Claremont Nursing Home

Claremont Nursing home is a purpose-built care home providing personal and nursing care. The home is split into two separate ground floor units, Claremont House and the Lodge. Nursing care is provided to people living in Claremont House whilst specialist dementia care is provided to people living in the Lodge. At the time of our inspection 42 people were living at the service. The service can support up to 52 people.

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

Improvement was needed to ensure people always received good quality, compassionate, individualised and safe care as a minimum standard.

Actions to detect, investigate and report allegations of abuse or neglect were not sufficient. Adults at risk were not always effectively safeguarded in a timely manner. The local authority had received a high number of safeguarding referrals from relatives and external professionals raising concerns about people’s care. Due to the poor record keeping within the service, some concerns had been difficult for the local authority to investigate.

People did not always receive personalised care that met their needs. Some care records were poorly completed and did not reflect that people were receiving care in accordance with their assessed needs.

Staff had not ensured that risks relating to the development of pressure ulcers were fully mitigated, and that pressure relieving equipment in place was suitable and in line with best practice guidance.

Where people were at risk of falls, or had sustained falls, systems were not sufficiently robust to mitigate risk as far as possible; individual data was not being reviewed to identify themes or trends to reduce risk.

Staff had not always received regular supervision that ensured good practice within the service. Clinical training had not always been completed by all registered nurses, and training relating to falls prevention and pressure area care was not set as mandatory for staff to complete to ensure they were sufficiently skilled. Staff told us, and we observed, they were very rushed when supporting people, and felt they could not spend quality time with people. Some people told us that they had to wait for staff to respond to their request for support. Staff were recruited safely.

Auditing processes had not been effective. Analysis of accidents and incidents were not robust. Some areas we identified as requiring improvement at the last inspection continued to be unmet. This included completion of documentation to ensure people’s assessed needs were being met, and the management of risk.

People were mostly 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.

Improvements were found in the management of people’s medicines with some minor improvements still required. Where the supply of people’s medicines had been an issue, staff had not always followed incident procedures, so that the issues could be promptly resolved.

Infection control procedures across the home were improved. However, some further improvements were required to ensure complete cleanliness within the home.

Systems and processes designed to identify shortfalls, and to improve the quality of care were not always effective. While some improvements were noted since the last inspection in February 2022, on-going concerns were raised on this inspection.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 24 February 2022).

We issued the provider with a Warning Notice, notifying them that they were failing to comply with the relevant requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and a timescale by which they were required to become compliant. We undertook a remote review of the Warning Notice in November 2022, and found not all areas had been met.

At this inspection we found the provider remained in breach of regulations.

Why we inspected

We received concerns in relation to people’s nursing care needs and safeguarding procedures. 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 changed from requires improvement to inadequate based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Claremont nursing home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, staffing, safeguarding and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Claremont Nursing home is a purpose-built care home providing personal and nursing care. The home is split into two separate ground floor units, Claremont House and the Lodge. Nursing care is provided to people living in Claremont House whilst specialist dementia care is provided to people living in the Lodge. At the time of our inspection 41 people were living at the service. The service can support up to 52 people.

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

We could not be assured that people received their prescribed medicines as there were gaps in medicines administration records (MAR). This included topical medicines such as creams. MAR charts did not always indicate why medicines were not given, which was unsafe practice.

Risks in relation to people's care were not always assessed or sufficiently detailed to ensure people were cared for in a safe way. There was not always accurate guidance in place for staff about how to manage or reduce risk. Food and fluid charts were not consistently completed to ensure people were receiving an adequate intake.

Infection control processes were not robust. Areas of the service were found to be unclean, including in people’s bedrooms and communal areas and kitchens. People were not sufficiently protected from the risks associated with the spread of infection, including from COVID-19 due to non-compliance of cleaning regimes. Staff and people were tested for COVID-19 in line with government guidance.

