Archived: Clayfield Care Home

Clayfield Care Home (Clayfield) is a residential care home providing personal care and support to 15 people aged 65 and over at the time of the inspection. The service can support up to 15 people.

Clayfield accommodates 15 people in one adapted building. Bedrooms are on each of the three floors with stair lifts to access these. Communal areas are all on the ground floor.

People’s experience of using this service and what we found

People said they enjoyed living at Clayfield and staff were kind and caring towards them. One person said, “It feels like home. I feel well looked after.” At the last inspection we found some issues relating to the safety of people. These were shared with the provider at the time of the inspection and the issues were quickly rectified. This included ensuring all specialist mattresses were checked on a regular basis to ensure they were set at the right setting for people’s weight. Hot water temperatures were checked and the temperature was now being recorded. All free-standing furniture has been fixed to the walls to prevent the risk of it falling onto someone.

People were supported to maintain a healthy balanced and varied diet. People said they enjoyed the food, drinks and snacks being offered to them. Where there was a concern about poor hydration or nutritional intake, staff monitored this closely. People who were at risk were offered fortified drinks and additional snacks.

Care and support was well planned. Each person had a care plan and risk assessment for all aspects of their assessed needs. This included their health care and emotional wellbeing.

Staff understood people’s needs and wishes. They worked in a way which promoted people’s independence whilst keeping them safe.

People were enabled to take part in a range of activities and outings which suited their needs and preferences.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff were well trained, supported and motivated to provide the best outcomes for people. The caring ethos and values of the service being a home from home were embedded into their everyday practice. One staff member said, “Here we have more time to chat to people, to get to know them, give them that extra bit of TLC!”

Staff understood how to keep people safe through assessing risks, understanding abuse and who to report to and through safe recruitment practices.

The quality of care support and the environment was kept under review with regular audits. Staff were encouraged to make suggestions for improvement. Staff said they were valued and listened to.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (Report published January 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider had improved risk management.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Clayfield is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Clayfield care home accommodates up to 15 people in one adapted building. Communal areas are all on the ground floor whilst bedrooms are on three floors. The upper floors are accessible via stair lifts. There is no passenger lift. People living at this service have conditions associated with frailty, old age and dementia. On the day of our inspection there was people living at Clayfield.

Since the last inspection a new registered manager has been appointed. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found some safety issues which may have placed people at potential risk. These included

• One Air wave mattress being set too high for the weight of the person using them, which had the potential to prevent or cause skin damage.

• One wardrobe had not been secured to the wall and was a potential risk as it could have been pulled over.

• One radiator was next to a person’s bed and not covered to protect against risk of burns. We were told the radiator had been turned off.

• There were other radiators which had not been covered in communal areas, which were a potential risk of burns if someone fell onto them as they were hot to touch.

• Checks on water temperatures to ensure the water was not too hot had only been ticked as being done, it did not record the temperature. We cannot therefore be assured that the water was at the right temperature on each check.

Following the inspection, the registered manager contacted us to say these areas of risk had all been addressed.

We found recruitment was not always robust to keep people protected from the risk of employing unsuitable staff. For example, gaps in employment history had not been recorded as explored and file had two references from the same employer.

People said they enjoyed living at Clayfield. One said “yes we are very happy here, well looked after. It is a good home.”

Care and support was well planned. The service used an electronic care plan system which recorded people’s assessed needs in terms of their personal care and healthcare care. It was less detailed in terms of their emotional needs being met. However, the plans lacked detail about people’s preferred routines and past social histories. When we spoke with staff they knew people well, but for newer staff this information would be useful. Following the inspection, the registered manager informed us that some people had a “This is Me” booklet, which families had completed and gave a picture of people’s past life, what they did for a living and who was important to them. The registered manager said she was going to ensure a one-page social history summary was made available in people’s rooms for easy reference for staff to refer to. She said she would also include more detail in the electronic care plan.

There was sufficient staff with the right skills to meet people’s needs. People said their needs were met in a timely way. Staff were kind, caring and compassionate in their interactions with people throughout the day. People’s privacy and dignity was fully respected.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People's consent to care and treatment was sought. Staff used the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and understood how these applied to their practice.

