Medhurst Care Home

1 Cromwell Road, Crosskeys, NP11 7AF.
Tel: 01495 270385
Email: medhurst4care@gmail.com

Contract Monitoring Report

Name/Address of Provider: Medhurst residential home,  1 Cromwell Road, Crosskeys, Newport, NP11 7AF
Date of Visit: Wednesday 13 September 2023
Visiting Officer(s): Amelia Tyler: contract monitoring officer
Present: Pauline Docherty: responsible individual, Medhurst. Helen Havard: home manager, Medhurst

Background

Medhurst is a two-storey residential home located in Crosskeys and is registered to provide care for up to 25 residents (including up to 9 residents with dementia). There are 27 rooms, one if which is a double. The home has been owned and managed by Pauline Docherty for several years and is a well-established home.  Helen Havard took over the role of manager in September 2021 and Pauline remains the named responsible individual.

Two announced visits took place on 13 and 20 September 2023 and at this time there were eighteen residents who had been supported to move by their local authority, seven were funding their own care.

The purpose of the visit was to work through the monitoring template, review the previous recommendations and speak to residents, staff members and relatives to gain their views of the service.

The previous monitoring visit had been completed on the 18 August 2022, and at this time there were eleven actions identified (five corrective and six developmental). These were reviewed and the findings outlined in the section below.

Depending on the findings within this report, the manager will be given corrective and developmental actions to complete.  Corrective actions are tasks which must be completed (as governed by legislation etc.) and developmental actions are those deemed to be good practice.

Previous Recommendations

Service providers maintain a written record of all training undertaken or to be undertaken by staff.  RISCA version 2 (April 2019) regulation 36
Met.  The contract monitoring officer was given a copy of the training matrix and it was noted that two members of staff have a level 5 qualification, one has level 4, seven have level 3, and 5 have a level 2 qualification.  It was also explained that there are also an additional four members of staff starting their level 2 qualification.
 
All staff to attend appropriate training around communication to ensure they can understand and be understood by residents.  RISCA version 2 (April 2019) regulation 24
Partially met.  It was acknowledged that communication had been added to the training matrix and 11 members of care staff had completed this course, however, there were still gaps where staff members still needed to attend.
 
The statement of purpose to clearly record the date of review and due of next planned review. RISCA version 2 (April 2019) regulation 7
Not met.  It was stated that the review date to be recorded on the document and the date of the next review.  The responsible individual explained this had been carried out in June 2023 to add the name of the new deputy manager, but this had not been recorded.
 
All staff to have formal supervision session with a senior member of staff at least every 3 months.  RISCA version 2 (April 2019) regulation 36
Partially met.  There were gaps in the supervision matrix provided and it was highlighted that this had been caused by staff sickness and outbreaks of Covid.  It was noted hat prior to this, supervisions had been completed every other month.
 
Annual appraisals to be completed for all employees at the home.  RISCA version 2 (April 2019) regulation 36
Met.  It was documented that all staff had had their annual appraisal, with the exception of the manager (who had had to take unplanned sick leave) and another member of staff who had returned from long term sickness.

Developmental actions

All minutes of any meeting should clearly record who chaired the meeting and who attended.

Partially met.  Minutes were seen of staff team meetings from 02.05.23, 07.06.23, 14.06.23 and 16.06.23 and it was observed that the minutes did not record who the chair was.

Handover records should be clearly timed, dated and record who was in attendance.

Met.  Records were seen of handover meetings which provided a brief outline of any issues and had been signed by all staff present.

The manager to consider how appraisals and supervisions are recorded to shows the previous 4 supervisions and last appraisal so it can easily be evidenced that these are compliant with regulations.

Met.  The manager had considered the recording of the appraisals and supervisions.  The appraisal record provided the date due, when completed and when to be repeated.  The manager and responsible individual said the date to be obtained is carried forward from the previous year, and this was working well for them.

Consideration to be given to how the training matrix can be amended to clearly demonstrate when the most recent training and refresher courses were attended.

