Inspection Report onBrynhyfryd Care Home

Love LaneBuilth Wells

LD2 3BG

Date of Publication Tuesday, 9 October 2018

Welsh Government © Crown copyright 2018.You may use and re-use the information featured in this publication (not including logos) free of charge in any format or medium, under the terms of the Open Government License. You can view the Open Government License, on the National Archives website or you can write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gsi.gov.uk You must reproduce our material accurately and not use it in a misleading context.

Description of the serviceBrynhyfryd care home includes Glan Irfon annexe. Brynhyfryd provides personal care and accommodation for 30 people over the age of 60 years who have personal care needs, up to 13 of whom may have a diagnosis of dementia or mental infirmity. Glan Irfon annexe provides care and accommodation for up to 12 people over the age of 18 years who may require a short period of intensive reablement or an in-reach service of rehabilitation. The service is owned by Bupa Care Homes (Partnerships) Limited and the manager is Denise Bufton.

Summary of our findings

1. Overall assessment

People receive timely care and support from staff familiar with their needs. Care records give staff guidance about people’s basic needs, but require improvement to make them person centred.

People live in an environment that is in part institutional and requires significant investment and improvement. Checks make sure staff are suitable but staff are not provided with necessary or appropriate training. Information about the service is misleading so people may not be making an informed choice when considering using the service. The quality of the service is checked and the home is well managed on a day to day base. Significant improvements are needed to ensure the organisation provides an adequate service and invests in the premises and staff.

2. Improvements

Improvements made since the last inspection include;

Opportunities for activities, including outings have improved.

A small number of lounge windows have been fitted with privacy screening.

There had been some improvements in number of formal staff supervisions provided.

The medication policy and procedure had been updated in 2018.

3. Requirements and recommendations

Section 5 of this report sets out our recommendations to improve the service and theareas where the care home is not meeting the legal requirements. These include the

following:

Care planning.

Mealtimes. Premises. Staff training and supervision. Information provided about the service, including complaints. Quality assurance. Welsh Active Offer.

1. Well-being

Summary

People are generally treated with respect but improvements are needed in people’s experience at mealtimes and opportunities for socialisation and stimulation in Glan Irfon. People have positive relationships with staff and are provided with activities, (in Brynhyfryd). People’s spiritual needs are acknowledged and supported but additional efforts are needed to improve access to Welsh culture.

Our findings

People are provided with choices, including activities. People spoken with told us they could decide how to spend their time, including getting up and going to bed. We saw people were able to choose where they sat and if they wanted to join in activities or spend time in their room. A programme of activities was on display in Brynhyfryd. This included bingo, local walks, music quiz and church services. Photos were displayed of recent outings to local places of interests. Activities were not provided in Glan Irfon but people who are well enough are supported to go to Brynhyfryd to join in group activities such as visiting entertainers or bingo. One person was being supported to go ‘next door’ to Brynhyfrd for meals on the day of the inspection so they could enjoy a socially stimulating meal time. People in Brynhyfryd, but not Glan Irfon, are generally provided with opportunities to socialise and be positively occupied if they want to be.

People are provided with a varied menu but meal times need to be improved. Three people told us, “the foods usually good”. The menu was displayed in Brynhyfryd, but not in Glan Irfon. It was positive to see coloured bowls had been purchased to use for food such as ice cream and porridge to make it easier for people with dementia to distinguish. Condiments were provided. We saw people being supported by staff who were stood over them and staff clearing plates containing uneaten food away very quickly. We did not see anyone being offered ‘seconds’. Staff spoken with told us that there wasn’t always enough main meals or pudding left to be able to offer people ‘seconds’, and this had been the situation on the day of the inspection. We saw one person sat in the communal lounge who was unable to move to the dining room. They were not offered their main meal until the majority of people in the dining room had finished their meals which meant that they could see and smell the food but had to wait for over 30 minutes for their own meal. People do not benefit from a positive, relaxing meal time with sufficient food always available.

