Archived: Cloverfields

Cloverfields is a nursing home providing personal and nursing care to 17 people aged 55 and over at the time of the inspection. The service can support up to 35 people. The home is split over three floors and people have access to communal areas and a large garden.

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

Risks to people’s safety were not always considered and governance checks were not robust. Areas with the potential to cause harm were identified, for example, missing bedrail assessments. Accident and incident forms were completed but it was not always clear whether lessons had been learnt or families had been notified.

People were supported by enough staff but felt there were times when more staff were needed. People felt safe and were supported by staff who had been trained in recognising abuse.

Medicine guidance and information was not always complete, and staff felt they were not always given clear instructions for administering people's medicine.

Infection, prevention and control measures were in place but not all of the government guidance was being met. Indoor visits to the home were yet to be facilitated.

The provider was open to the concerns raised and was already taking action to improve the care people received.

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

Rating at last inspection

The last rating for this service was good (published 19 November 2019).

Why we inspected

The inspection was prompted in part due to concerns received about the overall governance within the service. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment and the overall governance of the home at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

• People were supported by staff who worked solely at the home. Where possible, people were supported specifically by allocated staff to reduce movement of staff between residents.

• External contractors who were required to undertake essential work at the home wore Personal Protective Equipment (PPE) in line with current guidance, were not permitted to work elsewhere and were included in the home testing programme.

• People were supported to engage in socially distanced one-to-one activities which helped to promote their positive social and emotional wellbeing. The activities programme had been adapted to ensure compliance with current guidance and was now spread across two rooms to limit the number of people involved in each activity.

• People were provided with their own equipment such as pens for colouring in to limit swapping and sharing and reduce the risk of transmission of infection.

• People who were at disproportionate risk of Covid-19 were identified through the implementation of a 'persons under monitoring' form which was added to their daily notes to ensure they had an increased level of observation.

• People were supported by staff who wore PPE in line with current guidance.

• People were supported by staff to communicate where the use of PPE caused barriers. Where a person had a hearing impairment, staff used a white board to support them with communication.

• Furniture, soft furnishings and carpets in the home had been replaced by materials that reduced the risk of transmitting infection.

Cloverfields is a nursing home providing personal and nursing care to people aged 65 and over at the time of the inspection. The service can support up to 35 people and at the time of the inspection 30 people were living at the home.

Cloverfields provides a homely environment to people receiving respite or long-term care. The home is situated close to local amenities and is part of the local community. The home is situated over two floors with large communal areas on the ground floor.

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

People received safe and effective care and support to meet their individual needs. People were protected from harm as risks were assessed and managed and staff were confident to recognise and report abuse.

People received their medicines as prescribed and there were procedures in place to ensure the process was carried out safely.

People were supported by a staff team who had the knowledge and skills to meet their needs effectively.

Recent staffing issues were being addressed and resolved to ensure there were sufficient staff to meet people’s needs in a timely manner. Staff were well supported by the provider and their colleagues.

People’s needs were assessed and documented in care plans that were in the process of being re developed to ensure more personal information was recorded. Staff were confident they could meet people’s individually assessed needs.

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 worked in partnership with health and social care professionals to ensure consistency and ensure people received appropriate and safe support. People were supported to access healthcare, and other agencies, when required. People received appropriate support to eat and drink and their nutritional needs were met.

Staff were caring and respectful, promoting people’s privacy, dignity and independence.

People’s care was responsive to their changing needs. People, relatives and health and social care professionals were involved in the assessment and planning of their care. This joint working meant people’s needs were met. People knew how to raise a concern and always felt listened to. Information was available in different formats to make it accessible.

People spoke highly of the home’s activities programme and the daily activities which were extremely popular, inclusive and engaging.

People felt the service was well managed despite there currently being no registered manager. Staff knew about the appointment of a new manager and were aware of their plans were to develop the service.

People who used the service and staff had opportunities to share their views about the service. Staff felt listened to when they shared feedback. The provider carried out audits to ensure the quality of care provided and feedback was sought from people who used the service to ensure their satisfaction.

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

Rating at last inspection

The last rating for this service was good. (Inspection took place in April 2017). At this inspection the service has remained good.

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cloverfields on our website at www.cqc.org.uk.

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.

Cloverfields provides accommodation for up to 35 people who require nursing or personal care. At this inspection 29 people were living there.

A manager was in post and present during our inspection. The manager was newly appointed and commenced work at Cloverfields approximately eight weeks before this inspection. We confirmed that they had submitted appropriate applications to become the 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.

At the last inspection on 12 and 16 May 2016, we identified five areas where the provider was not meeting the requirements of the law. There were not enough staff on duty to meet people's needs and this compromised their safety. There was not enough staff available to ensure people ate and drank sufficient amounts. People did not receive support or assistance in a timely manner. The provider did not have sufficient systems in place to resolve people’s concerns. Quality checks were not robust enough to ensure people received a good level of care.

