Cantref Care Home - Results of Quality Assurance Questionnaires late 2019 - Aug 2020
Responsible Individual: Anthony Bailey
Manager: Joanne Pritchard
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, it is 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’s survey came at a particular difficult time as we are amid a pandemic situation. Our care home has been locked down with no visitors since the 13th February 2020 aside from emergency healthcare professionals. The survey has been conducted to relatives via email and many have responded on behalf of their relatives. With our healthcare professionals, we also had to elect email as the way we would correspond, however, we do not have everyone who would usually visit the home’s email address and due to the confidential element of our GP practices etc. we do not have as many responses as we would usually have. The staff survey is currently being completed during our second set of supervisions this year. We elected to take the first quarter supervisions through observation practice, as our aim was to maintain social distance as much as possible, however the second quarter of supervisions, staff have been informed their supervisions are due and we have proposed a “pop in” plan daily Monday to Friday for those already at work in order to complete a more personalised supervision, particularly to check on wellbeing as this last couple of months has had an impact on every staff member with plans cancelled, weddings cancelled and many of them for a long period of time not being able to see family members or socialise in the “normal” way. Residents surveys will only be conducted this year with those who have capacity to formulate their decisions as it seemed a bit of an unfair factor to have staff on standby with these when it would be families who would ordinarily gain their foresight on an impartial basis.
Do people feel their voices are heard, they have a choice about their care and support and are opportunities made available to them?
What do we do well – and how do we evidence it?
From pre assessments to the completion of Individual Plans, individuals and their families are the primary source of information. They are very in depth and the Mental Health Capacity Act is the core to the process and whether the individual themselves assist with this formality, or the family or prime caregiver, the onus is very much on individual choice and consent is gained for all answers. We would usually include the following paperwork.
Choice and Control
Communication preferences
Personal Care
Nutritional and Hydration preferences – we are very in tune to this, it can be exceedingly difficult to push fluids in care, so we have ordered more fruit such as varied melons and adapted our offerings to include more moreish food items with hydration in mind. Our menus are continually monitored and adapted through the seasons as mealtimes in care are hugely important.
Social, Cultural and Leisure Activities
For our recent assessments, we have had to rely on gaining as much insight into a person as is possible by utilising our healthcare professional’s knowledge of a person prior to them coming in, as we have been unable to undertake our pre assessments in the usual way. We have asked families to fill in the “All About Me” paperwork to also gather as much choice information as possible. For the future, we hope to formalise our own questionnaires to use so that we can explicitly formulate from the responses whether we are the best setting for someone’s care and to appreciate the information on preferences to implement into their care plans. This will evidence us particularly well if someone is due a return from a hospital admission. We have found the feedback or handover of those returning from local hospital stays to be the more challenging and we hope in the future to progress a more open working relationship when it comes to what is best for the individual, rather than what is best for the hospital, and a more adequate and supported system needs to be in place to protect those individuals returning for their care and for those who already live here.
Do people feel their voices are heard, they have a choice about their care and support and are opportunities made available to them?
What do we do well – and how do we evidence it?
For our relatives’ questionnaires this year, we opted to send a copy of our complaints protocol. This is due to previous feedback over the years that they were unsure of the procedure, or not had the reason to use it. Our complaints policy is contained in all rooms and discussed during care plans, however as with all companies it is something that is not at the forefront of someone’s mind unless there is a reason to be unhappy about something and in the first instance we would anticipate that relatives, residents and staff would ask to speak to the manager as a first proposal. We are a small family run home and pride ourselves on an open and transparent relationship with relatives and provide them with as much information as possible, particularly with any areas of concern they have for their relative or loved one. We have been fortunate enough since our last QA not to have been approached for a complaint’s form for any means. We do actively express however that our residents, as much as is possible for their capacity, choose what support and opportunities are made available to them to live here as comfortably and independently as possible.
