Background to this inspection
Updated
16 August 2016
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.
This was an unannounced inspection which took place on the 21 July 2016. The inspection team consisted of two inspectors and an expert-by-experience in care for older people. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Prior to the inspection we reviewed the information we had about the service. This included information sent to us by the provider, about the staff and the people who used the service. Due to the short notice of the inspection we did not ask the provider to complete 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 reviewed notifications that had been sent in that gave us information about important events that had taken place.
During our inspections we spoke with the registered manager, the deputy manager, four people that used the service, four relatives and five members of staff. We looked at four care plans, three recruitment files for staff, medicine administration records, supervision and appraisal records for staff, and mental capacity assessments for people. We looked at records that related to the management of the service. This included minutes of staff meetings, surveys with people and staff and audits of the service. We observed care being provided during the inspection particularly at lunch.
The last inspection of this service was on the 12 August 2015 where we found one breach of regulations.
Updated
16 August 2016
This inspection was carried out on the 21 July 2016. Clare House Nursing Home provides residential, nursing and respite care for older people who are physically frail. It is registered to accommodate up to 30 people. The service also provides end of life care to people with the support of the local palliative care service. On the day of our visit 24 people lived at the service.
On the day of our visit there was a registered 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. We were also assisted by the deputy manager, who was also the clinical lead.
People said that they felt safe. Relatives of people felt their family members were safe. One person said, “I feel safe because if I needed help at night there is always staff available.” Staff had knowledge of safeguarding adults procedures and what to do if they suspected any type of abuse.
There were enough staff deployed at the service. We saw that people’s needs were met by staff when they needed help. People told us that there were enough staff. One person said, “There is an abundance of staff.”
Risks to people’s safety were identified and appropriately managed. Staff were aware of the risks to people and what actions they should be taking that included risks around their care. Incidents and accidents were recorded and action taken to reduce the risks of these occurring. There were robust recruitment processes in place before staff started work.
People's medicines were managed safely and medicines were stored securely and in an appropriate environment.
People and relatives told us that they felt staff were competent in their roles. One person said, “I feel confident with them (staff)” with their clinical care.” Staff had the training and experience they needed to meet people’s needs. Staff’s competencies were assessed regularly in one to one meetings with their manager.
People’s human rights were protected because the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty (DoLS) was being followed. Where gaps had been identified around MCA assessments these were being addressed by the registered manager.
People had mixed views about the quality of the food at the service.although we found people were provided with adequate nutritious food to maintain their health. Comments included, “The food is quite good and tasty” and “The food is acceptable but not exciting.” People at risk of dehydration or malnutrition had effective systems in place to support them including being regularly weighed and food and fluid charts being put in place if needed.
People had access to a range of health care professionals. Advice given by health care professionals was followed by staff.
People and relatives felt that staff were kind and caring. One person said “The carers are just brilliant.”
Staff interacted with people in a kind and compassionate manner and treated with people with dignity and respect. It was clear that staff understood people’s needs and how to communicate with people. People and relatives were involved in decisions about their care.
People were cared for in a compassionate and dignified way at their end of life. The registered manager told us that more work was being undertaken to ensure that people’s wishes about end of life care was obtained.
Detailed assessments of people’s needs were undertaken and people felt they were getting good, responsive care. One person told us “My health has improved (since moving in) I am much more mobile because of the care I am getting.” The registered manager confirmed that where there was information missing around the particular needs of people that this was would be addressed.
There was a lack of social interaction for people who were being cared for in their rooms and activities were not always person centred. However there were other activities that people participated in including, poetry, music, pet therapy, bingo, drawing, move and groove, donkey visit and church services. The registered manager told us that more work was being done to address the personalised activities. We have made a recommendation that this aspect of peoples care is improved.
People and relatives were aware of the complaints process and people were supported to make complaints if they needed to. Complaints were responded to appropriately.
People, relatives and staff said they were happy with the management and running of service. One person said, “I find (the manager) to be very approachable, pleasant, friendly and takes on board what you are saying.” We saw during the inspection that the registered manager engaged with people positively and had a good amount of knowledge about the people living at the service.
There were systems in place that ensured that people and staff were involved in the running of the service and staff felt valued and appreciated.
There were a number of systems in place to make sure the provider assessed and monitored its delivery of care including audits, surveys and meetings with staff. Records were kept securely.
Services that provide health and social care to people are required to inform the Care Quality Commission (CQC) of important events that happen in the service. The registered manager had informed the CQC of significant events in a timely way. This meant we could check that appropriate action had been taken.