QUALITY ASSURANCE FEEDBACK AUGUST 2024
Our mission: “Our goal is to enhance the quality of life by delivering top-notch care and surpassing our clients’ expectations. We achieve this through a team of dedicated, motivated, and well-trained staff, supported by a continuous improvement program to uphold these high standards”
Registered Manager: Joanne Pritchard Responsible Individual Director: Anthony Bailey
Part of the Social Care Wales Act 2016 requires providers to conduct regular reviews of the quality of care and support that they provide. . 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 continually improve.
The date of our last inspection was October 2023, and we have no outstanding issues.
This year we have formulated our questionnaire by emailing relatives and our healthcare professionals. For staff our paper version was placed in the common working area for completion, anonymously if they wished and placed in our box by the front door.
Feedback from Professionals: 7 Relatives and Residents: 17 Staff: 11
Thanks for taking the time to complete the survey. A choice was given to families 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?
AIM - Individual Centered goals / Holistic achievements / Collaberations / continuious improvement
Relative’s Response for Room 9 “Fantastic Home and Care, Fantastic Staff. Always recommend Cantref to other people looking for care for their parent or parents”
We understand that Personal Outcomes focus on what individuals want to achieve in their lives rather than just the service they receive. That may be regaining some independence following an illness in hospital but still having the choice to say, “I will try going back home, just to see if I can cope”. We aim to give our residents the empowerment to take an active role in their care.
Personal outcomes begin with pre-assessment paperwork, we also work with professionals who are equally dedicated to ensuring that each resident receives personalised and attentive care. We want to collaborate with our residents and their families to ensure care plans are achievable and that we do our best to work realistically and leverage the strengths and resources of everyone involved.
There are over 600 questions that build into individual care plans. These are tailored but are not rigid as 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, Opticians, Dental Teams and Podiatry, St David’s, 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. We keep families informed and involved where consent is gained. We scored highly in our surveys for “keeping families informed”. (Care plans are updated, but not printed off each time for environmental reasons).
We have added a “Personal Outcome” button into our caredocs software, so that we are able to quickly document them in observations. These may be health related, a social benefit, or an acknowledgement of their independence or emotional wellbeing.
“Cantref Care Home performs an excellent level of care to our patients. The environment is centered on their residents i.e. very homely, loving and caring. All staff are well trained and respectful to their residents, families and visiting healthcare professionals”. Advanced Nurse Practitioner
“A safety culture and always seeking to improve – a welcoming environment and not an institution, friendly and professional staff”. Fire Safety Consultant
“I have contact with Cantref on a very regular basis and have always found the staff to be polite, courteous and helpful and they provide excellent care for their patients and communicate any problems promptly and accurately”. GP TGS
Our focus has been more centered around wellbeing and in the Spring, we purchased a specially adapted minibus. We had found that we were more restricted with our cars and if we wanted to take one of our residents out, we could only take two. Given that many have mobility constraints, a bus with the mechanical ability to upload a wheelchair has been beneficial. Our most recent trip was to Marks & Spencer. In September, we will have two weeks of continual bus plans for residents so that we can really go to town before the Autumn.
We have worked with some of our residents on menu options, some have diabetes or actively watching their weight and so have had a choice in what their preferences with some foods might be. We have a bigger menu board now with the daily menu and space for ideas for menu items. Gluten Free options also. We have regular resident meetings carried out by our Activities Coordinator.
We are currently advocating and working with one of our residents so that they can achieve returning to their home, which is a big wish of theirs and something we hope greatly that we can have a hand in and for this to be a success.
We would love to investigate obtaining more plants (atrium) as they provide several benefits and overall health. Our outdoor areas have been upgraded and improved for residents to choose to sit out when they wish, even if they are not actively participating in an excursion, they have been able sit out and get some fresh air. Many residents have been asking to do this themselves and this has been an unexpected but welcome positive as we know they feel safe to ask and they have taken it upon themselves to encourage others to go out also.
Are people happy and supported to maintain their ongoing health, development and overall wellbeing?
RELATIVES RESPONSE FROM ROOM 3 “VISITS FROM OUTSIDE ENTERTAINMENT, ANIMALS, DANCERS, SINGERS ARE MUCH APPRECIATED”
We have had no formal complaints since our last QA. Our policy is available, however many responders either note that they have had no need to complain or have not answered the question to determine the same point.
We have only raised one concern in the year 2023 / 2024, and this again was to the hospital who discharged a resident with a cannular in their arm. This was removed via our District Nursing team. We have not had a response from the hospital in connection with this. We also had a complaint in 2022/2023 regarding an incident of this also.
