Archived: Clevedon Court Residential Home

The service is registered to provide care and support for up to 22 people with learning disabilities, autism and older people. At the time of our inspection there were 20 people using the service.

People’s experience of using this service:

People who needed to be kept safe through continuous supervision had left the home unobserved placing them at risk. Staff did not have access to guidance about actions to take if a person was missing from the service. Suitable action had not been taken to prevent a reoccurrence.

People were at risk from potential harm and abuse. Safeguarding referrals were not consistently made to the local authority safeguarding team when allegations of abuse were made, or incidents were witnessed in the service. Incidents were not investigated, or action taken to keep people safe. Unexplained injuries, including unexplained bruising, had not been investigated appropriately or referred to the local authority safeguarding team.

People were at risk of injury from hazards in the environment relating to poor maintenance. Risks from scalding water had been identified, however the risks had not been assessed or managed. The registered manager could not provide assurances or evidence about which taps had been fitted with temperature control valves. Some wardrobes had not been secured placing people at risk.

Some medicines prescribed ‘as required’ were not being managed safely to ensure people received these correctly.

Following the inspection, we wrote to the provider and registered manager requiring them to take urgent action to address these risks and protect people from further risks.

The environment had not been properly maintained and there were malodours in areas of the home. Decorating works that had been completed were of a poor standard. There were discarded items in the garden, including an old cistern.

People did not have consistent access to meaningful activities. The service had identified that this was an area for development and had taken actions to improve this, including ordering horse shoes for people to decorate and arranging for a performer to visit the service.

Staff did not consistently receive training in line with the provider’s list of mandatory training. Staff were not receiving regular appraisals as the registered manager had suspended them to focus on areas they assessed as more important. Staff were recruited safely and received regular supervision sessions.

There was a programme of quality audits and provider checks in place. However, these had not been used effectively as issues found by inspectors during the inspection were not recorded in the corresponding audit. Audits lacked detail and effective improvement plans had not been developed as a result.

There were not enough suitably qualified staff deployed across the service to meet the needs of people.

The service did not consistently submit statutory notifications to the Care Quality Commission.

We observed some kind and caring interactions between staff and people However, we also observed some undignified interactions between staff and people. People’s wishes were not always listened to or acted on.

Questionnaires had recently been sent to people, relatives and staff. The registered manager was reviewing the responses received. No recent meetings for relatives or people had occurred. During our inspection a large team meeting took place.

The registered manager had responded to complaints in a timely manner and spoken with staff involved when required. Relatives told us they could approach the registered manager with their concerns.

Food looked appetising and people were offered a choice of meals. People and relatives spoke positively about food at the service.

Rating at last inspection: Inadequate (published March 2019)

At the last inspection we identified nine breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009.

We asked the provider to submit copies of monthly reports for areas of particular concern. The provider had been submitting this information to the Commission.

Why we inspected: This inspection was brought forward due to information of risk and concern; we received information that two people subject to Deprivation of Liberty Safeguards had left the home unobserved.

Enforcement: We identified five continuing breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one continuing breach of the Care Quality Commission (Registration) Regulations 2009.

This inspection identified one new breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Full information about CQC's regulatory responses to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up: The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

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

Clevedon Court is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service is registered to provide care and support for up to 22 people with learning disabilities, autism and older people. The home is set out over three floors and there is a lift and stair lift for people to use. There is a ground floor dining room, lounge area and a garden area to the rear of the home. Most of the bedrooms offer ensuite facilities.

There were 19 people living in the service at the time of our inspection.

There was a registered manager for the service. 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 were at risk of serious harm from falls from heights and burns from hot surfaces. Most of the first and second floor windows were not restricted to a safe opening width and this placed people at risk of falling from these windows. Most of the radiators/heaters were either uncovered or only partly covered placing people at risk of burns should they come into contact with these potentially hot surfaces. No risk assessments were in place to reduce risks to people. Following the inspection, we wrote to the provider and registered manager requiring them to take urgent action to address these risks and protect people from further risks. Action was taken as required with window restrictors and most radiator covers fitted.

People were not always protected from the risk of abuse. There was no effective system being used to ensure that safeguarding referrals were made to the local authority and we identified that the service had not made referrals for some incidents when they should have. When safeguarding incidents had occurred, they were not always recorded as such and this meant that the service could not identify trends or themes.

Medicines were managed safely. Medicines were stored correctly, including medicines that required refrigerated storage and appropriate checks were completed. Staff members signed the medication administration records (MAR) when creams and ointments were applied.

Peoples dignity and privacy was not consistently respected. During our inspection we observed one person being assisted to use the toilet with the door open in a communal area. We also observed a person in a wheelchair being made to wait in a corridor while the person who had been assisting them answered the telephone and the door. No guidance or reassurance was offered to the person.

The service did not consistently recruit people safely. In one staff file we identified that a person who had disclosed a criminal conviction had been employed by the service without a photograph ID or risk assessment. This meant that people were not always protected from potential abuse.

