Clare House Residential Home

Clare House Residential Home is a care home registered to provide personal care for up to 25 older people including people living with dementia. At the time of the inspection there were 19 people residing at the service.

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

Environmental factors placed people at risk. Not all windows had working restrictors on, water temperatures were too high, and wardrobes were not attached to the walls. All of these issues were rectified after the inspection.

Records were not always kept up to date and detailed. We found missing recording in cleaning schedules, daily tasks, meals and pressure care.

Medicine management required improvement. Peoples medicine administration records were not always completed fully.

Oversight of the service had improved since the last inspection; however systems and processes were not always effective in identifying risks to people.

People were supported by staff who knew them well, had been safely recruited and had the relevant training and skills to meet individual needs.

The environment appeared clean and hygienic and processes protected people from the risks of COVID-19. Staff, people and visitors were tested regularly for COVID-19. The provider had a decoration action plan in place and work had started to improve the environment.

People, relatives and staff were asked to feedback on the service and felt listened to by the registered manager.

People, relatives and staff were positive about Clare House and the support offered to people living there.

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

Rating at last inspection and update.

The last rating for this service was requires improvement (Published 30 April 2019) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We received concerns in relation to safeguarding, records and oversight. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has not changed from requires improvement, based on the findings of this inspection.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

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

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to oversight and risk management at this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Clare House is residential care home that was providing residential for 19 older people including people living with dementia.

People’s experience of using this service:

¿ People told us the liked living at Clare’s House and felt safe.

¿ People told us staff were kind and respectful to them.

¿ The provider did not always follow safe staff recruitment procedures.

¿ People’s care records did not always have enough information for staff to understand and respond to a specific need. Records were not kept up to date with specific information.

¿ Whilst people told us they received their medicines as required, medicine administration records (MAR) were not always filled in correctly.

¿ The registered manager completed quality audits however these did not effectively pick up any issues.

¿ Not all people we spoke to knew who the registered manager was.

¿ There had not been any staff or resident’s meetings held within the past 6 months.

¿ Not all information within the care plans had been updated.

¿ People told us the food was good and there was always enough to eat.

¿ People were being supported daily to make choices and decisions about their care.

¿ People knew how to make a complaint.

¿ Staff and people living at Clare House were involved with the local community. This included the local church and primary school visiting people who lived there.

Rating at last inspection:

GOOD (report published 16 November 2016)

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

Going forward we will continue to monitor this service and plan to inspect in line with our reinspection schedule for those services rated requires improvement.

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

This inspection took place on 7 October 2016 and was unannounced.

During the last inspection on 29 April and 4 May 2016, we identified that the provider had not always operate effectively the systems for receiving, recording, handling and responding to complaints.

This was a breach of Regulation 16 (1) (2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following the inspection the provider sent us an action plan detailing the improvements they were going to make, and stated the improvements had been implemented.

We undertook this unannounced focused inspection on 7 October 2016, to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to the requirement that had been made.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Clare House Residential Home on our website at www.cqc.org.uk

A registered manager was 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.

We reviewed the systems in place to respond to complaints and found they had been strengthened and the processes in place were more robust.

While improvements had been made we have not revised the rating for this key question; to improve the rating to 'Good' would require a longer term track record of consistent good practice. We will review our rating for ‘responsive’ at the next comprehensive inspection.

The service had a 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 30 March 2015 we asked the provider to take action to make improvements to, staffing arrangements, staff training, care planning, medicines management and governance systems. The provider sent us an action plan telling us how they planned to improve. We found at this inspection the actions had been completed.

The provider had not always operated effectively the systems for receiving, recording, handling and responding to complaints.

The provision of social and leisure activities did not fully meet the needs of the service.

People told us that they felt safe and were protected by staff providing their care. The staff were aware of what constituted abuse and of their responsibilities to report abuse.

Risks to people using the service and others were assessed, and measures were in place to reduce and manage any identified risks.

Staffing levels were sufficient to meet people’s current needs. The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service. Staff training and on-going training was provided to ensure they had the skills, knowledge and support they needed to perform their duties. Staff supervision systems ensured that all staff received support through one to one and team meetings to discuss their learning and development needs and the needs of the service.

People received their medication safely and the systems to receive, store and administer medicines were appropriately maintained.

Staff knew how to protect people who lacked the capacity to make decisions. There were policies and procedures in place in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People’s nutritional needs had been assessed and they were supported to make choices about their food and drink. Their physical and mental health was closely monitored and appropriate referrals to health professionals were made.