Medicines were well managed and people received their medicines on time.

Staff had training, support and supervision to do their job effectively. Staff confirmed their views and their opinions were listen to and they felt valued.

Accidents and incidents were carefully monitored, although the significant event log they used to record these did not include any learning or prevention strategies. When we spoke with the registered manager, she was able to give examples of lessons learnt and actions taken to prevent falls for example, but agreed this was not always recorded on the events log.

People’s healthcare needs were well met. People were encouraged to eat a balanced diet. Two people said they did not like the teatime options. The registered manager said this had recently been reviewed and now included more hot options. People knew who and how to make any concerns or complaints to. Complaints were taken seriously and investigated.

Systems to ensure good infection control were in place.

People and staff said the registered manager was open and inclusive.

We have made two recommendations in relation to recruitment and good governance.

Clayfield Care Home is registered to provide accommodation for 16 older people who require personal care. The home was full on both days of our inspection.

At the last inspection on 29 April and 13 May 2015, we found six breaches of regulation. These were because: people’s care plans were not personalised and up to date; risk assessments were not in place; medicines were not safely managed; not enough staff were deployed; people’s rights under the Mental Capacity Act 2005 had not been adhered to; the correct procedures had not been followed to deprive people of their liberty, and systems were not in place to ensure the safe management of the service. The provider wrote to us with an action plan to say what they would do to meet the breaches of regulation by 15 September 2015. At this inspection, we found they had followed their action plan and now met the legal requirements.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

People received care suitable for their needs. Staff knew people well, understood them and cared for them as individuals. People were relaxed and comfortable with the care staff who supported them. Care staff spoke to people in a respectful and kind way. Two people said, “They (care staff) are very kind, nice and friendly … they are very careful with me” and “I am so happy … I love it here … all of the staff are lovely, all of them.”

Care staff were safely recruited. They were trained, motivated and enjoyed their work. They received regular supervision and felt supported by the registered manager. Two care workers said, “There have been lots of changes made … it is a better place to work now … it’s all positive” and “The service has improved … it’s all for the best … (the registered manager) looks after us.”

Care staff had a good understanding of safeguarding and knew how to recognise the different types of abuse. They knew the correct action to take and who to report any concerns to.

Each person had a care file and suitable risk assessments in place which were clear and up to date. Health and social care professionals were involved in people’s care and their advice acted upon. Mental capacity assessments had been carried out and applications made to the local authority if people were deprived of their liberty.

Safe practices ensured people received their medicines in a safe way. People were encouraged to eat a well-balanced diet and make healthy eating choices. People lived in a home which had undergone significant updating and refurbishment with further improvements planned.

The culture at the service was open, homely and friendly. People and their relatives were very complimentary of Clayfield, the registered manager and care staff. Two relatives said, “(My relative) was very happy here as soon as she came in … the staff have a sense of who they (people who live in the home) are and who they have been … we have already identified (my relative’s) needs are improving since being here” and “I have to say that the staff here go above and beyond what their care job is, they are absolutely amazing. We are really happy.”

There was a complaints policy and procedure in place with information about how to raise concerns or complaint. Systems were in place to assess the quality of the service and make improvements.

Care and treatment was planned and delivered in a safe way. People told us they felt 'safe and well cared for'. At mealtimes, people needing it had constant support. People told us there were enough qualified, skilled and experienced staff to meet their needs We saw the atmosphere in the home was calm and people looked well cared for.

People were protected against the risks of unsafe accommodation and equipment because the provider had maintenance systems in place. People made comments like 'My bedroom is comfortable and I have some of my own things in there' and 'I'm very comfortable here'. We saw a selection of rooms, all of which were clean and well maintained.

People said the home was 'well run'. Visitors said the 'Approach is friendly and informal in a very caring way' and they were kept up to date with developments about their relative's wellbeing. Professionals told us people's needs were 'Well met' and the team were 'Very proactive' in getting the support required.

The provider was compliant with all outcomes we looked at.