Measures are not in place to access Welsh culture. The manager told us that no one currently living or working at the home spoke Welsh as their first language, although some people and staff spoke, and understood Welsh greetings. The Information provided does not make any reference to how the service will meet people’s Welsh cultural needs. The pre admission form asks people their first language but does not make any reference specifically to Welsh, and does not ask people if they wish to receive a service in Welsh if possible. The responsible individual told us that people’s language preferences would be recorded in their ‘senses and communication’ care plan. The self-assessment completed by the organisation in 2017 stated they were ‘working towards’ implementing the Welsh Active Offer. There is little pictorial signage throughout the home and none of the signs are bi

lingual. People are currently able to receive a service in the language of their choice but improvements are needed to ensure people’s Welsh cultural needs can be met if required.

2. Care and Support

Summary

People receive care and support at the right time from staff with who they have comfortable and positive relationships with. People are supported to stay as well as they can. Improvements in care planning to allow detailed recording of people’s life history would enable staff to use this information to inform how care and support is provided.

Our findings

People receive the right care at the right time, but efforts are needed to ensure documentation allows the planning and recording of person centred care. We saw staff anticipated, and responded promptly to requests for assistance and that people were encouraged to be as independent as possible. Care records included details of people’s care needs, and were generally up to date. On one record we saw information about the person’s life history had been provided by Social Services but not included in the care plan or the life history section. We did not see any evidence that people were asked how they wanted their care and support to be delivered and none of the people spoken with were able to remember being asked about this. The section to record people’s life history was extremely small and does not allow the recording of anything other than the briefest of details about individuals. We understand the organisation has developed person centred planning documentation, but this is not used in this home. We noted the manager and staff work to mitigate the impact of this and to deliver care in a person centred manner as far as possible. Records included information if people had been subjected to an application under the Deprivation of Liberty Safeguards legislation. (DoLS) about any restriction on their liberty, including decisions about where they lived.

Records showed people were supported to access medical and healthcare services promptly whenever necessary. It was positive to see that the service works closely with healthcare and medical professionals, particularly in Glan Irfon, with a nominated health professional undertaking pre admission assessments, (on forms specific to the unit), which were then agreed with the registered manager who does not undertake any assessments. Staff told us that if they had a ‘medical query’ they would approach health employed staff and the deputy manager if the query was a ‘BUPA’ issue. The ‘Guide to Brynhyfryd’ tells readers that it provides care for Parkinson’s but this is not included in the Statement of Purpose or the services registration. it does not detail how such care and support would be provided and does not provide training for staff.

However, records did not include any information or guidance for staff on diagnosed medical conditions, such as dementia and diabetes, or how this may impact on people’s care and support needs and training is not provided for staff on such topics. Daily records were completed but these were a list of care tasks and did not include details about people’s well-being or how they had spent their time. Care records in Glan Irfon were detailed by room number not the person’s name. We saw a senior member of staff responsible for providing personal care with very long artificial nails which are inappropriate due to the potential risk of harm to people’s skin. This had not been identified by the manager but they took prompt action once we brought this to their attention. The manager assured us this issue would be discussed with all staff to make sure they were aware of the homes policy. The manager told us that two beds in Glan Irfon were allocated to provide palliative care for people living in the community, although this was not detailed in the Statement of Purpose (undated, but the most recent). It is referred to in the Statement of Purpose, (2016) although the specific numbers are not included. It is difficult to understand how providing palliative care in a reablement environment would be appropriate or meet the needs of people accommodated there. We also noted that the criteria for admission for Glan Irfon excludes people with ‘dementia /confusional state requiring intensive level of support’ but is unclear who this is determined. People’s individual needs and preferences are understood and anticipated but not always recorded in a person centred manner.

Medicines management is safe. The medication policy had been updated in 2018. We saw systems were in place to make sure people received medicines as prescribed. Medicines were stored securely and records were well kept. The manager was unaware of the practice of protected mealtimes to ensure people were able to focus on eating and drinking. We saw that it was the services policy to interrupt people when eating their meals in order to give out medicines which is not person centred and for people with dementia may result in the person not resuming eating their meal. People can be confident they will receive medicines as prescribed but improvements are needed in line with good practice.

3. Environment

Summary

People are supported to personalise their rooms within the significant constraints of the room sizes. Systems are in place to make sure facilities and equipment are maintained and safe. People live in an environment that is not always suitable, homely or well maintained. The premises require considerable investment and improvement.

