Archived: East Clune Care Home

East Clune Care Home is a residential care home providing personal care for up to 30 older people, in one adapted building. This includes older people who may be living with dementia, a physical or mental health disability and a sensory impairment. At this inspection there were 25 people living at the service

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

Staff now received timely training for peoples’ care. The service was well managed and led internally by the registered manager, to help ensure person centred, safe and effective care. The provider’s external governance and oversight arrangements had been revised and improved since our last inspection, to consistently ensure this for people’s care ongoing.

People’s care and diverse needs were effectively assessed before they received care and consistently accounted for. Staff supported people to maintain or improve their health and nutrition when needed; as agreed with them and any external health professionals involved in their care.

People were supported to have maximum control of their lives and staff supported them in the least restrictive way possible. The provider’s related policies and systems supported this practice. Jointly agreed information sharing protocols were followed, to ensure consistent, informed care as agreed for people’s care, if they needed to move across local care services.

Staffing, risk management and medicines arrangements for people’s care, helped to ensure people were protected from the risk of harm or abuse when they received care from staff. The provider took action when things went wrong at the service and referred to relevant authorities involved with people’s care when required to do so.

People received care from kind, caring staff who ensured their dignity, equality and rights in their care. Staff knew people well; how to communicate with them and understood what was important to them for their care. People were appropriately informed, involved and supported to understand, agree and make ongoing decisions about their care.

People received timely care that was tailored to their individual needs and wishes. People’s independence, choice and engagement in relation to home life, community access and their contact with family and friends was promoted

People and their relatives were informed and confident to raise any complaint or concerns about the service, if they needed to. People’s views and feedback were regularly sought. Findings from complaints and feedback were used to help inform and ensure any service improvements needed.

Management and staff understood their role and responsibilities for people’s care. There were effective arrangements for communication, record keeping and information handling at the service, along with relevant engagement and partnership working for people’s care and safety

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 Requires Improvement (published March 2019). There was a breach of regulation. The provider completed an action plan 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

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.

People’s experience of using this service:

Staff supported people in a compassionate, caring, responsive and friendly manner. They encouraged them to be as independent as possible, while taking into consideration their abilities and any risks associated with their care. All the people we spoke with made positive comments about how staff delivered care. They told us they were happy with the general environment and how the home was managed.

People received safe care and treatment. Assessments had been completed to help make sure risks associated with people's care were identified and managed in a way which respected their freedoms and choices. People were safeguarded from the risk of abuse. Accidents and incidents were monitored to identify and address any patterns or trends. People's medicines were managed in a safe way.

There were enough staff on duty to meet people's needs in a calm and unrushed manner, but further recruitment was required to minimise the use of agency staff. However, the provider made every effort to use the same agency staff, thereby giving people consistent care.

The service was clean and tidy, and people were protected from the risk of infection, however, some areas needed attention. We discussed this with the management team who gave reassurances plans were in place to address these areas.

Recruitment procedures continued to make sure staff employed were suitable to work with vulnerable people.

Staff had not always received the training they needed to develop and update their skills and knowledge. Support and supervision sessions had been provided.

Care and support was planned and delivered in a way that met people’s individual needs and preferences. Where possible, people had been involved in planning their care. Care plans outlined peoples’ needs and risks associated with their care, as well as their abilities and preferences.

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 received a varied and healthy diet that offered choice and met their needs. Everyone we spoke with was complimentary about the meals and snacks available at the home.

There was a range of social activities and events available for people to take part in if they wished to.

The service had an open and positive culture that encouraged involvement of people using the service, their families and staff. The management team was readily accessible and promoted teamwork. Staff had a clear understanding of their roles and responsibilities.

Checks and audits had been completed to identify any areas the service needed to improve. However, training had not been audited effectively to identify all shortfalls, and not all audits provided information about the timescales and completion dates to address the areas needing improvement.

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

Rating at last inspection: Good (report published 24 September 2016).

Why we inspected: This was a planned comprehensive inspection based on the rating at the last inspection.

