Clarendon House Residential Dementia Care Home

Clarendon House Residential Dementia Care Home is registered to provide accommodation and personal care for a maximum of six adults who have dementia care needs. At the time of this inspection, there were three people using the service.

People’s experience of using this service:

At the inspection of 29 & 30 October 2019, we found four breaches of regulations. At our inspection of 29 July 2020, we found that improvements had been made and the provider had complied with three of the regulations. At this inspection we identified that further improvements had been made to the benefit of people using the service. Since our last inspection of 2020 the service had worked hard to make improvements in areas such as improving the premises, staffing arrangements, care documentation and in improving quality monitoring.

Risk assessments had been prepared for people. These contained guidance for minimising potential risks such as risks associated with falling, choking, suicide and risk associated with the pandemic. One person had been prescribed blood thinning medicine. We asked the provider to ensure that potential risks are identified and staff are informed of these risks, which they did, as this medicine is considered to be a high risk medicine.

The service followed safe recruitment practices and records contained the required documentation. The staffing levels were adequate to ensure that people’s care needs were attended to. Our previous inspection identified that there was inadequate deployment of staff. This was a breach of Regulation 18, Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Staffing). During this inspection we found that the service had made improvements in respect of this and staff were adequately deployed.

There were arrangements for safeguarding people. Care workers had been provided with training on safeguarding people and knew what action to take if they were aware that people were being abused.

There were suitable arrangements for the administration of medicines. Medicine administration record charts (MAR) had been properly completed. Medicine audits had been carried out.

The premises were well maintained and there was a record of essential maintenance and inspections by specialist contractors. Window restrictors were in place.

Suitable fire safety arrangements including personal emergency and evacuation plans (PEEP) and weekly fire alarm checks and fire drills were in place.

The premises were clean and tidy. Infection prevention and control measures and practices were in place to keep people safe and prevent the spread of the corona virus and other infections. Staff had received infection control training. They had access to sufficient stocks of personal protective equipment (PPE).

Staff were supported to care for people. They had received training and had the knowledge and skills to support people. Supervision had been carried out. However, no appraisal of performance had been organised for one staff who had worked over a year.

Staff understood their obligations regarding the Mental Capacity Act 2005 (MCA). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Care needs of people had been attended to. There were suitable arrangements for caring for people requiring care for specific physical and psychological conditions. Care plans were in place.

The service had a policy on ensuring equality and valuing diversity. Effort had been taken to respond to the diverse needs of people who used the service.

At our last inspection the service did not have effective quality assurance systems for monitoring and improving the quality of the service provided for people. This was a breach of Regulation 17, Health and Social Care Act (Regulated Activities) Regulations 2014 (Good governance). During this inspection we found that the service had made improvements and was no longer in breach. Checks and audits of the service had been carried out and action had been taken to rectify deficiencies noted.

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 inadequate (published 16 July 2020) and there were breaches of regulation in relation to safe care and treatment, staffing, good governance and person-centred care. 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected:

We undertook this focused inspection as we had concerns regarding the service, and we wanted to check that people were well cared for. The inspection was prompted in part due to concerns received about staffing and the safety of people who used the service. A decision was made for us to inspect and examine those risks. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led. The overall rating for the service has improved to Good.

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

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 coronavirus and other infection outbreaks effectively.

The last comprehensive inspection found risks related to the staffing levels and the safety and maintenance of the premises. A warning notice was issued for a breach of Regulation 12 (Safe care and treatment). The service did not have adequate numbers of staff deployed to meet the needs of people. A warning notice was issued for the breach of Regulation 18 (Staffing). The service did not have effective quality assurance systems for monitoring and improving the quality of the service provided. A warning notice was issued for the breach of Regulation 17 (Good governance). The service did not ensure that people received person-centred care which met their care needs and reflected their preferences. This was a breach of Regulation 9 (Person-centred care). The service was given the overall rating of inadequate.

People’s experience of using this service:

We carried out this inspection to check on compliance with the three warning notices issued and a requirement made following the last inspection in October 2019. We also received information raising concerns about how people using the service were being kept safe.

We found the provider had made improvements in complying with the three warning notices issued and the requirement made. However, further improvements were needed in the staffing arrangements and the quality assurance systems.

