QA Report 2023

Regulation 50 of the Social Care Wales Act 2016 has re-enforced the aim of monitoring, reviewing, and improving the quality of our service. It is not only an exercise to appreciate feedback, but also a key importance in highlighting and developing our relationship with individuals, families and visiting professionals and how they perceive us as a care provider and for us to work on the things we could do better.  Our aim is to continue to monitor our ideals daily and to formulate reports approximately every six months.

This year we have formulated our questionnaire using Microsoft Forms. We have had about 50% feedback from staff, 77% feedback from relatives and 10 responses to those we sent out as Healthcare Professionals.

Thanks to everyone for the feedback and for taking the time to complete the survey. Families have been left to discuss the questionnaires with their relatives if they wished and to pass on to others who visit and have insight into Cantref.  We have written some insights in response to the questions to evidence each section.

How well do we do on focusing on individuals well being and personal outcomes?

Our score from relatives and residents 100%

Opinions of Healthcare Professionals was very good also

We learn a lot from pre assessment and going out to visit a potential newcomer to the home. These assessments can take place with family, healthcare representatives and the individual in most cases. We focus a lot of our time on answering questions and being available to families and individuals who are making the decision to come into care. Our main aim of assessment is to ensure we are the best place for that individual and that they are happy and contented for the next chapter of their life.

Care plans are extensive. There are over 60o questions to answer when someone comes into the home. All care needs are tailored around the care plan but are not rigid. Care needs change, as does our input. We work closely with our GP’s, Advanced Care Practitioners, District Nurses, Social Workers, Occupational Therapists, Counsellors, Mental Health Teams etc, to ensure that our care plans are documented and upheld with any change. This in turn gives our individuals and their families the reassurance that we are doing our jobs properly and to the fullest potential to look after that person in the appropriate and most dignified manner. Care plans are updated, but not printed off each time to reduce the carbon footprint of the home.

“As a Social Worker it is lovely to work alongside Cantref as I know that they will support the residents well- Going over and above”.

“Always very friendly and helpful, provide excellent care for their residents and always want the best for them”.

“As a district nursing team, we have complete faith that all residents in Cantref are well cared for. Any issues appear to be identified at an early stage and brought to our attention. Staff always follow any guidance we give. Residents are treated like family.

“It is always a pleasure working with the team at Cantref. They are committed to providing a wonderful service for their residents. Always ‘step up’ when a patient becomes End of life. The best testament I can give, is that I would be very happy for any relative of mine to be cared for by them. Not only that I would like to be cared for by them when my time comes!”

Are people happy and supported to maintain their ongoing health, development and overall wellbeing? Please comment at the end if you have any concerns

All relatives voted Yes for this question

“To date we have no concerns whatsoever about the level of care that our mother is receiving at Cantref Care Home. She has settled in extremely well, is very happy (more so than when she lived independently and alone) and she says that all the staff who care for her are truly wonderful (her words). We had heard about Cantref Care Home before mother became a resident and all the reports were good. That has certainly proved to be the case. We cannot thank the management and all staff at the care home enough for everything that they are doing for our mother. Keep up all the good work.”

From both Healthcare Professional QA report and our feedback from relatives, for 2022/2023 there was no need for either party to highlight a complaint. From the specific question of whether they would feel confident in approaching management regarding a concern or a complaint or raising one in the first instance and they responded that they would feel reassured and supported and some responders specifically said they had not had the cause to raise any worries.

We have raised a few concerns ourselves. Whilst appreciating the difficulty the Health Service has, our apprehension lies with the general delay of ambulances and furthermore once our resident has left the building, the amount of time they are on an ambulance rather than receiving the care that they require. Our Paramedic teams who have visited over the last year have been second to none and do the utmost that they can offer, nevertheless, the worry continues once they leave. The only way we have seemed to cope with this is to promote forward thinking with the care of our residents so that they can remain as healthy as possible, and we do that with the support of our very good GP service and the help and support of our District Nursing team.

