Archived: Clova House Care Home

Updated 19 September 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 19, 21 and 25 July 2017. The first day of the inspection was unannounced. It was carried out by two adult social care inspectors, a specialist advisor and an expert by experience. A Specialist Advisor is someone who can provide expert advice to ensure that our judgements are informed by up to date clinical and professional knowledge. The Specialist Advisor who supported this inspection was a specialist in nursing care. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. Two adult social care inspectors returned to the service on 21 July 2017, when we were also assisted by two nurses from the Community Infection Prevention and Control Team. They provided specialist advice and guidance regarding the prevention and control of infection in a care setting. Two adult social care inspectors concluded the inspection on 25 July 2017.

The inspection was prompted in part by a notification of an incident following which a person who used the service sustained a serious injury. This incident is subject to further investigation and, as a result, this inspection did not examine the circumstances of the incident.

However, the information shared with Care Quality Commission about the incident indicated potential concerns about the management of risk of falls from beds. This inspection examined those risks.

Before the inspection, we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We contacted the local authority contract and commissioning team to gain their feedback and reviewed the information we held about the service, which included notifications the provider had sent us. Statutory notifications tell us about specific events which occur at the service and about which the provider is legally required to inform us of. We used this information to help us plan the inspection.

During the inspection, we spoke in private with eight people who used the service and had general conversations with a number of other people. We also spoke with six relatives of people who used the service.

We reviewed a range of records. This included eight people’s care records. We also looked at the records for four permanent staff and four agency staff files relating to their recruitment, supervision, appraisal and training. We viewed records relating to the management of the service and a wide variety of policies and procedures.

We spoke with the manager, two regional managers, three senior care assistants, two maintenance staff, the chef, two ‘resident experience’ managers, the activities co-ordinator and the provider’s health and safety advisors. We met and spoke with two healthcare professionals.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We looked at all the facilities provided including communal lounges and dining areas, bathrooms and people's bedrooms with their consent where possible.

Updated 19 September 2017

This inspection took place on 19, 21 and 25 July 2017. The first day of our inspection was unannounced, the second day the provider knew we were returning and the third day was unannounced. At the last inspection, which took place on 17 June 2015, we rated the service ‘Good’.

Clova House Care Home provides residential care for up 32 older people. At the time of our inspection, nine people lived on a unit on the first floor, which specialised in supporting people who may be living with dementia. Another 21 people lived on a residential unit which spread across the ground and first floor. The provider was supporting people in a dementia unit, but had not agreed with the Care Quality Commission to provide dementia care. This was discussed with the regional manager and will be addressed outside the inspection process.

During the inspection, we identified some areas of the service needed additional maintenance to ensure people’s safety. For example, not all fire doors automatically closed and a fire escape was not properly maintained. A fire risk assessment had been completed, but appropriate action had not been taken to address the recommendations contained within it. Staff had not received fire training to meet the provider’s fire procedures and we observed a poor response when the fire alarm sounded. We shared our observations with the local fire safety officer who visited the service in light of our concerns.

We found that medicine management systems were not always safe. The environment was not clean and infection prevention and control practices were not effective. We found mattresses and equipment contaminated with what appeared to be bodily fluids or showing evidence of ingrained dirt. Chairs and cushions were dirty. We found the provider was not compliant with Criterion 2 of The Health and Social Care Act 2008 - Code of Practice on the prevention and control of infections and related guidance.

There were gaps in staff supervision and appraisal. We found unsafe recruitment and induction procedures in relation to agency staff who were in widespread use. This meant the provider had not taken reasonable steps to ensure staff were suitable to work in the service.

We found staff lacked understanding about how positive support could be effectively used to guide people’s care and promote their emotional wellbeing and safety. People's care plans were not always clear and were not consistently followed in practice. We identified concerns regarding the support provided for people to engage in meaningful activities.

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 about how the service is run. The manager was present on all days of the inspection.

Since our last inspection, the service had not had continuity of managers as the registered manager had been away on extended leave and an interim manager had left the service before they returned.

At the time of this inspection, the provider and manager were working with the local authority to address concerns they had about some aspects of the care provided. We found the manager had begun to implement improvements the local authority had suggested. However, we identified on-going concerns around people’s safety and wellbeing and concluded the provider had failed to ensure the manager had the support they needed in their role.

We found breaches of regulations relating to safe care and treatment, person centred care and staffing. We were concerned that the provider’s management team and staff at the service had not identified and addressed these concerns. Audits to monitor the service were in place, but had been ineffective in monitoring and maintaining standards of hygiene and promoting good infection prevention and control practices.

Concerns raised with the provider regarding poor record keeping and care plans by the local authority had been acted upon. However, some records we looked at were not consistently maintained.

We identified breaches of regulations relating to safe care and treatment, staffing, person-centred care and the governance of the service. You can see what action we told the provider to take at the back of the full version of the report.

There were safe recruitment practices in relation to permanent staff. Staff understood their responsibility to identify and respond to safeguarding concerns.

We received mixed comments on the quality of the food from people who used the service. People did not always receive effective support at mealtimes to ensure they ate and drank enough. Applications for Deprivation of Liberty had been made and the principles relating to the Mental Capacity Act 2005 were understood by the staff we spoke with. The décor in the dementia unit was not suitably adapted to reflect best practice in dementia care. People had access to community healthcare services to meet their needs, and community staff told us that communication with the senior care staff was good. We observed staff being kind and people told us they were caring, but people's dignity was not always supported.