Our care plans are centred around an individual and these are updated regularly. Should staff note a change or there be a development in someone’s care, this is put onto the white board in our staff office to be transferred over to the individual care plan. These are usually adaptations to mobility changes, by way of using new equipment, or medication changes, every update we make ensures that we are looking after the individual in the best way possible and that all relevant parties in care, be it doctors, mental health teams, social workers and families are all up to speed with this valued information should they require to have access to these details. We do not actively print off a care plan every time there is a change however, we decided we would save paper and printing time to help with the environment and the administration time. ALL care plans are computerised our highly regarded system is managed by very competent staff and in the areas where elements require updating, the system makes these prompts. Our care system has also had many updates since March to help evidence any Covid19 testing/results and temperature scanning (which is done twice daily).
We include the families and friends of those who live at Cantref as much as we can, with consent. Families are 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. We include family and, for many individuals who do have capacity, they prefer this involvement as it helps with them achieving a satisfactory outcome and understanding of their healthcare needs and why we are doing what we do. With a transparent relationship with the families it helps our care teams and provides families with the reassurance that their loved ones are being looked after to the best of our ability. Families are also kept informed about any care home activities or news on our Facebook page and during the initial lockdown stage of Covid19, this proved a lifeline to those families who could not visit and kept them as informed as possible. Permission, as always, is requested from our families and individuals prior to any pictures being posted and illustrates to all those who access this platform how invested we are in keeping our ladies and gents entertained but also our stance on our own policies and procedures that we have developed through this time. The feedback we have had from families with regards to Facebook has been very supportive and we are thankful that we are able to keep them all up to date at the same time and any concerns or questions we are able to answer quickly.
We had a lot of indoor (VE DAY) activities, PRIDE support, and outdoor activities planned for 2020. Our singers were pencilled in twice a month during the summer and that alongside our trips and Zoolab visit would have stood us in good stead for entertainment. However, despite the cancellations, it did give staff the opportunity to make muster up their own entertainment as much as possible to help keep spirits up. More recently Musicare has developed their format, and we have had a couple of sessions of music that has been carried out just outside the conservatory so that our individuals can be involved on the inside, but are safe due to the distance and them being indoors. It will continue to work in this way for the foreseeable future.
Individuals do have the opportunity to assist with our menu’s and in the Summertime, the menu will differ, and it is currently at this time we will open dialogue with our individuals to gage the interest on what they think should be on the menu in the Autumn. Mealtimes are so important as a social aspect to those who live here and so it is an area that we are always striving to improve and we encourage variation including the ideas of our cooks who work hard to achieve great meals and puddings. Teatime thoughts that are to be proposed at our next meeting include, chunky kedgeree frittata and naan bread pizzas. The residents meeting is proposed over the next week or so. Our last one in January got some approval with the menu choices and new additions were made, but we are always ready for a change by the time the Autumn is almost upon us. From our previous residents meeting a welcome request from one of our ladies was that new residents are introduced to everyone. We now ensure this is part of induction and it does make it very welcoming for that individual who could otherwise be rather daunted by a new environment.
Are people happy and supported to maintain their ongoing health, development and overall well being?
What do we do well and what is the evidence for this?
We have had individuals choosing the décor of their rooms (should their room be at the point of refurbishment) and we have found this to be successful. In 2020 we have only had to update two rooms so far. The main one was room three and the lady who resides there was asked about her favourite colours and what her requirements would be. Our lady welcomed the colour green and requested “nice and bright”. We had just about managed to decorate it prior to lockdown, we have some finishing touches left to do Our lady in room three is very pleased and often now spends a lot more time in there as she finds it calming. It has also been quite a good room as we were able to provide “window visits” safely to the family quite early on after lockdown eased. Room 20 has been updated also and when we have sent pictures to families who have been looking for respite placements etc. to give them some idea of the rooms and the visual aspect inside the home.
The “Coloured Walking Frame” scheme is still something we are involved in, however with Covid19 and the restrictions and limitations of personnel visiting the organisation this has ceased for the time being.