Our findings

People do not live in an environment which maximises independence and supports them to achieve a sense of well-being. One person told us they liked having a small outdoor space by their room and had been supported by family to personalise the room with items from home. We saw corridor walls were all the same colour and bare. Although the home accommodates people with dementia there was no evidence the organisation had given any consideration to making the premises dementia ’friendly’ such as using good practice guidance about suitable colour schemes, sensory walls, suitable sized pictorial signage or memory boxes to promote people’s independence. The home is close to a public footpath and passers-by can see into the lounge areas comprising people’s right to privacy.

It was clear that Brynhyfryd requires significant improvement and refurbishment due to wear, tear and long term lack of investment. Examples include water ingress on ceilings, painted surfaces peeling and marked, rusty radiators, rotten wooden windows and exterior fascia board. Glan Irfon is a modern institutional, medical model facility, no efforts have been made to ensure it provides a homely environment for people communally or in individual rooms which are all painted the same colour. The only pictures on display are advertised for sale which is inappropriate. Staff spoken with did not know where the pictures were from. All furniture is the same style and same colour. The notice board contained only information relevant to staff such as details of forthcoming meetings. A staff sitting area was provided in a corridor in the manner of a ‘nurses station’ in hospitals. We saw information about the organisation and staff notices on display throughout both areas of the home which means that the environment is not domestic in style and not viewed by the organisation as people’s home. A ‘home improvement plan’ was in place. The last entry was April 2018 when it noted a celling hoist was out of order. It was not recorded if this issue was addressed. A long term maintenance and improvement plan was not in place. A lack of storage space means equipment was stored in corridors and communal bathrooms, including hoists and trolleys containing dirty laundry. People do not benefit from an environment that is well maintained and meets their needs. This is a serious matter and a notice of non compliance has been issued. This can be viewed at the back of this report.

People can generally be assured their health and safety is taken seriously. We saw records were kept of checks and servicing of equipment used such as hoists, electrical items, clinical waste, the lift and fire safety equipment, apart from the ceiling hoist referred to in the above paragraph. However, records available on the day of the inspection showed that the fire risk assessment had not been reviewed since May 2017. Following the inspection, the responsible individual provided evidence to show it was reviewed March 2018. The laundry is purpose built and in line with good practice had separate in/out doors. However, these doors were next to each other and not at opposite ends of the room so were ineffective in promoting good practice. In communal bathrooms we saw paper towels and liquid hand

wash was provided but also saw open buckets used to store soiled clothing and a broken wheelchair. We saw boxes of disposable gloves in communal bathrooms and disposable vomit bowls, but there was no evidence that risk assessments had been competed in relation to the risk of ingestion or cross infection. People are cared for in an environment where equipment is generally checked to make sure it is safe but improvements are needed in infection control practices.

4. Leadership and Management

Summary

Information is available about the service in a Statement of Purpose and Service User Guide but they do not include all the required information and include information that may be misleading. Information about complaints is incorrect and complaints are poorly managed.

Basic staff training is provided but requires improvement to make sure people’s needs are met in line with the Statement of Purpose, Service User Guide and good practice. Measures are in place to check the quality of the service but the lack of support and long term investment by the organisation is impacting on people’s quality of life.

Our findings

Information is provided about the service. We were provided with two versions of the Statement of Purpose, (2016, and undated, but written after the 2016 version). The 2016 version notes that people with dementia are not able to access services in Glan Irfon. The Statement of Purpose (undated) did not include all the required information including, how to make a complaint, the size of the rooms available and the qualifications and experience of the registered person(s). It did not make clear the differing facilities, or who can be accommodated within the separate buildings of Brynhyfryd and Glan Irfon. Glan Irfon is noted in the Statement of Purpose (2016) as a reablement facility, we are therefore unclear why two beds are currently being allocated to provide palliative care, despite staff not being provided with end of life training. People are not provided with clear and accurate information so they can make an informed decision about using the service. This is a serious matter and a notice of non compliance has been issued. This can be viewed at the back of this report.

