Archived: Claremont House

Claremont House is a residential care home providing accommodation and personal care to up to 20 people. The service provides support to older people, some of whom were living with dementia. At the time of our inspection there were 18 people using the service.

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

Improvements were needed to aspects of record keeping. Although people received their medicines safely, medication administration records (MARs) were not always transcribed accurately. Medicine audits did not always identify issues with recording. Although staff knew people's support needs well, some care plans contained conflicting information about the support people needed. Staff needed to make improvements to how they respond to feedback from people that use the service to ensure they were fully involved.

People were supported by staff that knew them well and understood any risks to people. There were enough staff to support people and staff had been safely recruited. Staff followed infection prevention and control measures and the home was clean and hygienic.

People were positive about the support they received from staff and told us they enjoyed living at the home. Staff supported people to be as independent as possible. The culture of the home was calm and friendly and staff worked together to ensure people were empowered to spend their time how they chose. Staff were positive about the management of the service and told us they felt supported. Health professionals that worked regularly with staff to support people were positive about the attitude and knowledge of the staff team. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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 good (published 28 January 2020).

Why we inspected

This inspection was prompted by a review of the information we held about this service. 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 remained the same 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.

Follow up

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

We found the following examples of good practice.

People were supported to have visits from and keep in touch with their loved ones throughout the pandemic. The conservatory and front garden had been adapted to support visiting when visits inside the home had not been allowed. People now received visits inside the home in line with government guidance. Visitors were provided lateral flow device (LFD) tests by the home and had their temperatures checked on arrival. The registered manager told us they had kept people’s families up to date about visiting procedures through regular phone calls.

Staff were able to effectively cohort groups of people throughout the home if needed. The registered manager told us that during an outbreak of COVID-19, staff had been assigned to provide support for select people to minimise the risk of transmission. When people had to self-isolate in their bedrooms, one to one activities were provided for people.

There were safe arrangements for people who chose to go out. People who went out regularly had agreed to take lateral flow tests on the day they went out and had been provided hand sanitiser bottles to take with them.

Staff had thought creatively about how to provide entertainment for people when external entertainers were not able to come into the home. One member of staff provided regular singing performances for people, which were very popular. Staff had involved people’s families as much as possible throughout the pandemic, including when visitors were not allowed inside the home. For example, when parties and celebrations were held inside the home, families were invited to come and be involved in the garden areas. Staff also kept a social media group for families to be kept up to date with pictures and videos of their loved ones.

The home was clean and tidy. Staff were wearing personal protective equipment (PPE) in line with government guidance. The registered manager had installed wall mounted PPE stations on each floor of the home. Staff had received training in putting on and taking off PPE safely.

Staff worked exclusively at the home and agency staff were not used unless they could be booked to only work at the home. Staff were offered additional incentives to work overtime in order to reduce the need for agency staff. The management team supported staff wellbeing. The registered manager had provided staff with an employee assistance programme that focused on health and wellbeing. Staff could access this for support with mental and physical wellbeing and staff could be referred for counselling and talking therapies through this.

Claremont House is a residential care home providing personal care for up to 19 older people with a variety of needs, some living with dementia. The service also provided short or long-term holidays for people, for example when their health deteriorated or when they came out of hospital, which was known as respite. At the time of inspection, there were 18 people using the service, two of which were staying on respite.

Claremont House is situated in Seaford and close to the town centre. The house is built over four floors, with a lift. There were communal bathrooms, a lounge, dining room and conservatory where people could sit in the sun at the front of the house. There was also a wheelchair accessible garden.

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

We identified some improvements were needed to the quality assurance process and records. Some people’s records were not reflective of their current support needs and mental capacity assessments did not reflect people’s and others involvement. We also found some improvements were needed to feedback surveys, for example how results were gained, analysed and fed back.

People told us they felt safe and we observed that staff knew risks to people well. Staff understood signs a person could be at risk and what actions to take if they suspected abuse. People received their medicines safely and as prescribed. People told us there were always enough staff and we observed call bells to be answered quickly, ensuring people didn’t have to wait. The registered manager and staff reflected on any incidents together and took actions to ensure risks were mitigated.

