Clarkson House Residential Care Home

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety at the time. There was an increased risk that people could be harmed.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always have a culture of safety. Lessons were not always learnt to continually identify and embed good practice.

The registered manager completed a variety of audits and checks to identify shortfalls and ensure action was taken to mitigated risk as much as possible. However, we found some shortfalls in the completion of risk assessments and care plans as they did not always contain enough detail to guide staff on action taken to mitigate risk, for example in relation to people who were living with dementia or falls. The registered manager had identified these issues but action had not yet been taken to address and mitigate these risks in the records.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

There was evidence of good working relationships with healthcare professionals. A relative told us, “The home arranged for an optician to check [family member’s] eyesight and provided new glasses.” One person commented, “I know when I don’t feel well, and the staff will call a doctor.” Records showed that staff made appropriate referrals when needed and generally incorporated advice and guidance into care plans. We observed staff had good working relationships with health care services.

The provider worked well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

The registered manager maintained oversight of safeguarding’s and worked well with the local authority to ensure safeguarding concerns were investigated. People told us they felt safe, and feedback from friends and family was very positive. One relative commented about how much a person had improved during their time at the service. There were suitable policies and procedures in place to safeguard people, and staff competed training in this area and understood their responsibilities.

The provider did not always work well with people to understand and manage risks. Records did not always demonstrate that staff provided care which met people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Suitable risk assessments were in place for individual’s needs, but it was not always clear these records were completed correctly. For example, we noted on a number of occasions fall risk assessments had not considered an individual’s risk of hypertension and a heart condition, which meant the level of risk may not have been correctly identified. Where people had fallen there were some inconsistencies in how these falls were recorded within the care records. For example, one person’s fall risk assessment had recorded they had not had any falls in the past 12 months, similarly a review of the person’s care plan indicated they had not had a fall that month, but the analysis of accidents and incidents records indicated that this person had recently fallen without any injury. Risk assessments in relation to people’s other risk behaviours, such as mobilising without staff support, and distressed behaviours were in place. However, these did not always contain enough detail about how to mitigate these risks for that individual, or other people who might be affected.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

There were several areas of the home which required attention to make them safe, including the laundry and outside garden area. The provider had made a number of improvements since our last inspection to redecorate and refurbish bedrooms, bathrooms and communal spaces. The kitchen had been completely refurbished, with industrial standard equipment and other areas for improvement to the environment were ongoing. Wardrobes were secured to the walls and window restrictors were in place. We found a couple of radiator covers which had come loose from the wall and raised this with the registered manager who took immediate action. Appropriate checks of the premises and equipment were in place.

The provider did not always make sure there were enough qualified, skilled and experienced staff available.

People did not always feel there were enough staff. One person commented, “I feel they are short staffed during the week. They are always very busy. I’ve had long waits sometimes with the call bell.” We observed staff were very busy and not always able to provide the support people needed in a timely way.

At the time of our visit there was no activity worker in post. We were told that staff would encourage people to engage in activities, but limited evidence of this was seen at the time. People told us about previous activities they had enjoyed at the service. One person told us, “There are no activities happening at the moment. I really enjoyed a trip to Blackpool last year. We had a meal at [a pub] and then a ride through the illuminations.” The provider was in the process of recruiting to this role. Suitable recruitment processes were in place.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The home was generally clean and tidy. There was an ongoing programme of redecorating which aided the provision of full deep cleans in some areas of the home. There were systems in place to ensure cleaning and deep cleaning was completed regularly. There were plans to refurbish the laundry room, which at the time of our visit was small and difficult to keep clean and dust free, to ensure it supported good infection prevention and control practice. We noted people’s clothes were at times left outside people’s bedrooms and spoke to the registered manager about this and this was immediately addressed. Staff were seen to use PPE appropriately. One person told us, “The staff wear gloves and aprons to deliver care.” Another person commented, “I fell the home is clean and tidy and well kept.”

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

Whilst some improvements had been made to how people’s medicines were managed there continues to be areas of shortfall which we found at our last inspection. We found that there were inconsistent records of the opening dated of liquid medicine and creams. This meant that staff would not be able to identify if a medicines date had expired and was no longer effective. We found some improvements were needed to ensure that some management of medicines people needed occasionally, which had been prescribed at a variable dose or which needed to be given covertly, hidden in food a drink had all the information needed to guide staff. The registered manager was responsive to this feedback and took action to seek further advice. People’s patch records did not demonstrate these were rotated in line with the manufacturers guidance to mitigate the risk of damage to people’s skins. The registered manager was responsive to this feedback and took action to seek further advice and we found no evidence to indicate the person had come to harm.

Controlled drugs were safely stored but a system of checking these on a regular basis was not being completed in line with the policy. The registered manager started this process immediately.

We found some examples where people’s topical creams’ prescribing label was no longer legible. We asked the registered manager to remove these and arrange for replacement prescriptions ensuring topical creams were being used in a way they had been prescribed.

Staff mostly maintained a running count of people’s medicines, and counts were correct and there were no missing signatures. There were suitable arrangements for the storage of people’s medicines and we spoke with the registered manager about the arrangements for storage of surplus medicines.