Inspection on 14/09/07 for Cloverfields

This inspection was carried out on 14th September 2007.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Cloverfields 01/08/06

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Cloverfields Chester Road Whitchurch Shropshire SY13 4QP Lead Inspector Deb Holland Key Unannounced Inspection 14th September 2007 10:00 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 Cloverfields DS0000067172.V344686.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. Cloverfields DS0000067172.V344686.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cloverfields Address Chester Road Whitchurch Shropshire SY13 4QP 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) 01948 667 889 www.newparkhouse.co.uk Cloverfields Care Ltd Mrs Monica Evans Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places Cloverfields DS0000067172.V344686.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home must provide the following minimum staffing levels for 32 service users: 8am - 4pm 4pm - 9pm 8pm 8am 2 RN`s 1 RN 1 RN 5 care assistants 5 care assistants 2 care assistants These are minimum levels required throughout the 24 hr day, including weekends, for service users who have low to medium dependency nursing needs. Additional staff must be on duty when high dependancy service users are accommodated. These minimum levels are for direct nursing and personal care only. They do not include ancilliary staff. They are exclusive of the manager`s time. The home may accommodate a maximum of 32 elderly persons to include up to 3 (Three) terminally ill persons. The home may accommodate a maximum of 32 persons requiring nursing care. 1 August 2006 2. 3. Date of last inspection Brief Description of the Service: Cloverfields is situated in on the outskirts of Whitchurch. It is owned by Cloverfields Care Ltd and provides long-term nursing and personal care for 28 elderly persons. The Registered Manager is Mrs Monica Evans. The home is an elegant country house with bedrooms on two floors. It has a tranquil, well maintained garden and car parking facilities. The home is well supported by its local community with regular visitors and use of local facilities. Cloverfield Care Ltd makes their services known to prospective service users in their Statement of Purpose, web site and service user guide. The inspection report is available in the home. Cloverfield Care Ltd’s rates are reviewed annually on 1st April each year and service users are notified one month in advance. The only additional charges to service users are for hairdressing, newspapers and private chiropody appointments. This is clearly laid out in the terms and conditions. Fees for care range from a minimum of £370 to a maximum of £480. All service users pay monthly by standing order or by cheque. Cloverfields DS0000067172.V344686.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A range of evidence was used to make judgements about this service. This included information provided by the home’s manager in the annual quality assurance assessment (AQAA); records relating to residents and staff; discussion with people who use the service and visitors; discussions with the staff team; discussion with the manager; previous inspection reports; the home’s own quality assurance processes, and observation of the environment and care experienced by people using the service. Surveys were sent to three GP surgeries, two of which were returned. The manager was present at the home during the inspection and was very helpful, as were the staff. What the service does well: What has improved since the last inspection? A new shower room has been provided, and carpets provided in the dining room and lounge. New seating and beds have also been purchased. Cloverfields DS0000067172.V344686.R01.S.doc Version 5.2 Page 6 A consultancy is now used for staffing, ensuring that any recruitment or personnel issues are dealt with professionally. The involvement of the new provider has continued to allow improvements to be made, and it was reported that communication between the new owners, management and staff has continued to benefit everyone. A requirement was made at the last key inspection that the provider should install thermostatic sluice facilities. At this inspection, it was stated that this was complied with but that contractors had mistakenly removed the sluice disinfector when undertaking another piece of work and this was going to be returned as soon as possible. The presentation of pureed meals has improved in that elements of the meal – meat, vegetables, etc – are now liquidised individually before being served. 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 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Cloverfields DS0000067172.V344686.R01.S.doc Version 5.2 Page 7 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 Cloverfields DS0000067172.V344686.R01.S.doc Version 5.2 Page 8 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3&4 Quality in this outcome area is good People have the opportunity to visit the home prior to admission and assessments are carried out as part of the admissions process which ensure that the home can meet the person’s needs This judgement has been made using available evidence including a visit to this service. EVIDENCE: It was stated that in considering an admission, the home’s manager takes into account information provided by the local authority, the relevant GP surgery and her own assessment. Assessments were seen on files. The home’s assessment format is that provided by the Royal College of Nursing and provides a comprehensive picture of someone’s needs. On the day of inspection, a relative of someone requiring care arrived unannounced at the home and was provided with relevant information and a tour of the home. Cloverfields DS0000067172.V344686.R01.S.doc Version 5.2 Page 9 The home’s manager ensures that up to date guidance is available for staff and individual files contained information about the needs that people had, e.g. for special diets. The provision of training, guidance and supervision supports staff in being able to deliver good care. Feedback from people living at the home, relatives and health professionals confirmed that staff have the skills to meet the needs of people living at Cloverfields. Cloverfields DS0000067172.V344686.