The premises were clean and tidy. There were weekly fire alarm checks, fire drills and an updated fire risk assessment were in place. There was a current safety inspection certificate for the electrical wiring. The side gate to the house was kept locked.

The home had a procedure to ensure that people received their prescribed medicines. Staff were aware that medicines to be given as required (PRN) such as painkillers should only be given when needed. Written protocol and guidance had been provided for staff. We however, noted that the guidance was not sufficiently detailed for two people.

We received information that three people had sustained falls within the past four months. We noted that there were arrangements in place to prevent and manage falls when they occurred. Risk assessments had been carried out with guidance on falls prevention. The home had a strategy for falls prevention and staff were aware of action to take to prevent falls and if people had a fall.

Improvements had also been made to the staffing arrangements. However, not all the requirements of the warning notice had been met. Risks remained around the night staffing arrangements and management duty arrangements. We were not confident that the night staffing arrangements were sufficiently satisfactory for the service to continue providing safe care for people.

There were at least two staff on duty during the day to attend to people. We however, noted that the two staff on night duty had worked continuously over a seven-day period for the past two months prior to this inspection. This may place people at risk as staff may become overly tired. It may have impacted on the management of the home as the rota did not indicate that time had been set aside for their management roles. In view of the unsatisfactory arrangements, there is still a breach of regulation which we will look at further at our next inspection.

We further noted that the rota was not always accurate as staff who were on duty were not always recorded on the rota.

Appropriate arrangements were in place to ensure person-centred care. People’s likes, and dislikes had been recorded. There was evidence that consultation had taken place with people or their representatives and end of life care arrangements had been documented. The communication needs of people had been assessed and guidance provided for staff on how to communicate effectively with people.

There were improvements in the quality monitoring systems. However not all the requirements of the warning notice had been met. Checks and audits had been carried out since the last inspection. These included checks and audits of care plans, medicines, health and safety checks and checks on the maintenance of the home. The audits were not sufficiently detailed as they did not always include details of items checked and any deficiencies which may have been noted. We further noted that the rotas were not always accurate, and the PRN protocol was not sufficiently detailed. There is still a breach of regulation which we will look at further at our next inspection.

The manager informed us that the registered manager no longer wished to be in day to day control of the service. The manager also informed us that he had submitted an application to become the registered manager. His application had been received by us.

Rating at last inspection:

The last rating for this service was inadequate (published 7 February 2020 and there were four breaches of regulations. At that inspection we identified breaches in relation to the health and safety of people's care, lack of suitably qualified staff, lack of person-centred care, and inadequate quality assurance.

Why we inspected:

We undertook this targeted inspection to check on compliance with the three warning notices issued and a requirement made following the last inspection in October 2019. We also received information raising concerns about how people using the service were being kept safe. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns.

They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up:

The service remains in special measures and remaining breaches will be followed up at the next inspection.

About the service:

Clarendon House Residential Dementia Care Home is registered to provide accommodation and personal care for a maximum of six adults who have dementia care needs. At the time of this inspection, there were five people using the service. Only one person was able to converse with us. Two other people were very limited in their response to us.

People’s experience of using this service:

The quality of care had deteriorated since the last inspection. People's welfare and safety had been placed at risk due to a lack of staff, vigilance and effective management of the service.

People did not always receive personalised care and support that met their individual needs and choices. There was a lack of social and therapeutic activities. Although there was an activities timetable, we saw no activities being organised for people during the inspection. We also noted that people’s likes, and dislikes had not been recorded. There were no end of life care plans for people. We found a breach of regulation in respect of these deficiencies.

There were arrangements for supporting staff and providing them with essential training. Supervision and a yearly appraisal of their performance had been carried out. We however, noted that details of what was covered during supervision and induction were not documented. Staff had been vetted and the staff records contained the required pre-employment checks such as two references, criminal record checks and evidence of their right to work in this country. We however, noted that the home had inadequate staffing levels. The staff rota stated that with one exception, there was only one staff on duty on each shift. The staff on duty were involved in both care and housekeeping duties. Having only one staff on duty during the day and at night meant that people may not receive adequate care and would be at risk in the event of an emergency such as a fire incident. In addition, certain duties such as care documentation and providing activities may not always be attended to. We found a breach of regulation in respect of the above deficiencies.