Prior to Covid19 and ready for Christmas 2019 we had our new conservatory built. This went from a Perspex roof older style to a larger slated “warm roof” with Velux windows. The individuals here really love this area to sit and look at the birds and the Blorenge Mountain and Sugar Loaf Mountain. The new conservatory has improved our carbon energy footprint by keeping the warmth in as it is better protected by the insulated slated roof.
Mobility is always a factor we are keen for individuals to try and retain as much movement as possible. We have had lack of physio input for the obvious reasons and so have been resourceful in participating in what we can do ourselves with encouragement for those who have declined in this area through age, hip injury or contributing health factors . With the use of the equipment that we know well, like the handling belt, we have been able to encourage a fair few to attempt in walking with their mobility aids rather than for us to utilise the steady aid too much. It has provided some with a much-needed lift or confidence boost and our individuals enjoy trying again which is particularly good for their wellbeing.
Hairdressing has become another skill that has been homed in on by our care staff. We have been lucky to either have someone who chose hairdressing before care initially so have their NVQ and know-how and those staff members who really like to put 100% into doing what they can with rollers and tongs, the old fashioned way. It has been great to see the older staff members passing on what they know to our younger staff members and we think we have been lucky that hair and appearance have been addressed throughout the pandemic. Even painting someone’s nails or giving one of our gents a good shave and a haircut really gives them a boost. Our usual hairdresser has been in constant contact throughout these difficult times and hopefully at some point in the future she can return for this service, but for now we count ourselves very lucky that our staff have picked up some great hair skills.
Visitation has been a huge factor with our individual’s wellbeing. Our care home was a hub of activity always under “normal” circumstances with visits from families, friends, healthcare professionals, entertainers etc. In Mid-February, this ceased to exist due to the threat that Covid19 posed to our care home. We have been incredibly lucky that we have had considerable understanding from families and friends, however it undoubtedly changed the environment as we once knew it. Initially, staff took on the additional duty of activities and as we were the main people that our individuals saw daily, we had to improvise our skills on many occasions. We always knew that after a certain period we would have to offer alternative methods due to our ladies and gents really missing out on their regular visits. We adapted at the point we thought necessary and safest and we were lucky that road noise at that point was relatively low and so our conservatory window or front door initially became the meeting point with the gate as a barrier and a two metre distance signage for visitors. Individuals remained inside the building and whilst the warm weather helped, as the RI, the responsibility was to look further ahead and it was decided that the Perspex we had on order would be put to better use with a more permanent and more private facility. We subsequently built what is known as the Cantref Care Station, and this is now the meeting area for relatives and friends to meet up with their loved one. There are two entrances to the cabin and Perspex / enclosure is from floor to ceiling to protect our individual whilst the meeting takes place. We have added in a speaker system to assist with the acoustics of those who are hard of hearing. The Care Station has the appearance of a train platform waiting room and is decorated accordingly with plenty of pictures of summertime holiday spots to promote conversation. There has had to be strict rules for the Care Station and as we head into Autumn/Winter there will be heating added and lighting. We purchased an anti-bacterial misting machine to completely sanitise the cabin in between visits. We can currently accept approximately 20 visits a week by varying family members and our GP’s / Healthcare Professionals are able to still conduct visits in a safe environment should they require.
iPad’s have been supplied to us to help with the pandemic and for people to keep in touch with their families. The iPad’s have been a good source of contact; however, most staff have found that our ladies and gents are less confused with the telephone. Through the initial lockdown however, these were a great option to enable many of our individuals to see their relatives in real time. We initially would do weekly calls with families to reassure them. We think it made a great affordance for families to be able to see some normality within the home as they were unable to come and visit in person.
