Inspection on 03/08/06 for Clanfield

This inspection was carried out on 3rd August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Clanfield 03/03/09

Clanfield 24/11/05

Clanfield 25/05/05

Clanfield 11/01/05

Clanfield 08/04/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Clanfield 3 Toll Bar Road Islip Kettering Northants NN14 3LH Lead Inspector Mrs Kathy Jones Unannounced Inspection 3rd August 2006 10:30a X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Clanfield DS0000012743.V306047.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Clanfield DS0000012743.V306047.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Clanfield Address 3 Toll Bar Road Islip Kettering Northants NN14 3LH 01832 732398 01832 734094 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Paulette Yvonne Crossley Mrs Paulette Yvonne Crossley Care Home 30 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (20), of places Physical disability (5) Clanfield DS0000012743.V306047.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No more than 5 service users may fall within the category of Physical Disability (55 years and over). 24th November 2005 Date of last inspection Brief Description of the Service: Clanfield is a care home providing personal care and accommodation for 30 service users who are over 65 years of age up to 5 whom also have dementiarelated care needs. Clanfield is privately owned by Mrs Paulette Crossley who is also the Registered Manager. The home is located in the village of Islip. The village of Islip, although quiet, is on the outskirts of the town of Thrapston. There are, therefore, numerous shops and other community facilities within a reasonably short distance, although realistically transport would be needed for this resident group to travel into the town. Clanfield is a two-storey house, with lift access to the upper floor, set in large and attractive gardens and providing a peaceful setting for the residents There are twenty singe bedrooms and five shared rooms with eleven of the single bedrooms having en-suite facilities. The following fees were provided by the registered manager as being current at the time of submission of the pre-inspection questionnaire on 3 July 2006: • Fees range between £348.55 and £395.00. The fees include personal care, accommodation and meals. Chiropody and hairdressing services can be arranged and are charged separately. Other costs would include clothing, toiletries and newspapers. Clanfield DS0000012743.V306047.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. All standards identified as ‘key’ standards and highlighted through the report were inspected. The key standards are those considered by the Commission to have a particular impact on outcomes for residents. Inspection of the standards was achieved through review of existing evidence, pre-inspection planning, an unannounced inspection visit to the home and drawing together all of the evidence gathered. The review of evidence and pre-inspection planning was carried out over the period of half a day and involved reviewing the reports of statutory inspections carried out in May and November 2005 and the service history, which details all contact with the home including notifications of events reported by the home and telephone calls. A pre-inspection questionnaire submitted by the registered manager, seven comment cards from relatives/visitors, one from health professionals’ and one partially completed from a resident were also reviewed. The information gathered assisted with planning the particular areas to be inspected during the visit. The unannounced inspection visit covered the late morning and afternoon of a weekday. The inspection was carried out by ‘case tracking’ which involves selecting residents’ and tracking their care and experiences through review of their records, discussion with them, the care staff and observation of care practices. Observations were made of residents’ general well being, daily routines and interactions between staff and residents. The management of residents’ medication was reviewed. An induction training record was reviewed and two files for newly recruited staff to check the adequacy of the recruitment process. Communal areas and a sample of residents’ bedrooms were viewed and arrangements for refurbishment and redecoration discussed with a member of staff. Feedback on the inspection findings was given to members of the management team throughout the inspection visit and to the registered manager at the end of the inspection. What the service does well: Residents and relatives are happy with the care provided in the home. Relatives and visitors are made to feel welcome and there is a relaxed and comfortable atmosphere in the home. Relationships between staff and residents appear to be very good and throughout the inspection the inspector Clanfield DS0000012743.V306047.R01.S.doc Version 5.2 Page 6 noted that staff were making time to talk to individual residents and involve them in conversations. The provision of activities and stimulation for residents is something the home does well with efforts being made to provide activities, which stimulate the interest of individuals as well as the group. Residents’ are consulted about what they would like to do and staff will arrange it if possible, for example a trip to a nearby village tea shop. The home was clean, tidy and there were no offensive odours identified. Furnishings are comfortable and there is a large well maintained garden providing a pleasant outlook. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by Clanfield DS0000012743.V306047.R01.S.doc Version 5.2 Page 7 contacting your local CSCI office. Clanfield DS0000012743.V306047.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Clanfield DS0000012743.V306047.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, Std 6 is not applicable, as the home does not provide intermediate care. Quality in this outcome area is good. This judgement has been made using all the available evidence including a visit to the service. The admission process provides assurances that the needs of Residents entering the home can be met. EVIDENCE: Prior to a resident being admitted to the home an assessment of their needs is carried out. On the day of inspection a member of staff had visited two prospective residents to carry out an assessment. Review of the documentation and discussion confirmed that there is a process for establishing if the home is able to meet the needs of residents admitted to the home. Initial information gathered on one of the assessments was minimal, however the member of staff confirmed that further information from other sources would be gathered prior to making a decision about the homes ability to meet the prospective resident’s needs. Clanfield DS0000012743.V306047.R01.S.doc Version 5.2 Page 10 The inspector was informed that residents’ and their relatives are encouraged to visit the home prior to making a decision about moving in and that initially they would move in on a trial basis. Clanfield DS0000012743.V306047.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using all the available evidence including a visit to the service. The overall care provided to residents’ is generally good with health care services and advice being accessed as appropriate. EVIDENCE: Comment cards received from seven relatives/visitors and a health professional stated that they are happy with the overall care provided. Residents and a relative spoken to during the inspection were also happy with the care. Care plans are in place, which are documents to instruct and guide staff in the actions that they need to take to meet a resident’s care needs. A sample check of care plans confirmed that they are based on the needs of each individual. There was evidence that the management team are checking that care plans are reviewed regularly, kept up to date and that the information in the plan accurately reflects residents’ needs. The inspector was informed that some additional training and support was being provided for staff in writing care plans. Clanfield DS0000012743.V306047.R01.S.doc Version 5.2 Page 12 Advice was given following discussion with a staff member and review of records to implement more detailed recording for all residents’ whose food and/or fluid intake is poor. One resident’s daily notes showed several entries indicating missed meals or “small” meals. As on some days there was no reference to the amount eaten it was difficult to establish if she had eaten well on that day or if it was just that no reference was made. Fluid intake charts contained entries such as “cup of tea”. Advice was given that if this method of recording is being used to have a guide for staff about the amount of liquid in the cups or glasses used and to ensure they are recording the amount taken rather than just that offered. Comments from a health professional include confirmation that the home communicates clearly with them and that staff demonstrate a clear understanding of the care needs of residents’. A sample check of the management of residents’ medication identified that there is a system for recording medication received, administered to residents’ and any returned to the pharmacist. Advice was given to consider ways of simplifying the recording system to enable any member of staff to easily carry out an accurate medication audit. A small bottle of tablets was found without a pharmacy label specifying the name of the resident they were prescribed for. Staff advised they would return these to the pharmacist for appropriate labelling to reduce the risk of error. The inspector was informed that tablets are crushed for three residents with the approval of the General Practitioner and relatives due to difficulties for residents in swallowing. There was no information or guidance alongside the medication administration records to guide staff and no evidence that the pharmacist had been consulted about the possibility of the medications being supplied in a liquid format or of any reduction in the effectiveness of the medication as a result of crushing. A comment received from a relative said that staff were not always checking that residents’ had actually taken their medication. A tablet was recorded as being found on a resident’s bed, which would appear to support this. The senior staff member on duty on the day of the inspection was clear that it was part of the home’s procedure to check that medication had actually been taken before signing it as given. Senior staff confirmed that staff practice would be monitored. Staff were observed to speak to and treat residents’ with respect and were mindful of dignity issues. Clanfield DS0000012743.V306047.