Our second concern has been the development of our E-Mar system and the support we receive for that. E-Mar is the electronic medication administration system that we use which combats errors and has an electronic way of recording the way in which we perform the medication round. It gives detailed reporting for management; it gives close control of all medication provided, reassurance to our staff, to our residents and a much clearer view of administration. It is a much better system that paper MAR charts, which we have moved away from. Much to our disappointment, after dealing with Shackleton’s Pharmacy for over thirty years, it was their business management (email) decision to not provide that service for us anymore citing revenue profit as the reason. Our concerns for this were that we would be left without a pharmacy system for our orders. We therefore visited Malpas Pharmacy and they have taken over our E-Mar system and they will deliver our monthly orders for medications. Shackleton’s have stipulated that they will still provide us with our urgent medication such as antibiotics and we hope that this will continue so that our residents are not left without the medication support that they need.

Thirdly, we raised a concern with the ABUHB for returning a resident with a cannular in situ in their arm. This was not an instance in which it had been pre-arranged with our district nursing team and in turn can cause distress for the resident involved. As a district nurse was visiting anyway, they very kindly dealt with this, and we raised it with the MAU team at Nevill Hall who have since apologised for this error.

Our fourth concern has been with the change of telephone system and door entry system. It has been a difficult implementation and one that the relatives have been extremely patient with. It has been intermittent in terms of reliability, and we hope that from now the system causes less disruption for all. We have had to make the decision to move from analog communication to digital, it is not very well publicised yet, but this will be implemented across the country from 2025. We believed to be forward thinking and pro active went ahead with the switch, but it has had its problems.

It is important to us to involve the families and friends of those who live at Cantref as much as we can. We understand that families like to be kept in the loop, particularly with health and how we care for their relative or loved one. Any falls, changes in behaviour and any plans of action that we have in mind, as we often find that minor tweaks in medication or just the clarification from a doctor that someone has a UTI can reassure families that we are making the adjustments we need to ensure individuals are at their optimum health.

Do you feel that we keep you updated and reassured with family members health issues or any observations? Are we responsive to changing care needs for EXAMPLE, Please comment if you have any concerns.

Are people happy and supported to maintain their ongoing health, development and overall wellbeing?

We have had a few residents’ meetings throughout 2023, our activities coordinator Alli structures these and most of our residents join in. Recommendations of the most recent meeting comprise of asking for a dining chair with arms, and a blind for the conservatory when it is particularly sunny. Both of which we are looking in to, but in the adversary of honesty, these sometimes get pushed back to when there are more pressing or urgent jobs that need action.  

Currently our activities are centred around Autumn. We have displays of Autumnal poems and there are painting and knitting crafts ongoing for décor into the Autumn and Halloween and Remembrance Day. Trips out have been limited, this is due mostly to the weather this year and it being too hot, in May to it being too wet. Activities coordinator has done a sterling job of ensuring everyone is asked if they wish to venture out when we had a good day and taking them out where possible. It is not always to everyone’s preference, whilst it does seem very nice to go out on trips and change of scenery, it can often to lead to great anxiety to be outside of the environment for an extended period and takes great coordination and reliance upon mood on the day to whether our ladies and gentlemen are willing to participate or not.

Covid inoculations have been completed in early September 2023 and flu jabs are next. Equipment has been provided for some of those residents who have upstairs rooms, and their strength is not optimised due to mobility and for downstairs to enhance the ease of use for those who’s upper body strength may decline.

We regularly risk assess room allocation and initiate a change for those who’s health has deteriorated, and we are better able to implement any equipment or observations on them without it being too intrusive or difficult.

Infection control is important to us, we have lists of duties that are incorporated by staff and our very hard-working cleaner so that standards do not slip. It is more difficult now to initiate less contact with visitors, we still try to implement the “please do not visit if you feel poorly” ethos, however, the outside world has become more of a tolerant place living with Covid-19 since the lockdowns caused undeniable stress for everyone involved. We are more mindful that with vaccinations, our residents are protected, and should they suffer with any illness relating to any virus variations, then they will get through it with relative ease. 

Our hairdresser Linda continues to be our hairdresser and Chiropodist Glenyse is a regular visitor also. We have regular visits by Musicare, Beth the Singer and other musical acts. We have the Meadowbank Nursery visit every two weeks and this is a great uplift for all our residents who get to craft with toddlers from the nursery.

Please comment on the general atmosphere of the home.

“Such a lovely atmosphere, a real home from home. The staff are so kind. It has a real family atmosphere. “

“Friendly staff make for a relaxed and upbeat feeling around the home. I often hear laughter”.

“Really friendly and welcoming. When I visit there is a happy buzz about the place from staff”.

