Background to this inspection
Updated
9 April 2016
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check 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 11 February 2016 and was unannounced. Our visit was carried out by two inspectors and an expert-by-experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Before we carried out the inspection we reviewed the information we held about the service. This included statutory notifications that the provider had sent us in the last year. A statutory notification contains information about significant events that affect people’s safety, which the provider is required to send to us by law.
During our visit we spoke with 15 people who used the service and three relatives. Observations were made throughout the day.
We gained feedback on the service from one visiting healthcare professional. We also spoke with the acting manager, the head of care, five care staff, the housekeeper, cook, activities coordinator and the maintenance person.
We viewed the care records for six people and the medicines records for eight people who used the service. We tracked the care and support of two of these people. We also looked at records related to the management of the home. These included staff recruitment files, staff training records, quality auditing systems, health and safety records and minutes of meetings.
Updated
9 April 2016
This inspection took place on 11 February and was unannounced.
Clarence House provides residential care and support for up to 41 adults. Some people also stay at Clarence House for periods of respite or convalescence, before returning to their own homes. At the time of our inspection, 28 people were living in the home.
The service is required to have 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 registered manager had left the service in December 2015 and an acting manager was currently completing their probation with the organisation, with plans to register with the CQC upon successful completion of this. This person had been working in the home for three years and, prior to taking on the manager’s role, had been the head of care. This person is referred to as the manager throughout this report.
People were safe in the home. Staff had a good understanding of safeguarding and knew what constituted abuse. Staff knew how to keep people safe and reported any issues of concern appropriately. Although the premises and some equipment looked very ‘tired’ and well worn, staff were observant and communicated any areas of concern promptly to ensure the premises remained safe for people. Risk assessments were clear and detailed and reviewed regularly. Staff acted in accordance with the guidance and protocols that were in place to help reduce the risks for people. People received their medication on time and in the manner the prescriber intended.
Staffing levels were sufficient to meet people’s needs appropriately and all the staff on duty had the skills and knowledge to support people effectively and meet their needs in a timely manner. Appropriate and safe recruitment practices were followed, to ensure staff were suitable to work with people in a care environment.
Staff received good support from each other as well as from senior staff and management. Staff received good levels of supervision and the management team were approachable.
The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. The manager and head of care ensured the service operated in accordance with the MCA and DoLS procedures and staff demonstrated a good understanding of the MCA, DoLS, capacity and consent. People were supported to make their own decisions as much as possible, even where limited capacity had been identified.
People received enough food and drink to meet their individual needs and staff had a good understanding and knowledge of people’s dietary needs.
Prompt referrals were made to healthcare professionals as needed and any advice or guidance given was followed appropriately by staff. There was also consistent monitoring and appropriate communication between staff, regarding people’s healthcare needs and any changes.
People were actively involved in planning their own care as much as possible and, even when people’s capacity was limited in some areas of decision making, staff ensured they were supported appropriately to make informed choices for themselves.
The staff were kind, caring and compassionate. People were treated with dignity and respect and their privacy was always upheld. People were also supported to do as much for themselves as possible, in order to enhance and maintain their independence.
People had access to activities that complemented their interests and enhanced their wellbeing. Visitors were welcome, without restrictions. People were listened to and their complaints were welcome. Any complaints were fully investigated and actions taken to improve the quality of care provided.
There were effective systems in place to monitor the quality of the service and these were used to develop the service further. Staff and people living in the home were involved in making decisions on how the home was run.
Record keeping and management systems were in good order, with effective auditing and follow up procedures in place. Administrative support for the service was an effective and valuable asset.
An open and inclusive culture was demonstrated in Clarence House, with clear and positive leadership at all levels.