Ty Afon Care

Contract Monitoring Report

• Name of Provider: Riverwood Housing
• Name of Service: Ty Afon House Residential Home
• Date of Visit: Wednesday 15 November, 2023, 10.00 a.m. – 1.30 p.m.
• Visiting Officer: Andrea Crahart, Contract Monitoring Officer
• Present: Rebecca Hemmings, Responsible Individual

Background

Ty Afon House is a three bedded home, located in a quiet residential area of Blackwood. There is one person who is funded by Caerphilly County Borough residing at this property, with two other people, who are funded by other Local Authorities.

There have been no Safeguarding concerns or other issues of concern about the service over recent years.

The Care Inspectorate Wales (CIW) undertook an inspection in July 2023 which read very positively, and there were no areas for improvement noted.

The manager of the service is registered with Social Care Wales (a regulatory body that sets standards for the care and support workforce).

The Home’s Statement of Purpose and Service User Guide which outline the services aims and objects were provided and had been reviewed in May 2023.  ‘Easy read’ versions were available for people who would require these also.

The Home has a food hygiene rating of 5 awarded to them, which is very good.

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

Previous Actions – Corrective and Developmental

Corrective

There were no corrective actions to address in relation to the visit undertaken in 2022, however, developmental actions included the following:

• To consider introducing a Bristol Stool chart to capture information on a daily basis to Support individuals (as discussed during the visit). Timescale: Within 1 month.  Action met.
• To write Personal Emergency Evacuation Plans (PEEP) for each individual to ensure their specific needs are taking into account in the event of a fire.  Timescale:  Within 1 month.  Action met.

Responsible Individual

The Responsible Individual (RI) for the service is expected to undertake quarterly visits to report on its compliance, quality and performance.  It was evident that very thorough reports had been compiled from visits made during the first half of 2023 which covered e.g. trends, feedback received from stakeholders and checks relating to service user’s wellbeing etc. A six monthly quality review had also been produced.

The contingency plan in the event of the manager being absent from the service would be that the RI would manage the service.

The Home’s policies and procedures were viewed to ensure that they were up to date and that planned review dates were in place. All the policies were up to date, had made reference to current terminology and been comprehensively written.

File and Documentation Audit

All documentation viewed for an individual was presented in an orderly way and included an index and subject dividers.  A personal profile at the beginning of the file included important contact details relating to e.g. next of kin, health professionals etc.  A Missing Person’s profile was present also, in the event that the person went missing, including a current photograph.

The file included a CCBC Care & Support Plan written by a social worker, and a Care & Support Plan Review, both of which had been compiled this year.

The Personal Plan (Support Plan) contained information pertinent to the individual to enable staff to support him as well as possible, with information regarding ‘my best day’, ‘my worst day’, including ‘things I like to do’ and ‘don’t like’. The plan included guidance information relating to how to support the person in terms of domestic tasks, eating/drinking, dressing, hair/oral care, communication etc. which were all very informative and would provide sufficient information for a new member of staff to be able to support that person.  A daily diary provided an overview of the activities that the gent enjoyed throughout the week. and a section named ‘my outcomes’ which listed a number of different areas to work towards e.g. to help prepare cold snacks for himself, and there were indicators to note whether the person had met these, or was still working towards them etc. There were guidelines in terms of how to support the person during epileptic seizures (should they occur), supporting with dressing/undressing and other general guidelines relating to daily living.  The morning and evening routines were also very detailed.  The Personal Plan had recently been reviewed and was therefore up to date.

Suitable Risk Assessments were also present which provided essential guidance in how to best support the individual in many situations e.g. epileptic seizures, transporting by car and in the community, bathing, eating out, assistance on and off the bus etc.  These had also been reviewed very recently.

It was evident from documentation that health appointments had been held with various health professionals etc. chiropodist, dentist etc.  Other records included a weight chart and bowel chart which were completed on a regular basis.  There was an accident record on file for a situation that occurred earlier this year.

Staffing and Training

Current staff levels are based on individual’s assessed needs and current Local Authority funding.  The staff team continue to enjoy excellent staff retention, and when staff absences do occur these are covered by the existing staff team or via ‘relief’ staff from other Riverwood Housing establishments, negating the need to employ agency staff.  This also provides a level of continuity and familiarity for the individuals supported.    

Ty Afon has an induction process for staff that is in line with the All Wales Induction Framework which has been compiled by Social Care Wales.    Although it was evident that staff had certificates on file to indicate they had received an induction, these did not include any further information. However, the RI Individual confirmed that a decision had already been taken to include this additional information on staff files going forward.

A staff training matrix indicated that many staff had attended training relevant to their role, with some gaps and others courses had been pre-booked.  Staff had attended training such as medication, fire safety, food hygiene, health and safety, safeguarding etc.   Other training available includes e.g. epilepsy, autism, Mental Capacity Act/Deprivation of Liberty Safeguards.  The manager confirmed that training is now mostly undertaken face to face, which is something that the staff prefer.

All staff have either successfully completed an NVQ/QCF qualification in Social Care (level 2, 3 or 4), or are working towards one appropriate to their role.

Staff do not generally work over 48 hours per week and are contracted to either work on a part time or full time basis.