Infection control has been incredibly enhanced. We took the decision early to wash our uniforms at work and keep our uniforms at work, changing at the beginning and end of shift. A new washing machine was ordered for staff uniforms only and our staff toilet turned into a makeshift laundry. It has placed more pressure on our night teams, but we believe it has been a paramount move in keeping cross contamination to a minimum level. Keys and phones are sanitised (everything that comes into the building is sanitised) and staff adhere to the two-metre ruling whilst wearing a face mask for the entire duration of shift as well as other PPE during personal care. New uniforms have been purchased and the Winter will see the addition of our own Cantref Care Fleece Jackets to wear outside (for meals and breaks) as no coats or other items will be able to be brought near or in the building. Lockers will be purchased, and all staff will house their coats, scarves, and bags outside and away from the building – and change into their laundered uniform. We are hoping that this will not only minimise risk of Covid19, but any bug that is prevalent to the colder months. PPE initially was notoriously difficult to obtain, however with foresight, we had managed to overt catastrophic low levels of PPE by ordering early and everything that we could. It was made more difficult by suppliers who were also struggling with demand, but they also took the decision to only commit to Public Health England. We have therefore been helped with our supply by Monmouthshire with items that had been difficult to obtain on a regular basis. Supplies more recently have eased and for now we are able to obtain a decent stock of items (for the time being). Individuals have adapted marvellously to us with our face masks, though it is not the ideal, it is what is required to prevent us passing any virus to our colleagues or residents. Staff are also currently Covid19 tested (mouth and nose) and have been tested for approximately three months up to the time of report.
Security has been an immense addition to Cantref, and it includes the Care Station more recently. It has been difficult to implement with only one sole maintenance representative and with the job of CCTV and building and putting in electrics for the Care Station it has been a full-on couple of months. The CCTV has provided staff with the security that they need, particularly at night-time. The CCTV 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 now that it is there, and we now wonder what we would do without it.
We have a few new flower boxes that have been created and sent down to us via our maintenance employee KB. The aesthetic surroundings of the building have had to be reassessed to ensure our individuals have plenty to look at. We had even managed to attract some starlings and blackbirds to our bird feeders which was nice, and the birds became quite friendly with staff on their breaks, particularly with any crumbs.
Some of the comments that we have had on our QA forms 2020
“The staff at Cantref are outstanding. They are knowledgeable and caring and will always go the extra mile for patients. I have been especially impressed with how well they have managed the Covid pandemic” – Doctor N
“No concerns – all aspects of the care are of the highest quality, in an extremely positive, friendly, and caring environment provided by all staff and all management” – BT on Behalf of Relative
“We have all been extremely happy with how our mother is cared for and that every effort is made to make it feel like “home”. Particularly impressed with how the staff have adapted to lockdown and really pleased with the fact you took the initiative to close the home to visitors in advance of the Government advice. We are sure this has enabled the home to remain covid-19 free and hope that this remains the case going forward. The staff are friendly and caring and always seem to have a smile in what must be very trying circumstances. Thank you for all you do” – M Family
“If when myself and my husband had to go into a care home, Cantref is the home we would choose” – MJ
“I have not had a moments concern that you are all doing your utmost to keep the residents and yourselves as safe as possible but still maintaining the high standards of Cantref” – SP
What specific action do we need to take to make the improvements / OR developments successful and how will this be measured?
What are our action plans for the specific outcomes and the focussed actions that are needed to improve and the timescales?
Covid19 has impacted our everyday working life and many of the jobs that we had planned for improvements were pushed back to make sure that we had facilities in place that were more important to help with the pandemic, this is an evolving and continuing process. We had to develop new ways of working and management, after initially working different days, we separated offices to help with social distancing. We have always had to be mindful, that as a family business, if one of us were poorly, it was likely that three would be off for a period of time, so we did our best to overt this. As the RI, I took my obligations and initially began working from home and adjusted the maintenance jobs to the outside areas of Cantref. Our aim now, is to return our makeshift office back into a lounge area for individuals to enjoy and the timescale for this is imminent, one of our previous offices will cease be a storage room for PPE and become a second office for the time being. Protocols and infection control and our Covid19 testing measures has meant that many jobs are now ready to be started again by maintenance which will include creating “pod” dining areas for our staff to have their meals on break. The gazebo has worked incredibly well for staff, however with the colder months heading our way and us wanting to maintain social distancing, we must think of how best to ensure their comfort and safety.