The working relationship with Malpas Pharmacy has been good and what was a nervous time in transition from Shackletons as our main medication provider last year, Malpas has not given us cause to be concerned. Shackletons still provide our home with “acute” medications such as importantly needed antibiotics. We sometimes must chase or determine where are prescriptions are, this can take some time, but we endeavor to have these types of items in the building asap so that a resident can be treated and health improved.
We have had a few residents’ meetings throughout 2023/24, our activities coordinator Alli structures these and most of our residents join in. From previous meetings we have put in place the blinds on the conservatory windows that were requested, and we have a board in place that announces our lunch time meal and gives people the opportunity to write on the board any menu ideas. We did try bacon rolls for breakfast! However, due to our varying cognitive abilities with our current clients, it tended to increase their anxieties as it was not the “usual” breakfast that they would be used to. We have registered with NAPA who, like us, are “dedicated to making a positive impact on the lives of individuals by championing the importance of activity, engagement and overall wellbeing”.
Currently our activities are centered around Autumn. We also have a packed program with the Meadowbank Nursery toddlers who visit on a Thursday, which is a huge success and something that has been ongoing for a few years now and we are very grateful. We have had trips to Marks and Spencer, Raglan Garden Centre, Goytre Wharf and we have had lovely visits from The Falconry and Bird Centre and a Shetland Pony. From the responses from our residents regarding the activities and musicality of the home, they all really find this positive and impactful.
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. We have, following a brief stint with Sara Steady’s which we proved not to be of benefit to our individual users at Cantref, have purchased brand new Arjo Steady’s which the residents and staff much prefer in terms of the ergonomics and ease of use.
Infection control is important to us, at the request of one of our staff meetings, a seven day a week cleaning rota has been implemented as a trial to give the care staff extra support to complete their duties, without having to think about completing the cleaning also on the weekend.
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.
Relatives Response from room 16 “My father has been a resident at Cantref since Sept 2023, My sister and I visited many care homes and Cantref was the only one we felt was appropriate. As a qualified nurse who has worked in the nhs for 25 years, I have very hight standards when it comes to care of the elderly. It is the little touches that make the difference – the rugby dates on his door. As a family, we have had no regrets and are reassured knowing he is in the safest of hands when we are in work – thank you (concise version).
From our QA responses we score highly on keeping relatives informed and we will always aspire to involve them in our rationale in requesting, implementing or improving care. 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. We mostly let families know via an email and then they telephone us. Or we speak with them when they visit the home.
Covid and flu inoculation have been booked in for October 2024. We now have regular reviews with our CMHT and there is a new referral system. Dentistry timings have also improved, and we continue our weekly GP reviews and are fully supported with our GP’s and District Nursing Teams.
We must think quick in this setting when there is a slight deterioration as we do not have qualified nurses on site. We regularly implement a urine check or chest exam, blood check with our GP’s and from those results and us knowing our residents well, we discuss how best to proceed in terms of referring to our Community Mental Health, Memory Team, DoLS etc. We currently have 4 residents we have implemented paperwork, however, there appears to be big delays in the service. We always explain to families what a DoLS is and why we put them in place and our staff are trained in the understanding of Deprivation of Liberty Safeguarding.
Please comment on the general atmosphere of the home.
“We would like to thank the “unseen workers who work a lot outside of the home”.
“Everything is 5* “
“Everyone has a role to play whilst working or visiting the care home and whatever the circumstances, there is always someone to answer you questions”.
“Nice to see younger care staff joining the team “
“Most wonderful care home, my mother in law is so happy and this is the greatest commendation you could find”.
“A lovely care home, beautifully presented with the emphasis on care. Everybody is so friendly and caring, the staff and the residents. I would recommend this care home to any person who is needing care”.
Just a reminder regarding 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.
Concerns or sugggestions from family “The big tree in garden, seems to be getting taller and wider – do you need to have it checked for safety?”
Our response to this is that – we had already had a tree surgeon come to look at the tree in question some time before the QA’s went out, however, due to the birds nesting, we had to wait for a time which was appropriate. The tree has been nicely thinned out and should now not look quite so intimidating. Thank you for your comment.
Concern or suggestion from FAMILY “when we have rain the entry button goes on the blink and the signal is intermittent”
We have had to raise concerns with our WIFI provider (we had to change from Analog). We know that this is sometimes a cause of frustration for our families visiting also as the entry system sometimes ceases to function and we must spend time with engineers on the telephone trying to resolve this. We hope, in the future, to reassure families, that when our current contract comes to an end, we will source a local company who would perhaps take care- home business more reassuringly and be available to come on site should we need them.
