Archived: Clevedon Court Nursing Home

We found the following examples of good practice.

We were safely shown around the whole home but we did not enter people’s bedrooms. This was because we wanted to keep our movements in the home to a minimum, complying with the provider’s visitor’s policy. The home was exceptionally clean throughout. Since the start of the pandemic, the provider had increased the level of housekeeping staff to support additional cleaning. The home was equipped with all the necessary equipment and cleaning products to maintain a clean and safe environment.

The provider had a visitor’s policy and procedure in place. Each person’s family/friends had been notified of the policy. The door entry system included a temperature scan. Visitors were not let into the home if they were running a high temperature. Visitors who did not have a recent negative COVID-19 test result had to complete a lateral flow test and then wait outside until the result was known. The registered manager explained that at the current time only people who were receiving end of life care or were very poorly were being visited in the home. The visitors were provided with personal protective equipment (PPE) and then shown to the area of the home they were visiting.

Pre-booked window visits could be arranged with other families. The staff team were also supporting people with telephone calls and video calls in order to keep in contact with their family. In preparation for when families were able to visit their loved ones again, a visitor’s pod had already been installed in the garden. This facility will always have to be pre-booked.

Staff practised social distancing from their work colleagues and people as much as they were able. They wore additional PPE when delivering personal care. For those people who were living with dementia, the staff did their best to ensure the two metre social distancing rule was complied with.

Staff supported people with social activities. There was reduced use of the lounges for group activities – people were taking it in turns to use the lounges. The staff had assessed each person’s level of loneliness and risk of isolation. Social time was allocated to them and the care staff visited them in their rooms and spent 1:1 time with them.

The home was open for admissions. When people were admitted from home or hospital they had to have a negative PCR result within the previous 48 hours and after admission to the home had to isolate in their room for a 14 day period. There was a number of new admissions in December 2020 and the processes in place had prevented COVID-19 from entering the home. Some rooms were being kept empty to allow for a potential need for an isolation area to be set up.

PPE was being used effectively and correctly by all the staff who were on duty. The management team monitored compliance continuously. A designated member of staff completed regular PPE competency checklists with individual staff members. The service has a plentiful supply of PPE and was complying with current guidance

Staff had received training on the correct procedures for donning and doffing PPE and good hand hygiene techniques. Infection prevention and control training was mandatory but additional COVID-19 training had also been delivered to the staff team.

The registered manager said people were now used to the staff wearing face masks. To aid recognition though, the staff may have an un-masked picture of themselves in their pockets to show a person who needed assurance.

There was a weekly testing programme for staff in place. Each week staff had a full COVID-19 test (a PCR test) and twice a week a lateral flow test. People living in Clevedon Court were tested each month. All but one person has had their first dose of vaccine, as had the majority of the staff team. The management team had a plan in place to use the top floor bedrooms if there was an outbreak of infection so people could continue to be cared for but be isolated from the others.

One lounge has been taken out of use and was now used as a staff changing area. The furniture in other lounges had been spaced apart to encourage social distancing. Most people chose to be looked after in their bedrooms. Each bedroom had their own ensuite facilities consisting of a toilet, wash hand basin and shower. The five bedrooms on the top floor had an ensuite with a toilet and wash hand basin only, plus there is a shared shower room on the same floor.

The service has an Ozone machine and a fogging machine to sanitise areas. This was used for example to sanitise communal areas and after the visitors pod has been used.

The provider’s policies and procedures were up to date and included COVID-19 information. The service was supported by the local authority COVID-19 team who kept them abreast of any changing practice and expectations. The registered manager met with the provider every fortnight but had daily contact with them.

The accommodation is arranged over two floors, with bedrooms on both floors all with en-suites. The home has various lounges and sitting rooms, offices, a medicines room, kitchen facilities, communal bathrooms and toilets.

At the last inspection, the service was rated Requires Improvement. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Clevedon Court Nursing Home on our website at www.cqc.org.uk. The provider provided an action plan of how they were going to address the shortfalls found during that inspection.

At this inspection we rated the service as Good.

People were not having their views sought for the purposes of continually evaluating and improving such services.

People felt safe and staff were able to identify abuse and who to go to.

People were supported by adequate numbers of staff to meet their individual needs.

People received their medicines safely although some records required improving.

People had a personal evacuation plan in place in case of an emergency. Care plans contained risk assessments and support plans confirmed people’s individual needs.

The service was working within the principles of the Mental Capacity Act. Capacity assessments were in place including best interest decisions if required.

People had mixed views on the meals provided at the home. We observed people having choice and different meal options, however, there was little opportunity to sit at a dining table due to their being minimal tables and chairs in the dining rooms.

People had referrals made when their health needs changed and most records confirmed people’s individual daily intake of fluid although one person didn’t have an accurate record of their fluid output.

People felt supported by staff who were kind and caring and who respected their privacy and dignity.

People were given choice about how they spent their time and we observed people spending time in their rooms, the communal areas and visitors were free to visit when they wished.

Care plans contained important information relating to people’s like and dislikes, their previous occupation, families and routines. Pre-admission assessments were undertaken prior to people living at the home. Where complaints were raised these were investigated although the providers complaints policy needed updating.

Quality assurance systems identified shortfalls and actions required. People and staff were happy in the home and all felt it was a homely positive environment.

Notifications were made when required and people were encouraged to remain independent.