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7 - 10 Quality in this outcome area is good Assessments and care plans are clear, reviewed regularly, and provide staff with the information they need to care for people well. Contact is maintained with doctors and other professionals to promote residents’ well being. Systems are in place which ensure that people receive the medication which has been prescribed for them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care provision for three people was examined in detail. In each case it was found that the information in the assessment and care plan was followed through to the care provided, the diet provided and the way in which people spent their time. Risks are individually assessed and individual preferences are recognised and observed. It was evident from one care plan and a discussion about that person, that independence is promoted and people are involved in decisions and choices about how their care is delivered and how they are kept Cloverfields DS0000067172.V344686.R01.S.doc Version 5.2 Page 11 safe. The assessment and plan for supporting someone with no verbal communication was particularly good, with flash cards available if the day to day approach informed by knowledge and experience of what the person indicates through gesture should fail. Care plans are thorough and regularly reviewed by the manager and key worker. The home maintains a central assessment and care plan plus a “kardex” recording system, which also includes guidance and records for some key areas of care, such as blood sugar monitoring, dressings plans and records. Records are also maintained of a detailed check, usually weekly, of particular personal and hygiene needs having been attended to, such as nails, skin care, hair care etc. Appropriate systems are in place to assess risks of people developing pressure sores and taking steps to prevent, treat or reduce sores. Equipment such as pressure relieving mattresses are used and outside advice obtained as and when necessary. Professional advice is sought when needed and the home’s manager acquires up to date guidance and information to keep her own and the staff knowledge current. Working relationships with local GP practices are described as good, and this would appear to be confirmed by a letter on file from a GP in response to a concern raised by a social worker, in which very positive views of the home’s work with a particular individual are expressed and the feedback gathered from our survey work. One survey returned by a local GP stated that the home always seeks advice and acts upon it to improve health care and that communication between the home and health care professionals is good. The second survey returned by a GP was also positive about the health care liaison and provision and stated that communication was good with “caring staff and Matron with a good atmosphere”. Medication administration for those people whose care was examined in detail was found to be satisfactory. This included storage and recording of controlled drugs. It was found that there was no way to check the temperature of either the room or the fridge where medication was being stored. Insulin both in stock and in use was being stored in the fridge. Insulin which is in use should be stored at room temperature. Ms Evans took prompt action to remedy this by distributing additional guidance for staff, and obtained new thermometers. Excessive amounts of a controlled drug were in stock that the resident for whom it is prescribed hadn’t needed for some twelve months. It was explained that this is because the repeat prescription process allows this to happen, even if the request is crossed out. Although this poses no risk to service users, it is unwise to have excessive amounts of a controlled drug on the premises. Cloverfields DS0000067172.V344686.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12 - 15 Quality in this outcome area is good The home provides a range of activities and there is a lot of contact with the local community and residents’ relatives, so people have a good quality of life. The meals at the home are good, offering variety and catering for different nutritional needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Many of the home’s residents are local people with relatives who live locally. There are frequent visitors to the home and staff described it as being busy and sociable. A lot goes on without the home’s direct involvement with families taking people out to the pub, the local canal, shopping, etc. The home has an activities co-ordinator who works two days per week, who promotes individual and group interests. Photos are on display of events, such as parties, outings and celebrations of festivals. The home receives visits from the mobile library and has large print and talking books for those who need them. People spoken to said that they could spend their time where they liked Cloverfields DS0000067172.V344686.R01.S.doc Version 5.2 Page 13 and some prefer to quietly read the newspaper or watch TV rather than be sociable. Holy Communion is provided once a month. Everyone spoken to said that the food was fine and the home’s “satisfaction questionnaire” confirmed this. Alternatives to the main menu are available and people are provided with special diets e.g. gluten free, pureed, as necessary. For those residents whose care was examined in detail, all showed a slow weight gain. Cloverfields DS0000067172.V344686.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 – 18 Quality in this outcome area is good The service has a complaints procedure that is up to date and accessible to enable anyone associated with the service to complain or make suggestions for improvement. Staff are provided with in-house training about abuse and are aware of what they must do to protect residents This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s complaints procedure is made available through documentation provided to individual people and is on display in the hall. People spoken to were confident that if they raised concerns they would be dealt with quickly and easily. It was stated in the service’s AQAA that the home’s open door policy ensures that concerns are dealt with promptly and do not generally escalate into complaints. Ms Evans has obtained guidance on the new Mental Capacity Act and the use of advocates. The home has documented one formal complaint and maintained appropriate records. This was referred to the multi-agency safeguarding procedures and an investigation, which with Ms Evans has co-operated fully, is ongoing. Staff are provided with training relating to complaints and identifying/responding to abuse during induction. In-house training is provided Cloverfields DS0000067172.V344686.R01.S.doc Version 5.2 Page 15 through use of a DVD to support and illustrate the home’s policy. Records were available of staff having undertaken this training from 2004 to date. Ms Evans and one of the nurses are to undertake formal training in the near future. Cloverfields DS0000067172.V344686.