Clarendon Court Care Home

Clarendon Court is a residential care home providing personal and nursing care to 53 people at the time of the inspection. The service can support up to 55 people. Care is provided across three separate floors, each of which has separate adapted facilities. One of the floors specialises in providing care to people living with dementia.

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

Governance systems had improved since the last inspection. The quality of information within care plans had improved and contained accurate information about people’s needs and we could see how audits were used to drive improvements.

Some people felt that there were not always enough staff as staff were busy and didn’t always have the time to spend talking with people. The registered manager used a dependency tool to determine staffing levels and there was evidence of ongoing recruitment of new staff. We saw no evidence that this had a negative impact on the care people received.

Medicines were managed safely and the registered manager was responsive to any issues we identified during the inspection.

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.

Staff were motivated and committed and people spoke positively about the care provided.

People had access to other professionals when they needed then and the registered manager worked closely with other agencies to ensure successful outcomes were achieved.

Systems were in place to ensure the safety and wellbeing of people. These included systems to protect people from the risk of abuse and to ensure that people could share their views on the service being provided at Clarendon Court.

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 August 2018) and there was one breach of regulation. 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. The overall rating has now improved to good.

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.

We took action by requesting the provider send us an action plan stating how and when they would achieve compliance. During this inspection we found that the service was no longer in breach of this regulation. Some action had been taken to ensure that safeguarding referrals were reported appropriately. However, we found a further breach relating to records and good governance. You can see what action we told the provider to take at the back of the full version of the report.

Clarendon Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Clarendon Court accommodates up to 55 people across three separate units, each of which have separate adapted facilities. One of the units specialises in providing care to people living with dementia. At the time of the inspection there were 54 people receiving a service.

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.

Overall, people and relatives were complimentary about the care and support provided at the home. The home was very clean and well maintained.

In the main, any safeguarding concerns had been identified and reported appropriately to the local authority and CQC. However, we found two examples where local safeguarding procedures had not been followed. Staff needed to follow reporting procedures when the registered manager was not at the service.

Whilst in most cases action had been taken to mitigate any risks, records were not always complete and up to date. Staff spoken with could explain action taken to manage any identified risks more safely. However, care plans and risk assessments did not always provide staff with clear information and guidance about potential risks and how these should be managed.

Staffing levels were calculated using a tool based on the dependency of people living at the service. We reviewed the dependency tool which indicated that there were sufficient numbers of staff to meet people’s needs. Staff were recruited using safe practices. People received their medicines safely, we noted that staff needed to ensure they were aware when people needed regular monitoring, when taking certain medications.

People received sufficient to eat and drink and staff acted to address any concerns. However, we found in some cases that care plans were not always updated with the latest information. People were positive about the food available.

Where possible staff enabled people to make their own decisions and we observed staff obtaining verbal consent from people. Staff understood and complied with The Mental Capacity Act 2005 (MCA)and where people lacked capacity to consent we saw that mental capacity assessments and best interest decisions were recorded.

People were supported by suitably skilled and knowledgeable staff. Staff were up to date with training and received regular supervision and appraisals.

Staff were kind and caring in the way they approached people. People told us that were treated with dignity and respect. People received care that was centred around their individual needs and staff were aware of people's individual preferences. People and their relatives were included in decisions about their care.

Care plans were in place for each person. Those for wound care showed good evidence that specialist opinion was sought from the tissue viability team. Most parts of the care records were recorded well, however some care plans had not been consistently updated and records were not always signed or dated.

People could take part in person-centred activities and were encouraged to maintain hobbies and interests. The activities coordinator was very motivated. There were a range of activities available which people could choose to take part if they wished.

People and relatives were positive about the management of the service. They told us they were in regular contact with the staff and the registered manager, who was very approachable and were always kept up to date. Staff were positive about the support they received from the management team.

