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We are carrying out a review of quality at Clovelly House. We will publish a report when our review is complete. Find out more about our inspection reports.

Reports


Inspection carried out on 27 November 2019

During a routine inspection

About the service

Clovelly House is a residential care home providing personal care to 17 people aged 65 and over at the time of the inspection. The care home accommodates up to 21 people in one adapted building.

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

People’s health, welfare and safety were placed at risk because the provider did not have effective systems in place to assess, monitor and improve the safety and quality of the service. There was a lack of management oversight of the service and the management team failed to understand the importance of this aspect of their role.

Comprehensive risk assessments were not in place to ensure staff knew how to keep people as safe as possible. Staff did not have the competence or skills to respond appropriately in emergency situations, which put people at risk. There was not an effective system in place to learn lessons from incidents or accidents. Staff numbers and deployment meant that people were not always fully supported in the way they wanted to be and there was a risk that both people and staff were not safe. Medicines were not managed safely.

The provider did not have a satisfactory system in place to ensure that people were protected from abuse and harm. Staff did not have the training or support to carry out their role in line with current good practice guidance and did not always support people to eat and drink enough.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and procedures in the service did not support this practice.

Staff did not always show respect for people or treat them as adults. People were not always given opportunities to make decisions about their care and did not have many choices about the way they led their lives. Staff did not always encourage and support people to maintain their independence.

Care plans had not all been updated or reviewed so staff did not have sufficient guidance to provide each person with the care they wanted. Staff were not always following care plans and records of care were incomplete. The provider had failed to ensure that people would receive the best possible care, in line with their preferences, at the end of their lives as no end of life care planning had been done.

At the start of the inspection there was a serious risk in the event of fire as fire safety arrangements were not robust enough. The provider addressed some of the issues so fire safety had improved by the third day of the inspection.

People told us they felt safe and were happy living at Clovelly House. Relatives were satisfied with the care people received. Activities were organised and people told us they had enough to do. New staff were recruited in line with the regulations and staff were aware of their responsibilities to protect people from the spread of infection.

People spoke highly of the staff and liked the food. People and their relatives knew how to complain but had never needed to. Staff involved other healthcare professionals to support people to maintain their health.

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 23 May 2018).

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding including the number of falls and serious injuries; care planning; and a number of other concerns about the safety and effectiveness of the care being provided to people living at the home. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the rep

Inspection carried out on 10 April 2018

During a routine inspection

Clovelly House is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The home accommodates up to 21 people in a two storey building which is served by a main lift and some stair lifts up to the upper floor. Nursing care is not provided.

At our previous comprehensive inspection in April 2017. We found two breaches of the regulations. The home was rated as requires improvement. We undertook a focussed inspection in September 2017 and found improvements had been made. We did not review the rating of the service at this time. This unannounced inspection took place on 10 April 2018. The service is now rated as good.

A registered manager is not a condition of the services registration.

People felt safe living at the home, with the staff, and with the care and support the staff gave them. Assessments of all potential risks to people were carried out and guidance put in place to minimise the risks.

There was an effective recruitment process in place to reduce the risk of unsuitable staff being employed. There was a sufficient number of staff with the right experience, skills and knowledge deployed to make sure that people were kept as safe as possible. Staff followed the correct procedures to prevent the spread of infection.

Assessments of people’s support needs were carried out before the person was offered a place at the home. This was to ensure that the home could provide the care and support that the person needed and in the way they preferred. Technology and equipment, such as hoists, were used to enhance the support being provided.

Staff received induction, training and support to enable them to do their job well. People's nutritional needs were being met and people were supported to have enough to eat and drink. A range of external health and social care professionals worked with the staff team to support people to maintain their health and well-being.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People and their relatives were involved in planning their care. Information about advocacy services was available if anyone wanted an independent person to assist them with any decisions they wanted to make. Staff respected people’s privacy and dignity and encouraged people to remain as independent as possible.

Care plans were personalised and gave staff guidance on the care each person needed. People were encouraged to participate in activities and interests of their choice.

The service had received a number of compliments from people and their relatives. Staff were happy to be working at the home.

People and their relatives were given opportunities, such as written questionnaires and meetings, to give their views about the service and how it could be improved.

The provider was aware of their responsibility to uphold legal requirements, including notifying the CQC of various matters. The management team worked in partnership with other professionals to ensure that joined-up care was provided to people.

Inspection carried out on 14 September 2017

During an inspection looking at part of the service

We carried out an unannounced comprehensive inspection of this service on 19 April 2017. During that inspection two breaches of a legal requirement was found. This was because we found that the provider had failed to notify the Care Quality Commission (CQC) of important events. The provider had also failed to obtain all the required documentation before staff were employed.

After the comprehensive inspection, the provider wrote and told us what they would do to meet legal requirements in relation to the breaches. We undertook a focused inspection on 14 September 2017 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this breach. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Clovelly House’ on our website at

www.cqc.org.uk.

Clovelly House is registered to provide accommodation for up to 21 older people some of whom may be living with dementia. There were 21 people living at the service at the time of our inspection.

The registered provider manages the service which means there is no requirement to have a separate registered manager. A registered provider has legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

At this focused inspection on 14 September 2017 we found that the provider had followed their action plan and the legal requirements had been met.