A guide is produced about the service. A ‘Getting to know Brynhyfryd’, (undated) refers in part to the previous manager, states it offers ’Parkinson’s care’, although this was not included in the Statement of Purpose. It did not include any information about how people with Parkinson’s would be supported with their specialist care and support needs and the organisation does not provide staff with training in this subject. The guide does not include all the required information and makes no reference to the facilities offered at Glan Irfon. People are not provided with clear and accurate information so they can make an informed decision about using the service. This is a serious matter and a notice of non compliance has been issued. This can be viewed at the back of this report.

Complaints are not well managed. The service had received one complaint since the last inspection. The investigation was poor, incomplete, had not covered all the issues raised and the person raising the complaint had not been informed of the outcome. Information about complaints both on display, and in the Statement of Purpose and Guide did not include the correct timescale within which a complaint should be investigated. The information provided for staff about complaints (dated January 2015), refers to English legislation, for example the Duty of Candour. It did not include the required timescale of 14 days within which a complaint should be investigated. The Terms and Conditions of residency did not include any details of the complaints policy and procedure, but referred

readers to a separate document which was not attached. People cannot be confident they will be provided with the required information to be able to make a complaint.

Checks make sure staff are suitable. We checked the recruitment records of two staff who had started work since the last inspection. They evidenced checks had taken place to make sure staff were suitable before they started work. The reference request sent to applicant’s former employers included details of professional bodies operating in England, but not professional bodes relevant in Wales such as Social Care Wales. People are protected by robust recruitment processes but they need minor improvement to make sure they are relevant in Wales.

The organisation does not always ensure people receive care from appropriately trained staff. The manager told us all staff work both in Brynhyfryd and Glan Irfon. However, despite people using Glan Irfon having specific, complex care and support needs, including palliative care, no additional training has been provided. Staff spoken with told us there was, “not enough training for the complexity of needs” and that additional training had been requested on many occasions. Basic staff training is provided, but not in all necessary topics. The manager confirmed that the service did not use a structured 12-week induction training programme in line with guidance published by Social Care Wales to ensure staff were provided with the recommended level of information and skills. New staff completed a brief in house induction training course but this would not provide staff, particularly staff new to care work, with the level of knowledge recommended by Social Care Wales. Following the inspection, the responsible individual told us the service was now using the All Wales Induction framework which will provide staff with a robust induction. We saw staff completed work books as part of their training but were informed staff were not provided with feedback about any areas they had failed to complete correctly. Information provided by the manager showed that 17 staff, (29%), had achieved a Qualifications and Credit Framework, (QCF), with a further three staff registered on such courses. Records showed that although the service is registered to provide accommodation and care for people with dementia it provided staff with only basic ‘awareness’ training which would not provide them with the level of knowledge and skills required. Staff spoken with told us they would welcome, “more training” on dementia. The range of training was limited and did not include end of life care, first aid, continence, falls prevention or common health issues such as diabetes or stroke. It did not include training about Parkinson’s although the front page of the ‘Getting to know Brynhydryd implied the service offered specific ’Parkinson’s care’ which it does not. People do not benefit from a service where staff are provided with a range of necessary training. This is a serious issue and a non compliance notice has been issued. This can be viewed at the back of this report.

Systems are in place to provide staff with formal supervision. Staff told us they thought staff “worked well as a team” and were “listened to “by senior staff. Two staff told us that they felt more confident working in Glan Irfon since the deputy manager had been in post and was based in the annexe to provide advice and support. The manager told us policies and procedures were in place to provide staff with formal supervision and an annual appraisal and that they were ‘catching up’. However, there were still 18 overdue and needing to be arranged. People cannot always be confident that staff are provided with regular formal supervision of their practice.

Measures are in place to review and monitor the quality of the service. A Quality Assurance Report January 2018 was provided. However, the report referred to a home of another

name so we cannot be confident the information in the report was relevant to Brynhyfryd. Staff meetings had been held with minutes taken. A residents meeting had been held in February 2018. The minutes recorded who had attended and details of what activities people would like to be available but did not show that people were asked their views about any other aspect of life in the home. It did not record any action to be taken to ensure people were supported with the choices they had expressed. A further meeting had been held in June 2018. People had requested an ice cream van was arranged to visit but no record was made of any action to arrange this. Three people living at the home had completed a questionnaire to find out their views of the service in July 2018. All had been completed by staff and identified the person. Comments included, “I can’t fault the staff, they’re all very good” and “food is always very good!”. One person indicated that they were non committal on their opportunity to personalise their bedroom. The record of such views in 2017 did not include any comments made by people or a record of any comments other than those that were positive. People do not benefit from a service that is committed to ongoing improvement and investment .

