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Care and Social Services Inspectorate Wales
Care Standards Act 2000
Inspection Report
Blaenmarlais Care Home
Redstone Road
Narberth
SA67 7ES
Type of Inspection – Baseline
Date(s) of inspection – 23 January 2015
Date of publication – 16 March 2015
Welsh Government © Crown copyright 2015.
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Summary
About the service
Blaenmarlais Care Home is registered with Care and Social Services Inspectorate Wales
(CSSIW) to provide personal care to up to 24 people aged 65 and over, including one
named person with dementia/mental infirmity. It is a family run, large, detached home set
within its own grounds on the outskirts of Narberth, Pembrokeshire. The property is a
listed building so some restrictions to modifications would apply. The home is easily
accessible from main road routes and there is parking space available for visitors. The
registered provider of the home is Fred Barnfield and the registered manager is Gwladys
Barnfield.
What type of inspection was carried out?
This scheduled, annual inspection was carried out on 23 January 2015. It was an
unannounced, baseline inspection which explored four quality themes: quality of life,
quality of staffing, quality of leadership and management and quality of environment.
We (CSSIW) had a tour of the home and met many of the people living there. The Short
Observational Framework for Inspection (SOFI) tool was not used on this occasion as we
were able to gauge the experiences of people living in the home through discussions. We
also spoke with the registered manager, staff on duty and visiting relatives. We selected a
sample of care and staff records to examine, along with other relevant documentation,
such as the home’s welcome pack, maintenance records, finance records, staff training
matrix, accident/incident records and information obtained from internal audits. A
medication audit was also undertaken.
What does the service do well?
The home has a very organised system in place for managing and monitoring care and
staff records, making it easy to access the most up to date, important documentation
quickly. The home boasts a well organised staff training matrix that enables staff to
become equipped with a range of care skills and supports them to develop on a personal
and professional level.
What has improved since the last inspection?
There was one notification made following the previous inspection in September 2013.
We saw evidence that the following has since been addressed:
Medication records have been completed fully and correctly
In addition, a “Dementia Garden” has been created which, during the warmer seasons,
adds to the outdoor sensory stimulation offered by the home.
What needs to be done to improve the service?
On this occasion a non compliance notice has not been issued. However, we notified the
registered manager that they were not compliant with The Care Homes (Wales)
Regulations 2002 in relation to the following:
Regulation 13 (4) (c), as medicines had been dispensed and left unattended, posing
an unnecessary risk to the health and safety of the more vulnerable people living in
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Regulation 38 (1) (e), as not all events affecting the wellbeing or safety of people
living in the home had been reported to CSSIW
The following three recommendations were also made:
1) To provide further detail within people’s care plans with regards to providing and
maintaining their oral care and hygiene
2) To ensure that copies of identity documents are retained within staff records
3) To obtain feedback from stakeholders, as well as from people living in the home,
their representatives and staff, for the next Quality of Care Review
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Quality of life
People living in Blaenmarlais Care Home can be assured that they will be treated
respectfully and have choice and influence over how they are cared for. We observed
people to be appropriately dressed and comfortable, with their dignity being upheld
during interactions with staff. We spoke with one person who was enjoying reading a
newspaper in their bedroom, which was located close to the home’s lounge; we were
informed that they enjoyed hearing and watching activity as it unfolded nearby but
preferred the privacy and quiet of their own space. We saw that some people chose to
eat lunch in the home’s dining room whilst others had opted to have it presented to them
on a tray in their own rooms. Many people we spoke with commented that their choices
were supported and respected by staff. There was a detailed account of one person’s
work and life history within their care records and this had proved informative with
regards to topics discussed during individual activity sessions. Warmth was shown on
the day of the inspection as one person’s birthday was celebrated with a family meal,
followed by a round of “Happy Birthday” and the presentation of a birthday cake and gift.