The service had a registered manager in post. 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 registered manager had an ethos of honesty and transparency and managed complaints effectively.

The provider had failed to have effective quality assurances systems that ensured the assessment and delivery of care for people was appropriate. This resulted in them failing to identify the issues we found during the inspection. For example, people’s records, including risk assessments and care plans did not always accurately reflect people’s needs or the care they required. They were also not always personalised to reflect the individual’s needs. One staff member told us; “There is a lack of readable documents for people staying for rehab.” In addition, people’s end of life care was not consistently planned to reflect their needs and preferences. People did not always have personalised end of life care plans.

People living at the service were not always able to communicate their views and experiences to us due to their healthcare needs, so we observed care provision to help us understand the experiences of people who used the service. We found people did not always have their dignity respected. For example, everyone was supplied with a continence aid on their bed even if they had not been assessed as needing one.

We also found aspects of medicine management were not always safe. Their medicines were not always managed correctly and it was unclear whether people had been given all their medicines at the right time.

People who stayed for rehabilitation were cared for by a separate team of visiting professionals. Their care was discussed at regular “ward rounds” and included arrangements for external physiotherapists and occupational therapists to visit. However the staff employed by Clevedon Court Nursing Home were not included in the ward rounds and had no care plans or other information about the care of these people. Yet staff were providing day to day care for them. One staff member said; “We don’t have time to go on ward rounds.” Staff confirmed these people often had higher needs than they were aware of and that they did not know their full medical, health or personal history, including nutritional and social preferences. There was minimal amount of information for the transition of these people from the main hospital to Clevedon Court for onward care and rehabilitation. Pre- assessments were not always carried out to ensure people’s needs could be suitably met.

Improvements were needed to how people were kept safe in emergency situations, such as fire. For example, the service held an emergency box for staff to use in the event of an emergency and this held evacuation plans, building plans and information on people and their next of kin contact details. However, this held outdated information about who was currently residing in the service. Not everyone had an emergency evacuation plan in place to assist staff in an emergency. This could place people at risk as the emergency service would not have all the information needed to assist people who required support to leave the building safely.

People were protected by safe recruitment procedures and new staff completed an in house induction programme. Staff had undertaken training and had the right skills to meet people’s needs. However, staff did not complete the Care Certificate (a nationally recognised set of skills training). People were cared for by staffing levels where they were normally good, however since the opening of the eight rehabilitation beds staff told us they had found that they did not have so much time to spend with people. One staff member said; “We seem to be doing a lot more (for people staying for rehabilitation) than we were expecting to do.” Another said; “We thought they would be able to do more for themselves but the demands are high.”

Improvements were needed to ensure team meetings were taking place to help inform and involve staff in decisions about the running of the home. Improvements were also needed to ensure staff received regular supervisions or appraisals to give staff an opportunity to discuss any issues or to discuss topics including how best to meet people’s needs effectively.

People receiving rehabilitation care had restricted visiting times in place without explanation being given to them or their relatives. The registered manager said this was because of visits from physiotherapists and occupational therapists. However, we observed these professionals often visited in the afternoon.

People looked relaxed with the staff and there was a friendly and calm atmosphere. People chatted and enjoyed the staff’s company. Comments included; “Very kind and caring staff” and “I wouldn’t be anywhere else.” A relative said; “Lovely lovely place.”

People were supported to maintain a healthy balanced diet. People told us they enjoyed the meals, there was plenty of it and we observed people were not rushed. People had opportunities to take part in a variety of activities arranged by the services activities co-ordinator.

The service was clean, well maintained and decorated. The staff team worked hard to create a home from home environment. There were no malodours experienced throughout the service at the time of this inspection.

We found a number of breaches of the regulations. You can see what action we told the provider to take at the back of the full version of the report.

We found that the policies and procedures used to guide the staff to support people safely had not been recently updated. This put people at risk of unsafe care.

We found during this inspection the home had taken action to improve aspects of their record keeping and were developing systems to ensure records were kept accurately.

People told us the staff treated them with respect and were polite to them. People's diversity, values and human rights were respected.

We found that care plans were sufficiently detailed and gave staff good information about how to support people in the home in a person centred way. These were regularly reviewed.

People confirmed there were daily activities available. People enjoyed a range of activities and on the day of our visit they were preparing for an Italian themed evening.

There were systems in place to monitor the quality of the service and this included gaining feedback from people receiving support.

People told us that they felt safe and well looked after. One person told us 'I would suggest it to anybody'

We found that up to date records about training and health and safety checks were not easily accessible to the manager and some care records were not fully completed to ensure staff had accurate information.

People told us that the staff treated them with respect and spoke to them in a polite and appropriate manner. People's diversity, values and human rights were respected.

Care plans included personal information to enable staff to support people in a person centred way. This included life histories, important relationships and people's cultural and religious beliefs. In addition, care plans included information where the person was independent and where they required support.

People we spoke with told us they were happy with the care and support that was in place. One person said 'the staff cannot do enough for me and I only have to ring my call bell and their respond very quickly'. One relative told us 'I feel very confident that my husband is well cared for and I have no concerns about the care and support that is being provided'.

People confirmed there were daily activities available. This included daily activities organised by the activity co-ordinator and external entertainers.

People we spoke with told us that the home was regularly cleaned and they had no concerns in relation to cleanliness.