5. Improvements required and recommended following this inspection

5.1 Areas of non compliance from previous inspections

None

We have issued four non compliance notices following this inspection.

5.2 Recommendations for improvement

Improvements are needed in the way mealtimes are organised and support provided.

Consideration should be given to managing medicines in a person centred manner, for example by protecting mealtimes from interruptions when possible.

The fire risk assessment should be reviewed yearly. Serious consideration must be given to improving the environment in Glan Irfon

to make it homelier. Consideration should be given to providing staff with information and training

about diagnosed health conditions so they are better placed to meet people’s needs.

Consideration should be given to providing care planning documentation that allows staff to record in detail, information about people’s life history.

Significant improvements are needed in the way complaints are managed. Information about how to make a complaint must detail that complaints will be investigated within 14 days. Information provided to staff about complaints must be relevant to the services registration in Wales.

All new staff must complete a detailed, structured 12 week induction training in line with guidance published by Social Care Wales. The staff rota must show which staff on each shift are qualified to provide first aid. The employment reference form must include details of professional bodies relevant in Wales. A significant increase must be made in the number of staff supported to achieve QCF qualifications.

Staff must be provided with regular formal supervision. Consideration must be given to how the service will meet the requirements of the

Welsh Active Offer. Consideration should be given to proving people with independent/advocacy

support to complete quality assurance questionnaires. Consideration should also be given to removing the section for people to identify themselves to encourage people to give their views freely.

6. How we undertook this inspection

This was a planned, full inspection as part of our inspection programme. It took place on 31 July 2018 between 1.55. p.m. and 5.10.p.m. and 1 August 2018 between 8.40 a.m. and 16.50 p.m. We also reviewed issues raised in previous inspection reports.

The following methods were used;

We spoke with the manager, deputy manager, regional director and seven staff.

We spoke with six people living at the home and two relatives.

We used the Short Observational Framework for Inspection (SOFI). The SOFI tool enables inspectors to observe and record care to help us understand the experience of people who cannot communicate with us.

We looked at a wide range of records including the Statement of Purpose, Quality of Care Report, Service User Guide, staff records and the four people’s care records.

We reviewed medicines management.

We undertook a tour of the premises.

Further information about what we do can be found on our website: www.careinspectorate.wales

About the service

Type of care provided Adult Care Home - Older

Registered Person BUPA Care Homes (Partnerships) Limited

Registered Manager(s) Denise Bufton

Registered maximum number of places

42

Date of previous Care Inspectorate Wales inspection

5/03/2018 & 9/03/2018

Dates of this Inspection visit(s) 31/07/2018 & 1/08/2018

Operating Language of the service English

Does this service provide the Welsh Language active offer?

No

Additional Information: This is a service that does not provide an ‘Active Offer’ of the Welsh language. It does not anticipate, identify or meet the Welsh language needs of people who use or intend to use their service. We recommend that the service provider considers Welsh Governments ‘More Than Just words’, follow on guidance for Welsh language in social care.

Care Inspectorate Wales Care Standards Act 2000

Non Compliance Notice

Adult Care Home - Older

This notice sets out where your service is not compliant with the regulations. You, as the registered person, are required to take action to ensure compliance is achieved in the

timescales specified.

The issuing of this notice is a serious matter. Failure to achieve compliance will result in Care Inspectorate Wales taking action in line with its enforcement policy.

Further advice and information is available on CSSIW’s website www.careinspectorate.wales

Brynhyfryd Care Home

Love LaneBuilth Wells

LD2 3BG

Date of publication: Tuesday, 9 October 2018

Welsh Government © Crown copyright 2018. You may use and re-use the information featured in this publication (not including logos) free of charge in any format or medium, under the terms of the Open Government License. You can view the Open Government License, on the National Archives website or you can write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gsi.gov.uk You must reproduce our material accurately and not use it in a misleading context.

