Archived: Clova House Residential Care Home

At this inspection we found that improvements had been made to staffing and managing risks. However although people's day to day capacity had been assessed and recorded within some care plans, there was no evidence that people had been supported to make significant decisions about their care or well-being, such as changes to the way their care is provided and the level of supervision they required each day.

We were told that the provider had not submitted any DoLS applications to a supervisory body although some of the people living in the home were under constant staff supervision and may not have capacity to make decisions in their best interests. This meant that people living in the service may have decisions made for them that may not be in their best interests and could have their liberty deprived This was a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Clova House provides accommodation for up to 20 older people. At the time of inspection there were 16 people using the service. The service is located in a residential area of Shelton Lock. Clova House is a converted domestic dwelling and provides accommodation on two floors and is served by both a passenger lift and a stair lift.

The provider is also the 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.

There were sufficient numbers of staff deployed within the service to meet people's needs. The provider had implemented a revised management structure since our last inspection to improve administration and support for staff. Staff told us that they felt supported by the new deputy manager.

The service kept people safe and effectively managed risks to people using the service. Records showed that risks to people's health and well-being had been identified, assessed and managed in an appropriate way. People we spoke with were happy with the care that they received and told us that they felt safe in the service.

People who used the service told us that staff were kind and caring. We saw that staff treated people with dignity and respect.

Staff had attended a variety of role specific training. We observed that staff were not always consistent in responding to the needs of people living with dementia. Some staff told us that they struggled to understand the right approach to support people living with dementia. We raised this with the deputy manager and recommended that the service finds out more about training for staff, based on current best practice, in relation to the specialist needs of people living with dementia.

There were procedures for monitoring and assessing the quality of the service. However our findings showed that the provider's approach to quality assurance was fragmented and we found that some audit processes were out of date or ineffective. There were further improvements required to quality assurance and monitoring to ensure that processes were robust and effective.

You can see what action we told the provider to take at the back of the full version of the report.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found-

Is the service safe?

People had been cared for in an environment that was safe and well maintained with equipment that was serviced regularly. Staff were trained and knew the needs of people using the service and how to meet those needs safely and as the person wanted.

People's care needs were assessed and some risks were identified but the complexity of support plans made it difficult for new staff to understand people's needs and the risks. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

People's nutritional needs were assessed but professional advice and support was not always obtained to ensure that people's needs were met in the most suitable way. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made and how to submit one. However, assessments have not been completed on people's ability to make decisions about their care needs. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

People received their medication when they needed it and records were well maintained with staff receiving the training they needed to administer medication safely.

Records indicated that audits to monitor the quality and safety of the service had not taken place for two years. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service effective?

People told us they were happy with the care that they received and that their needs were met by staff. It was clear form our observations and from speaking with staff that they understood the needs of people using the service. One person told us. 'They help me when I need help, they ask me what they can do to help and they are always there when you need them.' Staff received training to meet the needs of the people living at the home.

Is the service caring?

People using the service were supported by kind and attentive staff. We observed staff showing patience and taking time to talk to people when they provided support. People told us they could choose how they spent their day. We observed people being able to eat their meals when they wanted to and we were told by people using the service they could eat in their room if they wanted to. One person told us. 'I always have my breakfast in my room.'

Is the service responsive?

People had their needs assessed before moving to the service. Support plans showed how people wanted to receive their support. People spoken with confirmed they received their care as they preferred it. 'Staff know exactly what I like and how I like my tea, they are very good.'

Is the service well-led?

Staff spoken with understood the standard of care expected of them by the provider, the provider spent time speaking to people using the service on a daily basis to ascertain their views. However this was not recorded and quality assurance systems in place were not being used. Staff told us they were clear about their role and responsibility.

We saw there were enough staff on duty to meet people's needs. We found the premises were clean and hygienic, although untidy in some areas, and staff knew how to prevent the spread of infection.

We observed people's care and support during the visit and saw that they were well supported. People using the service told us they thought they received the right support. One person said 'We're okay here' and another said 'it's very friendly'.

We found that improvements were required to medication procedures. Medication administration record (MAR) charts were not completed consistently so it was unclear whether some people had had their medication on some occasions, there was no medication refrigerator, some drugs records did not correspond accurately with the amount of medication in stock and policies and procedures were out of date.

We found complaints were handled properly and people told us they were confident they would receive a courteous response if they raised any concerns.