With our activities of the summer cancelled, we need to look at how we can entertain our ladies and gents without compromising their safety. We have been working closely with Musicare to come up with a solution. We will continue to inform families of any updates with this as our continuing stance on visitation currently is that we remain closed. Our “indoor” area is our care station where we know that individuals are safe. Halloween and Christmas will probably focus on our cooks to entertain with food and we have been looking at ensuring everything is ordered shortly to make mealtimes as appealing and a talking point as possible. At Christmas we would usually have an abundance of entertainment, including our Curry and Concert evening with the Baptist Church, however, this year, it is not meant to be. So, our main focus now is to ensure we have a program in situ and that everyone who lives here has input into what they wish to do as it will be very different to how the year normally ends.
Heating for the Care Station to ensure comfort in the colder months is also our priority. We may have to close visits for a few days to ensure that we can finish those jobs as ultimately we want relatives to continue to visit, but also know that they will not be freezing cold, they will be comfortable and safe.
We have managed to complete our Fire Safety Training on Zoom, which was good. Our Fire Safety Office Ray, tailors his presentation to our care home and basis the training on who we have in the rooms and how best we would ensure their safety if there was a fire. Our aim now is to ensure that we are proactive with training such as Vital Signs which we corroborated with ABUHB and this has been great in enabling our staff to initiate the health checks of our ladies and gents should they fall poorly.
Identify areas of improvement or suggestions that we have discussed as teams…
As teams we have discussions almost daily, particularly with regards to the wellbeing of our individuals. We are greatly supported by our GP’s and Nurse Practitioners and District Nurses and any concerns or worries we can discuss with them and receive weekly reviews via our GP’s currently. One area that we improved upon, with agreement with our nursing team, was the way visits were performed. The team suggested that it would be better for one nurse to attend and to attend to our insulin diabetics, but also any other dressings or minor health involvement practices. This was to save varying visits by the team throughout the day and cut down on entries into the home. We organised our front lounge to become a “clinical area” and as this is at the front of the building it is an area that can be sanitised each time assessments have been carried out, without too much disruption and there is no requirement for healthcare professionals to walk around the building as they would have done previously.
Menus are an area as a team we discuss and amend or improve areas that we feel we are able. We did have a very warm spell and as with all elderly ladies and gents it is exceedingly difficult for some to gain full understanding of the benefit of them drinking their drinks and keeping hydrated. The team suggested melon medley’s, fruit, lollies and different flavours of squash and pop to try and make the demands to keep hydrated that bit more appealing.
Observation is a noticeably big role of our care staff and the relevance of understanding someone’s characteristics plays a huge part in us being able to detect any problems or concerns we have with our individuals. Team handovers, our care system, and our appreciation of conversing as a group about each lady and gentleman helps in identifying possible ailments that we can discuss with our healthcare professionals to obtain a review. We risk assess bedrooms, as we are able as a team also to prioritise those who need more input with their care needs. It may be that an individual may be best looked after by being brought downstairs or to be transferred to a room that houses specialist equipment to continue their care to the best capacity. We have been mindful since February to include (hypothetical) scenarios of care, for all individuals, if Covid19 infiltrates our home and how best to manage our care home in accordance with infection prevention. It is an action plan that we hope not to put into place, however we have the capacity to “zone” off areas of the home should it be necessary, and have the required PPE, at this time, to assist staff with dealing with the issue.
We already have a steadfast protocol of how our policies and procedures are reviewed. These are done six monthly and any relevant changes or additional requirements are passed on to staff as part of the course.
Manager Joanne Pritchard carries out the extensive work on keeping our policies and procedures to a high standard six monthly
Our aim is for all staff to be competently trained in all relevant areas of their job role. Clearly all infection control has been updated with staff understanding the processes of the prevention of contamination within the building. All our staff all have access to Redcrier training portal which they can access through their phone, laptops or iPads in order to refresh and complete any training we ask them to. We are able now, which is new this month, to assess competency which will aid our evidence to our directorate and to add to our robust training analysis.