Environment Our Ref: NONCO-00006594-DJCL

Non-compliance identified at this inspection

Timescale for completion 23/11/18

Description of non-compliance/Action to be taken Regulation number

Premises: the registered person have failed to ensure that the premises are well maintained and suitable.

24 (1) (a)24 (2) (b)24 (2) (d)24 (2) (l)

Evidence

The registered person is not compliant with regulation 24 (1) (a) (2) (b) (d) (l) regarding the premises.

This is because we saw the home required significant investment to redecorate, refurbish and maintain the premises and grounds to an adequate standard.

The evidence includes;

• It was evident that the premises have deteriorated due to long term lack of investment.• The dining room ceiling paper is lifting off the surface.• The ceiling in room 23 is stained and discoloured due to water ingress.• A significant number of radiators are rusty.• The communal lounge is close to a public footpath and pedestrians are able to see into

the lounge. This compromises people’s right to privacy. This was raised in the last inspection report and some windows, but not all covered in a privacy screen.

• There have been no funds provided to promote people's independence and make the environment suitable for people with dementia including, memory boxes, the use of colour in walls and doors, sensory walls and larger, pictorial bi lingual signage.

• Celling lighting was dirty and full of flies.• We saw furniture, including chairs and tables, worn through wear and tear that needed

replacing.• Wooden window frames and exterior fascia are visibly rotten.• Storage facilities for equipment is not provided leading to equipment stored in communal

bathrooms and corridors.• The organisation does not have an ongoing, long term plan to maintain and improve the

premises, but only addresses urgent, 'business critical' maintenance issues.

The above list of issues is not exhaustive but are a range of examples.

The impact on people using the service is that they are not provided with an adequate standard of living.

Leadership and Management Our Ref: NONCO-00006602-HDYV

Non-compliance identified at this inspection

Timescale for completion 26/10/18

Description of non-compliance/Action to be taken Regulation number

Statement of Purpose: The registered person(s) have failed to ensure that the Statement of Purpose includes all the required information so as to enable people to make an informed choice when considering using the home.

4(1)(c) Sch1.014(1)(c) Sch1.024(1)(c) Sch1.034(1)(c) Sch1.054(1)(c) Sch1.064(1)(c) Sch1.074(1)(c) Sch1.104(1)(c) Sch1.124(1)(c) Sch1.134(1)(c) Sch1.144(1)(c) Sch1.154(1)(c) Sch1.164(1)(c) Sch1.174(1)(c) Sch1.184(1)(c) Sch1.194(1)(c) Sch1.20

Evidence

The registered person(s) is not compliant with regulation 4 (1) (c) Schedule 1 (2) (3) (5) (6) (7) (10) (12) (13) (14) (15) (16) (17) (18) (19) (20) (a) (b) regarding the Statement of Purpose.

This is because although we were provided with two Statements of Purpose, neither document included all the required information.

The evidence includes;

At the inspection we asked the manager to provide a copy of the current Statement of Purpose, the information immediately below refers to the document provided which was undated but we were assured this document was the latest copy.

It does not include;• the relevant qualifications and experience of every registered person.• the number, relevant qualifications and experience of staff working at the home.• information about who can be accommodated at the home does not include Glan Irfon.• It does not provide accurate information about the range of needs the home intends to

meet, including reablement in Glan Irfon and states it provides care for people with Parkinsons's although it does not provide any training for staff to do so. The age range detailed in the Statement of Purpose is not reflective of the current registration with CIW.

• It does not make it clear that nursing care is not provided.• the arrangements in place to make sure people are consulted about the operation of the

home.• how people will be supported to maintain their religious faith.• the arrangements for people to main contact with their relatives, friends and

representatives.• specific detail about how a complaint will be dealt with, for example when it would be

acknowledged, investigated and a response provided.• any reference to how people's plans would be reviewed.• the size of rooms available.• provide details of any specific therapeutic techniques available.• the arrangements for respecting the privacy and dignity of service users.• any reference as to how the arrangements will be made to ensure due regard is paid to

the sex, sexual orientation, religious persuasion, racial origin, and cultural and linguistic background and disability of service users.