A varied and nutritious four weekly rolling menu ensures that people living in the home
benefit from a healthy diet. We spoke with one of the home’s cooks who advised that all
meals were freshly prepared. The lunchtime meal smelt and looked appetising with
people’s specific dietary needs having been met, aided by a list displayed in the home’s
kitchen that outlined the meal preparation required for each individual. The cook was
able to identify people who required a low fat or diabetic diet and reported that there was
good communication from care staff regarding any changes in dietetic need. We were
informed that a range of hot and cold drinks are provided throughout the day in addition
to specific requests. There was clear attention to people’s level of nutrition and
hydration within care records and we saw that, in one instance, food and fluid monitoring
charts had been commenced where risks to an individual’s oral intake were particularly
compromised.
There was also evidence of health promotion as people were
encouraged to drink and monthly weight monitoring had taken place.
The home’s varied activity schedule supports people to remain active, positively
occupied and stimulated. Led by a designated activities coordinator, the programme
includes physical, mental and sensory based activities that show consideration to
people’s social and religious needs. These included: clay pot making, chair exercises,
flower arranging, Holy Communion and “Make a Group Story.” We observed an
interactive question and answer session that was held in the home’s lounge and
attended by a fairly large group of people. The session was delivered in a calm and
relaxed manner and group discussion and interaction was promoted. The care records
we examined contained social profiles and activities plans which outlined people’s
individual preferences and acknowledged any impacts on people’s desire and/or ability
to participate in activity sessions. One person’s activity plan acknowledged their
enjoyment of watching birds at their feeders and this was confirmed by the individual
whom we observed to be sat in their bedroom chair with a clear view from their window
of the bird feeder. We saw that individual level of participation was monitored with one
to one time being allocated to those preferring to spend time in their own rooms; such
activity included poetry readings and discussions about family life and local news.
People living in the home can be assured that they will experience appropriate,
responsive care from staff who have an up to date understanding of their individual
needs and preferences. We examined a sample of people’s care records and found
them to be consistently organised and easy to navigate, with clear evidence of monthly
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risk assessment and care plan reviews. There was evidence of people living in the
home, or their representatives, having had an input into the devising of the care plans,
and the information they contained demonstrated knowledge and understanding of
individual preferences and behaviours. We saw evidence of people having received
general practitioner (GP), chiropody and phlebotomy input and changes to people’s
needs were clearly identifiable through their monthly care plan reviews.
We
recommended, however, that further detail is added to care plans relating to providing
and maintaining oral care and hygiene as there was limited instruction for one person
who required frequent assistance. The registered manager confirmed that new
documentation is being developed in respect of this, having attended recent training in
oral care and identifying this as an area requiring improvement.
To ensure that people remain safe we notified the registered manager that unnecessary
risks to the health and safety of people living in the home must be eliminated. This is
because we observed medication having been dispensed and left unattended. Action to
rectify this was taken immediately.
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Quality of staffing
The home have designated staff for housekeeping, catering, laundering and
maintenance services which enables people to receive timely support from care staff.
The detailed, specific guidance within people’s care plans support staff in organising the
undertaking of essential tasks whilst allowing time for people to engage with staff. A
number of people we spoke with reported that staff responded promptly to call bells and
we observed staff to be relaxed in their approach to care delivery. People are cared for
by familiar staff as turnover is low with no new staff having commenced employment
within the previous 9 months. Staff we spoke with reported no issues with regards to
staffing levels and, although busy, felt that they managed to effectively meet people’s
needs.
The home’s extensive staff training matrix helps to ensure that people living in the home
are cared for by staff who are competent and confident in meeting their particular needs.
Each staff member has a dedicated training file which monitors their attendance at
training sessions and contains the certificates that they have been awarded with. A
commendable 28 training certificates had been awarded for one staff member who had
subsequently achieved “Carer of the Year” status. The registered manager informed us
that individual training records were closely monitored and we saw that an array of
certificates had been awarded in mandatory and specialist topics, such as end of life
care, confusion and dementia, essentials of food safety, use of portable fire
extinguishers and practical continence care. The registered manager informed us that
well over 50% of the staff team had achieved a care qualification recognised by the Care
Council for Wales (CCfW). We observed staff tending to people’s needs confidently and
it was apparent from discussions with people living in the home that staff were familiar
with their individual routines and preferences.