We encourage assessments and competency checks to frequent and carried out in a dynamic fashion, compared to simply refreshing training every 3 years. With our training, we currently stand at more than 75% of our staff having completed training to their fullest capacity and 75% of our staff have either a QCF level II or QCF level III in Health and Social Care. Our newest members of staff are currently at the beginning of the process but the certificates of understanding are being built up gradually.
Progress now will be made to enhance our social spaces for staff. I have sourced special anti-bacterial paint to freshen up and sanitise the break-time zone as well as cleaning and anti bac painting the storage cupboards. I have created “dining pods” for safe areas to eat/drink and recuperate whilst on break times, these are seating areas that are sectioned off with Perspex to adhere to the social distancing protocols. Our lockers for next season are high on the agenda and are due shortly.
Maintenance of the outside areas will be updated, and lockers will be delivered soon.
Are people happy and supported to maintain their ongoing health, development and overall well being?
What do we do well and what is the evidence for this?
Unfortunately, the children from Meadowbank Nursery have not been unable to visit since lockdown and this is unlikely to re-start until there is a vaccine in place to protect our individuals. We will be working hard with staff to think about how best to approach wellbeing through entertainment, particularly going into the darker months where mood and health can fluctuate.
The appearance of our home is very is especially important and we cannot allow standards to slip. We always look forward to enhancing the décor in accordance with the seasons and will be ensuring that our activities cupboards are stocked with plenty of creative pursuits for our ladies and gents to take part in.
Cantref basis its environment on being bright, airy, practical but with modern elements. We have local pictures painted by local artists, rooms are as light and bright as they can be, handrails have been painted to be more visible to those with eyesight decline or dementia and have coloured walking frames. We have a feature at the top of the stairs with a wall decal and words of encouragement to keep moving. Our dining crockery is all brightly coloured to ensure visibility to those who are impaired visually.
We had hoped to improve more on the bathroom areas and enhance these zones to be more of a sanctuary, however more urgent jobs had to take precedence due to Covid19. Now, whilst our bathrooms are very practical, they can be improved to make the whole experience of shower and bath days one to look forward to rather than it be a standard event. We have ordered new coloured face cloths and towels for the time being. To reassure families, all our bathing safety equipment (hoists / chairlifts) within the home have been assessed in 2020. These important evaluations have not had any ease of restrictions, we have just had to adapt the way we have approached these getting done with our engineers.
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 (care station) and all updates and observations are put onto our Caredocs system.
From our QA responses, our individuals are happy with the activities. Some relatives had concerns with Vitamin D and their loved ones exercise levels, as they would usually go out for walks etc. To reassure as much as we can with that, GP practices prescribed Vitamin D supplements to all our individuals early on in the pandemic. We have only been utilising our garden areas (on a warm day) and care station currently in order to keep our ladies and gentlemen as safe as possible. As stated above we are looking at ways we can adapt entertainment, particularly for the winter months.
End of life is an area we feel is as important as the life prior to becoming poorly. We have a robust advanced individual care planning system that promotes and enables us to ask the sometimes-difficult questions regarding end stage care. We try in all circumstances to look after our individuals in the environment that has become their home if we are able to do so and we cannot do that without the experience of staff and the incredible service of our district nurses and GP’s and the massive support we receive from the St David’s Palliative Care Team. We are always overwhelmed by the incredible support families provide us with and with the passing of some of our residents, it provides us with great positivity that we stay in contact with many families. Our thoughtful well wishers have provided us with handmade cakes, offers of help and encouragement and have sent parcels or donations as a thank you for all the help staff have provided them at these emotionally difficult times.
“Thank you so much for all you and your colleagues have done for Mum since she arrived at Cantref, but especially in the last few months, weeks and days. During the week I spent there from the 7th of this month it became clear to me how caring and professional all the staff were and it was a great relief to see and know that. My sister and I have been in daily contact since then of course and we have been reassured at every turn that Mum was in the best possible hands. I wish you the best possible future in these troubled times.”
What has been the feedback and do we feel could there could be improvements?