• the services policy on restraint.• It does not make it clear that people with dementia are not able to access services within

Glan Irfon.• It does not make it clear that two beds at Glan Irfon are currently allocated to provide

palliative care and how this will be achieved in a reablement environment and by staff who have not been provided with any training in how to deliver care and support to people at the end of their life.

We were later provided with a separate Statement of Purpose dated 2016. This referred to National Vocational Qualifications, (NVQ), although this were superseded by Qualifications Credit Framework, (QCF), in 2011. It did not include details about;• how to make a complaint. (Schedule 1 (14))• any specific therapeutic techniques used. (Schedule 1 (17)).• the services policy on restraint. (Schedule 1 20 (a)).• and how a service was offered with due regard to sexual orientation, linguistic and

disability of people considering moving into the home. (Schedule 1 (19)).

The impact is that people are not provided with accurate information so as to be able to make an informed choice when considering using the service.

Leadership and Management Our Ref: NONCO-00006603-GPDD

Non-compliance identified at this inspection

Timescale for completion 26/10/18

Description of non-compliance/Action to be taken Regulation number

Service User Guide: The registered person(s) have failed to ensure the Service User Guide includes all the required information to enable people to make an informed choice when considering using the service.

5 (1) (a)5 (1) (b)5 (1) (c)

Evidence

The registered person(s) is not compliant with regulation 5 (1) (a) (b) (c) (d) (e) regarding the Service User Guide.

This is because the guide supplied did not include all the required information, and could be considered to include misleading information about the services provided.

The evidence includes;• The guide (undated), does not include a summary of the Statement of Purpose.• Page 15 refers to the previous registered manager.• Page 16 states the service is 'regularly inspected by the Care Quality Commission' the

regulator in England.• It does not include any reference to the annexe, a 12 bed reablement unit, Glan Irfon or

its purpose.• It does not include a standard form of contract.• It does not include a copy or a summary of the latest CIW inspection report.• It does not include details of the complaints policy.

The impact is that people are not provided with accurate information so as to be able to make an informed choice when considering using the service.

Leadership and Management Our Ref: NONCO-00006610-LJYP

Non-compliance identified at this inspection

Timescale for completion 23/11/18

Description of non-compliance/Action to be taken Regulation number

Staff training: The registered person has not provided staff with necessary or appropriate training to meet people's needs.

13 (4) (d)13 (5)13 (6)

Evidence

The registered person(s) is not compliant with regulation 13 (4) (d) (5) (6) 18 (1)(a) (c)(i) regarding staff training.

This is because the organisation does not provide staff with the range of required or appropriate training so as to be able to meet people's needs.

The evidence includes;• Training is not provided on topics including continence management, diabetes or other

health conditions despite people being accommodated with such care and support needs.• Emergency first aid is listed on the training record supplied. However, no staff have

completed this training and the staff rota does not indicate which staff on each shift are qualified to provide first aid.

• records showed that safeguarding training was recorded as overdue, by the organisations records, for 20 staff.

• food hygiene training for 21 staff was recorded as overdue by the organisations record.• moving and handling training was recorded as overdue, by the organisations record for

15 staff.• fire safety training was recorded as overdue by the organisations record for 13 staff.• Training was provided about dementia but this was at a basic level and not appropriate

for a service registered to provide care for up to 13 people with a diagnosis of dementia. Records provided showed that out of 77 staff, 38 staff had not completed any training since 2015 with 12 of those staff not completed any training since 2012/2013. This means they may not be aware of current good practice guidance.

• The Service User Guide states the service provides care for people with a diagnosis of Parkinson's. The organisation does not provide staff with training about Parkinson's and how it impacts on people's care and support needs.

• The manager and staff told us that two beds in Glan Irfon were solely for the use of people who need palliative care. The organisation has a policy ‘care during the last days of life’ dated 2016. It provides information about the physical signs of imminent death and gives staff advice about to support people at the end of their life. It does not identify that staff will be provided with any training on how to do this. Training records show that the organisation does not provide staff with training on how to support people living at Glan Irfon for palliative care, (or those needing end of life care in Brynhyfryd). Staff spoken with

confirmed this and told us any knowledge they had, had been obtained informally from District Nurses.

The impact of this is people may not be receiving appropriate care from well trained and knowledgeable staff.