Staff were observed to be kind and caring, and relatives confirmed this. However, there had not always been enough staff to engage with people meaningfully or provide individualised care and support. Staff we spoke with told us the management always tried to find extra staff, but often short notice sickness meant they were unable to. Staff told us that staffing levels were however improving. Staff had not always received appropriate supervision that ensured good practice within the service. Staff were recruited safely.

Auditing processes had not always been effective. Issues the management team had identified in November/December 2021, remained areas of concern. There was a new registered manager in post. Initial feedback from staff and relatives about the new manager was positive.

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 5 July 2019).

Why we inspected

We undertook a targeted inspection to look at infection prevention and control procedures. We identified several issues, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We have found evidence that the provider needs to make improvements.

Please see the safe and well-led sections of this full report.

The overall rating for the service has changed from Good to Requires Improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Claremont Nursing Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to infection control, risk management, medicines, and governance processes.

Please see the action we have told the provider to take at the end of this report.

We issued the provider with a Warning Notice, notifying them that they were failing to comply with the relevant requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and a timescale by which they were required to become compliant.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Claremont Nursing home is a purpose-built care home providing personal and nursing care. The home is split into two separate ground floor units, Claremont House and the Lodge. Nursing care is provided to people living in Claremont House whilst specialist dementia care is provided to people living in the Lodge. At the time of our inspection 27 people were living in Claremont House and 25 people in the Lodge. The service can support up to 52 people.

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

The care provided was person centred. We found some improvements were needed to the written records of people’s care including risk assessments and associated analysis, but this did not detract from the overall quality of the care provided. The service was proactive in responding to and reducing risks to people. People received timely care through the provision of enough staff. Medicines were managed safety and people received these when required.

People, relatives, and healthcare professionals spoke positively about the quality of care. There was a warm, friendly and inclusive atmosphere. The service was proactive and committed to ensuring the quality of care was sustained and developed. Quality monitoring and governance frameworks were effective.

The service understood that community inclusion and meaningful activity enhanced the wellbeing of people in the service. Activities were tailored to people’s interests and the service ensured it played a key role in the community, for the benefit of people using it.

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.

People received enough to eat and drink. The service worked closely with healthcare professionals and provided the right support and training to meet people’s health and care needs. The design and decoration met the needs of people in the service.

Staff were kind, caring, and attentive to people’s needs. This included being quick to offer reassurance to people when they became upset or anxious. People spoke positively about their relationships with staff and told us they felt respected and listened to.

The service responded robustly towards any concerns or complaints received. The duty of candour, which is their legal responsibility to be open and honest with people when something goes wrong, was met.

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 (report published 17 December 2016).

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.

Claremont Nursing Home provides residential and nursing care for up to 52 older people, some of whom may be living with dementia or a physical disability. The home is divided into two areas for those requiring nursing care or for those living with dementia. The home is purpose built and accommodation is over one floor. At the time of this inspection there were 50 people living within the home.

There was a registered manager in post. 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.

Processes were in place to help ensure only those people suitable to work within the home were employed. Staff received an induction, ongoing training and competency checks to help them meet the needs of those living within the home. Staff received regular formal and informal support.

People received care and support from staff that enjoyed their work and felt valued by the management team. Staff worked well as a team and supported each other. We saw that the home was organised and that it ran efficiently.

There were enough staff to meet people’s individual needs. People told us that they received the support they needed and, during our visit, we saw that people received prompt assistance.

Staff were caring and thoughtful in their approach to supporting people who used the service. People’s dignity and privacy was maintained and staff were respectful. People had choice in how they spent their day and their independence was encouraged as appropriate.

Processes were in place to help protect people from the risk of abuse and local safeguarding policy was adhered to. Risks to those that used the service, staff and others had been identified, assessed and managed. Premises were maintained and regular checks were in place. Accidents and incidents had been recorded and analysed to identify any trends or contributing factors in order to help mitigate future risk.

People received their medicines appropriately, safely and as prescribed. Healthcare provision was regular, prompt and received as required.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. People’s capacity to make decisions had been assessed and DoLS applications made appropriately. Improvements were required in relation to assessments being decision specific. However, the service had identified this and were working towards introducing documentation to support this.