Enforcement: There is a breach in regulatory requirements. You can see the action we asked the provider to take at the end of the report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up: After our inspection we requested an action plan and evidence of improvements made in relation to staff training and quality monitoring. We will continue to monitor intelligence 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.

East Clune Care Home provides accommodation and personal care for up to 30 older people, including some who may be living with dementia. At the time of our visit, there were 24 people living at the service. There was a registered manager at this service. 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.

People were supported safely when they received care. Staff recruitment, training and deployment arrangements helped to ensure this. People felt safe and both they and staff were informed and confident to raise any concerns they may have in relation to people’s care and safety.

People’s medicines were safely managed and risks to people’s safety associated with their health condition, environment or care equipment were assessed before they received care and regularly reviewed. People’s care plans showed staff the care actions required to mitigate any related risks, which staff understood and followed. This helped to protect people from the risk of harm or abuse.

People were satisfied with their care. People enjoyed their meals and they were supported to maintain and improve their health and nutrition in consultation with external health professionals when required.

Staff were trained, informed and supported to provide people with the care they needed. Staff understood people’s health, dietary and related care needs. People’s care plans were well maintained and helped to inform this.

Staff understood the Mental Capacity Act 2005 and followed this to obtain people’s consent to or provide care in their best interests when required. People’s related care plan records mostly helped to ensure appropriate decision making in relation to their care, treatment or finances in their best interests. Action agreed and confirmed by the registered manager following our inspection helped to fully ensure this.

People and relatives found staff to be consistently kind, caring and respectful. People were supported to maintain their preferred contacts with family and friends, who were appropriately informed and involved in their care.

People received individualised, timely care, which took account of their rights, known daily living routines and lifestyle preferences. Staff understood people and knew how to communicate with them in a meaningful way.

A range of environmental aids, adaptations and equipment helped to promote people’s independence, orientation and inclusion in home life. A successful funding award bid by the provider helped to ensure a more tailored and supportive environment designed for people living with dementia.

Peoples’ views about their care were regularly sought and they were consulted and supported to engage in home life in a way that was meaningful to them. People and their relatives knew how to raise any concerns or complaints they may have about the service and were confident these would be listened to and acted on.

People, relatives and staff were confident about the management and running of the service. The management culture was open, visible and approachable with a strong ethos of ‘teamwork.’ Staff understood their roles and responsibilities for people’s care and they were encouraged and supported to raise concerns or make improvements to this when required.

The provider had sent us written notifications when required, telling us about important events that occurred at the service, in accordance with their legal obligations to us.

Regular management checks of the quality and safety of people’s care and arrangements to seek people’s views about this; helped to identify, plan and ensure any improvements that may be needed. Improvements made and assured from this helped to ensure the quality and safety of people’s care.

We found the home was clean and hygienic and that people were mostly protected from the risks of infection. One person told us,' I am especially impressed with the how clean the home always is.'

We also found where improvements were made since our last visit. These included in some of the provider's arrangements to monitor the quality and safety of care and services people received. The improvements also meant that people experienced care and support that met their needs, protected their rights and ensured appropriate arrangements for the management of their medicines.

At our last visit to East Clune on 28 February 2012 we found that people living in the home had limited opportunity to express their views or preferences regarding their care, staff had not received appropriate training in the Mental Capacity Act 2005 or the Deprivation of Liberty Safeguards and the provider did not have effective systems in place to ensure all essential health and safety checks were being carried out. In their action plan, the provider told us that they had put a number of arrangements in place to address these issues.

In the 12 months prior to our visit, the home manager had left their post and an acting manager had been brought into the home until a permanent replacement was recruited.

There were 21 people living at East Clune at the time of our visit. All of these people were receiving long term care, as opposed to short-term respite care. During our visit we found that some improvements had been made and people living in the home had access to more activities and residents meetings were taking place. We also found that people care plans did not always reflect their individual needs. People we spoke with told us they were happy but that sometimes staff seemed busy.