Clare House Care Home

Clare House Care Home is a residential care home providing personal and nursing care to up to 38 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 32 people using the service.

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

The provider had systems in place to safeguard people from the risk of abuse and staff knew how to respond to possible safeguarding concerns. Safe recruitment procedures were followed and there were enough staff to meet people’s needs. Medicines were managed safely. Staff followed appropriate infection control practices to prevent cross infection.

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.

Care plans were personalised and recorded people’s preferences, so staff knew how to respond to people’s needs appropriately. The provider employed activity coordinators to organise group activities and individual one to one sessions.

The provider had systems in place to monitor, manage and improve service delivery and to improve the care and support provided to people.

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 17 December 2019). The provider completed an action plan after the last inspection 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 inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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 is good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Clare House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Clare House Care Home is a nursing home providing personal and nursing care to 38 older people at the time of the inspection. The service can support up to 40 people. The home was divided into two units and people were cared for by qualified nurses and care assistants. Some people had complex nursing needs.

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

During the inspection we found there were systems in place to identify and manage risks but these were not always suitable as risk management plans were not always effective for people at risk of falls. Incidents and accidents were not investigated and recorded consistently and did not always demonstrate learning outcomes to prevent future incidents. We also saw examples of medicines not being managed safely which included instructions that were not clear and opening dates not recorded. Care plans did not always fully reflect people’s needs and end of life wishes had not been adequately addressed in a personalised way.

The provider had systems in place to monitor, manage and improve service delivery and to improve the care and support provided to people but these were not always effective and had not identified issues we found at the inspection around risks to people’s safety and wellbeing.

The provider had systems in place to safeguard people from the risk of abuse and staff knew how to respond to possible safeguarding concerns. Safe recruitment procedures were in place and there were enough staff on duty to meet people’s needs. Staff followed appropriate infection control practices to help prevent cross infection.

Supervisions and competency testing provided staff with the support they required to undertake their job safely. People were supported to maintain their health and access healthcare services appropriately. People were also 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 and relatives told us staff provided support in a kind and respectful manner. People were involved in day to day decisions about their care. Staff respected people’s dignity and promoted their independence.

Families were welcomed to the service. People had the opportunity to engage in activities in the home. There was a complaints procedure in place and the provider knew how to respond to complaints appropriately. People and staff reported the registered manager was approachable.

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 2 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvement. Please see the safe, 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.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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 and associated Regulations about how the service is run.

At the last inspection on 2 June 2015, the service was rated Good.

This inspection took place on 2 May 2017 and we found the service remained Good.

People were happy with the care they received. They liked the staff and found them kind, caring and polite. We observed that the staff cared for people in a sensitive and compassionate way. Visitors and relatives of people who lived at the service were satisfied with the care people received.

The staff felt supported and enjoyed working at the service. They worked as a team.

People were administered medicines in a safe way, they lived in a safe and well-maintained environment and the risks they were exposed to had been assessed. There were enough staff to keep people safe and meet their needs. Staff recruitment procedures included checks on their suitability to work with vulnerable people.

People were able to make choices about their care and treatment and there was evidence they had consented to this. The staff had the training and support they needed to care for people in a suitable and safe way. People were able to make choices about the food they ate and were offered a varied and balanced diet. People's health needs were being met and they were able to access other healthcare professionals as needed.

People were supported to take part in a range of different activities which reflected their needs and interests. Their care was planned with them to make sure their wishes were identified and followed. People knew how to make complaints and most people were satisfied that any concerns they had were addressed.

There were systems for auditing the quality of the service and for listening to the views of the people who lived there and other stakeholders. Records were appropriately maintained. The provider's senior managers regularly visited the service and provided guidance and support.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, staff and carers told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People were being cared for in an environment that was safe, clean and hygienic. The records we read showed that the home was cleaned daily. We found the environment neat and tidy with no unpleasant odours. The people we spoke with told us that they felt safe in the home. One of the people we spoke with said, 'The place is clean and tidy.' We saw that the service had effective infection control procedures. Equipment in the home included hoist and evacuation ski pad, which had been well maintained and serviced on an annual basis under maintenance agreements.

There were enough staff on duty to meet the needs of the people living at the home and keep them safe. The staff records we read showed that the staff had received appropriate training to keep people safe. Training included health and safety and manual handing. Staff were able to explain how this training kept the people who used the service safe. We observed staff interaction with people who used the service. We saw they followed the infection control procedures and wore gloves and aprons when appropriate.

There were arrangements in place to deal with foreseeable emergencies. This included 24 hours staffing and first aid training. Each room had a call alarm that people could use in an emergency.

The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom. The staff we spoke with had received DoLS training and understood their responsibilities in relation to this legislation.

Is the service effective?

People told us that they were happy with the care they received and felt their identified needs were being met. One of the people we spoke with said, ' The staff are attentive to my needs.' We observed staff's interaction with people. The staff were polite, offered people choices and made sure they were happy with the care they provided.

Is the service caring?

People were supported by kind and attentive staff. The staff we saw were caring when supporting people. The people we spoke with said, ' The staff are nice' and said that staff were, 'Good' to them. We saw staff treated people in a pleasant manner and took time to re-assure people and understand what they wanted.

Is the service responsive?

People's needs had been assessed before they moved into the home. The records we read showed that staff had asked them about their likes and dislikes prior to them moving into the home. We saw records of social activities that showed people had access to the things that were important to them. People had been supported to pursue social activities that they enjoyed. We saw the care plans were regularly updated and people were given the opportunity to change their mind about what they wanted to do.

Is the service well-led?

The staff we spoke with were aware of the aims and objectives of the home and had a good understanding of the quality assurance processes that were in place. We saw that people were regularly asked what they thought about the service and the manager took action to resolve any issues. We read the most recent annual customer feedback questionnaire and found that the majority of people using the service were positive about the service. People told us that the manager had consulted with them before implementing changes to service. For example, when there had been a change to the schedule of planned social activities.

We carried out our recent visit to ensure improvements had been made and we also checked that other standards were being met.

People told us since our last visit that improvements had been made. One person told us 'we had a meeting with the new manager she seemed to listen to what we had to say, she seems very good".

A person who had recently been admitted to the home said "it's very nice here, it's not like my own home but the staff are good, they make sure I am safe."

Another person who had been using the service for many years told us "its not like how it used to be, I don't really have many people to talk to anymore, I would like to have a few more things to do, as I like chatting to people and being in good company."

Following our recent visit we found that improvements had been made to the running of the service, we also found standards were being met in additional areas that had not been previously inspected.

One person told us "they have resident meetings and it's a waste of time people don't turn up". The same person also told us they were frequently not offered what was on the menu for dinner and told us "you never see a strawberry in here even when the supermarkets are giving them away".

Decisions regarding end of life care were not always appropriately documented and records did not contain sufficient information about the person's wishes.

Care assessments and care plans were up to date and regularly reviewed. However, they were not always detailed enough to make sure the staff could deliver care effectively in line with people's assessed needs. We observed that people were not always treated with dignity and respect and they were ignored or spoken to inappropriately. We looked at staff training and found that there were gaps in staff knowledge and skills.