There were some quality assurance processes in place and audits were carried out on a regular basis. Despite the quality assurance and audit systems in place, these were not effective as care plans did not always record the needs of people adequately and safeguarding procedures had not always been followed.

Clarendon Court Care Home opened in 2010. It is purpose built to provide nursing care for older people including people with dementia. Some respite care is also provided. The home is registered to provide care for up to 55 people. It is a three storey building and all resident's rooms are en-suite and there are spacious social and dining areas. At the time of our inspection there were 52 people living at the home. Clarendon Court was last inspected on 28 June 2014 and was compliant in all of the areas inspected at that time.

There is a registered manager in place. 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 identified one breach of the relevant legislation, in respect of safeguarding. You can see what action we told the provider to take at the back of the full version of the report.

Staff had received training in safeguarding and understood their responsibilities to protect people from harm and abuse. Staff knew how to report concerns and told us that they felt able to raise concerns appropriately. However, we found evidence that the service had not reported two safeguarding concerns to the local authority, as required by the local Adult Safeguarding Policy and Procedures. The issues had been dealt with through the provider’s complaint procedures but these had not been appropriately reported, therefore people could not be sure that they were fully protected from harm and abuse.

People felt safe and told us that they received the support that they needed, in a way that respected their wishes. We found that there were sufficient staff, who ensured that they supported people in a thorough and unrushed way.

People’s medicines were administered safely. However the registered manager told us that the storage of medicines was an issue because the home could not fully control the temperatures of the treatment rooms, where medicines were stored. The provider was aware of the situation and was taking steps to address the concerns and was arranging for the necessary alterations to the air conditioning system to be made.

We found that staff were skilled, knowledgeable and well trained. They received a thorough induction when they began their employment with the home and received on-going training updates.

People's consent was gained before any care was provided and the requirements of the Mental Capacity Act were met.

People’s nutritional needs were met. We observed that people had plenty to eat and drink and were given appropriate food choices. We saw tat staff supported people and understood their nutritional needs. We found that people’s views about the quality of the food was mixed. Some told us that it was good, whilst other people said that it was “average” or “alright.”

We saw that people were well cared for and very comfortable in the home. The people and visitors who we spoke with were very complimentary about the care that they received and told us that the staff were kind and caring. There was a warm and friendly atmosphere within the home. We observed that staff were skilled and patient, treating people with dignity and respect. People were able to make choices about the way that they were supported.

Care records were personalised and they reflected the support that people needed so that staff could understand how to care for the person appropriately. Daily charts were not always completed fully or at the time that the care was provided. We saw that staff responded to people’s changing needs and sought involvement from outside health professionals as required.

There was a full and varied activities and entertainment programme available to people. Individual activities were also available, such as the therapy dog, or reading the newspaper. People told us that they could choose whether they wished to take part in the activities. We saw that two lounge rooms had been creatively adapted into a “pub” and “garden room”. These had been effectively decorated and people were looking forward to making use of the rooms for socialising and relaxation.

We found that the home was well-led. People knew who the registered manager was and felt able to raise any concerns with him. Staff told us that they felt well supported. We saw that regular team meetings were held, as well as supervision meetings to support staff. There were comprehensive quality assurance processes in place and people's feedback was sought about the quality of the care.

During the inspection we spoke with the deputy manager, the administrator, and nine staff members. We also spoke with seven of the people who lived in the home and three of their relatives.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service and their relatives, the staff supporting them and from looking at records.

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

Is the service safe?

Staff we spoke with had a good understanding of the process they would follow if a safeguarding incident occurred. "Safeguarding" means taking steps to make sure that people who use services do not suffer abuse and includes responding properly if there are any allegations or suspicions of abuse.

The staff were able to describe various forms which abuse might take and each member of the care staff we spoke with showed an understanding of their responsibilities when caring for vulnerable adults. Staff told us that they had received training in protecting vulnerable adults and the Mental Capacity Act. The home's administrator showed us records that demonstrated that all staff had received Safeguarding Adults training which was updated regularly on a rolling programme on a yearly basis. We also saw that all staff had received training in the Mental Capacity Act and the Deprivation of Liberty Safeguards (DoLS).

