Archived: Clitheroe

Clitheroe is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Clitheroe accommodates up to 28 people in one adapted building who receive personal care. At the time of this inspection there were 20 people living at the home.

At the time of our inspection the service did not have a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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. The previous registered manager had left on 14 April 2017 and a new manager had been in post since 23 April 2017. The manager advised that she planned to submit an application to CQC to become the registered manager for the service.

During a previous inspection on 5, 6 and 13 July 2016, we found a breach of the regulations relating to staffing levels at the home. We carried out a follow up inspection on 12 January 2017 and found that improvements had been made and the provider was meeting the regulation. During this inspection we found that all regulations were being met. However, we found that some staff had not received Mental Capacity Act 2005 training and a Deprivation of Liberty Safeguards application had not been submitted to the local authority in respect of one person who lived at the home.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way; the policies and systems at the service supported this practice. However, we found the staff we spoke with lacked a clear understanding of the main principles of the MCA and some told us they had not received MCA training.

We found appropriate policies and procedures in place for the safe management of people’s medicines and people told us they received their medicines when they should.

People told us they received safe care. Most people and their relatives that we spoke with were happy with staffing levels at the home. Staff felt that staffing levels were appropriate to meet people’s needs.

People who lived at the home liked the staff who supported them and felt that staff had the knowledge and skills to meet their needs.

We saw evidence that staff had been recruited safely. The staff we spoke with understood how to safeguard vulnerable adults from abuse and were clear about the action to take if they suspected abusive practice was taking place.

We found that people’s risks were assessed and managed appropriately. Care plans and risk assessments were updated when people’s needs changed. This meant that staff had up to date information to ensure they were managing people’s needs and risks effectively.

We found that staff received an appropriate induction, effective training and regular supervision. Staff told us the manager was approachable and they felt well supported by her.

People were happy with quality of the meals provided and told us they had lots of choice at mealtimes. We saw evidence of this during our inspection.

People received support with their healthcare needs and were referred to a variety of community healthcare professionals where appropriate.

We observed staff communicating with people in a kind and respectful way. People told us staff respected their privacy and dignity and encouraged them to be independent.

People were supported to take part in activities inside and outside the home. People who lived at the home were happy with the activities available.

We saw evidence that the manager requested feedback about the service from people who lived at the home and acted on the feedback received.

People who lived at the home and their relatives told us the home was well managed. They felt that the staff and the manager were approachable. Staff told us they felt standards of care at the home had improved since the arrival of the new manager.

The manager regularly audited many aspects of the service and shared the outcomes of audits with the provider. We found that the audits completed were effective in ensuring that appropriate standards of care and safety were maintained at the home.

We undertook this focused inspection on 12 January 2017 to check whether the provider had made the improvements necessary to meet 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 Clitheroe on our website at www.cqc.org.uk.

Clitheroe is a residential home which provides accommodation and personal care for up to 28 older people. At the time of the inspection there were 18 people living at the service. Bedrooms at the home are located over two floors and a lift is available. There is a lounge, conservatory and dining room on the ground floor and all rooms have wheelchair access. All rooms are single occupancy. There are suitably equipped toilet and bathroom facilities on each floor.

At the time of our inspection there was a registered manager in post who had been registered with the Commission since January 2016. 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.

During this inspection we found that the provider had made improvements and legal requirements were being met.

People living at the home and their visitors told us that staffing levels had improved since our last inspection. They told us that staff were more visible and people did not wait long for support when they needed it.

Staff told us they were still busy. However, they told us the additional member of staff each day helped them to respond to people’s needs in a timelier manner and gave them the opportunity to interact with people.

A community healthcare professional who visited the home regularly told us that staffing levels had improved.

We found that the service was still short staffed and agency staff were being used at the home. However, the managing director told us that staff recruitment at the home was on-going and we saw evidence of this. He told us of plans to improve staff retention at the home.

Clitheroe is a residential home which provides accommodation and personal care for up to 28 older people. At the time of the inspection there were 18 people living at the service.

Bedrooms at the home are located over two floors and a lift is available. There is a lounge, conservatory and dining room on the ground floor and all rooms have wheelchair access. All rooms are single occupancy. There are suitably equipped toilet and bathroom facilities on each floor.

At the time of our inspection there was a registered manager in post who had been registered with the Commission since January 2016. 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 our last inspection on 9 July 2015, we asked the provider to make improvements to staffing levels at the home and the management of complaints. The provider sent us an action plan detailing the improvements that had been made. During this inspection we found that further improvements were required in relation to staffing levels at the home. You can see what action we told the provider to take at the back of the full version of the report.

People told us they felt safe at the home. However, some people living at the home and some relatives expressed concerns about staffing levels at the service. Some of the staff we spoke with felt that staffing levels at the home were not sufficient to meet people’s needs. Staffing rotas provided for inspection purposes by the registered manager were not a true reflection of the staff on duty at the home.

We saw evidence that staff had been recruited safely. The staff we spoke with understood how to safeguard vulnerable adults from abuse and what action to take if they suspected abuse was taking place.

There were appropriate policies and procedures in place for managing medicines. However, staff did not always observe that people had taken their medicines and people did not always receive pain medication when they needed it.

We received mixed feedback from people about their satisfaction with the care they received. Some people were happy with the care provided at the home. However, some people felt that their needs were not being met at the home.

People and their relatives expressed concerns about the high staff turnover at the home and felt that this meant that staff did not always know them and how to meet their needs.

We found that staff received an appropriate induction and effective training when they joined the service. Staff told us they received regular supervision.

Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The service had taken appropriate action where people lacked the capacity to make decisions about their care.

