Archived: Ty Gwyn Residential Care Home

Ty Gwyn Residential Care Home is a residential care home that was providing personal care to eight older people with learning disabilities at the time of the inspection.

The service had been developed and designed in line with the values that underpin the Registering the

Right Support and other best practice guidance, with the exception that the home accommodated more

than six people. These values include choice, promotion of independence and inclusion. People with

learning disabilities and autism using the service can live as ordinary a life as any citizen and the staff within

this service were exceptional in ensuring this was the case for people living at this home.

People’s experience of using this service:

The provider had failed to ensure financial stability and at the time of inspection, the home was under administration and was up for sale.

Improvements were required to ensure people had all their healthcare needs met, for example, their dental care.

Improvements were required to staff training to ensure they were effectively trained in all areas of care.

People regularly commented about the kind and caring nature of staff, and felt they were well treated.

Staffing arrangements were good and people were enabled to pursue activities they enjoyed.

Staff understood people’s risk assessments and had measures in place to reduce those risks.

Appropriate arrangements were in place to manage people’s medicines.

People were supported to give consent to their care and appropriate systems were in place to support the principles of the Mental Capacity Act.

People were encouraged to be independent and staff respected people’s privacy.

People’s care plans had personalised information about people’s care needs and had good guidance to staff about how to meet people’s needs.

There was not a registered manager in place however the appointed manager was in the process of applying to become registered.

The manager supported an open and inclusive culture and encouraged staff to work together as a team.

We have made a recommendation for the provider to arrange regular dental appointments for all people who require it.

Rating at last inspection:

Good (published 11 October 2016)

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Ty Gwyn Residential Care Home provides care and support for up to twelve people with learning disabilities or autism. At the time of our inspection seven people were using the service. The accommodation was offered over two floors accessible by stairs and a stair lift. There were two communal lounges and dining areas. There was a large well-maintained accessible garden for people to use should they wish to.

There was a registered manager in place. It is a requirement that the service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People felt safe with the support offered. Staff understood their responsibilities to protect people from abuse and avoidable harm and to remain safe. The provider had a system to manage accidents and incidents appropriately. Risks to people’s health and well-being had been regularly assessed. For example, where a person had risks to the health of their skin, staff followed guidance that had been made available to them.

The provider had a suitable recruitment process in place for prospective staff including undertaking relevant checks. People and staff were satisfied with the number of staff available to offer them care and support. We found that staffing numbers were suitable to help people to remain safe.

People received their prescribed medicines in a safe way. Staff received regular guidance and understood their responsibilities to handle people’s medicines safely. Medicines were stored appropriately and guidance was available and followed by staff about how people preferred to take them.

People received care and support from staff with the appropriate knowledge and skills. Staff had received regular training in topic areas such as epilepsy and fire safety. New staff received an induction when they started to work for the provider. They had regular meetings with the registered manager so they could receive feedback and guidance on their work.

People were supported in line with the Mental Capacity Act 2005. People were supported to make their own decisions and the provider had documented their capacity to make decisions where this was necessary. Staff understood their responsibilities under the Act. The registered manager had made an application to the appropriate body where they had sought to deprive a person of their liberties.

People chose what they ate and drank and were satisfied with what was offered to them. People had access to healthcare services such as to their doctor or dentist. Staff had guidance on people’s health conditions so they knew how to provide effective support.

People received support from staff who showed kindness and compassion. Staff protected their dignity but people’s care records were sometimes written in ways that could be seen as lacking respect for them. The registered manager told us they would remind staff about the use of professional language when writing in people’s care records. The provider had arrangements for storing people’s care records safely and discussions about their care needs occurred in private.

People were supported to be as independent as they wanted to be in order to retain their skills. People were, where they could, involved in decisions about their care including how they chose to spend their time. The registered manager considered involving advocacy services where people may have required additional support to speak up.

People had contributed to the planning of their care where they were able to. People had care plans that were regularly reviewed and were centred on them as individuals. Some people’s care plans lacked specific details about their care requirements. The deputy manager told us they would review the information to make sure it was detailed so that staff had all of the information they required to provide responsive care. Staff knew about the people they supported and offered their assistance in line with people’s preferences and routines that were important to them. People took part in activities and interests that they enjoyed when they chose to including cooking and arts and crafts.

People knew how to make a complaint. The provider had a complaints policy in place that outlined what they would do should they receive a complaint.

Staff felt supported and knew their responsibilities as the provider had arrangements in place for them to receive regular guidance and support. Staff knew how to report the inappropriate or unsafe practice of their colleagues should they have needed to.

People and others involved in their care had opportunities to give feedback to the provider. The registered manager was aware of their responsibilities and had arranged for quality checks of the service to take place to make sure that it was of a high standard. For example, checks on the cleanliness of the home and on people’s medicines routinely occurred.

