Clarence House & The Granary

Clarence House & The Granary is a residential care home providing personal care for up to 21 people who live with learning disabilities. The accommodation consists of two houses situated in the same grounds. Clarence House can accommodate up to 12 people; The Granary can accommodate up to nine people. At the time of the inspection 16 people were living at the home.

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

Quality monitoring systems were in place; however they had failed to identify some of the shortfalls found at inspection. In addition, analysis and follow up of specific incidents had not been robustly documented.

Staff knew how to manage risks identified in relation to people’s care and support. However, care plans and risk management plans did not always reflect the knowledge staff had and applied in practice.

Staff knew how to keep people safe from abuse and were confident to raise concerns with the registered manager or external agencies.

There were enough staff to support people’s needs and wishes. Staff had received training for their roles. Safe recruitment procedures were in place for new staff.

Medicines were administered safely, and we were assured measures were in place to prevent the spread of infection to people, staff and visitors.

There was a positive and open culture in the home. People, their relatives and staff were encouraged to share their views about the services provided.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture such as choice, promotion of independence and inclusion.

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 24 January 2020).

Why we inspected

The inspection was prompted in part by notification of a specific incident. Following which a person using the service died. This incident is subject to a coronial investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of falls risks. This inspection examined 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.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

The service had been developed and designed before Registering the Right Support and other best practice guidance was introduced. The service was a large home, bigger than most domestic style properties. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area. There were deliberately no identifying signs or anything else outside to indicate it was a care home.

The principles of Registering the Right Support reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. The service applied these principles.

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

People using the service received planned and co-ordinated person-centred support that was appropriate and inclusive for them. People's care and support focused on them having as many opportunities as possible to gain new skills and become more independent.

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.

People were involved in developing and reviewing their care plans and they had regular opportunities to share their views and opinions.

Staff knew people well and treated them with respect and kindness. They understood the importance of maintaining people’s privacy and dignity.

Risks to people’s health, safety and welfare had been identified and management plans were in place to minimise those risks. People were supported by staff who understood how to recognise and report any signs of abuse. Medicines were managed safely and in line with good practice guidance.

There were enough staff, who were well trained and supported to meet people’s needs. There were systems in place to ensure new staff were recruited safely and were suitable to work with people who lived in the home.

Staff ensured people had access to appropriate healthcare services and their health needs were met in a timely manner. They supported people to eat and drink enough to maintain their health.

People were encouraged to take part in their local community and engage in hobbies and interests of their choice. They were also supported to maintain relationships with family and friends.

There was an open and responsive culture within the home and systems to monitor the quality of services and drive improvements were in place.

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 (published25 May 2017).

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.

There was 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.

On the day of our inspection staff interacted well with people. People and their relatives told us that they felt safe and well cared for. Staff knew how to keep people safe. The provider had systems and processes in place to keep people safe.

Medicines were administered and managed safely. Although PRN protocols were usually in place we found two occasions where they were not and it was not clear what dose of medicine had been given.

The provider did not act consistently in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. If the location is a care home the Care Quality Commission is required by law to monitor the operation of the DoLS, and to report on what we find.

We found that people’s health care needs were assessed and care planned and delivered to meet those needs. People had access to healthcare professionals such as the district nurse and GP and also specialist professionals. People had their nutritional needs assessed and were supported with their meals to keep them healthy. People had access to drinks and snacks during the day and had choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.

There were sufficient staff to meet people’s needs and staff responded in a timely and appropriate manner to people. Staff were kind and sensitive to people. Staff were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs. The provider had a training plan in place and staff had received supervision. People were encouraged to enjoy a range of social and leisure activities. They were supported to maintain relationships that were important to them.

Staff and people who lived at the home felt able to raise concerns and issues with management. Relatives were aware of the process for raising concerns and were confident that they would be listened to. Regular audits were carried out and action plans put in place to address any issues which were identified. Accidents and incidents were recorded and investigated. The provider had informed us of notifications. Notifications are events which have happened in the service that the provider is required to tell us about.

Clarence House and The Granary can provide accommodation and care for 21 people who have a learning disability. There were 19 people living in the service at the time of our inspection. The accommodation is two properties that are linked by a courtyard.

There was 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.

Medicines had not consistently been safely managed. Background checks had not always been completed before new staff were appointed. Staff knew how to respond to any concerns that might arise so that people were kept safe from abuse including financial mistreatment. People had been helped to avoid the risk of accidents and there were enough staff on duty.

Staff had received most of the training and guidance that the registered persons said they needed and they knew how to support people in the right way. People had been assisted to eat and drink enough and they had been supported to receive all of the healthcare assistance they needed.

Staff had ensured that people’s rights were respected by helping them to make decisions for themselves. The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 and to report on what we find. These safeguards protect people when they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. In relation to this, the registered manager had worked with the relevant local authorities to ensure that people only received lawful care that respected their rights.

People were treated with kindness and compassion. Staff recognised people’s right to privacy, promoted their dignity and respected confidential information.

People had been consulted about the support they wanted to receive and they had been given all of the support they needed, including people who could become distressed. People had been helped to enjoy a wide range of interests and hobbies and there was a system to resolve complaints.

Quality checks had not always ensured that problems in the running of the service were quickly resolved. People had been asked about how they would like to improve their home. Good team work was promoted and staff were supported to speak out if they had any concerns because the service was run in an open and inclusive way. People had benefited from staff acting upon good practice guidance.

We reviewed the procedure for obtaining consent to care, treatment and support. We found there was a comprehensive consent document in place, to obtain people's consent.

People had detailed person centred care plans in place. These helped us to understand the needs of people and in particular those with complex needs and those people who had limited verbal communication skills.

We observed people being supported to eat and drink sufficient amounts, and people were assisting with food preparation. We observed lunch and noted people had a choice of food and those who required assistance were assisted. We checked to see that medication was being administered appropriately and found that there were robust medication procedures in place, and people received their medication when they needed it.

We saw people were supported to make choices and decisions for themselves. Staff knew the people well and were able to communicate effectively with people and were able to understand what people were saying.

Two people who we spoke to spoke very positively about living at the home. We were shown the quality monitoring procedures and noted the provider had systems in place to use feedback to improve the quality of care people received.

We saw people were given support to make choices and decisions for themselves wherever they could do so and staff were aware of how each person communicated their needs, wishes and choices. We saw people were treated with respect and dignity and in a way which maintained and developed their independence.

Where they were able to people told us things like, 'Personally I'm really happy here, I think it's a good place to live', 'I feel safe living here, I have my own keys for my room as well' and 'Staff always listen to me.'