Feedback from the professionals
For the year 2019/20 we have not had any recommendations from the professionals so far. Our aim is to continue to build on all our formalities that work well and to be part of the team who improve people’s outcomes from invaluable joint working arrangements. Should we have had something highlighted to be changed, we would accept and consider suggestions and work towards improving the outcomes for all the people who live or work at Cantref.
Feedback from the staff
For the year 2019/20 we have worked as a team more so than any other year with the constant threat of the pandemic. There have been no areas of concern fed back to management from their QA responses regarding any improvements from their perspective. Many have adopted the ethos of “adapt and overcome” and have been fantastic in leaving their own anxieties of Covid19 at the door whilst concentrating on the wellbeing of our residents and bringing as much normality to their day as possible. We have all liaised together with many ideas and adjustments to normality. It is now my main priority to ensure their safety at work, whilst continuing efforts to reiterate their responsibilities and commitments with infection control protocols throughout this next stage.
From my own perspective
Staffing levels have, at times, been a little concerning due to the formalities and protocols of Covid19. We have had staff with health concerns, even minor ones, who were anxious or shielding, and those who had to stay home from work due to childcare and the rules of the Welsh Government during lockdown. Precautionary and very stringent measures have been imposed onto staff since February, and any staff showing any symptom were not to attend work. Since February the guidelines have evolved and become more clarified with scientific evidence and the availability of testing. Staff still do not attend work if unwell or have been in contact with anyone who is showing symptoms and have to isolate until testing has been carried out. There can therefore be undue and unforeseen pressures on the rota, however it is a situation we knew would be more difficult heading into the colder months and it is something we plan and converse about on a daily basis with management meetings and liaising with staff. We have been incredibly fortunate so far that we have not had any influx of Covid19 into our home. Recruitment has been however terribly frustrating during this time and it has been exceedingly difficult to get feedback from candidates once application forms have been sent out. For a night care role, a total of 48 application forms were sent out and only six in total came back, three of those did not attend interview. I would not say that our recruitment standards are lax, but the situation with lack of committed candidates is something that needs to be improved upon for the future should we require good quality staff and it is something that I feel could be highlighted in our next local authority forum meetings when they resume. I have no doubt that the initial recruitment drive for the NHS, those on the furlough scheme and possibly the media surrounding care homes affected the process somewhat. We do not have agency staff at this home and it has been down to the hard-working efforts of the staff in situ at Cantref and the very amenable involvement of them all to make changes to their schedules and annual leave that has bypassed any concerns we have had. They have been incredible in their support and understanding during this time. We can only hope to improve the flow of the workforce and all work together to ensure that staffing levels are maintained throughout the next phase of difficulty and uncertainty.
To reassure our relatives
At present our inspector colleague telephones fortnightly for a comprehensive and detailed conversation regarding the home. All relevant questions are asked that would usually be asked when an inspector visit’s the home and any evidence is provided to our inspector that is asked for. Any discussions that take place or any feedback would be pointed out by our inspector and we would work with them to achieve improvement in the areas we felt necessary.
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?
What we do well and how we evidence it?
We can ask our individuals directly whether they feel safe and protected, however the responses would be different for all as we cater for many different categories of healthcare problems, speech, cognition, learning difficulties, anxiety etc. We therefore must draw upon the working relationships we have with individuals, relatives and advocates and listen to our staff who are entrusted by our individuals to look after them and to notice things that may not be quite right. At our recent residents meeting, when residents have been asked if everyone feels safe and well, the response was they did feel safe and all were happy with the care station for their visits. Some were not keen on our facemasks but understand the reasons for them and they have all have managed amazingly well with this.
It is part of our duty as a care provider to act on any hint of an issue immediately for the safety and protection of our individuals. We, as a home, have instigated only one duty to report over the last twelve months which received a satisfactory outcome.
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. At present we have applied for one DoLS and have one in situ for our residents (2 out of 21). 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.
All staff are compliant in Safeguarding and complete this module yearly. The Redcrier system prompts individuals to refresh their training at the time required. Staff are observed daily, and supervision is carried out quarterly. One of the key topics we talk about at each supervision is abuse and whether they have or have ever had a concern they wish to talk about.