The premises were not well maintained, and we noted several health and safety deficiencies which put people at risk of harm. These included the absence of weekly fire alarm checks, a fire risk assessment which had not been updated and excess furniture in the garage which housed the fridge, freezer, washing machine and tumble dryer. There was no current safety inspection certificate for the electrical wiring. Inadequate safety arrangements put people at risk of harm. We found a breach of regulation in respect of these deficiencies.

The registered manager monitored the quality of some aspects of the service. However, our findings indicated that comprehensive checks and audits had not been carried out since May 2019. This may place people at risk of harm and not receiving a good quality service. We found a breach of regulation in respect of this.

The home had a procedure to ensure that people received their prescribed medicines. Staff had received medicines administration training and there were no unexplained gaps in the medicine administration records (MARs). They were aware that medicines to be given as required (PRN) such as painkillers should only be given when needed. There was however, no written protocol to provide detailed guidance for staff. This means that staff may not be fully informed and people may be put at risk. The manager stated that guidance would be provided.

People who used the service had dementia and four were unable to provide us with their view regarding the quality of the care provided. One person stated that they were satisfied with the services provided. Feedback from two relatives indicated that they were satisfied with the care provided and they found staff to be caring and communicative.

Arrangements were in place to help ensure people were protected from the risk of abuse. Staff had received training on how to safeguard people.

Risk assessments had been documented. Risk assessments covered areas such as the risk of falling, behaviour which challenged the service and pressure sores.

People’s healthcare needs were attended to. Appointments had been made for healthcare professionals to attend to people. This was confirmed by a healthcare professional we spoke with. This healthcare professional also informed us that staff had followed their guidance and one aspect of the care of their patient had improved.

Meals were prepared by staff in the home. These appeared nourishing. People’s weight had been monitored and recorded in their care records. A person with eating difficulties had been referred to their GP and dietitian so that they can receive specialist attention.

The bedrooms and lounge were clean. There were no unpleasant odours in the home. We however, noted that two used cloth aprons were left hanging in the hallway. These were unsightly and may pose an infection risk as they should be stored separately and washed after use.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that an individual being deprived of their liberty is monitored and the reasons why they are being restricted is regularly reviewed to make sure it is still in the person's best interests. We noted that two people had DoLS authorisations. However, the service had failed to notify the CQC of this.

Staff had been provided with training and understood their obligations regarding the Mental Capacity Act 2005 (MCA). They knew that people should be supported to have choice and control of their lives in the least restrictive way possible. Staff gained people's agreement before providing them with assistance with personal care and other activities.

Staff respected people’s privacy and feedback received indicated that people had been treated with respect. Staff had a caring approach towards people.

Staff had an awareness of ensuring equality and valuing diversity. People were not subject to any discrimination on account of their religious, cultural or other individual characteristics. A person wanted to attend their place of worship. The registered manager agreed to make arrangements for this to be done.

There was a formal complaints procedure in place which was available to people. No complaints had been documented. The registered manager stated that none were received.

The home had a management structure in place with the registered manager, a manager, a deputy manager and a team of care workers. The registered manager however, informed us that she would soon be resigning from her post and one of the partners would be applying to become the registered manager.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

Rating at last inspection:

The service had been inspected on 2 November 2018 and was rated as Good.

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

Why we inspected:

This was a scheduled planned comprehensive inspection.

Enforcement:

We found four breaches of the Health and Social Care Act 2018 (Regulated Activities) Regulations 2014.

Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Follow up:

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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. 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.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Everybody we spoke with told us that they were happy with living at Clarendon House. They said that staff were caring, that they received their medicines on time, that the food was tasty, and that staff treated them with respect.

People told us that they were able to make their own decisions and could choose what they want to eat, when they want to get up or what time they wanted to go to bed. Relatives and friends were able to visit people who used the service and people maintained good links with the community.

The service had close links with various health care professionals to ensure that people’s health and wellbeing was managed appropriately.

We observed that staff had good relationships with people who used the service and care was delivered in a person-centred way.