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good Cloverfields is comfortable and homely and people live in a safe, well maintained environment This judgement has been made using available evidence including a visit to this service. EVIDENCE: Improvements – such as new carpets and furniture - and maintenance continue to ensure that the home provides a pleasant and comfortable environment. Communal areas are pleasant and comfortable. Individual rooms are suitable for residents’ needs and some have been made very individual by the additional of the person’s own furniture, pictures and possessions. There are various places to sit, meaning that people can choose, and people make use of the terrace and garden when the weather permits. Bathing facilities have been improved by the installation of a walk in shower. Cloverfields DS0000067172.V344686.R01.S.doc Version 5.2 Page 17 The home performed well in an infection control audit, and systems are in place to minimise cross infection. Although the home’s washing machines can cope with soiled linen most laundry is outsourced with appropriate systems to reduce cross infection. The home’s recently installed sluice disinfector has been removed by mistake and it was stated that it will be re-installed in the near future. Cloverfields DS0000067172.V344686.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27 - 30 Quality in this outcome area is good Staff are deployed in sufficient numbers, and provided with relevant training, to fulfil the aims of the home and meet the needs of the residents This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of inspection the home was accommodating twenty-four people, seventeen requiring nursing care. During the day there are four people providing hands on care, one nurse and three carers. This is in addition to the manager, during the week, plus the kitchen and cleaning staff. There is also a handyman and an activities co-ordinator, who works two days per week. At night there is a nurse and two carers on duty. Although staff commented that this level meant they were busy, it appears from the comments of people living at the home and the appearance of the home that their efforts mean that levels are adequate for the current occupancy level. The home employs five qualified nurses in addition to the manager, and some twenty-five care staff. Qualified nurses are encouraged to update their training and knowledge and care staff are supported to develop through induction, training and supervision. Eleven staff have reached national vocational qualifications (NVQ) at Level 2, a further two are working towards Cloverfields DS0000067172.V344686.R01.S.doc Version 5.2 Page 19 this and two staff have the award at Level 3. Staff stated that the training provision was good and that they would like to develop further. Staff working in the kitchen and domestic staff have also been supported to acquire vocational qualifications. People spoken to were very positive about the staff and observed interactions showed that affectionate and cheerful relationships exist. Feedback from local health care professionals is that staff have the right skills and experience to care for the residents and are “well trained caring staff”. The service has only employed one new starter in the last twelve months, which means that people are supported by a stable and consistent staff group. The file for this new starter showed that all the necessary checks had been conducted and that induction training had taken place. This person had just started working towards their NVQ and their first appraisal had been conducted. Ms Evans shows an awareness of issues of race and gender issues in the context of staff providing intimate personal care for people with individual belief systems and preferences. Cloverfields DS0000067172.V344686.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is good The manager of the home is very experienced and provides good leadership and direction so that people are cared for well and have the benefit of a stable staff group. The manager and staff are well aware of their responsibilities to keep people safe, promote well-being and work in the residents’ best interests This judgement has been made using available evidence including a visit to this service. EVIDENCE: Ms Evans is an experienced manager and provides strong leadership to a very stable staff group. Ms Evans maintains her own training and knowledge of current issues and ensures that information and guidance is available to the staff group. Quality assurance systems are in place, with a formal Cloverfields DS0000067172.V344686.R01.S.doc Version 5.2 Page 21 questionnaire for residents/relatives conducted in summer 2007. The results of this confirm that “customer satisfaction” is high, with all the questionnaires reporting either “satisfied” or “very satisfied” with the service. Ms Evans also operates an informal “open door” approach and has a lot of personal contact with residents, relatives and visiting professionals. Reviews conducted by key workers deal with peoples’ views about the service as well as reviewing individual care plans. Comments from residents and relatives on the day of inspection were also positive – “excellent staff and home” being one. Audit systems are in place and any lapses dealt with. Ms Evans provides formal supervision to all the care staff herself. The home has no dealings with residents’ money. Safe working practices are promoted through staff induction, supervision and training. Routine maintenance and safety checks are conducted, records were seen to be up to date and well maintained for the fire alarm, emergency lighting, passenger lift and hoists. Risk assessments are in place for working practices and individual people. The handyman is responsible for fitting and checking bed rails and has been provided with the guidance for undertaking this task. The home has a business plan and routine maintenance is recorded. Cloverfields DS0000067172.V344686.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 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 X X X X X 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 3 3 X 3 X X 3 Cloverfields DS0000067172.V344686.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? YES 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. 1. Standard OP26 Regulation 23(2)(k) Requirement The registered provider must install thermostatic sluice facilities. Previous timescale of 31.12.06 not met Timescale for action 30/10/07 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 The home’s manager needs to ensure that medication administration and storage systems are part of the quality assurance/audit system within the home Cloverfields DS0000067172.V344686.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. Extracts may not be used or reproduced without the express permission of CSCI Cloverfields DS0000067172.V344686.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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