People living in the home can be assured that they are cared for by staff who have been
through appropriate recruitment checks and induction training. We saw that the requisite
Disclosure and Barring Service (DBS) checks had been carried out and could be
reviewed via an online database.
The staff records we examined contained
documentary evidence of the home’s interview and induction procedures, which we
found to be thorough. However, proof of identity was not available for some staff despite
having been viewed during the recruitment process. We recommended, therefore, that
copies of identity documents are retained within records for all staff, in line with
regulation. We saw that the home’s policies and procedures were covered during staff
induction with priorities being set to support learning at various stages. Staff records
contained certificates which demonstrated their completion of the Social Care Induction
Framework for Wales. One staff member we spoke with reported to have settled well
into the home and gained a lot of knowledge and experience since starting employment.
People living in the home can enjoy being cared for by motivated staff who are
appreciated and want to make a positive difference to people’s lives. The registered
manager informed us that the introduction of the “Carer of the Year” system had
provided some promotional opportunities for staff. The staff members we spoke with
were caring in attitude and demonstrated a desire to place the people living in the home
at the heart of any decision making. One staff member we spoke with was enthusiastic
about undertaking a nail care course that would enhance their role within the home and
offer an additional service to the people living there. The registered manager advised us
that annual staff appraisals had been brought forward in efforts to address and reiterate
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expectations in relation to good record keeping and acknowledging the limitations of own
competence. We saw that the home’s appraisal system gave staff the opportunity for
self reflection, followed by a meeting with the registered manager to discuss and assess
individual progress. The appraisal records we examined showed that individual training
needs had been identified along with particularly strong and particularly weak areas of
practice. We saw evidence of staff having received formal, individual supervision every
1-3 months. These sessions included observations of staff during care delivery and
praise for personal contributions and individual accomplishments. A staff member also
told us about the personal satisfaction they felt at having been supported by colleagues
in developing their English language skills.
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Quality of leadership and management
The registered provider and manager of the home live on site, thus people can be
confident in their visible accountability. We were informed that the manager provides
regular hands on care which had proven effective in establishing and appreciating the
individual needs of the people living in the home, and observing staff in practice. The
manager’s knowledge of people’s needs was evident from our observations and
discussions, and we saw that prompt action was taken to facilitate any individual
requests. Staff and people living in the home praised the management team,
commenting on their approachability and availability to offer guidance and support when
needed.
People living in the home can be assured that they will experience a consistent service
that is based upon quality improvement. We saw that recent audits had been
undertaken relating to numerous aspects of the home and service delivered, such as
care planning, psychological care, pain control, staff training and development, catering
and property management. The results of these had been compiled into an annual audit
summary and development plan that outlined areas for improvement. These included
updates to the home’s décor and staff training being organised in relation to total
dementia care. It also identified that financial audits and risk assessments would be
brought forward to ensure that all developments were based on a sound financial
platform. We were advised that the data collected from internal audits had been used to
inform the home’s annual Quality of Care Review, along with feedback obtained from
questionnaires that had been disseminated to people living in the home and their
relatives. We recommended, however, that the views of other stakeholders and staff are
also sought and used to inform the home’s next Quality of Care Review, in line with
regulation.
The rights of people living in the home are protected with regards to managing their own
finances. We were advised that key operated cash boxes were available for use within
people’s own rooms if they had been assessed as being able to manage their money
independently. A safe was available for storing people’s valuables although personal
monies were not held by the home. Overseen by the registered provider, we were
informed that most purchases were made by the home. Relatives were subsequently
invoiced for any expenditure and provided with the corresponding receipts.
