Care Home: Clayfield

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What the care home does well Clayfields is a small home that provides people with a very clean safe and homely environment. Individual care and support is well planned and delivered by staff who know and understand the needs of the people they support. People we spoke to during the inspection said that they enjoyed living at Clayfields and that staff treated them with respect. Comments included `` Its very nice here. We are treated like royalty. I can`t think of anything they could do to make it better.`` We received 8 surveys from people who live at the home, although in some cases they had been completed by family members on their behalf. Comments to the question what does the home do well included, ``All of it.`` ``The feeling of security, having a bath every morning.` `Clayfields has provided excellent care for my mother. All aspects of her daily personal requirements are looked after sensitively, always treating her as an individual human being. The staff are first class. The confidence I have in Clayfields gives me such piece of mind. All the staff are very supportive.` We also received two surveys from health care professionals who said ``A very kindly well run residential home.`` and ``Clayfields always keeps us informed of any changes of requirements for its service users. It always acts on information we provide.`` The home ensures that there are activities and outings to suit individuals who live there and are constantly looking for new ideas to engage people. A balanced diet is offered that includes choice and variety and takes into consideration individual likes and dislikes. The staff team have good training and support and are managed by someone who is committed to providing the best outcomes for people to ensure that they continue to have choice in their lives. What has improved since the last inspection? The registered providers have continued with their programme to refurbish and update rooms and facilities to ensure that the home is welcoming and safe. They have also continued to invest in training to ensure that staff have good knowledge and skills in working with frail elderly people with dementia What the care home could do better: The registered provider must ensure that staff are employed only after all the relevant check are completed to ensure that they are suitable to work with vulnerable people. The registered provider should ensure that hot water regulators are checked on a regular basis to ensure they are working correctly. Key inspection report Care homes for older people Name: Address: Clayfield Clayfield 3-4 Clayfield Villas Victoria Road Barnstaple Devon EX32 8NP     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Joanne Walsh     Date: 0 1 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Clayfield Clayfield 3-4 Clayfield Villas Victoria Road Barnstaple Devon EX32 8NP 01271374066 01271374066 clayfield@piltonia.supanet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Antony John Hollick,Mrs Lynette Sylvia Hollick care home 13 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 13. The registered person may provide the following category of service: Care home only Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Dementia, over 65 years of age (Code DE(E)) Mental Disorder, excluding learning disability or dementia, over 65 years of age (Code MD(E)) Date of last inspection Brief description of the care home Clayfield comprises two Victorian houses, which have been converted into one residence. The resulting property offers spacious accommodation, which is well Care Homes for Older People Page 4 of 26 0 0 0 Over 65 13 13 13 Brief description of the care home maintained. Externally the property has a front garden extending to the main road and at the rear an enclosed, easily assessable and pleasant courtyard area. The home is situated within easy reach of the resources of Barnstaple. Clayfield is registered to accommodate up to 13 older adults who may also have dementia or mental health problems. The accommodation is on two floors, which can be accessed by either stairs or the stair lift. Fee information can be obtained directly from the home. Additional charges are levied for hairdressing, chiropody, and items such as magazines and newspapers if these are required. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection took place during a week day in September 2009 and lasted approximately seven hours. The focus of the inspection was to gain the views of the people who live at the home and individuals were spoken to during the inspection and care practice observed throughout the day. We also spent time talking to staff and spent time looking at some of the key documents including plans of care, assessments, staff recruitment files, records relating to medications and individuals finances. This helps us to understand how well the home is run. The home had been notified that a review of the home was due and had been asked to complete and return an AQAA (Annual Quality Assurance Assessment). This shows us how the home has managed the quality of the service provided over the previous year. It also confirms the dates of maintenance of equipment and what policies and Care Homes for Older People Page 6 of 26 procedures are in place. Information from this document was used to write this report. During the inspection 3 people were case tracked. This involves looking at peoples individual plans of care, and speaking with the person and staff who care for them. This enables the Commission to better understand the experience of everyone living at the home. As part of the inspection process we try ask as many people as possible for their opinion on how the home is run. We sent questionnaires out to people living at the home; representatives, health and social care professionals (including GPs and care managers) and staff. At the time of writing the report, responses had been received from 8 people living at the home, and from 6 staff and 2 from health care professionals. Their comments and views have been included in this report and helped us to make a judgment about the service provided. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 26 following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. New people are only admitted once the home is confident that they have assessed and can meet those assessed needs. Evidence: We looked at the information the home had obtained for the two newest people to move in. The registered manager said that wherever possible they try to get the family and the individual to make several visits and to look at other homes in order to assist them to make an informed decision about whether Clayfields is the right placement. The pre admission assessment information gave a brief outline of the individuals needs and this is then used to help inform the plan of care. Where individuals are funded the assessment and care plan from the funding body is always obtained. Some of these were in evidence. Care Homes for Older People Page 11 of 26 Evidence: One person we spoke to was able to confirm that they visited the home before moving in and that the registered manager had assessed their needs. Staff spoken to during the inspection said that they usually had good information and discussions about individuals needs shortly before or as new people were moving in. One staff member said as we are a small home, it is easy for the staff team to get to know individuals needs. Care Homes for Older People Page 12 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals personal and health care needs are well met, and minor improvements in medication recording will help to ensure that the system is fully robust. Evidence: During this inspection we looked in detail at the plans of care for three people living at the home. We also spoke with the individuals and with staff about how they deliver care and support to those individuals. We saw that plans of care give good details about what the individuals assessed needs are and how staff should meet those needs. Where there are risks, risk assessments are in place and all of this information is reviewed monthly or sooner if needs have significantly changed. The plans also contain moving and handling assessments, falls risk assessments and nutritional risk assessments. Where an individual has been identified as being at risk for poor nutritional intake, staff monitor and record food and fluid intake. The home now also ensures that in line with the Mental capacity Act, they assess and review individuals metal capacity. Plans state that individuals may lack capacity but that they should always be encouraged to make choices such as what Care Homes for Older People Page 13 of 26 Evidence: they would like to wear. The registered manager said that they are working at ways hey can extend this further for people whose dementia means they are unable to retain information, so for example having picture menus to help people make choices. Plans include nighttime routines and what staff should do to help someone settle for he evening. This ensures that staff are providing support in a consistent way, which is essential to ensure good quality care is provided. People we spoke to during the inspection said that they enjoyed living at Clayfields and that staff treated them with respect. Comments included Its very nice here. We are treated like royalty. I cant think of anything they could do to make it better. We received 8 surveys from people who live at the home, although in some cases they had been completed by family members on their behalf. Comments to the question what does the home do well included, All of it. The feeling of security, having a bath every morning. Clayfields has provided excellent care for my mother. All aspects of her daily personal requirements are looked after sensitively, always treating her as an individual human being. The staff are first class. The confidence I have in Clayfields gives me such piece of mind. All the staff are very supportive. We also received two surveys from health care professionals who said A very kindly well run residential home. and Clayfields always keeps us informed of any changes of requirements for its service users. It always acts on information we provide. We saw that staff clearly understood the needs of the people who live at the home and practice we observed showed that people were treated with respect and dignity by staff. We checked the storage and recording systems for medications and found that it was safely stored and in the main well recorded. We recommend that any changes to medication records are double signed to help prevent errors occurring. We also recommend that where a variable dose is prescribed that the records clearly show what actual dose has been administered. This is dome routinely in most cases, but we did find one medication where it was unclear what dose had been given. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals social and diverse needs are well met. Evidence: The routine of the home appeared flexible to suit individuals needs and wishes. People were seen to be assisted to get up at different times during the morning and plans of care record individuals preferred daily routines, particularly the nighttime. When asked some people were able to tell us that they could choose when they got up and went to bed, that they were assisted to have choices throughout the day and that they were able to choose where they spent their time. One person said, that they were not allowed out, but when asked where they would like to go, they said Oh no dear I am quite happy here, I dont need to go out. The home tries hard to offer a range of activities including games, arts and crafts and trips out to the local shops and park area. During this inspection staff were seen engaging people in a quiz, talking one to one with people and in the afternoon in a craft session making place cards. The registered manager said that they are trying to get more information about individuals past hobbies and interests to enable them to widen the activities and if possible to tailor the activities to meet needs and wishes. She explained that it is not always easy to get this information and that sometimes a Care Homes for Older People Page 15 of 26 Evidence: past interest or hobby is not something that will engage the person now. Two staff have addition skills in activities and they had brought in new sessions such as aromatherapy, reflexology, themed activity days, new games that include getting people to remember the past, such as how much things cost. Staff who we spoke to and those who returned surveys said that they work well at ensuring people have things to do each day. The visitors book shows that people visit at different times throughout the day and the registered manager said that people can have a meal with their family member and that they have several social events and get together to encourage family and friends to stay in touch. The home has a large library of large print books and a collection of old time DVDs to have afternoon film sessions. The registered manager said that they do not have the television on often as they find people do not tend to watch it and they do not want to always have it on a background noise as this can be distracting for people. The home offers a good range and choice of meals. People said they really enjoyed the food and there were no negative comments. The main meal is served at lunchtime and this was observed to be a pleasant unhurried and relaxed time for people. Staff assisted people in a discrete way and the meals were attractively presented. The menus are planned around individuals likes and dislikes and people are offered a choice. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals views are listened to and acted upon Evidence: The home have simple stated complaints procedure that is made available to everyone who moves in and their family and Representatives. We looked at how the home records complaints and saw that they record what and how they have investigated an issue and what they have done to resolve any complaints. They have not had any complaints in the last twelve months. The commission did receive a concern from an anonymous source saying that people were being got up too early. We did not find any evidence of this. Where people were early risers, this was recorded in their plan of care and they were assorted to get up when they wished. The home records when they get people up each morning and what care and support has been given. We did not find any evidence to substantiate this concern. Staff spoken to and those who returned surveys said that they had training in the protection of vulnerable adults and those asked knew what they should do if they suspected abuse occurring. Some individuals we spoke to, who were able said that staff listened to them and that they could make any concerns known. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Clayfileds provides people with a clean homely and well maintained environment Evidence: During this inspection we looked at all the communal areas and some of the individual bedrooms. The home is kept clean and fresh smelling to a very high standard. Communal areas are homely and inviting. There are two lounges, each with a dinning area, so individuals are not having to sit in a large group. Bedrooms have been personalised and there is an ongoing programme to update and refurbish rooms. Not all radiators are covered, although the registered provider gave assurances that these are the ones that are not in use, as in they are not needed so are turned off and therefore do not present as any risk of burns for people. Some of the fire exits have not been alarmed, and we would recommend that the provider looks at how they can be assured that if someone did open these doors and left the building, that staff would be aware of this. We spot checked the water temperature on some of the taps and found that the hot water from the downstairs toilet tap was running very hot. The registered provider said that a mixer valve had been fitted so he would need to check if this needed adjusting. The regulators on taps should be tested on a regular basis to ensure that they are still working correctly. Care Homes for Older People Page 18 of 26 Evidence: The home has policies and procedures for infection control and the laundry area is well organised and meets required standards. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are well trained and supported, but more robust practices are needed in recruitment to ensure that people are fully protected. Evidence: The home has sufficient staffing levels to meet the needs of the current individuals who live at Clayfields. There is normally two care staff on per shift plus either the registered manager and/or the assistant manager. They also have a cleaner most days and two waking night staff. The staff training information shows that there are regular opportunities for training. More recently 3 staff have completed dementia care training and three have done an infection control. They follow the skills for care national induction standards for any new staff and everyone is either doing or has completed NVQ training in care. This is the national vocational skills training, that ensures people understand the ethos of good practice in care. Staff spoke to said they they enjoyed working at Clayfileds, that they were given good training and support by management and that sufficient staffing was in place to meet the needs of people. We checked the recruitment files for three newer staff and found that they had started Care Homes for Older People Page 20 of 26 Evidence: their induction training before all their checks had been completed. This is not good practice and could place people at risk. Staff should only be employed once all checks are completed to ensure they are suitable to work with vulnerable people. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and run in the best interests of the people who live there Evidence: The registered manager is qualified and experienced to run the home. She has completed training in understanding the needs of the people who live at the home as well as the relevant management training. Staff and individuals who live at the home say that the manager has an open and inclusive approach and that both can talk to her about any concerns they have. She has appointed an assistant manager to assist with management and running of the home. The home try to involve family and friends of people who live at the home as much as possible, both in formally reviewing the quality of care and support via surveys, but also less formally, with regular chats with visiting family and friends of people who live at the home. The home does not handle monies on behalf of people. For those who are unable to Care Homes for Older People Page 22 of 26 Evidence: handle their own finances the registered provider pays for things such as hairdressing and chiropody and then invoices the family or Representative in arrears Receipts are kept for all items or goods paid for so invoices can be verified. The AQAA provided us with information about how well the home ensures health and safety is protected via regular servicing of equipment and maintenance of electrical and heating systems. Staff told us that they have updated training in all aspects of health and safety, and the ensures that induction training for new staff follows national guidance as specified by The Skills for Care Council. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 29 17 All potential new staff must 31/10/2009 have relevant checks in place before they commence employment To help protect individuals who live at the home Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 38 The registered provider needs to ensure that water regulators are checked on a regular basis. Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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