If people required equipment, the manger ensured that he liaised with the relevant professionals. The environment was homely and generally well maintained.

Staff had access to a variety of training to ensure they had the right knowledge and skill to meet people’s needs.

Staffing levels were appropriate to meet people’s needs and everyone told us that there were sufficient staff deployed.

The provider had appropriate systems in place to ensure people who used the service were safe from avoidable harm. Risk assessments provided sufficient detail to ensure that staff knew how to manage risk.

The manager undertook regular checks which ensured that quality of care provided was monitored and any improvements were made if required. People who used the service, relatives and staff spoke very positively about the manager and told us that the team worked very well together, which ensured people who used the service received a good service.

More information is in the detailed findings below.

Rating at last inspection: Requires Improvement (date last report published) 10 January 2018.

About the service: Clarendon House Residential Dementia Care Home is a residential care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. Clarendon House Residential Dementia Care Home is a care home that provides personal care and accommodation for up to six older people who live with dementia.

Clarendon House Residential Dementia Care Home is a family business. The service is owned by Mr and Mrs Kritikos. The registered manager is Mrs Kritikos, who does not work at Clarendon House Residential Dementia Care Home. The service is managed by Mr Kritikos. However, the registered manager does not work within the service. The service is managed by Mr Kritikos.

Why we inspected: This was a planned inspection based on the rating at the last inspection. During our last inspection we rated the service requires improvement. During this inspection we found the service had made the required improvements and was no longer in breach with regulations.

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 any concerning information is received, we may inspect sooner.

During our last inspection in October 2015 we rated the provider overall Good.

Clarendon House Residential Dementia Care Home is a residential care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

Clarendon House Residential Dementia Care Home is a care home that provides personal care and accommodation for up to six older people who live with dementia.

There was a manager registered with the Care Quality Commission (CQC). The registered manager covered two services and the provider employed a designated manager at Clarendon House to provide consistency and a constant presence. A registered manager is a person who has registered with the CQC 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, in particular controlled drugs, were not always managed safely. Storage, recording and administration of controlled drugs did not comply with the relevant legislation.

Risks to people who used the service in relation to the treatment or care were assessed and management plans were put into place to mitigate such risks. However, the lack of servicing the stair lift on a regular basis might have put people under unnecessary risk.

The service did not have a formal quality assurance monitoring system, which resulted in shortfalls in relation to medicines management and the operation of equipment used to lift people.

People were protected from abuse and staff had the appropriate skills and knowledge to understand the different forms of abuse and knew how to report them appropriately.

The home was clean and free of unpleasant smells and staff followed appropriate infection control procedures.

Accidents and incidences were discussed with staff and looked at to see if similar incidents and accidents could be avoided in the future.

People were assessed to ensure treatment or care provided was suitable to their needs.

Staff received the appropriate support, supervision and training to ensure that they had the right skill set to support people who used the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

People who used the service were provided with wholesome, nutritious and home cooked meals, which were prepared according to their likes and dislikes.

The home worked well with external health and social care professionals to ensure people’s differing health care needs were met.

Overall people lived in a well maintained and homely environment, which was suitable to their needs.

Staff were observed to support people with kindness and respect, people were consulted prior to care or treatment was provided and they were encouraged to maintain their independence.

People’s privacy and dignity was respected and staff understood that people were allowed and able to make their own decisions.

Care was person centred. Reviews of people’s care records ensured that people’s changing needs could be responded to and be met.

Complaints made by people who used the service were taken seriously and were investigated to ensure lessons were learned.

While the service did not provide specific end of life care, people were supported to be as comfortable as possible if they fell ill or if their health deteriorated.

The management at the home was visible, approachable and supportive. People who used the service, relatives and staff spoke positive about the care and support provided by the manager.

We found three breaches during this inspection. You can see what action we told the provider to take at the back of the full version of the report.

We undertook this focused inspection on 4 February 2016 to check the provider had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Clarendon House Residential Dementia Care Home on our website at www.cqc.org.uk.

Clarendon House Residential Dementia Care Home is a care home that provides personal care and accommodation for up to six older people who have dementia care needs. On the day of the inspection there were six people residing at the home.