Audits were not used effectively to identify potential risks to people. The audits we reviewed did not identify issues that we had found during our inspection. For example, the lack of window restrictors on windows throughout the home, the decorative state of the premises and the poor management of infection prevention and control.

The service maintained safe levels of staff. Although the registered manager did not use a staffing dependency tool, the deputy manager would increase their time spent delivering care as and when required.

People were not consistently protected from the spread of infection. The environment was dirty in many areas, malodours were identified and carpets and furnishings were visibly stained and in need of cleaning or replacement.

The service did not work in accordance with the Mental Capacity Act 2005. The registered manager was not aware that applications to deprive people of their liberty had an expiry date. This meant that some people were deprived of their liberty unlawfully.

We observed kind and caring interactions between staff and people. This included staff being patient when people took time to mobilise, one member of staff offering a person a ‘hug’ and staff offering people words od reassurance.

There was nothing documented to guide staff in how to support people during the end of their life. When we asked the registered manager for evidence, we were told that no one using the service had wanted to have their end of life wishes recorded and that this had caused anxiety for people asked.

The service did not consistently submit statutory notifications to the Commission. Registered providers must notify us about certain changes, events and incidents that affect their service or the people who use it.

Staff told us that the registered manager was approachable and that they would approach them with concerns.

There was a complaints procedure in place and complaints were responded to and investigated by the registered manager. We saw that issues highlighted in one complaint had been addressed.

Questionnaires were sent to people, their relatives and healthcare professionals. The registered manager told us that they had not received a significant number of responses. However, the responses that were received were not reviewed so that the information could be used to drive improvement and makes changes.

The service worked with external agencies including opticians, GPs and district nurses. We also saw effective communication and respectful exchanges between staff working at the service.

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.

The provider wrote to us with an action plan of improvements that would be made. They told us they would make the necessary improvements by March 2016. During this inspection, we found the required improvements had been made.

Clevedon Court is a care home that provides care and support for up to 22 people with learning disabilities or autism; they can also look after people as they get older so they don’t have to move to a different home. The home is set out on three floors and is close to local amenities. There were 21 people living in the home at the time of our inspection.

There is a registered manager in post. 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 suitable recruitment procedures and required employment checks were undertaken before staff began to work at the home. Staffing levels and skill mix were planned, implemented and reviewed to keep people safe at all times. Any staff shortages were responded to quickly and appropriately. Staff received regular training and were knowledgeable about their roles and responsibilities.

Although staff did not fully understand the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) regulations, they were following the code of practice by giving people choices and respecting their decisions. The registered manager understood their responsibilities and made appropriate applications to the local authority.

Systems, processes and standard operating procedures around medicines were reliable and appropriate to keep people safe. Monitoring the safety of these systems were robust.

Assessments were undertaken to assess any risks to the person using the service and to the staff supporting them. This included environmental risks and any risks due to the health and support needs of the person. The risk assessments we read included information about action to be taken to minimise the chance of harm occurring. Relatives told us people were kept safe and free from harm.

Staff knew the people they supported and provided a personalised service. Care plans were in place detailing how people wished to be supported and families were involved in making decisions about their care.

People were supported to eat and drink. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

Staff told us the registered manager was accessible and approachable. Staff and relatives felt able to speak with the manager and provided feedback on the service.

We have made one recommendation; that records are reviewed to ensure they are accurate, complete and up to date and provide all the necessary information for staff to follow.

We spoke to three people who used the service at Clevedon Court. They told us that 'the staff always ask us how we would like to be looked after'. This meant that people have been able to choose how they are cared for, and have given their consent to the care they received.

We saw that there were comprehensive assessments from which care plans were developed. These care plans were reviewed every month by the manager and signed by the person using the service. This meant that people were fully involved in deciding the care and support they received.

People told us that they liked their bedrooms and were able to personalise them with their own furniture, pictures and ornaments. The premises was well maintained and benefitted from a "wet room" recently installed. This meant that people could choose to have a shower whilst seated or a bath if they preferred.

There was an effective staff recruitment system in place and staff were suitably qualified and knowledgeable to undertake their role.

There were clear procedures for receiving, handling and monitoring complaints. People who used the service told us that they could speak to the manager or the deputy if they had a concern. They told us that the manager and deputy were very approachable.

Everyone we spoke with told us that they liked living at the home and were able to make choices about their care and support.

People told us that they attended meetings with staff to discuss their care and support. They said that they felt listened to and were able to influence how their support was provided.

We saw that interactions between staff and people living at the home were positive and respectful. Staff took time not to rush people and listened to what they had to say.

People living at the home told us they were supported to attend health appointments. One person told us 'staff will get the doctor to visit if you are not well enough but most of the time they will take us up to see the doctor'.

People we spoke with told us that they liked the staff and they felt safe at the home. Staff knew how to raise concerns and were confident that they would be dealt with by the management of the home.

Staff told us that they felt well supported in their roles and received regular training and supervision meetings.

We saw that people who used the service, their representatives and visiting professionals were asked for their views about the care and support provided and these were acted on.