Relatives told us they were involved in decisions about their family member’s care and had been involved in their care plan. However, the people we spoke with who lived at the home told us their care plan had not been discussed with them.

People living at the home and relatives were happy with quality of the food provided. However, they told us they would like more variety.

Two of the community healthcare professionals who provided feedback about the service, told us that people’s care needs were not always met and appropriate levels of hygiene were not always maintained at the home.

We observed staff communicating with people in a kind and caring way.

People told us staff respected people’s privacy and dignity and encouraged them to be independent.

Activities were provided by care staff at the home. However, some people felt that there was a lack of variety regarding what was available.

We saw evidence that the registered manager requested feedback about the service from relatives and acted on the feedback received.

Most people and relatives we spoke with were happy with the management of the service. However, one relative felt the service was not managed well and two staff told us the registered manager was unsupportive and unapproachable.

A variety of audits were completed regularly by the registered manager. However, we did not see evidence that the service provider completed checks to ensure that appropriate levels of care and safety at the home were maintained.

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

The inspection team who carried out this inspection consisted of two inspectors. During the inspection we spoke with six people who used the service, five members of staff, the registered manager and a district nurse. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' 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 who used the service told us they were satisfied with the support and care they experienced at the Clitheroe. One person said, 'I think it's alright'. However we found some practices were lacking in promoting the delivery of safe, effective care to meet people's needs.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We had reason to believe a person's liberty may have been restricted in their best interest; however appropriate action had not been taken in respect of this matter. Relevant staff had not been recently trained to understand their responsibilities in following this process.

People using the service did not have any concerns about the support they received with their medicines. However we found some medicine procedures had not been followed and there was lack of proper record keeping to promote safe practices and accountability. We found medicines were being stored above the recommended temperature which may reduce their effectiveness. This meant there was a risk people may not receive effective, safe support with their medicines.

A compliance action has been set in relation to these matters and the provider must tell us how they plan to improve.

Is the service effective?

Processes were in place for staff to attain nationally recognised qualifications. Staff spoken with, told us of the training they had received. They were aware of people's needs and gave examples of how they delivered support.

People were mostly satisfied with the catering arrangements at the service. They told us, 'The food is brilliant, we can choose what we want', 'There's plenty to drink', 'There are two choices and they find something else if you don't like it'.

Arrangements were in place to assess people's needs and abilities prior to them moving into the home. However, we found some processes for assessing; monitoring and responding to people's needs were inconsistent. This meant there was a risk people's needs may not be effectively identified and managed. We found people were not properly involved in planning and agreeing their support, which meant care may not be provided in line with their wishes. A compliance action has been set in relation to these matters and the provider must tell us how they plan to improve.

Is the service caring?

People who used the service told us they were mostly happy with the care they experienced at the Clitheroe.One person said, 'The care is good enough'. Staff spoken with confirmed people had access to a range of healthcare resources.

We observed staff treating people in a kind, friendly and respectful way. People told us they were happy with the staff team they said, 'The staff are brilliant', 'Very friendly', 'They are very good' and 'The staff are alright at the moment'.

We found some aspects of care delivery were lacking in promoting safe effective care. A compliance action has been set in relation to this matters and the provider must tell us how they plan to improve.

Is the service responsive?

We found arrangements were in place to assess people's needs and abilities prior to admission. This meant individual needs and choices would be considered and planned for before they moved into the home.

Records and discussion showed people were getting attention from healthcare professionals.

Arrangements in place to provide 'In- house' staff training and one to one supervision sessions. Some staff also said they had received an annual appraisal.

Is the service well-led?

The service had a registered manager responsible for the day to day running of the home. Staff spoke with described the manager as supportive and approachable.

We found people were involved with decisions which affected them informally, on a daily basis. However there was no information to show people were properly consulted on their experience of care provided at the service.

There were some systems in place to assess and monitor how the home was managed and to evaluate the quality of the service. However we found these systems had not been effective in identifying non-compliance with the regulations. This meant there had been a failure to identify significant shortfalls and make necessary improvements, for the well-being and safety of people using the service.

A compliance action has been set in relation to these matters and the provider must tell us how they plan to improve.

People who used the service told us they were satisfied with the care and support they experienced at the Clitheroe. They told us 'On the whole I am well looked after' and 'They are all very kind'.

We found there had been a lot of changes in the staff team, some people who used the service had found this unsettling. However, people made positive comments about the new staff.

We looked at staff recruitment practices and found satisfactory arrangements had been made to carry out relevant checks and employ suitable staff.

We found there were enough experienced and skilled staff available to provide care and support.

People were encouraged to maintain their independence and make there own decisions and choices. They were being supported to access the local community.

We found people experienced some good care and support. People told us the care was good and they were treated with respect. However, we found some progress was needed with care planning to make sure people receive effective care and support.

People were getting support with their healthcare needs and they had ongoing attention from health care professionals.

People told us they liked the staff. But some people thought there was sometimes a shortage of staff. We found action was being taken in response to this matter.

People said they were satisfied with the accommodation at the Clitheroe. However, we found some matters were in need of further attention to ensure people are provided with a good standard of accommodation.

People had no complaints about the services being provided at the home. They knew how to raise concerns and were confident they would be dealt with.

Satisfactory arrangements were in place to support people with their medicines. However, we found some matters were in need of attention to promote safer systems and practices.

People were being involved as far as possible in planning their care and were enabled to make decisions about matters which affected them.

People were treated with respect and valued as individuals, they were able to make choices and maintain independence skills.

People were getting support with their healthcare needs and they had ongoing attention from health care professionals.

People had no concerns about their care and treatment; they said they felt safe with the staff. They told us they liked the staff.

People were being consulted about their experience of service. We found that some checks on practices and systems were being carried out.