Feedback obtained during the inspection suggests that people’s expectations about life
in the home are matched by their experiences. The home’s Statement of Purpose was
incorporated into the information pack supplied to prospective and existing residents. It
was sufficiently detailed and reflective of the service provided at the home. People living
in the home told us that they were satisfied with their care and visiting relatives
commented that they ranked the quality of the home as higher than any other they had
visited.
Overall, people living in the home can be confident that they will receive effective
support from a service which can fully meet their needs. The registered manager was
clear about the range of needs that could be met effectively by the home. There were
well ordered systems in place for monitoring people’s safety and maintaining good
quality documentation. We saw that registration and insurance certificates were
displayed and all visitors to the home were monitored by a signing in book. There were
clear records kept relating to any accidents or incidents that occurred in the home and
these had been monitored through an internal audit. However, we notified the registered
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manager that any event affecting the safety and wellbeing of people living in the home
must also be reported to CSSIW.
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Quality of environment
People can feel uplifted by the environment in which they live. The home has a warm
and welcoming atmosphere and the presence of bench seats, sideboards and vases of
flowers offered a homely touch to corridors and communal areas. There was a sense of
calm as staff and people living in the home carried out their usual routines. The home
sits within large grounds, in which a “Dementia Garden” has been created. We were
informed that this is full of perfume and colour in the warmer seasons for people living in
the home to enjoy. We observed the home’s gardens to be well kept, courtesy of a full
time gardener. People living in the home have use of a large marquee, in which
celebrations could be enjoyed outdoors. Two bedrooms were being reconfigured at the
time of the inspection and we were informed that, when complete and approved, would
offer additional en suite facilities. Other planned improvements include a self contained
reception area being developed to the front of the property which will ensure that any
visitors to the home are promptly greeted on arrival.
The home has effective cleaning arrangements in place as we observed all parts of the
home to be maintained to a good standard of cleanliness. There was a feeling of
spaciousness throughout and relatives told us that they consistently found the home to
be “spotless.” People living in the home can thereby be assured that they will find the
environment light, airy, fresh and clean. We saw that expectations regarding cleanliness
were set out in a list of duties outlined for the home’s kitchen staff. The home’s dining
room was light and airy with patio doors leading to the home’s gardens.
People living in the home can feel reassured by an environment which offers a sense of
familiarity. There were numerous personal effects around the home, including a display
of colourful canvases in the home’s dining area that some people had painted. We saw
that individual bedrooms had been personalised with an array of ornaments, plants, soft
furnishings and photographs, and some contained people’s own pieces of furniture.
Thought had been put into the layout of people’s bedrooms as tables and call bells were
within easy reach for people with restricted mobility, and chairs had been positioned in
favoured spots, often offering views outside.
The communal space and numerous seating areas offered by the home allow people to
meet others and develop relationships. A large lounge adjoined the home’s dining area
and there was a separate “TV lounge” for people to occupy if preferred. We observed
there to be smaller seating areas both upstairs and downstairs should people wish to
spend time on their own or with a smaller group of people. People can also have private
space in their own bedrooms or in an upstairs room that had been dedicated for use
during hairdressing and chiropody appointments, or other consultations.
People can be confident that there is sufficient and appropriately maintained equipment
and facilities available for use within the home. A passenger lift provided access
between the home’s two floors and we saw that bathroom facilities were in close
proximity to communal areas, with one offering a walk in shower and bath. A resident
telephone was also available for use although we were informed that most people living
in the home had a telephone within their own rooms. The maintenance records we
examined confirmed that equipment had been appropriately serviced with any required
repairs having been carried out as recommended. We saw evidence of yearly Portable
Appliance Testing (PAT) and weekly internal and external pest control checks. Other
records confirmed that refrigerator, freezer and food probe checks had been carried out
daily, or more frequently as required, with temperature readings being within acceptable
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parameters. Overall, we found the home’s own monitoring system for managing the
servicing and inspection of equipment and facilities within the home to be effective in
ensuring the safety of the people living there.
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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.
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