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

Staff had the induction, skills and knowledge to meet people’s needs effectively. They were further supported with regular supervisions and team meetings by the management team. People’s nutritional and hydration needs were consistently met and they had support from health and social care professionals when they needed it.

People, their relatives and professionals described staff as, “Lovely”, “Kind” and, “Caring.” One relative said, “Very friendly and caring, they make it a proper home rather than just a care home.” We observed people and staff to be warm and caring towards each other and treated with mutual respect. People’s privacy and dignity was continually promoted. Staff valued the importance of people maintaining their independence and supported them to do this on a day to day basis. People’s views were considered highly important and continually sought.

People and their relatives told us that staff knew them, their preferences and support needs well and this is what we observed on inspection. People were involved in activities that were centred on their hobbies and interests. No complaints had been received, however people and their relatives told us they knew who they could speak to with any concerns. Staff had good knowledge of how to ensure people received dignified and pain free support when receiving end of life care.

People, their relatives and professionals were positive about the management team at Claremont House and felt it was well-led. The management team showed passion for improving and providing the best care possible for people. They worked in partnership with a variety of health and social care professionals to improve outcomes and the service provision.

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 good (published 22 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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 we receive any concerning information we may inspect sooner.

The registered manager was present during the inspection. 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.

This inspection took place on the 30 December 2016 & 3 January 2017 and was unannounced.

At our inspection on 4 and 19 June 2015 we found the provider was not meeting the regulations with regard to staffing levels, staff training, safeguarding people from improper treatment, person centred care, accurate and up to date records and assessing and monitoring the quality of the services provided. At this inspection we found improvements had been made and the provider met these regulations.

The quality assurance and monitoring system had been reviewed and audits had been carried out to identify areas where improvements were needed. Changes in the care planning documentation had been made in line with these reviews; the care plans were up to date and had been developed with the involvement of people and their relatives, if appropriate.

The recruitment process was robust, it ensured only people suitable worked at the home and there were enough staff working in the home to provide the support people wanted. The home had a calm atmosphere and people said they were very comfortable living there. They liked their rooms, were very positive about the food and said activities were available for them to join in if they wanted to.

Care and support was personalised to meet people’s individual needs, records were up to date and had been reviewed regularly, including care plans. Staff managed and administered medicines safely. People had access to healthcare professionals as required.

Staff had an understanding of their responsibilities with regard to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Staff had attended safeguarding training; safeguarding and whistleblowing policies were in place and staff said they had read and understood these.

Complaints procedures were in place. The registered manager encouraged people, relatives and staff to be involved in decisions about how they service improved and, people and staff were very positive about the management of the home.

We also took information from other sources to help us understand the views of people who used the service, which included residents' surveys and residents' meeting minutes.

The people we spoke with told us they were happy with the care they received and with the staff team. One person who used the service told us, 'On the whole the care is very good. They treat me very well.' Another person commented, 'I'm very happy here. The people couldn't be better. We are very well looked after.'

The people who used the service were supported to have adequate nutrition and hydration. People were given choices of food and drink to meet their diverse needs.

We saw that the equipment used to meet the needs of the people who used the service was suitable for its purpose, well maintained and used correctly and safely.

The provider had also ensured that sufficient numbers of staff with the right skills and abilities were employed to meet the needs of the people who used the service.

People's needs had been assessed and care and treatment had been planned and delivered in line with their individual care plan. People experienced care, treatment and support that met their needs and protected their rights. Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

One person told us. 'The girls are charming absolutely charming, they are there whenever I need their help and they let me do things at my own pace'.

A relative told us 'I have no concerns about the care here; it's a very good home'.

One care worker told us "We have time to spend with the residents, time to chat with them every day, that's one of the reasons why I enjoy working here so much".

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were cared for by staff who were well supported to deliver care and treatment safely and to an appropriate standard.

Staff records and other records relevant to the management of the services were accurate and fit for purpose.