Not met.  The contract monitoring officer explained again, how it would be beneficial to have a spreadsheet that captured this information to provide a quick overview of what staff have attended which course, and which staff need to attend refresher sessions.

To ensure accuracy, the supervision and training matrix to record the actual date this was completed.

Met.  Full dates were seen on the matrices.

The manager to complete risk assessments for any residents with diabetes, intolerances, or allergies.        

Met.  The contract monitoring officer saw evidence of allergies and diabetes being appropriately recorded.  There were risk assessments in place to inform new starters and catering staff of their dietary requirements.

Findings from Visit

Responsible individual

Copies of the quarterly reports completed by the responsible individual in January, March and June 2023 were provided.  It was noted that these reports provided information around engagement, activities, menus, staffing and the environment.

The statement of purpose was up to date and had been amended to reflect a change in the number of carers, kitchen staff and the new deputy manager. It is reviewed at least annually.  As previously mentioned, the document just needs to highlight the date of review and the next planned date.

It was explained that the home manager, responsible individual, and deputy manager all carry out the mandatory administrative work between them. If two of them were unexpectantly absent at the same time, they would notify the Care Inspectorate Wales and the commissioning team, and the remaining senior member of staff would cover in the short term.  The contract monitoring officer was told that the registered manager is very involved with the service and is always at the end of the phone to give advice and support.

All the policies and procedures including safeguarding, infection control, staff development, disciplinary, medication, complaints etc. were present and it was acknowledged these had all been reviewed within the past 12 months and there were recorded dates on the document to prompt the next review within the year to ensure they are still compliant with current regulations.

Registered manager

It was stated that there was no CCTV at the property and there were no concerns in relation to the fabric of the home i.e., no issues with the boiler, stair lift or sluice room.

The contract monitoring officer was informed that people can control the temperature in their rooms as they have access to the thermostat and the windows can be opened (although it was noted they are fitted with the necessary restrictors).

At the time of the visit, the manager said there were no outstanding regulation 60 notifications.

The registered manager doesn’t oversee any other services and it was explained that the visits carried out by the responsible individual are not planned as they are very involved with the service and are at the home regularly.  The manager informed the contract monitoring officer that they felt supported by the responsible individual.

There was evidence of referrals being made to relevant professionals to SALT in July and occupational health in September.

Although referrals had been made to the deprivation of liberty team, it was stated that they were very slow in the assessments being carried out.

Desk-top audit

There was evidence of mandatory training such as manual handling, food hygiene, safeguarding, infection control and medication.  There was not an overall matrix in place to be able to see briefly who had attended which sessions.  It was noted that this was completed following the visit.

The contract monitoring officer stated that as there were no job roles on the matrix, and it wasn’t indicated where training was not required, it appeared that there were more gaps than there were. From the information provided, there were ten staff to complete manual handling training, twenty one to do infection control, twenty seven to do health and safety, thirty four to do food hygiene, twenty nine to do first aid, nine to do safeguarding, twenty four to do dementia and twenty eight to complete fire safety training.

Once the matrix was forwarded, it was noted that the training for those that had completed was being refreshed regularly to ensure it was aligned to current legislation. Feedback is obtained from staff around the quality of training being provided during supervision and team meetings, and it was also acknowledged that the manager and deputy manager also attend these sessions.

Non mandatory training was evidenced around stroke awareness, catheter care, nutrition, sensory loss, bereavement, visual care, oral care, Falls (iStumble), and skin integrity.

Staffing and training

The manager stated there are 5 carers and 1 senior member of staff on shift between 06.45 – 19.00 and 2 carers a 1 senior member of staff between 19.00 – 06.45.

There is an activities co-ordinator at the home that work 27 hours a week and they try to be flexible in their working hours to meet the wishes of the residents rather than having a structured rota.

It was mentioned that the home has used agency staff when required.

The training is primarily interactive face-to-face sessions through the local authority and the local health board, such as diabetes and iStumble.  The home also uses an external trainer to provide mandatory courses although consideration is being given to senior staff completing train the trainer sessions to enable them to deliver training in-house.