We found that provider was sending in the required notifications to CQC and that all the required information had been obtained following the recruitment of new employees.

Inspection carried out on 19 April 2017

During a routine inspection

Clovelly House is registered to provide accommodation and personal care for up to 21 people. There were 19 older people living in the service at the time of the inspection.

This unannounced inspection took place on 19 April 2017.

The registered provider manages the service which means that there is no requirement to have a separate registered manager. A registered provider has 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 provider did not have a robust recruitment process in place to ensure that only staff of good character were employed within the service. People were looked after by enough staff to support them with their individual needs and who trained to carry out their roles.

Not all care plans contained up to date information about how people should be cared for. Whilst some risks to people had been identified there were not risk assessments in place for all risks. Staff were trained, supported and supervised to do their job. Staff treated people with dignity and respect. Various activities were offered based on peoples choices.

People received their prescribed medicines in a timely manner and medicines were stored and disposed of in a safe way.

People were provided with a good choice of meals. Staff referred people appropriately to healthcare professionals.

The provider was acting in accordance with the requirements of the Mental Capacity Act (MCA) 2005 including the Deprivation of Liberty Safeguards (DoLS). The provider was able to demonstrate how they supported people to make decisions about their care. Where people were unable to do so, there were records showing that decisions were being taken in their best interests. DoLS applications had been submitted to the appropriate authority. This meant that people did not have restrictions placed on them without the correct procedures being followed.

A range of audits were in place. However, these were not always as effective as they should have been. This was because they did not identify and fully detail the action to be taken. The registered provider had not always notified the CQC about important events that, by law, they are required to do so.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Health and Social Care (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 20 January 2015

During a routine inspection

Clovelly House is registered to provide accommodation and personal care for persons who require nursing or personal care for up to 20 people some of whom were living with dementia. Nursing care is not provided. There were 20 people living in the home when we visited.

This unannounced inspection was carried out on 20 January 2015. The last inspection took place on 14 October 2013, during which we found the regulations were being met.

The home did not have 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.

People told us they felt safe living at the home. Staff were knowledgeable about the procedures to ensure that people were protected from harm. Staff were also aware of whistleblowing procedures and would have no hesitation in reporting any poor care. People were safely administered their medicines.

There were sufficient numbers of suitably qualified staff employed at the home. The provider’s recruitment process ensured that only staff who had been deemed suitable to work at the home were employed after all pre-employment checks had been satisfactorily completed.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found that the registered manager and all staff were knowledgeable about when a request for a DoLS would be required. The deputy manager had submitted DoLS applications to ensure a person was only deprived of their liberty to ensure their safety. People who had limited capacity to make decisions were supported with their care and support needs in their best interests.

Staff respected and maintained people’s privacy at all times. People were provided with care and support as required and people did not have to wait for long periods of time before having their care needs met. People’s assessed care and support needs were planned and met by staff who had a good understanding of how and when to provide people’s care whilst respecting their independence. Care records were detailed, reviewed and up to date so that staff were provided with guidelines to care for people in the right way.

People were supported to access a range of health care professionals. This included a GP, hospital appointments and visits from district nurses and community psychiatric nurses. People were consistently supported with their health care needs in a timely manner. Risk assessments were in place to ensure that people were safely supported.

People were provided with a varied menu and had a range of healthy options to choose from. People with complex care needs, including those people with diabetes, were supported with a diet that was appropriate. There was a sufficient quantity of food and drinks available at all times.

People’s care was provided by staff in a social, caring and compassionate way. People were able to pursue their hobbies and interests and attend organised activities in the home.

The home had a complaints procedure which all staff were aware of. People were supported to regularly raise concerns before their concerns could turn into a complaint. Prompt action was taken to address people’s concerns and prevent any potential for recurrence.

People were provided with several ways they could comment on the quality of their care. This included regular contact with the provider, deputy manager, completing annual quality assurance surveys and attending meetings. The provider sought the views of a wide spectrum of other organisations as a way of identifying improvement.

Inspection carried out on 14 October 2013

During a routine inspection

People gave their consent before they were supported with their care needs. There was information available about advocacy services, should people choose to be represented by an independent agency.

All of the people that we spoke with had positive comments to make about their experiences of living at Clovelly House. They told us that they were treated well and said that they felt safe and were comfortable. They also told us that they had enough to do each day. People were supported to access a range of health care services.

People�s food likes and dislikes were catered for. People told us that they liked the food and that they always had enough to eat and drink.

There were maintenance and checking systems in place to ensure that people were safe when using different types of equipment for their support and care needs.

People said that they liked the staff and that there was always enough staff on duty to safely meet their individual support and care needs. Staff said that they enjoyed working at the home because the team of staff worked well together. They also said that they had the experience and training to safely do their job.

People�s views and suggestions were taken into account to improve the quality and standard of the service, if needed. The majority of records were kept up-to-date, so that people were protected from unsafe and inappropriate support and care.

Inspection carried out on 3 May 2012

During a routine inspection

People told us they were treated with respect by care staff. One person said, "They (staff) are always polite and usually have a chat with me each day. They are just the same with everybody who is living here". Another person said, "I like it when staff stay and talk to me". People said their accommodation was suitable for them and they enjoyed the furnishing and decorative style of the home. One person said, �It is a very nice homely place to be and I really like living here".

Reports under our old system of regulation (including those from before CQC was created)