Is the service effective?

We saw that communication was good within the home. A newsletter was circulated every three months and was on display in various places within the home. We saw relatives meetings had been held every two months since our previous inspection. We read the minutes of these and saw information about the home had been shared with the relatives. We saw that these minutes contained positive comments from relatives thanking the staff for the care that was being provided.

Team meetings were also regularly being held. We looked at the minutes of these and saw that the same meeting had been held at different times of the day to maximise the number of staff that could attend. We saw that the registered manager had held specific meetings to respond to requests made by staff. The staff we spoke to made very positive comments about the management team in the home, particularly the manager. The staff described them as very approachable. Comments included; "I can raise concerns whenever I like. If I tell them it's important they stop what they are doing and listen to me."

Is the service caring?

We spoke with seven people who lived in the home and three of their relatives during our inspection. All of the people we spoke to were very positive about the home and the staff who were supporting them. Comments we received included; "The care is not just very good, it's wonderful" and "The staff here are marvellous. They are kind and nice and helpful."

We saw that people were engaged in meaningful activity supported by staff that encouraged their well-being. We saw people singing, and socialising in various areas of the home. The deputy manager told us and we saw that staff were deployed to certain areas in the home to ensure that people were safe, supported and had access to a member of staff. We saw that staff had warm, positive relationships with people who lived in the home. We saw people hugging staff to say thank you for help that they had received.

Is the service responsive?

During our inspection we observed the staff interacting with the people who lived in the home. We saw that staff were very skilled in supporting people who have dementia. Staff told us that they had received dementia training and we saw that this training had been put to good use. Staff told us that the registered manager and the deputy manager worked alongside them to support people and meet their needs. We saw that the deputy manager was working a shift on the day of the inspection.

We spoke to nine members of staff who were working on the day of our inspection. Six staff members said that the home had enough staff. We were also told that when the home had been short staffed, the manager had stepped in and had worked shifts as a care worker and a kitchen assistant. Three staff members expressed some concerns about staffing levels and about accessing support if they needed it. We spoke to the deputy manager and they told us that every bedroom, communal room, bathroom and toilet in the home had an emergency button in it that if pressed would alert staff in other areas of the home that support was needed.

Is the service well led?

Team meetings were also regularly being held. We looked at the minutes of these and saw that the same meeting had been held at different times of the day to maximise the number of staff that could attend. We saw that the registered manager had held specific meetings to respond to requests made by staff. The staff we spoke to made very positive comments about the management team in the home, particularly the manager. The staff described them as "very approachable". Comments included; "I can raise concerns whenever I like. If I tell them it's important they stop what they are doing and listen to me."

We saw that a number of audits were completed in the home to assess and monitor the quality of the service being provided. We saw that the manager and senior staff completed audits in various areas such as medication administration, infection control and building safety. We also saw that the provider completed governance audits which involved an inspection of various areas within the home on a monthly basis.

We looked at the medication administration procedures because at our previous inspection we had concerns in this area. We found that the procedures had been improved.

We looked at the cleanliness in the home and the procedures around infection control. We saw that the home was clean and well maintained. One relative told us; "I'm always very concerned about cleanliness but you can't fault them. It's very clean."

We looked at the complaints procedure in the home and saw that it was on display in the reception and people who lived in the home had been given a copy of it.

We looked at the safety processes in place to protect people. We looked at four care plans and saw that people's needs were being met and that risks were hightlighted and procedures put in place to protect people. We looked at medication administration systems and found some concerns.

We looked at the staffing levels within the home and the processes in place to train and support the staff. We also looked at the quality assurance procedures in the home and found that the home regularly assessed and monitored the quality of the care that they were providing.