How do you find the exterior of the home and the gardens and care station?
Relatives Response from room 5 – “When you enter the car park, it is always tidy, the borders are well kept, they have a bus, have provided new seating, removed the hedge, a new bin store, the pathway and entrance are all kept tidy, though it is a shame the care station is not used more”
Work over the summer has been afforded to the outside whilst the weather was warm enough to achieve a lot. The big hedge has been removed and tarmacked to create a little bit more room in car par and the conservatory garden has been secured by a picket fence. We did submit plans for a new Oak sturdy reception frontage that would have a tiled roof and seating within, however, due to the National Parks and the aesthetic of the front of the building, it was unfortunately not approved this time. In the meantime, we have replaced the structure at the front door, put new plants in and Perspex the roof to protect visitors and residents from the elements. We have new outdoor furniture which has proved popular and allowed many of our visitors and relatives to sit out in comfort.
We are in the process of finishing the laundry with tiles and ensuring that it is fully functional for our team.
Care station can be back to full working use, however, has been a little used for storage whilst other tasks have been tackled.
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?
The biggest comments have been steered towards the bathrooms and these are next for us to target as they have been needing an upgrade for some time. One has been upgraded; however, the others need more thought into creating more space by sliding the doors rather than opening the doors. We are also hoping to implement an area for hairdressing, so that there is a “set” area of comfort for this, this should then take away the need to utilise a bedroom for space.
We have investigated a new bath suite that would make it easier for our residents and will be looking to purchase that in the next quarter.
We have successfully implemented a new call bell system. Safety flooring and new carpets have been laid. A new chair lift has been put in place, but we are still tweaking our requirements with this.
We are aware of some of the bedrooms that do need upgrading and will be working towards that over the winter period.
Relatives Response from room 4 – “Not enough ways to contact staff if a resident needs anything e.g. toilet when they are in the conservatory”
In response to above, we did trial a neck alarm and appointed “monitors” for this reason and the call bell would be initiated by them. However, we had not anticipated naps! Invariably and understandably, there are times when those “monitors” were napping. For the use of the neck alarm, we must take into consideration the cognition of those who use. To reassure our relatives however, we do have a toilet rota. We have also tried to implement for a few months now – protected mealtimes – for us to complete the toilet round, it is especially important for those who use the Steady for maneuvering. Toilet breaks are before and after breakfast, before and after lunch and then periodically after that. Of course, there are those who regularly attend the loo or feel they need to. We do our best to keep waiting time to a minimum, it adds to the reasons that the bathrooms are to be improved as there are many of our residents who require the larger areas of utilities to house the steady equipment.
How do you find the general appearance and demeanours of our residents, do you have any concerns?
“Lovely and clean home, all staff make contact with and are very helpful with any problems, patients look well cared for, I am a district nurse, and I am happy to attend the home”.
Relatives Response – “I would like to see, on times, biscuits, cake or even chopped fruit offered during coffee and tea times”
On Coffee and Tea times. We do offer biscuits to residents, quite often in fact. We must be mindful of those with diabetes and other health conditions where it is better if they are encouraged to eat their lunch time meal. We have offered melon and other fruits through the summer, particularly on hot days. At teatime, residents do have a home-made cake with their teatime option. All residents have their own items in their rooms or relatives do bring in items and share with everyone and we support this and appreciate it. Whilst we do have a stock of fresh fruit, it can often have to be discarded if there is a refusal to eat it (during the recommended date), we subsequently can have some wastage and would prefer to avoid this. Always best to afford us the options your resident would prefer, and we can therefore always have those items in stock or as an option. If we think of it, many would be having biscuits at 11am, 3pm and 5pm and 8pm – so we really try to keep a healthy balance of what we offer and more importantly, so that the main meals of the day are eaten at the normal times, which aids with medication administration also.
From my audits and talking to relatives, (rather than responses on the QA) – I am aware that items of laundry can sometimes prove to be a frustration to both staff and relatives. For staff, it is due to missing items not put in correct rooms and for relatives it is generally for the same reason. We have spoken to all the team periodically to limit missing items and the laundry and all its storage options and varying vessels for housing items before wash have been implemented. What I will say is that – it is only a good a system as the person using it. Many have worked here several years and have the process down to a fine art, they do try and pass this on, but sometimes there are errors. We can only try and improve on this. We have and always will offer to replace items that there are no answers for.
