Archived: Clemsfold House

When we inspected the service in May 2014 we found that care was not always delivered in such a way as to meet people's individual needs and to ensure their welfare. Where people had been assessed as at risk of constipation, appropriate bowel monitoring was not in place.

This inspection was carried out by an adult social care inspector. We spoke with the deputy manager, the administrator and three members of staff. We looked at four people's care and health records, including monitoring charts and Medication Administration Records (MAR). We also spoke with two people and one relative but their feedback did not relate specifically to the regulation we were reviewing.

We considered all the evidence we had gathered and found that the provider had taken action to address the concerns identified at our last inspection. New systems had been introduced and were effective. We saw that people's needs, in relation to the risk of constipation, were closely monitored. This enabled the service to take timely action to ensure that people received appropriate care and treatment to meet their needs. One member of staff said, 'We are required to note it down in the bowel chart. We also need to count how many days so that the person in charge can take some action if needed'.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with 10 people using the service, two relatives and seven of the staff supporting them. We also looked at records including three care plans and three staff recruitment files.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

The provider had reviewed the staffing level in the home and increased the numbers of staff on duty. People that we spoke with were complimentary about the staff. We observed that staff responded quickly to meet people's needs and ensure their safety.

We looked at the recruitment processes and found them to be safe and thorough. The home had carried out relevant checks to ensure that staff had the necessary skills and aptitudes to work with people living at Clemsfold House.

Systems were in place to make sure that the manager and staff learnt from events such as accidents, incidents and complaints. This reduced the risks to people and helped the home to continually improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, the manager demonstrated knowledge of their responsibilities in respect of this.

Is the service effective?

We found that care plans were detailed and provided up-to-date information about people's care needs and preferences. This meant that people were sure that their individual care needs and wishes were known and planned for.

We found, however, that appropriate monitoring was not always in place to ensure that people's needs were met. Where people had been assessed as at risk of constipation appropriate bowel monitoring was not in place. We have asked the provider to tell us what improvements they are going to make to ensure that people's assessed needs are managed appropriately.

People expressed satisfaction with the food at Clemsfold House. One said, 'The food here is very good'. We saw that they were offered a choice and that staff supported them to eat and drink in accordance with their needs. During lunchtime, we observed that the mealtime was well paced and allowed people the time they needed to eat their meal.

Many of the people who lived at the home had reduced memory or a dementia. We noted that the manager had taken steps to follow relevant research and guidance in order to support people in their care. For example the home had clear signage and individual bedrooms could be identified by brightly coloured doors.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff were patient and gave encouragement when supporting people. People that we spoke with were largely satisfied with the care that they received. One said, 'They are very kind to us'. Another told us, 'I don't have any complaints'.

Staff told us that they had time to deliver good care to people and that they were able to spend time with them. We observed that staff were quick to respond to people's needs and clearly knew them well. One member of staff told us, 'You can't do this job if you don't love them'.

Is the service responsive?

People, their relatives and staff told us that they were able to raise suggestions or concerns. One person told us, 'I can talk to any of the staff'. Where issues or concerns were identified we noted that the home had taken appropriate action. One of the two relatives we spoke with explained that they had regular discussions with the manager. They told us, 'The door is always open and she delivers what she says she will'. We found that the home listened and responded to feedback received from people, their representatives and from staff.

Is the service well-led?

Since our last inspection we found that improvements had been made in relation to staffing levels. This was also confirmed by people and staff that we spoke with and by examining records.

We saw there were systems for monitoring the quality of services provided. The manager demonstrated a commitment to making improvements to the quality of service provided to people. One member of staff told us, 'I tell the manager and she will take action'.

We found that people's care was based on an individual needs assessment and planned and delivered in line with their needs. . A person told us "I feel safe here" and a visitor said "people are treated with dignity and respect - I have never seen anyone be other than nice to them". We found that staff demonstrated a good understanding of people's needs and preferences.

Records showed that people's medicines were safely managed in the home. We found that staff administering medication were competent to do so. We saw evidence that people's medicines had been reviewed and changed to better meet their needs.

We have asked the provider to make improvements in the numbers of staff on duty at all times. This is because insufficient staffing levels may impact on the health, welfare and safety of people who use the service. Visiting professionals we spoke with told us that staff were 'knowledgable' about people's needs and we saw that staff completed appropriate training to help them care for people competently and safely.

We have asked the provider to make improvements in their system for the assessment, monitoring and management of risks in relation to staffing levels.

We spoke with three relatives, all of whom always visited the home unannounced. They told us that the privacy and dignity of their relatives was maintained at all times. We observed that people's own space, such as their bedrooms, was respected and staff did not enter without permission. One relative said that the care given was 'first rate' and that people were safe living at the home. Another relative told us that staff were 'very friendly'. All the relatives felt that any complaints or suggestions they made to staff would be listened to, but had none to make. They told us that they felt part of the process of caring for their relatives and that staff understood the importance of this.