Presently ‘The Active Offer – More than just words’ (revised Welsh Language Act) is not being implemented.  This requires providers of social care to provide communication in Welsh, without the person who requires it requesting it.  However, Ty Afon do have some support staff and members of the management team who are able to speak Welsh, but not enough staff to be able to provide a fully integrated Welsh language provision.  The RI has stated however if the need was required in future they would look to recruit accordingly.

Two staff files were examined and illustrated that a robust recruitment process had taken place. Files were in good order and included a file index which made it easy to locate the information.  The recruitment information consisted of e.g. two written references, a signed job description, Contract of Employment, application form (with no gaps in employment evident), interview questions, a photograph and ID. One of the application forms was not fully completed with the person’s educational/professional qualifications, which was brought to the attention of the manager during the visit. Training certificates showed that many courses had been attended and DBS (Disclosure and Barring Service) information were present. 

Regular staff meetings had taken place, with evidence that these had occurred on bi-monthly basis for the majority of the time so far this year.  Discussions included e.g. each resident and their needs, any maintenance issues associated with the Home, infection control etc.

Supervision and Appraisal

The Home’s current supervision matrix indicated that all staff receive regular supervisions on a three monthly basis and have also received annual appraisals.  It was evident from the two staff files viewed that meaningful supervisions had been held on a 1:1 basis, with conversations being held relating to training, rotas/work tasks, feedback from residents, health and safety issues, any other issues, and actions agreed with the staff member to take forward.

Activities

The resident, who is funded by CCBC continues to be supported to access a wide range of activities in the community and there is a plan in place to guide staff as to his preferences.  There are appropriate risk assessments in place to enable staff and the gent concerned to access the community safely.

It is the support workers role to always plan and organise activities on behalf of the individual’s living at Ty Afon.

Mobility Aids and Equipment

Currently no individuals require the use of mobility aids or equipment to support their mobility needs.

Managing resident’s money

Arrangements are in place to manage individual’s income and expenditure on a daily basis.  An expenditure record clearly showed the amounts that had been received and spent, with double signatures in place for each transaction, and receipts retained.   

Medication management

The individual who is funded by CCBC has his medication administered by support staff.  There was a current photograph of the individual concerned and a list of medication that he currently receives.

Staff complete a Medication Administration Record (MAR chart) when medication is administered.  Ty Afon use their own MAR chart as this is something that is not provided by the pharmacy.  However, the contract monitoring officer was made aware that arrangements are being made for a referral to be submitted to have MAR chart generated by the pharmacy in due course.

No individuals living at Ty Afon care home have their medication administered covertly.

Fire Safety

The Home’s Fire Risk Assessment had been reviewed in January this year and there were no changes required.

Fire drills had taken place on a regular monthly basis to ensure that all staff are involved in these.  The latest one was held in October 2023 and the only issue being that the service user did not want to evacuate the building at the time.

Regular checks had taken place in terms of e.g. emergency lighting, fire alarm testing, smoke alarms and fire extinguishers.

Complaints and Compliments

No complaints have been received and the provider is aware of the need to submit Regulation 60 reports to CIW if there are significant events.  There is a complaints policy and processes are in place to enable people to make a complaint if required, and the manager would be responsible for addressing these.

A list of advocacy services is available, in the event that they are needed so that the individual can be supported, and this is also confirmed within the Home’s Statement of Purpose.

When compliments are received the Home ensure that these are communicated to staff.  The reports written by the RI during the first half of this year indicated that families were positive about the care being received.

Service User and Stakeholder Feedback

The RI regularly produces reports in line with CIW regulations regarding the service, which are comprehensive, include feedback from stakeholders and any actions to address.

Staff feedback

A staff member confirmed that they had no issues at all with how the service ran and explained how well the systems and reviewing processes work at the Home.

The Home Environment

Individuals and staff are able to smoke in an area outside of the Home if necessary.  There is also a smoking policy to refer to.

The Home was very clean, tidy and areas seen were decorated to a high standard.  A new kitchen has been installed within the previous year and the outside area benefits from a large garden.   

Individuals do not have keys for their bedrooms (there is a disclaimer in place). All individuals have lockable cabinets within their rooms, and arrangements are in place to keep their money safe in cash tins which are stored in a lockable steel cabinet.

Temperatures in people’s bedrooms are controlled centrally and some people’s radiators have wooden covers.  However, another person’s radiator is controlled via its own valve and is kept on a low heat to ensure the person does not become too warm or scorch themselves.

Corrective/Developmental Actions

• Information to be collected from relevant staff member as to any qualifications they have gained, for adding to their application form.  Timescale:  Within one month.  RISCA Regulation 34.

Monitoring Officer’s Observations/Comments

Ty Afon House continues to be a welcoming and ‘homely’ place to live, with individuals looking well presented on the day of the visit. The Home is also comfortable and well maintained.

Conclusion

Individuals continue to benefit from a stable and committed staff team which provides valuable continuity of care.  Staff receive regular 1:1 supervision and appraisal sessions which cover pertinent areas and there is evidence of a two way dialogue.  

Documentation is comprehensive and person centred in its approach with there being a list of outcomes also for the individual to work towards which will be beneficial for their health and wellbeing.  The recruitment process is undertaken in a robust way and systems and processes are in place to oversee the service and recognise any areas for improvements as necessary.

The Contract Monitoring Officer would like to thank Ty Afon House for their time and hospitality during the monitoring visit.

• Signed: A. Crahart
• Designation: Contract Monitoring Officer
• Date: November, 2023