcome when they visit the home and are invited to be part of the flow of the home e.g. to share meal times, to be part of activities that are being held etc. The lounge areas are very comfortable, with sofas and chairs for people to use and items of memorabilia to stimulate the senses and tactile items to touch. People’s bedrooms look very comfortable, they are personalised and are decorated and furnished to a high standard.
Links have been forged with the local church (which holds a weekly craft class) and the local primary/nursery schools. Since the Covid-19 pandemic many of these links needed to be put on hold, however the home is now able to re-start these relationships and residents are benefitting from the visitors that are able to visit the home again.
There is a small outside veranda area for people to use which has a seating area, and is decorated with gardening items.
Mealtime observations
The contract monitoring officer joined some of the residents while they ate their lunch time meal. People were supported where they needed this, but otherwise people were able to eat their meal in an unhurried manner and in a very pleasant environment. The meal on offer was delicious and the tables were laid with everything people would need e.g. condiments, place mats, cutlery, serviettes, drinks etc. There was also soft music playing in the background.
Actions
Corrective/developmental
Policies/Procedures which are currently un-dated to have a review date added plus a future date for review. Timescale: Within 1 month. (RISCA Regulation 12)
Staff references to always be verified with the referee (signed, dated and any relevant comments documented). Timescale: Immediately and ongoing. (RISCA Regulation 35)
Appraisals to be focussed upon for all staff. Timescale: Within a year. (RISCA Regulation 36)
Conclusion
Residents reside in an environment which provides the opportunity for people to thrive, as they are supported to be as independent as possible and receive care and support from staff who are trained and are patient and caring in their approach.
The environment continues to be stimulating and inviting, where lounge areas are comfortable and bright, individual bedrooms are personalised, hallways areas have items of interest on the walls and the salon is a very inviting space.
It was evident from the 2 resident’s files viewed that the documentation is very detailed and person centred in its approach and had been reviewed regularly. The staff files also illustrated that a robust recruitment process had been undertaken, with just 1 area noted for improvement.
The monitoring officer would like to thank the manager and staff team for their time and hospitality during the monitoring visit.
Author: Andrea Crahart
Designation: Contract Monitoring Officer, Commissioning Team
Date: March 2023