Is the service safe?

People told us they felt safe with the staff that supported them. They told us staff safely helped them with their daily care and support needs. One person said, 'The staff are very caring towards me and I couldn't ask for anymore.' People were supported to take part in activities that were of interest to them, which included activities organised by the staff at the home and using the community facilities.

People told us they felt both safe and secure because they were cared for in an environment that had been maintained. People were able to access all areas of home safely. Communal areas were furnished which made it homely and comfortable. People had decorated and personalised their room to reflect their interests and things that what were important to them.

We, the Care Quality Commission, monitor the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Staff training records showed staff had been trained in Mental Capacity Act 2005 and DoLS. This meant that people could be confident that their best interests would be represented and that their wellbeing would be met reliably.

Is the service effective?

People told us that they were happy with the care and support that had been delivered and that their needs had been met. Staff were attentive and encouraged people to maintain their independence. Records we looked at showed people's care needs were met and that they had access to a range of health care professionals. We also found that people were supported to take part in meaningful activities and hobbies which they enjoyed. It was clear from our observations that staff had a good understanding of people's needs and that they knew them well.

Staff we spoke with were trained for their job role to help ensure people's needs were met reliably. Staff understood how to support each person, which helped to ensure risks, could be managed. We looked at the staff training matrix. That confirmed the provider had taken steps to ensure staff kept their knowledge and skills up to date and in line with current best practice.

Is the service caring?

People were supported by kind and attentive staff. We saw people were confident to ask staff for help when required. We also saw that staff were interested in what people had to say and replied in a manner that the person could understand. People told us that staff were caring and supported them in a manner that respected them as a person. We observed staff helped and supported people in a caring manner. We also looked at the records held about them and discussed people's care needs with them. They told us that their individual wishes for care and support were taken into account and respected.

Staff were aware of people's preferences and interests. This included supporting people to continue to attend day centres, take part in social events and outings, and use the local leisure facilities. We saw one person sat with a member of staff to have their nails painted whilst another read a magazine and a third person folded the laundry. People told us that staff helped them to keep in contact with their family, which promoted their wellbeing.

People were given information about the advocacy service when they moved to the home. Information was produced in a format so that it was suitable for the person to understand, which included the use of pictures and photographs. This meant that people could access additional support and/or advice when required. Staff had received ongoing training to help ensure the people received the appropriate support and knew how to access support from other health care professionals.

Is this service responsive?

People had the opportunity to visit the home to make sure it was the right place for them and that their needs would be met. One person said, 'My son visited first, then I came here a few times before I decided it was the right thing to do.' People's needs had been assessed before they moved into the home. People told us they were involved in reviewing their plans of care when their needs changed. People had access to health care professionals such as the doctor and the community nurse to meet their specific health needs. Records confirmed people's preferences and expectations had been recorded, and care and support had been provided in accordance with people's wishes.

Is this service well led?

People's personal care records and other records kept in the home were accurate and up to date. People knew about the information in their care records. People told us their care needs were reviewed regularly to make sure any new needs could be met reliably. Records showed the home's staff worked with other agencies and services to help ensure people received their care and support that was joined up.

The home had a system in place to assure the quality of service they provided and acted on any feedback and comments received. This included surveys to gather the views of people who lived at the home, relatives or their representatives. Regular meetings were held at the home where people made decisions about social events. They also had the opportunity to comment on any proposed changes to the home that could affect their wellbeing. The complaints policy and procedure were used effectively for the benefit of people living at the home and for making continued improvement to the quality of service provided.

Regular checks were carried out to ensure people's health, safety and wellbeing were protected. Information from incidents and accidents had been analysed and used to identify changes and improvements, and minimise the risk of them happening again. Prompt action had been taken to improve the service and put right any shortfalls that were found.

People told us they received their medicines on time. Appropriate arrangements were in place for the safe storage and administration of medicines. Records showed medicines were administered properly and people accessed health support when needed.

People knew who to contact if they were unhappy or were concerned about their care or support. One person said: 'I haven't got any complaints.' Another person said: 'Staff do what I ask them most of the time or I'll tell Claire (the manager).' They were confident that staff who looked after them were suitably qualified.

Record keeping arrangements were inadequate and improvements were needed. We found records were not kept of when checks and audits carried out, such as the provider's monitoring visits, checks on the premises, equipment and medication audits. Risk assessments and protocols for people who managed their own medicines had not been completed.

People were protected because there was effective staff recruitment and selection processes in place. Records showed appropriate checks were undertaken before staff began work. Staff received training which enabled them to meet people's care needs safely.

People's needs were met by enough qualified, skilled and experienced staff. People received personalised support that met their aspirations, promoted their involvement in the community and their independence. Arrangements were in place to ensure sufficient, qualified and experienced staff were available in the event that people's needs had increased and to manage staff absences.