No staff regularly work more that 48 hours a week, although it was explained that overtime is sometimes available if staff wish to work additional hours.

There was minimal evidence of the active offer being implemented although following the meeting, the deputy manager forwarded an initial assessment that documented that the resident had been asked about their preferred language and stated they wished to communicate in English. Due to the current legislation, the home must ask what language the individual wishes to communicate in.  It was acknowledged that at the time of the visit, there were no staff of residents that spoke Welsh.

Two staff files were viewed, and it was acknowledged that both contained two references (one being from most recent employer), application forms, interview records and conclusions, full employment histories, recent photographs, and DBS checks.

The contract monitoring officer was informed that the training certificates and inductions were held on a separate file.

Staff files did not contain copies of passports or birth certificates. If neither of these documents are available, it is recommended that a written statement is held on file with a date and signatures from the employee and the manager.

Following the visit, a copy of the training matrix that had been developed on a spreadsheet was shared with the contract monitoring officer that provided clear and accurate information that could be updated easily and allows the manager to identify any gaps in training.

Supervision and appraisal

The home aims to complete staff supervisions every other month, which is more frequent than the legislative requirement.  It was noted on the matrix that the manager had not attended a supervision so far in 2023 (although it was noted that the manager works closely with the responsible individual on an on-going basis).  No supervisions had been held during August or September at the time the visit was conducted. 

As there were four members of staff on long term sick it had not been possible to complete these.  There was a new starter on the matrix that had commenced employment in June that had not yet had a supervision session as they would only have completed their induction shortly before the monitoring visit.  All other members of staff had been part of a supervision meeting within the required three months. 

It was explained that supervisions are formal 1:1 confidential sessions that are documented.  The template was seen that covered the different topics that are to be covered, but there was not much evidence of a two way conversation i.e. if there were any difficulties supporting any of the residents, any support needs (including NVQ work being completed) any personal issues the home manager may need to be aware of, any issues around the staff team etc.

A copy of the appraisal matrix was provided, and this evidenced that one member of staff was overdue for their appraisal, but this had to be postponed due to illness. The manager had not yet completed their appraisal and there were an additional two members of staff that were overdue in addition to the people that were on long term sick.

File and documentation audit

Two resident files were looked at as part of the monitoring visit: It was noted that both files contained initial assessment forms, although the form on one file was not clearly labelled.  It is recommended that the manager ensures all future assessments are clearly headed.

Personal plans seen were personalised and person-centred and contained important detail.

It was observed that the plans around nutrition would benefit from additional information.  The plan did not state whether the overall objective should be to lose, gain or maintain weight, whether they had a good, balanced diet, what their appetite was like e.g. do they prefer to eat little and often?  There was also minimal detail around any preferences or foods they didn’t like and there was no evidence that the resident had been involved in completing the personal plan.

As mentioned earlier in the report, referrals were being made to external agencies when appropriate and this was reflected in the files seen.  The contract monitoring officer noted that a SALT appointment had been made for 21st June, and to audiology on the 23rd May, however there were no updates or outcomes recorded.

There were no agreements of file around notifying relatives of any incidents.  Due to confidentiality and difficult relationships within families, the manager must seek the views of the residents and (if appropriate) the relatives to gain written clarification over what action would be taken in different scenarios.

It was acknowledged that the manager, responsible individual and the members of staff spoken to have a thorough knowledge and understanding of the preferences, needs and wishes of the people living at Medhurst, however, this wasn’t always reflected in the detail on file.  There were no life histories on file, or detail around where they worked or what they like doing.  The contract monitoring officer was shown two 1 page profiles which contained some really good, detailed, personalised information around what is important to the person. It was requested that these be emailed across but hadn’t been received at the time of completing this report.