GDPR and confidentiality is our professional responsibility and all current protocols and procedures are up to date.
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. This area of health has been particularly important to us over the last year since the training by our local health board team and it has been extremely useful.
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.
We do have an admission protocol and currently only admit relevant healthcare professionals who need to perform medical intervention to enhance wellbeing. We still have a signing in book by the front door and all visitors are asked to sign in and out. Any visitor may be asked to identify themselves by the staff and should not feel upset if this happens, it is our way of keeping the home as secure as it can be. Our care station has strict guidelines also which are always under review and updated to ensure the safety of our individuals.
Do the individuals who live at Cantref feel that it is a place that supports their well being and can they achieve their personal outcomes?
What do we do well and can we evidence it?
At Cantref we are very conscious that it can be a big decision to come into care for both the individual and their families or advocates. We always advise that families gain as much information as possible from independent professionals to whom they have access to such as GP’s and the CIW. We have not been able to welcome any families into the home, unfortunately, who are at the beginning of this journey and this can prove quite difficult for families. It is a big responsibility to place someone they care for into a home they have not seen. We have therefore taken lots of pictures for our enquirers and videos from time to time to help during this phase and to try and ease any concerns. Individuals and families usually whittle it down to those homes they prefer, and it is at that point that we can complete an assessment on the care needs and requirements and quite how an individual would like to live at Cantref happily. Individual care plans are created over a period of time and that is the bible of ones needs and requirements for everything to do with their care. These are updated regularly to incorporate changes, enhancements, or recommendations. For the period of the pandemic, we have had to have as much involvement as possible with families through email / phone calls etc and healthcare professionals to help us formulate a picture of care for an individual and to ascertain whether that individual is best placed at Cantref and will be happy.
Independence is our main priority and ensuring someone maintains their abilities to help themselves as much as possible. Our activities coordinator makes themselves aware of individual requirements in terms of the levels of interaction that they would like to participate in, and they do their best to spread their wellbeing skills to keep individuals happy and motivated. It is an exceedingly difficult job, however somewhat rewarding when you know you have helped enhance an otherwise routine day.
Individuals have not had the opportunity to venture any further than our gardens during this time, however ordinarily without the restrictions of Covid19 any person, who we feel is safe to do so, is able to go out for walks or trips with staff or their family, some have even ventured home or to Tenby for a few days and returned to Cantref. We hope that this is something that resumes in the future.
Individuals who have decided that this is their forever home are given the option to personalise their rooms as much as they can. We have helped individuals pick out wallpaper and colour schemes, and those who wish can have their own telephone line for calls. We have WIFI throughout for iPad’s, tablets, and mobiles (which are regularly sanitised) and individuals are encouraged to speak to families by all means of contact, as much as possible. One individual recently was worried about their daughter’s birthday and that they would usually get some flowers. A bunch of flowers was therefore organised to come to the home and placed into the care station ready for their daughters arrival.
Through our most recent resident meeting, the minutes were documented and there were no complaints with the food, garden, environment. Of course, this can change periodically depending on individuals that you have living at Cantref and their expectations and demands, however we are always open to suggestions for improvement. Ideas for activities and to keep occupied were the main feature, some requested flags and décor for Armistice Day and to be able to participate with crafts ready for Halloween and Christmas and a buffet style Halloween party in which the staff dress up (we will do our best to comply). The Salvation Army to play outside has been mentioned and the visit of the local church. With the Care Station being built, we have placed a call to the local reverend for one of our ladies to receive communion and although there are a few formal restrictions in place, this is something their reverend is able to participate in. They will also bring booklets for staff to provide some information for us with regards to providing comfort and religious guidance for those residents who would usually participate in regular church visits should they not be in a care home with health limitations. The end comment to the minutes of the meeting concluded with many thanks given by our residents and that they appreciate everything that staff do to look after them. One commented that “everyone was wonderful” – thank you to them – this always pleases our staff and gives everyone the job satisfaction to know they are contented and it is a welcome boost that we need to continue onwards.