Staff were caring and compassionate and ensured that people’s privacy and dignity was respected at all times.

People using the service and their families were involved in making choices about their care and their care was based upon their individual needs and wishes. The care plans reflected people’s current needs and they were regularly reviewed and updated.

Improvements to the management governance systems to monitor the quality and safety of the service had taken place and being further developed.

We identified that the provider was not meeting regulatory requirements and were in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

People's needs had been assessed before they were admitted to Clare House. After admission to the home we saw that their needs were regularly reassessed to ensure they received the safe care they needed. This meant that staff had the information they needed to minimise identified risks to people.

There were suitable arrangements in place to respond to emergencies, with the manager or deputy manager always being available 'on call' to support staff to manage the situation safely and in a timely way.

We found that difficulties in recruiting staff had meant that sometimes agency staff had been used to ensure there were sufficient numbers of experienced staff on duty to meet people's needs safely. The provider said there had been difficulties recruiting new staff to work at Clare House because of the home's rural village location. We saw that where there had been a shortfall in the numbers of care staff on duty the provider had used agency staff on the shift affected to ensure people received safe care.

We saw that the provider was actively seeking to recruit additional new care staff so that people were assured of safe care from permanent members of the care team. As an interim measure until new staff were recruited the deputy manager also worked 'hands on' alongside care staff to ensure that there were sufficient numbers of staff to meet people's needs.

People were cared for in an environment that was clean and hygienic. We saw that the equipment in place for staff to use to support people with their care needs was appropriately maintained.

We saw that there were effective security precautions in place to ensure the premises were protected from unauthorised entry by people who had no legitimate cause to be in the home as a visitor or tradesperson. This meant that people felt safe living at Clare House.

Is the service effective?

Where people's ability to choose had been compromised by their dementia, we saw there was appropriate information about their care needs and abilities to guide staff so that people were still enabled to express themselves and make their feelings and wishes known.

One person we spoke with in their own room said they received all the support they needed to enable them to be as independent as possible. We spoke with staff and observed them going about their duties and we concluded that they had a good knowledge of each person's care needs and preferences.

Is the service caring?

When we saw staff interact with people their manner of approach was patient, kind, and good humoured. They encouraged people who struggled to do things for themselves. We saw that staff, although busy, were purposeful and unhurried so they had not 'rushed' people to do things. One person described the staff as "friendly and ever so kind".

Is the service responsive to people's needs?

Some staff said that recruitment difficulties had meant that sometimes when agency staff had been used people had felt unsettled until the temporary agency staff member had time to get to know what their care needs were. We spoke with three permanent care workers and they each had a good understanding of how to support people in a way that respected each person as an individual with different needs and preferences.

Is the service well-led?

The provider may wish to consider that we found staff had not always had the timely opportunities to enable them to discuss new ideas for improving and monitoring the service people received. This was because in the previous few months team meetings between staff and their manager had not happened as regularly as first planned. The provider recognised that ensuring these meetings took place as scheduled was important because they provided a forum for staff to discuss their ideas and proactively make a positive contribution to enhancing the quality of service provision at Clare House.

We spoke with a relative of a person that used the service, they told us that the staff had good understanding of their relatives needs and that they were satisfied with the care that their relative received.

We found that people's needs had been assessed and measures had been put in place to ensure that the risks associated with people's care were reduced. We found that staff had good understanding and knowledge of people's care needs.

We saw that staff had received supervision and that there was a training plan in place to ensure that staff received the training that they needed to carry out their roles. We spoke with two staff members who told us that they felt well supported in their roles

We spoke with a relative of a person who used the service who told us 'You couldn't wish for better staff. I would have no hesitations in recommending the service to anyone'.

We spoke with three staff members who all felt well supported and able to approach the deputy manager with any concerns. One staff member told us 'The care is good, everybody is friendly and everybody really cares'.

We found that people were involved in the planning of their care and that their needs had been assessed. We found that staff had a good knowledge of how to identify and report any safeguarding concerns. We saw that a complaint that had been made to the provider had been fully investigated and responded to appropriately.

However, we had concerns that not all staff members had received appropriate training to enable them to carry out their role. We also had concerns that care plans and assessments were not reviewed thoroughly to ensure that people's needs were being met.

We spoke with staff members who told us "I really enjoy coming to work" and "I love working here".

We found that people's care needs had been assessed and that people had been involved in the planning of their care. We found concerns with documentation and staff training.