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using all the available evidence including a visit to the service. The home provides suitable activities, encourages contact with friends and families and provides residents with choice and control over their lives EVIDENCE: Routines in the home take account of residents’ individual preferences. For example staff were heard asking a resident if they wanted to have lunch in the dining room or in the lounge. Three residents’ were having their tea in the conservatory rather than going into the lounge. The inspector was informed that some residents’ have motorised scooters and access the local town independently. Comments from seven relatives/visitors prior to the inspection state that they are made welcome in the home at any time. Observations and discussion with a visitor during the inspection confirm that visitors are encouraged and made welcome by staff. Clanfield DS0000012743.V306047.R01.S.doc Version 5.2 Page 14 A range of activities is provided and it was evident that residents’ are involved in decision making about activities. Some residents’ had suggested that they would like to visit a tea room at a local village and the activity organiser was in the process of trying to arrange for them to use the local community bus for the outing. Discussion with the activity organiser identified that she arranges activities that link in with residents’ particular interests and where possible brings in people from outside who have relevant occupations or hobbies to talk to residents’. On the day of the inspection the activity organiser had organised a quiz, which she did with small groups of residents in each lounge and prompted some lively discussion in the conservatory. People from an external organisation visited the home in the afternoon to run a session on physical mobility/motivation, which those residents’ who took part seemed to have enjoyed. While residents’ are encouraged to join in the activities their choice not to join in is respected. The garden is a source of enjoyment for some of the residents, a relative had brought in some tomato and lettuce plants and the residents are monitoring their progress. Clanfield DS0000012743.V306047.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using all the available evidence including a visit to the service. The home has procedures for dealing with concerns and complaints which residents and relatives are aware of and staff are aware of their responsibilities for protecting the people in their care. EVIDENCE: The Commission for Social Care Inspection have received no complaints about the service since the last inspection. The Registered Manager advised that one complaint had been received by the home about the attitude of a staff member. The complaint was appropriately investigated and dealt with. Of the seven relatives/visitors who submitted completed questionnaires, six confirmed that they were aware of the complaints procedure. Residents’ spoke to during the inspection had no concerns about the care they were receiving or how they were being treated. Staff spoken to had no concerns about how residents’ were being treated and were aware of their responsibilities to act to protect residents’. Staff have received protection of vulnerable adults training. Clanfield DS0000012743.V306047.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 24, 26 Quality in this outcome area is good. This judgement has been made using all the available evidence including a visit to the service. The home was clean, comfortable and in good decorative order providing a pleasant environment for Residents. EVIDENCE: Communal areas and a sample of residents’ bedrooms were viewed during the inspection. All areas were clean and tidy and comfortably furnished and some areas have recently been re-decorated. Communal areas consist of a dining room, which is accessed via a slope and has a hand rail for assistance, two lounge areas and a conservatory, which is used mainly by residents as a lounge area. Staff were using a corner of the conservatory as an office area at the time of inspection, which did not appear to have any detrimental effect on residents, confidentiality was maintained throughout the inspection and residents’ appeared to be enjoying the additional interaction with staff. Advice Clanfield DS0000012743.V306047.R01.S.doc Version 5.2 Page 17 was given to keep the use of this space under review and to monitor confidentiality issues. Residents’ bedrooms seen confirmed that they are encouraged to bring in personal items and that care is taken to ensure that they are comfortable. The registered owner/manager has given a senior member of staff responsibility for arranging any new furnishings or decoration in residents’ bedrooms in order to maintain good standards. Bed rails were in place on two of the beds seen during the inspection. The rails on one of the beds were quite loose creating a gap between the mattress and the rails creating a risk of injury. A senior member of staff agreed to ensure that the rails were tightened up prior to the resident going to bed. Advice was given to request an assessment by the District Nurse for the use of bed rails for residents’, which takes account of the individual and their needs and the suitability of the rails and the bed including any additional pressure mattress. The home was clean and no offensive odours were identified. The registered manager advised that care is taken to minimise odours in the home. The preinspection questionnaire submitted identifies that staff received training in infection control in April 2006. An anti-bacterial spray is available in the hallway of the home for visitors to use to help reduce the risk of transferring any infection. Appropriate action and liaison with relevant professionals has been taken in respect of residents’ returning from hospital with infections. Clanfield DS0000012743.V306047.