Archived: Clyde Court Nursing Home

Updated 23 December 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

We last inspected Clyde Court Nursing Home in November 2016. During that inspection we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service received an overall rating of ‘Requires Improvement’ and we took enforcement action.

This inspection took place over three days on 27, 28 September 2017 and 04 October 2017. The first day was unannounced, the service did not know we were coming. The second and third days’ were by arrangement. The inspection team consisted of one adult social care inspector.

Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We also reviewed information we held including safeguarding information and notifications made to the Care Quality Commission. A notification is information about important events which the service is required to send us by law.

We contacted Manchester City Council's contracts and commissioning teams and local NHS community services for information they held on the service. We also contacted Manchester Healthwatch. Healthwatch is an organisation responsible for ensuring the voice of users of health and care services are heard by those commissioning, delivering and regulating services.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of the people who could not talk to us.

We spoke with six people who used the service and four visiting relatives. We also spoke with the registered manager, deputy manager, clinical lead nurse, three registered nurses, and seven members of staff including care staff, the administrator, cook and domestic staff.

We looked at records relating to the service including care records and associated documentation, staff recruitment files, medicines records, policies and procedures and quality assurance records.

Updated 23 December 2017

This inspection took place over three days on 27, 28 September 2017 and 04 October 2017. The first day was unannounced which meant the service did not know in advance that we were coming. The second and third days’ were by arrangement.

We last inspected Clyde Court Nursing Home in November 2016. During that inspection we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service received an overall rating of ‘Requires Improvement’ and we took enforcement action.

Clyde Court Nursing Home is situated in the Didsbury area of Manchester. The home is registered with the Care Quality Commission (CQC) to provide accommodation to a maximum of 41 people who require nursing or personal care. At the time of our inspection, 33 people were accommodated at the home. Accommodation is over three floors and there is lift access. .

At the time of this inspection, the service had a registered manager. However, due to circumstances beyond their control, they were only present for day one of the inspection visit. For the remaining two days, the inspection was supported by the registered provider and deputy 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.’

During this inspection we identified four breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 in respect of: safe care and treatment, consent, person-centred care, and good governance. We also made a recommendation in regards to equality and diversity. We are currently considering our enforcement options.

Not all aspects of the service were safe. For example, clinical risk assessments and guidance completed by Speech and Language Therapy (SaLT) for people considered at high risk of choking were not always followed. We also found unsafe practice which potentially left the home vulnerable to unwanted visitors and provided a route for people who used the service to leave unnoticed by staff. This was because people living at Clyde Court were able to answer the front door unsupervised.

People’s medicines were managed in a safe way and we found systems in place which sought to ensure the safe storage, administration, ordering and disposal of medicines. This included medicines classed as a controlled drug.

Improvements had been made around systems for the prevention and control of infections and work had been completed to improve the physical environment.

We reviewed staffing levels and found these to be adequate to meet the needs of the people living in the home.

Policies and procedures for the safe recruitment and selection of staff were robust.

Accidents and incidents were recorded over two separate systems. This meant information was not captured consistently and it was not always clear what remedial actions had been taken to reduce the likelihood of such events occurring again in the future.

Staff received training which enabled them to carry out their roles effectively. Training included moving and handling, health and safety, safeguarding, first aid and infection control. Registered nurses had access to continuous professional development opportunities.

Mental capacity assessments had not been completed in line with the requirements of Mental Capacity Act 2005. We found examples of assumptions being made regarding people’s capacity to make decisions based on people’s age or medical diagnosis rather than an assessment that the person had been determined to lack capacity to make the decision independently.

The mealtime experience was pleasant and people told us they enjoyed the food at Clyde Court. All meals were freshly prepared and people were offered a variety of choices.

People who used the service and their relatives told us staff were caring. We also observed a number of positive interactions. Staff treated people with kindness and explanations were provided before undertaking care tasks with people.

The home was engaged in the 'Six Steps' End of Life Care Programme. This meant that for people who we were nearing the end of their life, they could choose to remain at the home to be cared for in familiar surroundings by people they know and could trust.

People who used the service at Clyde Court were from diverse backgrounds and the home benefited from a workforce that was representative of the local community.

We saw that a number of people were able to maintain community links by attending a local day centre and some people were regularly taken out by their family members. Communal activities within the home were provided and these ranged from armchair exercises, bingo, films nights and an entertainer who frequently visited the home. However, activities provided on a one-to-one basis were limited, particularly for people that were isolated on account of needing to be cared for in their own rooms.

People's care and support was not always delivered in a person-centred way and did not take sufficient account of their needs, likes, dislikes and personal preferences.

We looked again at systems for governance and quality assurance. We saw a new system had been established and there was a variety of audit tools in place which looked at areas such as infection control, nutrition, building maintenance, mealtimes and observational audits. There was a medicines audit tool but the template document in use was out of date and referred to the CQC’s old methodology and way of inspecting pre the changes implemented in 2014. Overall, we recognised that some improvements had been made in respect of the number of audits being completed but further work was required to ensure remedial actions were clearly documented.