Beechlea
Contract Monitoring Report
- Name of Provider: Beechlea (Abbey Ambitions), Markham, Blackwood
- Date of Visit: 26 July 2023 (Announced)
- Visiting Officers: Caroline Roberts, Contract Monitoring Officer
- Present: Wendy Gloster, Home Manager, Terry Wells, Senior Carer
Background
Beechlea is a residential home for individuals with learning disabilities, which is owned by Abbey Ambitions, they are a registered provider within the Caerphilly borough. Wendy Gloster is the registered manager for Beechlea, along with the sister home, which is also within the Caerphilly borough. Sam Gloster is the Responsible Individual for both properties.
Beechlea is situated in a residential street in Markham and is a good-sized property. The home is registered with the Care Inspectorate Wales (CIW) and the registration covers four adults over the age of 18 years. The registration also permits one older person with a learning disability and mental health needs. At the time of the visit there were four residents, all of which are funded by Caerphilly CBC.
CIW last inspected Beechlea in September 2021. During the inspection, no areas of non-compliance were identified. However, one recommendation was made by the visiting inspector, which was for the provider to ensure that all relevant pre- employment checks are completed before staff start working at the service Reg. 35 (2) (d).
The Directorate of Social Services have received no complaints in relation to Beechlea in the last 12 months. In the last year, 2 safeguarding referrals were received and both progressed via the All Wales Safeguarding process and via Social Care Wales.
During the visits to the property, the Monitoring Officer met with the Manager, and the Senior Support Worker. The Monitoring Officer also met all four residents.
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), and developmental actions are good practice recommendations.
Previous Recommendations
Corrective
For all staff to be up-to-date on mandatory training (RISCA Reg. 36) Partially met.
For staff files to hold all appropriate documentation (RISCA Reg. 35) Met
Evidence should be included to demonstrate that when reviews are undertaken, the reviewing officer has held discussions with the individual and/or representatives, taken feedback from the daily records and also conversations held with the allocated social worker. (RISCA Reg 16) Not met
A pre-assessment to be completed for any new potential placement. (RISCA Reg. 18) – no new placements since the last monitoring visit in 2022.
Developmental actions
For client files to hold life history details.
Files to evidence consent to contact family in the event of an emergency.
To continue having conversations in respect of DNACPR.
Findings
Documentation
The current make-up of Beechlea is four residents, all of whom are Caerphilly Borough residents. Whilst viewing the documentation, two files were viewed and verified as being Caerphilly placements.
All documentation was observed as being stored securely within the office and in a lockable cabinet.
Pre-Admission assessments were not observed on either file observed; however, it must be noted that the individuals have resided in Beechlea for a number of years and appropriate archiving had taken place.
Appropriate Risk Assessments were observed for individuals i.e., swimming, bathing, medication going to family, infra-red sensor equipment, transport/travel to name a few. Each file held Risk Assessments pertinent to the individual.
Daily records were viewed and were observed to be person centred, detailing what activities were being undertaken, what assistance was provided, how independence is promoted i.e., not going out in the rain as not liked, visiting parent, sleep routine, seizures, mood etc.
Records indicated that staff at Beechlea make appropriate contact with outside agencies in order to support the residents i.e., Audiology, Epilepsy Reviews, Opticians etc.
Reviews were observed to be undertaken in a timely manner; however, they did not evidence that the reviewing officer had held discussions with the individual and/ or representatives, taken feedback from the daily records and also conversations held with the allocated social worker (if one appointed). This was raised during the previous monitoring visit and has yet to be implemented/evidenced.
No clear goals/aims were observed within the documentation viewed. However, during observation, it was positive to note that residents at the home are encouraged to be independent in tasks they can undertake safely and with appropriate support from staff. Residents were given choices in food and what they wanted to do, where they wanted to go.
Appropriate contact details were in place for family members and the home evidenced positive relationships with family members involved in the care and support of individuals.
Should an individual be cared for in bed, support workers are expected to offer activities such as reading, hand massages, conversation etc. At the time of the visit, no resident was being cared for in bed and all residents were sat in the lounge area during the visit.
One file held basic background information on an individual, but all files would benefit from a brief background account at the front of all files. This will aid new starters and/or agency staff who do not know the individuals.