There were no activities being carried out and minimal stimulation during the visits apart from occasional visits from relatives.  The contract monitoring officer was told there had been a summer BBQ, a ‘tickled pink’ party outside in the garden and an Elvis tribute (8th September) and an Abba tribute (31st August).  Following the meeting, some lovely photos were shared with the contract monitoring officer of residents enjoying singing and dancing with an entertainer and there appeared to be lots of smiling and laughter.

Quality assurance

It was noted that the responsible individual completes annual QA reports and monthly reports providing an overview of the service.  It was acknowledged that there were 3 compliments in the book, however, these were undated so it would be impossible to know which regulation 73 report this should be included in.  A copy of a long email from a family member who had lost their father who had lived at Medhurst was seen and was very complementary about the care provided and how kind staff were.  Again, this was not dated and would be difficult to incorporate into the correct monitoring period.

There was one concern recorded around there being too many sandwiches on the evening ‘supper’ menu, and this had been appropriately addressed and more variety was now being offered.

It was explained that there were no formal minutes or meetings held for relatives or residents because of lack of attendance and it wasn’t felt that this was the best way to gain feedback from stakeholders about the strengths of the service and where possible improvements could be made.  The manager and responsible individual felt more informal gathering such as BBQ’s, fetes, coffee mornings etc were more meaningful. It is recommended that some record needs to be made of the conversations and comments made during these events to evidence collaboration for the regulation 73 reports.

Handover meetings are attended by all staff for 15minutes at the start and end of every shift.  Meetings are held in the dining room so that staff can still go and assist residents if needed. The handovers go through each resident on an individual basis to provide updates on any issues during the shift.  Any additional information is dealt with by the senior staff members through the communication book.

The contract monitoring officer was told there had been one accident in the past month, on the 2nd September.  Although the accident report was looked for, it wasn’t located during the visit and hasn’t been shared.  All members of staff are to be mindful to complete accident report in full, action and escalate with the relevant parties as necessary and record the outcome on file. 

There was evidence of fire drills being carried out regularly, with the most recent ones being 24.04.23, 29.06.23, 24.07.23 and 11.09.23.  It was noted that the times were recorded, attendees and the outcome i.e. if any actions are required.

Staff questionnaire

Two members of staff were spoken to during the visit to obtain their feedback and both demonstrated an understanding of reassuring residents if they become upset and how to support their emotional needs.  It was emphasised that this varies for each individual and different methods can be used to suit each resident.

Both members of staff explained that they have not been taking residents out in the community as often as they did before the Covid pandemic, however, if the staffing levels allow, they will take them out locally.  One staff member said that most residents don’t wish to go out very often and some are taken out by family members.  The contract monitoring officer was made aware that there are 4 or 5 residents that often attend a Church service on a Sunday.

It was emphasised that both staff members felt able to be flexible in their roles and have chance to chat with residents.  One said that they often have a good laugh together. It was noted that staff feel comfortable in sharing some details about themselves and details such as past holidays, where they went to school, what they did over the weekend etc and one also said that some staff will bring their dogs in as the residents enjoy seeing them.

The contract monitoring officer asked what they would do if they witnessed poor practice or something they felt could be a safeguarding issue, and they both said they would be confident in challenging the individual and report to the manager and escalate appropriately.  They also said the manager is supportive and approachable and always there if needed.

Resident questionnaire

The contract monitoring officer spoke to two residents during the visits and both said they were happy living at Medhurst, and one said they ‘love it here’. One explained they felt safer living there as they were having frequent falls when living alone and would feel vulnerable without their Zimmer frame.  They were supported to maximise their independence and enjoyed setting the placemats before meals and cleaning the tables.

Both residents enjoyed the food and one explained they had gained weight since living at the home.  One said their favourite meal was eggs, chips, and beans and the other mentioned they would like for more fruit to be made available.

It was stated that staff are very kind and careful when providing care. They said they were able to have a laugh and felt supported to do the things they want.

There was nothing they could think of that would improve the service, apart from one highlighting that they wished they were able to live on their own with some domiciliary support but acknowledged that they understood why this wasn’t possible due to the level of care needed.