The provider sent us an action plan in September 2016 telling us what they would do to make improvements and meet legal requirements in relation to the law. At this inspection we found the provider had taken the necessary measures to ensure the quality of care people experienced had improved.

People were supported by enough staff to safely meet their needs. People were safe as staff had been trained and understood how to support people in a way that protected them from danger, harm and abuse. People had individual assessments of risk associated with their care. Equipment required to reduce risks to people was provided and was appropriate to people’s individual needs. Staff knew what to do in order to minimise the potential for harm. The provider had systems in place to address any unsafe staff practice which included additional training or disciplinary processes if required.

People received help with their medicines from staff who were trained and assessed as competent to safely support them. The provider followed safe recruitment practices and completed checks on staff before they were allowed to start work.

People received care from staff that had the skills and knowledge to meet their needs. New staff members received an induction to their role and were equipped with the skills they needed to work with people. Staff attended training that was relevant to the people they supported.

People’s rights were maintained by staff members who were aware of current guidance and legislation directing their work. People were involved in decisions about their care and had information they needed in a way they understood. Staff received support and guidance from a management team who they found approachable.

People had positive and caring relationships with the staff members who supported them. People and staff felt able to express their views and felt their opinions mattered. People’s likes and dislikes were known by staff who assisted them in a way which was personal to them.

People had their privacy and dignity respected by those supporting them. People had access to healthcare when needed and staff responded to any changes in needs promptly and consistently.

People were supported to eat and drink sufficient amounts to maintain good health. People’s personal likes and preferences were known by the catering staff who supported them to make decisions regarding their diet.

People were involved in decisions about their day to day care and had care plans which were individual to them. Care plans contained people’s likes, dislikes and personal histories. Staff had a good knowledge of the people they supported. People and staff had positive relationships. People took part in activities they liked and found stimulating.

The provider undertook regular quality checks in order to drive improvements. The provider engaged people and encouraged feedback. People felt confident they were listened to and their views were valued.

We judged that the provider had made significant improvements to improve the quality of treatment and care to people who use the service. This evidence supported our judgement to improve the

rating to ‘Good’ overall during this inspection.

Cloverfields provides accommodation and nursing care for up to 35 people. On the days of our inspection there were 32 people in residence.

The home had a registered manager who was present for one day of the inspection. 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.

There were not enough staff on duty to meet people’s needs and this compromised their safety. However, people felt safe living in the home and staff knew how to protect them from the risk of potential abuse. People were protected from the risks of harm because staff knew about the risk posed to them and action was taken to avoid this from happening. People were supported by staff to take their prescribed medicines and they received them when needed.

People had a choice of meals but staff were not always available to ensure they ate and drank sufficient amounts. People were supported by staff who had access to routine one to one sessions [supervision] and training. People’s human rights were protected because the registered manager was aware of the principles of the Mental Capacity Act and the Deprivation of Liberty Safeguards. People were supported by staff to access healthcare services to promote their health.

Staff were aware of people’s care and support needs but people did not always receive support in a timely manner because there wasn’t enough staff on duty. People were encouraged to be actively involved in planning their care and their rights to privacy and dignity was respected.

People were involved in the assessment of their needs and were supported to do the things they liked. People’s views and concerns were listened to by staff and action was taken to address them but this was not always sustained.

People and staff were aware of whom the registered manager was and they were sometimes involved in the running of the home. Checks were carried out to monitor the effectiveness of the service. However, these checks were not entirely robust to ensure people needs were met when required.

On the day of our visit a director and a senior manager from the home's parent company were working in the home. They told us that they were addressing the concerns that had been raised with them. The home's manager had left several weeks earlier. An experienced interim manager was running the home.

People we spoke with were mostly happy with the service they received although they were aware of changes in the home. One person told us, 'They look after me well.' Another person said, 'It's very good, I have no complaints'.

People did, however, tell us that there had been a lot of agency staff in the home recently who did not understand their needs well. One person told us that they had not been able to go to bed when they wanted to when there had been a shortage of staff. People were very complimentary about the home's own staff. They told us that the staff were, 'Absolutely wonderful', and 'You can't knock the staff'.

We spoke with relatives of people living in the home. They were generally happy with the service their relatives received.

Most of the staff we spoke to told us that things had begun to improve in the home in recent weeks. One member of staff was not happy with the changes.

We found that there had been a period when staff were under severe pressure and that had not been well supported. The home's owners were now addressing this. At the time of our inspection, the local authority had just begun an investigation to see if the problems at the home had had any impact on the people living there.

We spent time with people over lunch. We saw staff being sensitive and caring in the way they helped people to eat. The cook came out to speak to people after the meal to ask how they had enjoyed it. One person told us that the staff "would do anything for me". Another person said the staff were "really kind".

People told us that there were lots of activities in the home that they really enjoyed, but some said they would like to go out more.

We found that care plans were detailed and up to date and that they gave the staff the information they needed to support people. The staff told us they felt well supported by the management but would sometimes like an extra staff member on duty.

People told us they felt safe in the home. Staff clearly understood the safeguarding policy and said they would feel comfortable raising any concerns.