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using all the available evidence including a visit to the service. Staff training, recruitment procedures and staffing levels provide good care and protection for residents’. EVIDENCE: Five out of seven relatives/visitors who sent in questionnaires confirmed that they felt there are enough staff to meet residents’ needs, one didn’t know and the other didn’t think there was. Comments from residents’ during the inspection and in one questionnaire received confirm that there are usually enough staff. At the time of the inspection residents’ needs appeared to be met and no shortfalls in staffing were identified. Observations during the inspection confirm that there are good relationships between staff and residents’ and relatives/visitors. Records reviewed for two recently recruited staff confirms that there is a thorough recruitment process in place, which includes obtaining references and a satisfactory criminal record bureau clearance prior to someone starting work in the home. Clanfield DS0000012743.V306047.R01.S.doc Version 5.2 Page 19 Records confirm that new staff receive induction training, which has been introduced since the last inspection and is based on current expectations for care staff working with older people. There is a programme of staff training and a senior member of staff has been allocated responsibility for ensuring that all staff have appropriate training to meet the needs of residents’. Staff are encouraged to undertake a National Vocational Qualification (NVQ) at level 2 which provides staff with a basic understanding of the care needs of Older People. With those staff who are just completing the course there will be just over 50 of staff holding the qualification. Additional training to meet residents’ needs includes: continence, loss and bereavement, Parkinson’s disease, pressure and catheter care, dementia, protection of vulnerable adults and health and safety training. Discussion with a member of the management team identified that there is a more pro-active approach to staff training with individual training needs being identified. Clanfield DS0000012743.V306047.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36, 38 Quality in this outcome area is good. This judgement has been made using all the available evidence including a visit to the service. The home is managed in the best interests of the residents. EVIDENCE: The registered owner who is also the registered manager has a number of year’s experience of managing the home. The registered manager works part time in the home with the day to day running of the home being carried out by the deputy manager and senior staff. The registered manager is clear about her responsibilities in relation to the management of the home and responsibilities for residents’ care. Clanfield DS0000012743.V306047.R01.S.doc Version 5.2 Page 21 The adequacy of the management arrangements was questioned during previous inspections, however improvements were identified at the last inspection in understanding and meeting the requirements of the legislation, which sets the framework for the provision of care for older people. This inspection has confirmed that the management team overseen by the registered manager are working together effectively to provide good outcomes to residents. A relative has said commented that the home is very efficiently run and that other people speak highly of the home. The registered manager has no formal qualifications however the deputy manager has completed the registered managers award. A programme of staff supervision is in place with each of the senior team responsible for supervising a group of staff. The inspector was informed that work is in progress to develop a quality assurance programme to monitor and maintain standards of care. A sample check of staff training records identified that staff receive training in safe working practices, which include first aid, movement and handling and food hygiene. Clanfield DS0000012743.V306047.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 2 X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X 3 X 3 Clanfield DS0000012743.V306047.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations Clear guidance based on the advice of the General Practitioner and the pharmacist should be in place to guide staff in the administration of individual medication for residents’ who have difficulty swallowing with evidence of regular review. There must be evidence that the District Nurse has been consulted regarding the use of bed rails for individual residents and is satisfied that the rails are appropriate for the bed, any additional mattress and the resident. Regular monitoring of the condition and use of bed rails should be in place based on current guidance. (Guidance can be obtained through the medical devices agency) A quality assurance system should be implemented. 2. OP22 3. 4. OP22 OP33 Clanfield DS0000012743.V306047.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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