Relative questionnaire

One relative spoke to the contract monitoring officer and said they were always made to feel welcome at the home and are always offered a drink when visiting.  They described the atmosphere and friendly and caring.

It was mentioned their mother had lived at Medhurst for nearly a year and felt comfortable in asking questions or raising any concerns if needed.  They said they felt confident that any issues would be addressed if raised.   It was noted that they felt able to be involved in any events or activities at the home.

The relative said they were kept up to date in relation to any hospital appointments, falls, or changes to their mother’s health.  They said there was good communication with the home.

The only thing they said they would change about the home is the décor and fabric due to the age of the building and it would be nice for her mother to have an en-suite bathroom, but noted they knew this wasn’t possible when they first viewed the home.

Discussion was held around how successful the home has been in providing a good quality of life for their relative and they said that staff had been very successful as her mother had been lonely and isolated when living alone.  They felt staff had gone out of their way to make the resident feel at home and explained that when a room had become available downstairs to allow greater freedom, they were consulted and shown the room before making the decision.

General observations

It was noted that all the slings and hoists were being serviced during the visit on the 20th September.  This did not disrupt the home environment and the home was calm throughout both visits.  The buzzer was not heard to be sounding for long periods of time, and good interaction was observed between staff and residents.

Mealtimes were observed to be sociable, and the quality of food was good, and residents said they were enjoying their meals.  It was noted that there did not appear to be a choice of dessert, however, all residents seemed to enjoy the cherry trifle that was offered. There was good interaction with staff that were supporting some of the residents with their food.

Corrective / Developmental Actions

Corrective

All staff to attend appropriate training around communication difficulties to ensure they can understand and be understood by residents.  RISCA version 2 (April 2019) regulation 24

The statement of purpose to clearly record the date of review and due of next planned review. RISCA version 2 (April 2019) regulation 7

All staff to have formal supervision session with a senior member of staff at least every 3 months.  RISCA version 2 (April 2019) regulation 36

Each member of staff to complete annual appraisal. RISCA version 2 (April 2019) regulation 36

Records of supervisions to contain more meaningful detail to help them reflect on their practice and to make sure their professional competence is maintained. This includes feedback about their performance from individuals using the service.  RISCA version 2 (April 2019) regulation 36

The home must be able to evidence that they are actively working towards offering a service in Welsh language.  RISCA version 2 (April 2019) regulation 24

Contracts of employment to be in place for every member of staff.  Caerphilly CBC contract agreement 2018, cause 22.6

All residents should have a written agreement in place with relatives (where appropriate) around what action should be taken for difference incidents.  RISCA version 2 (April 2019) regulation 25

Personal plans should be written and reviewed in collaboration with the resident and other parties involved in their care and this to be evidenced on the document. Where this isn’t possible, a clear explanation to be recorded.  RISCA version 2 (April 2019) regulation 15

The responsible individual must ensure that there are effective systems in place to record any accidents and incidents. RISCA version 2 (April 2019) regulation 77

Developmental

All minutes of any meeting should clearly record who chaired the meeting and who attended.

It is recommended that if staff passports and/or birth certificates are not available, that a written statement is held on file and clearly signed and dated.

Personal plans around nutrition to provide more detailed information.

The manager to ensure fruit is available for those that want it.

Conclusion

The home was comfortable and welcoming, and the staff work hard to maximise independence and give their residents the best quality of life possible. The home has had numerous challenges throughout the pandemic and maintaining staffing levels but had worked together as a team to meet the needs of their residents.

There are still some areas for improvement as highlighted in the actions above but the contract monitoring officer is confident that the responsible individual and manager will implement these going forward.

 It was pleasing to not that from the previous 11 actions, 9 had either been met or partially met.

Unless it is deemed necessary to move it forward, the next monitoring visit will be carried out in approximately 12 months’ time.

The contract monitoring officer would like to thank everyone involved for their time, hospitality and assistance with completing the process.

Author: Amelia Tyler      
Designation: Contract monitoring officer
Date: 18 October 2023