“The home is welcoming; staff are very pleasant and always helpful. It is clean and has a very positive atmosphere. We are always updated and reassured about ongoing health issues, well-being and residents all seem happy. We can ask questions any time either in person, phone or by other means of communication”.

“Welcoming and homely “

“The general atmosphere of the home is very good. The times we have visited staff have been friendly, residents appear happy. The lounges and sitting areas were tidy, the lounge at the front is welcoming and homely”.

“Exceptionally good. Mother has been at Cantref Care Home since January 2023, and we cannot fault the care home in any way. She has settled in extremely well. Much better than we thought she would. The atmosphere is always very welcoming, and all the staff are superb at dealing with all the residents”.

CCTV – we do have cameras in our public areas. It is important to share that this is not used for constant monitoring of individuals more as back up reference should there be a requirement to have some insight into an incident of a fall for example.  Whilst the CCTV is only in public areas, we are sure that our individuals and members of their families only feel more reassured. We do have forms that our families can sign on behalf of their relative if a resident does not have the capacity to understand the use of CCTV to protect their rights.  

How do you find the exterior of the home and the gardens and care station?

The average score for this question from relatives was a good 4.6 out of 5

We do have plans, as stated below, for the grounds outside of the conservatory and new patio and furniture will be added to the job list for the winter so that it is ready for the spring hopefully.

What are our specific improvements / OR developments 2022/23

The bathroom has been updated on the ground floor and new equipment obtained for the shower room.

The biggest job currently is the implementation of a new call bell system that is a lot more pleasant in terms of audio, it will give reports of how long a bell takes to be answered and will alert other staff if the bell has been answered and that they are in the room with the resident, it will also allow the member of staff to call on their team if there is an emergency. We will also have neck alarms for our more independent residents who are able to carry this around their neck and to call for assistance should they need it. 

Carpets and flooring will be replaced in key areas, and this should be done by the end of 2023. Windows have been ordered for some rooms who still have wooden frame and therefore the heat will be retained that little bit more.

Our laundry areas and staffing areas have been updated and the heat generated from the laundry has been worked so that it is recycled into the staffing areas to reduce carbon emissions.

We have heard your requests for seating on the patio. This is another job that will be planned into the winter, the patio surface will be replaced and made much more aesthetically pleasing and will act as a secondary area for residents and their families to sit. This is an exciting project and one we are looking forward to finishing so that they outlook from the conservatory is much more enhanced also. We will keep you posted on that.

 How do you find the general appearance of the rooms, we know some need wallpaper attention, paint touch ups etc. Do you feel that your relative is comfortable and happy in their room?

Our average score on this question was 4.2 / 5

We did have a respondent who ticked 1 out of 5 and so we contacted that family and asked if there was anything that they had concerns with. We actively have that room on the list as requiring renovation, however, until the call bell system has been put into place, we cannot decorate as it would mean that we would be potentially decorating twice, dependent on the wiring. The family responded that they had not meant to press 1 for the question and offered to take another questionnaire.

Another family had reservation regarding noise from a neighbouring room. We have investigated soundproofed panels and will put these in place in the next month or so to muffle any sound into the next room and this may work beneficially to ensure both parties can stay in their respective rooms and remain happy.

How do you find the general appearance and demeanours of our residents, do you have any concerns?

Our average score on this question was 4.6 / 5

Individuals who have capacity, can make decisions on their health and whether they require a GP or to see their Mental Health and other Healthcare professionals. We have quite a few individuals who are able to talk about their worries and decide whether they wish to see a professional and the reasons behind them. Individuals are taken to a private area for discussion and all updates and observations are put onto our Caredocs system.

From our resident meetings, our individuals are happy with the activities. Alli and all the care staff team have worked so hard in creating themes and activities around those themes and generally sit with them in the afternoon for regular chats.

Caredocs is updated with personal care input, and we document the consent from residents. This includes care such as facial hair removal, whether they wish to have their hair washed or wait for the hairdresser. We initiate body maps for those who have sustained any skin concerns, injuries, or bruising, whether this be in hospital or at Cantref. These allow us to daily check and update any changes for our colleagues to manage on the next shift.

We are proactive with any health changes or concerns. It helps to be very aware of each individual and their care needs and how they usually present. Any changes around their normal behaviour instigates an alert to us as the care team and we are responsive to that as are our GP’s and DN’s.

