This inspection took place on 9 November 2018 and was unannounced. When we last inspected this service in March 2016, we rated it overall good.
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.