Whilst viewing the documentation the monitoring officer noted there was no evidence of ‘Do Not Attempt Cardiac Pulmonary Resuscitation’ (DNAPCR). This is a sensitive matter to discuss; however, reason for not discussing should be recorded i.e. no n.o.k. and would not understand etc.
Activities
All staff have responsibility for supporting individuals with activities.
All residents are encouraged to go out at least once daily, to the local shops or out for a walk. However, individual choice is given, and two male residents were keen to discuss an air show that they were planning to attend over the coming week.
Birthday celebrations were discussed and discussions about going out for a meal to celebrate were also held, with residents looking forward to going out.
Some of the residents enjoy swimming and meeting with family members.
The residents enjoy holidays and going out to various shows etc.
Health and Safety
No trends regarding incidents/accidents have occurred over the last month.
The last fire assessment was undertaken on 29 April 2023, with no recommendations noted.
Regular fire drills are held and recorded, with no issues identified.
Mobility Aids and Equipment
A Bath Master is in place, and this is serviced once a year. There is also a hoist at the property and is generally used when individuals are not feeling well.
One individual uses a wheelchair when accessing the community and it is serviced by an outside company and it is the RI who ensures a service is undertaken.
Medication
Medication is stored correctly in a lockable cabinet and any controlled drugs are doubled locked. The home undertakes a monthly audit of the medication and at the time of the monitoring visit, no individual was receiving covert medication.
Controlled drugs are doubled signed; all other medication requires one signature only.
Managing residents’ money
The Senior advised that the money that goes in and out of the home, requires 2 staff members’ signatures, this was verified by the visiting officer.
The Home Environment
The home is spacious and welcoming. It comprises of a good-sized kitchen with a large sized utility room. All worktops within the kitchen area have been re-covered to a high standard.
The lounge area is an open, inviting space that consists of a sofa, a dining table and T.V. with photographs of the residents on display throughout. There are doors that open out onto a spacious garden area, which has a decking area.
Each resident has their own bedroom and are decorated to the individual’s personal taste. The rooms consist of personal belongings such as family photographs, collectable and ornaments; therefore, providing a personal area for the individuals to relax in.
The visiting officer was informed that no resident smokes; however, staff are permitted to smoke in the garden area only.
Nutrition
The home was inspected by an Environmental Health Officer in respect of food hygiene and safety on 20th June 2023 and rated as ‘5’ – Very Good.
There is a pre-set menu that the staff and residents create; however, this is open to change depending on the residents wishes.
On the day of the visit and prior to lunch, the Home Manager was observed asking each resident what type of potato they would like with their lunch and then later asking if one resident would assist her with the meal prep. This they were happy to do.
The residents were seen to enjoy a cooked lunch consisting of gammon, vegetables and cooked potatoes of their choice (some had baked, some chose roasted etc.)
Residents enjoy a healthy and well-balanced diet with fruit available and vegetables incorporated into the meals.
When asked if the residents enjoy assisting staff with meal preparation, the visiting officer was advised that some may assist (as observed). However, both staff and the manager advised that the residents have become more independent by returning used dishes to the kitchen and again this was observed during the monitoring process.
Quality Assurance
Abbey Ambitions usually use surveys to gather feedback, and these are shared with the residents, staff, managers and stakeholders. However, returns are remained low in number. Mrs Gloster advised that this was an area that had also been discussed with a Care Inspectorate for Wales inspector. Mrs Gloster and the Monitoring Officer, discussed possible telephone feedback and Mrs Gloster was happy to consider this suggestion.
The Monitoring Officer viewed the latest Quality Report, February to May 2023 within which, the RI covers a wide range of areas during his visit. The report is detailed and observed to be thorough.
Staffing
Abbey Ambitions continue to utilise the use of agency staff. The provider continues to strive and encourage new employees; however, this is still proving to be difficult.
The monitoring officer observed the training matrix, and it was identified that some members of staff require refresher courses in respect of mandatory training. The Manager advised that there is difficulty in sourcing a provider for one area of training; however, they will continue to seek a trainer in the specified area. The Monitoring Officer will seek further information on this area within 3 months’ time from the report.