People, and where appropriate their relatives, had been included in the planning of the care and support they received. Care plans were individual to each person and met their needs. People told us they received the care and support they required.

The service provided assistance with meeting people’s social and leisure needs. The people we spoke with told us they enjoyed the activities provided by the service and there was enough for them to do.

People’s nutritional needs were assessed and met. People received the diets they required and meals were provided at a time they wanted. Although they had mixed opinions on the quality of the food, they agreed they had choice in what they ate and assistance when and if required.

The provider had a robust system in place that monitored the quality of the service. It was used effectively, thoroughly, and drove improvement. People’s feedback was sought, listened to and used to further develop the service. Actions required to improve the service were regularly monitored to ensure completion.

People spoke positively about the management of the home. They told us that the management team were approachable, helpful and visible. People had confidence in them to take the right action and respond to any concerns they may have. People told us that they would recommend the service.

Prior to our inspection we had received information from the local authority safeguarding team regarding the care and support provided to people. These concerns had been investigated by the provider and the safeguarding team and measures had been put into place by the service to ensure that people were provided with a safe and effective service.

During our inspection we looked at the care and support provided to the people who used the service. We spoke with four people who used the service and two relatives and we looked at the care records of four people who used the service. We found that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

People told us that they were happy living in the service. One person said, "I am happy." A person's relatives told us that they were satisfied with the care and support that their relative was provided with.

We looked at the care records of four people who used the service and spoke with five people. One person said, "Yes, I get enough to eat, sometimes too much and I have to leave a bit." Another person said, "They (staff) are always on hand, I never have to ask twice (for drinks)." We found that the provider took appropriate action to ensure that people's dietary needs were met.

We assessed if people's medicines were being managed safely and followed up on issues we identified and raised during our inspection of 21 October 2013. During this inspection, we found there were gaps in the medication administration records and that there were numerical discrepancies of medicines so we could not be assured people were being given their medicines as intended by prescribers. We also noted additional poor practices relating to the recording and administration of medicines. We found that whilst there was some good information available about people's medicines there was still a lack of written information to assist staff in safely administering other medicines.

Our inspection of 12 August 2013 found that improvements were needed in 'The House' in infection control and the care provided to people. During this inspection we found that improvements had been made.

We found that call bells were answered promptly and care and support was provided to people when they needed it. We asked 10 people who used the service of their call bells were answered promptly. One person said, "Oh yes, they are very good." Another person said, "They come as soon as they can, I have no problems." We found that the service was clean and hygienic. People spoken with confirmed that the service was kept clean. One person said, "It is spotless." Another person said, "They keep it very clean."

Our inspection of 12 August 2013 we checked the medication management in 'The Lodge' and found that people were protected by the medication procedures and processes. However, prior to this inspection we received concerns about the management of medication in the 'The House.' During this inspection we looked at the medication processes and procedures in 'The House.' We found that the service did not protect people against the risks associated with the unsafe use and management of medication by way of appropriate arrangements for the recording, using, safe keeping and safe administration of medicines.

We spoke with nine people who told us that the staff treated them with respect and kindness and listened and acted on what they said. One person said, "They (staff) are all lovely." We saw that the staff interacted with people in a caring, respectful and professional manner. This was confirmed by seven people's visitors who we spoke with.

People and visitors in 'The Lodge' told us that they were happy with the service provided. People living in 'The House' told us that they were happy with the service but often had to wait for their call bells to be answered. One person who had needed support said, "I had to wait ages." Visitors in 'The House' also told us that call bells were not answered promptly. We found that the provider was aware of this issue and was taking action to address this.

We looked at the care records of eight people and found that they identified how their needs were met. People were protected by the service's medication procedures.

We saw staff records that showed that they were trained and supported to meet people's needs.

We found that the service was clean and tidy throughout. However, there was an offensive smell in 'The House'. We found that equipment in the service was safe and fit for purpose.