It is part of Cantref’s DNA to uphold the qualities of care and dignity as stipulated in our Code of Professional Practice. All our residents are bathed and showered, there is a rota for this, however, there are times when we must implement personal care and cleanliness unexpectedly, which we factor in. We would prefer this to someone being in wet clothing or being uncomfortable. We also work hard to dry residents properly and apply their creams ensuring they are as comfortable as possible. Our staff are trained to look out for stained tops, accidents, unruly facial hair, unclean nails, overgrown toenails etc and are keen to implement any change of clothing or reassurance or help with our residents. We regularly call on our lovely Chiropodist Glynese who always helps us out, particularly with those who have been discharged from a hospital setting as they do not appear to implement any foot care or nail care as they once did, and residents can present to us with unruly toenails which can sometimes be uncomfortable or prevent someone walking properly.
We always try an implement visual enhancement to pay homage to the seasons for example. Not everyone knows the date and time, however, from general aesthetic and feeling of the home, we do have some very nice regular comments from visitors. People who come to look around often feedback to us that Cantref feels very “homely” and that is the very thing that we want. We do attribute a lot of the aesthetic and demeanor of the home in aiding a new person “settling” in. We use aromatherapy for sensory purposes and keep the home clean and odor free, this is a credit to our team and in particular our two domestic staff who do very well in achieving this.
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.
Positive responses received for this question
As stipulated already, we are very well supported by our GP’s and District Nursing team. Many of our referrals for residents come from being recommended from previous relatives or Healthcare Professionals who know us well. We are very aware of our aspirations to provide high quality care for a residents stay with us, part of it is recognising changes in behavior, reluctance to eat, decline in movement ability etc and from this our team evaluates the best course of action. It is not always apparent why someone may be reluctant to eat, or eat a certain food, but when checked, if we can elicit any cause, we are able to refer to the community dentist for them to visit. The waiting times have improved now and this year we have sought their advice on several occasions and a few of our residents have had their problematic teeth removed in house and have been very brave. The quicker we initialise a response to a problem, whether it be teeth, or a urine check, then we can work towards a quick resolution and we think that families and residents are quite reassured by this due to their responses on the QA. Equally, part of that support we do provide is with end-of-life care also. End of life is something we feel very honored to be part of. Our team, along with GP’s and families usually get to chat about Advanced Care Plans and have everything in place prior to the stage where someone becomes acutely unwell. We work with families and GP’s to fulfil requests and ensure that dignity and all personal care needs can be met here if possible. We would not be able to achieve this as well as we do, without our working relationships with our GP’s, District Nurses and our Palliative Care Team from St David’s. We initialise and work towards receiving air flow products, the correct medications to be in situ and ensure residents, at this final stage in their lives, are very well looked after, clean and comfortable.
We have also had a number of school / college work experience individuals attend Cantref and it is good to see that system improving and us welcoming them to Cantref again.
Staff Responses:
Overwhelmingly good this year, thank you all
From our QA’s sent out, we received a very good amount back this year. We have been fortunate enough to welcome back a few following having children. We are supportive of our staff and acutely aware of the difficulties that can arise working in a care environment. The challenges become different at varying stages, dependent on the healthcare needs of those we look after. We did have a time when our steady’s were not working practically, despite having engineers to replace the wheels etc. We opted for a different brand of steady, which, once we listened to our staff, realised that these were not going to work in this environment. We work with each other on best practices, we hopefully show staff and afford all staff the recognition they deserve and help and support them throughout their Cantref career and this has been reflected in the QA’s we have received. So thank you to all of you.
Do people feel safe and protected from abuse and neglect? Are Staff Competent in their roles
Positive feedback for this question from relatives
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.
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.
Staff training completion is at 88%, we would achieve over 90%, however, have recruited someone new who is at the beginning of this journey. Most staff have completed their QCF’s and have utilised this certificate as part of their Social Care Registration. We are having difficulty signing up the remaining three, due to no funding, that we know of, being put into Health and Social Care, which in turn, makes it difficult to adhere to the SCW registration timelines. We have made our commissioning team aware and will keep checking for details on these qualifications to ensure they are implemented.
We have undertaken three Fire Safety drills since our last report. One at nighttime and two in the daytime with both day and night teams. This has been beneficial for everyone. Moving and Handling practical training was also very beneficial.
We have undertaken meetings with our teams, both day and night teams to keep regular interaction and understanding of any concerns or ideas that we can deal with or take forward. We do regularly consult with our teams using our Caredoc’s messaging system if we want opinions on who should be risk assessed to have a downstairs room for example.
Would you recommend our care home to others?
100% of responders put YES for this question
Thank you everyone.