Whilst viewing the supervision matrix, gaps were observed. This was discussed with the Home Manager, who confirmed that they were behind on supervision. Whilst the Home Manager and the RI are regularly at the property, therefore, in regular contact with staff/residents, it is important that staff are given the opportunity to have at least 3 monthly formal supervision sessions.
Whilst viewing two support worker files, it was noted that some documentation was not retained i.e. job description, signed contract of employment, birth certificate.
Mandatory training certificates were observed and, also Social Care Wales certificates.
Staff Question
During the visit, the Monitoring Officer had opportunity to speak with the Senior Support Worker and to ask some questions about how the home is run and if they had any concerns.
The Senior was knowledgeable about the individuals they support and was observed to interact well.
Previously, the monitoring officer was informed that mornings are the busiest time of day but once all individuals are supported and medication provided, the home is relaxed and that is when staff feel they can sit and engage in conversation with the residents, go out into the community or to go and sit in the garden if the residents wish to do so. This was observed during this monitoring visit.
I asked the Senior to provide me with information on one of the residents whose file I had viewed. The staff member was able to provide detailed information, with the individuals likes/dislikes. It was evident that the Senior knew the individual well and was able to provide the appropriate support.
Both the Home Manager and the RI spend a lot of time at the property and have a good working relationship with their staff team. The Senior advised that both managers are prepared to hear any suggestions staff may have and they will implement the ideas if they assist or improve the resident’s daily living.
The Support Worker advised that should they witness poor practice; they would intervene, try to resolve matters and report back to the manager.
All staff members are able to identify their own training needs and can discuss matters with the manager. Recently, staff have requested to attend BSL training.
The Senior had no issues to report and appeared to have a good working relationship with the staff team and the residents.
Residents Questions
During the visits, the visiting officer spent some time speaking with four of the residents.
On arrival at the property, handover was taking place between the senior and night worker; therefore, the monitoring Officer, spent time with three residents at the breakfast table.
All three were observed to be appropriately dressed for the weather and were happy to chat and exchange their knowledge on the female football matches taking place. The two male residents were very keen to discuss an air show that has been arranged by the Senior Support Worker and also the birthday celebrations that were going to take place that weekend.
Two individuals, out of the three, advised they were happy at Beechlea and all three were observed to have positive interaction with the staff member on shift.
Later in the morning, the fourth resident joined the others in the lounge area and whilst communication is limited with two of the residents, it was lovely to hear the laughter coming from the lounge area, when family members visited.
One resident was happy to show the visiting officer their room. A conversation was held in respect of the family photos on display. The room was observed to be clean, tidy and well maintained. The individual requested the Monitoring Officer to close their window as they felt their room was cold.
At the time of the visit there were no health concerns.
General
The home continues to have a lovely warm atmosphere, and it was evident that the residents had a good relationship with each other and the staff team. Laughter and communication were observed between staff and the residents, evidencing a relaxed atmosphere, with family visits encouraged and enjoyed.
The main areas of the home were found to be clean and welcoming and whilst being invited into one of the bedrooms, it was evident that the residents decorate and fill their rooms to meet their own personal taste.
Corrective and Developmental Actions
Corrective
For supervision to be undertaken in a timely manner. (RISCA Reg. 36)
Staff to document if residents / representatives are unable or unwilling to sign/take part in a personal plan development. (RISCA Reg. 15)
For mandatory training to be undertaken and for the Home Manager to continue to source appropriate training regarding First Aid – CMO will follow up in 3 month’s time. (RISCA Reg. 36)
For goals/outcomes to be clearly outlined (RISCA Reg. 15)
For all appropriate staff documentation to be retained on file. (RISCA Reg. 59)
Developmental actions
For the staff to retain only relevant and pertinent information on file and to archive data no longer required.
Do develop a brief background/pen picture of the residents and place at the front of each file.
Conclusion
The monitoring visit was positive, and it was pleasing to observe family visits and again observe the engagement between the staff team, residents and visiting family members.
Routine monitoring will continue at Beechlea, and the monitoring officer would like to thank all involved for their time, the information shared, and the hospitality shown during the visit.
- Author: Caroline Roberts
- Designation: Contract Monitoring Officer
- Date: 7th August 2023