During our focused inspection on 4 February 2016 we found that the provider had taken the necessary steps to ensure that people were not deprived of their liberty and care worker received the appropriate training in MCA 2005 and DoLS.

During the inspection, we spoke with one person who used the service and two relatives. We spent time observing and also spoke with two care workers, the registered manager and their deputy.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Staff understood their role in safeguarding the people whom they supported. They knew how to report any concerns they had to the manager and document any concerns promptly.

The home had systems in place to identify assess and manage risks relating to the health, welfare and safety of people who used the service. People's health, safety and welfare were protected and equipment to meet their care needs was provided if they required it.

The Care Quality Commission monitors the operation of the Deprivation of Liberty

Safeguards (DoLS), which applies to care homes. The registered manager knew when an application for deprivation of liberty would need to be submitted for authorisation.

There was a robust system in place to ensure the home was kept clean and people were not put at unnecessary risk of infection

Is the service effective?

Relatives of people using the service told us they were happy with the way their relatives were treated and staff were 'very nice and welcoming'. People's care needs had been assessed and care and treatment were planned and delivered in a way that promoted people's safety and welfare. Risk assessments had been carried out where necessary. Care plans had been regularly reviewed with involvement from people and those who were important to them.

Staff told us there was good communication amongst staff about the service and people's needs, which enabled them to carry out their roles effectively in providing the care and support people needed. They told us regular team meetings helped them keep informed.

Is the service caring?

We saw staff interact with people who used the service in a respectful manner supported and encouraged people to participate in activities. The relatives of the people using the service told us they were confident people were safe. Staff were seen using a variety of techniques to communicate with people and offering reassurance if they became distressed.

Is the service responsive?

People received individualised care that was responsive to their interests and preferences. Staff made sure people were supported to take part in activities they had enjoyed for many years including gardening and watching sport on television.

The manager conducted audits to ensure the standards of care given were met and monitored and did respond to issues as they arose. People's care and health were monitored closely. Written notes about people's health and care were completed by staff.

Is the service well-led?

The home had an experienced registered manager who was supported by a deputy manager. Checks to monitor the quality of the service were carried out. Staff meetings took place regularly so staff views about the service were taken into account. Staff were clear about their roles and responsibilities and felt well supported by management staff. The management team had systems in place to support workers.

Since our last inspection in May 2013, we noted that the registered provider had implemented a new care plan format from October 2013.

Care records we looked at indicated that the needs of people had been attended to and contained risk assessments where necessary.

We observed that there was good interaction between staff and people who used the service.

We looked at the staff rota for October 2013 and noted that the members of staff working on the day of the inspection was correctly recorded in the rota. However, we observed that the rota we were shown on the day of our inspection had not been changed to reflect that one member of staff had recently left the home. This was addressed by the provider after the inspection.

We observed that the home had various policies. It was however not clear when these were last reviewed.

During the inspection we spoke with member of staff who was working during the night shift and we also spoke with one person living at the home. This person told us that he was 'happy' at the home.

We observed that people appeared to be happy and comfortable. The atmosphere at the home appeared relaxed and people who used the service were watching TV together in the lounge.

Following a safeguarding concern received, we checked whether the doors of the bedrooms of people who used the service were locked and found that none of the doors were locked.

During the inspection we noted that there was no current staff rota and that there were no up to date records of the shifts staff worked. This meant that it was not evident that the health, safety and welfare needs of people who used the service were being met at all times. We also noted that people's care records were not always updated with necessary information regarding their care and progress.

People's care plans were regularly reviewed and included detailed information about the individual support and care that people using the service needed. People were involved in decisions about their care. People's independence and skills were promoted and supported by staff. We saw that people using the service were involved in carrying out some household tasks.

People were supported and encouraged to make decisions about their lives. During the inspection people decided what they wanted to eat and what they wanted to do.

People's health, safety and welfare were protected as they received the advice and treatment that they needed from a range of health and social care professionals.

Staff knew about their roles and responsibilities in meeting the needs of people who use the service and they supported people in a friendly and respectful manner.

There were enough skilled and experienced staff to meet people's needs.

Records were accurate and up to date.