Do you think that the Cantref team ensure that care and support is provided in a way that protects, promotes, and maintains the safe and well-being of individuals and that we seek support from relevant agencies and specialists where required. (We do incur delays from some outside healthcare sources unfortunately)

100% of people answered yes for this question.

How do you find staff appearance and attitude? Please write any concerns at the end of the questionnaire

We scored 4.73 / 5 for this question

Does the home appear to be managed professionally?

100% of people answered yes for this question.

From my own perspective

Staffing levels are good, we have had one of our members of staff leave for maternity and we will hopefully welcome them back in 2024. Recruitment for the service of care remains very arduous and we are finding that we are not getting a good selection of people through the recruitment portals. As management, we remain very appreciative to our very loyal and hard-working staff who help get us through the difficult or unforeseen circumstances of the rota. We do have a work experience person starting in early October. Of note, they said that they had applied for work experience in many care homes in Cwmbran and Monmouthshire and we were the only ones who responded.

Our team’s commitment to training is at the top end of the scale at 90%, we do have some staff who are actively finishing off their topics of training. All mandatory training has been completed. Wel done to those who are amid their QCF Level II in H&SC or have recently completed this. This takes our average to a high percentage of 90%.

We will be carrying out more Fire Safety drills shortly to remain in line with the guidance and to ensure that our staff are confident and reassured by their actions during an emergency. We have opted to do a silent fire alarm scenario using notelets to staff for the scenario – this will be to cause less stress on our residents as when the alarm goes off, it can cause severe disruption to those suffering with dementia.

 To reassure our relatives

We have not been contacted by our CIW inspector. We still notify CIW of any incidents that we are obliged to.

To date, through the QA questionnaires there have not been any concerns voiced by residents, however, our aim is to always improve, and we have adapted our procedures through the pandemic so far and will work as a team together to always ensure we achieve the highest standard of care for our individuals and provide safety and confidence for our staff.

Do people feel safe and protected from abuse and neglect?

100% of our responders put Yes for this question

For the protection of those who may come to harm outside of this environment and do not have the capacity to see themselves “at risk” if they were to leave, we are able to refer to the Deprivation of Liberty Safeguarding Team. We do have several under the protection of the DoLS.  We must work within the principles of the Mental Capacity Act and do everything possible to empower people to make as many decisions for themselves as much as they can. If a DoLS has been highlighted as a requirement of a particular individual, we do our best to inform relatives first as it can be a bit of a shock to receive a call and not know anything about the process. We will be putting together a booklet for ease to give relatives as much information as possible.

GDPR and confidentiality is our professional responsibility, and all current protocols and procedures are up to date.

We have an electronic signing in system at the door that we encourage daily visitors to sign in and sign out on. This leaves us feedback also.

All residents are part of the ABHUB Oral Health Scheme, and we have an Oral Health Champion(s) as part of our staffing teams. The oral care champion(s) are responsible for putting systems and processes into place so that oral health care plans are followed and that residents have access to preventive and treatment services when required. It was only evidenced to us recently that our previous local dentist who looked after out residents on a community basis has now been outsourced to Blackwood. There are delays in the service and currently we do not think that waiting times have improved at all since during the pandemic which can incur confusion to our residents and sometimes discomfort.

We have a strict NON-ACTION IS NOT AN OPTION rule on matters of Safeguarding. The Social Services and Wellbeing Act 2014 illustrated changes that impacted changes for adult safeguarding in Wales and all staff are currently compliant. Cantref and local authorities and all parties involved in safeguarding have the aim of stopping abuse or neglect wherever possible, preventing harm, and reducing the risk of abuse or neglect with any adult who requires care and support needs and to safeguard them. We always support them in making choices and ensure awareness that they have control about how they want to live. Staff are aware, from the policy, of their responsibility to report a suspicion of a safeguarding concern, who they report to, and are supported throughout the process. We do have a robust policy on discrimination which is contained in the ground floor office.

Would you recommend our care home to others?

100% of responders put YES for this question

 Thank you to everyone for reading, commenting and highlighting things to management and our team of hard-working care personnel. We really appreciate the feedback, and it is always a pleasure in passing on positive comments to the individuals who look after your loved ones.

We do not wish to become complacent, hence our QAs on an annual basis.

We will endeavour to continue with advocating the voice of our residents by encouraging regular meetings. We also sustain a supervision programme for all our staff in which they can come and speak with management. Our next group meeting as a big team will be on the 20th of October 2023.