Clarendon Beechlands

About the service

Clarendon Beechlands is a residential care home providing personal care to 18 people at the time of the inspection. The service can support up to 18 people who have a learning disability or autistic people, people with a mental health condition and younger adults.

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

Right Support: People did not receive the support required in a safe way. There was a shortage of staff, and not all staff were sufficiently trained. This meant staff were not always available to administer medicines, and staff did not understand their responsibility to report restrictive practices. This resulted in people experiencing unlawful restrictions on their daily life.

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 systems in the service did not support this practice.

Right Care: People did not always receive care and treatment that promoted their human rights or encouraged and promoted their dignity and privacy.

Right Culture: A lack of leadership allowed a poor culture to develop within the service. Whilst most people were happy to live at the service, and provided some good feedback, the management did not effectively assess areas of safety and quality and facilitate any drivers for improvement. Some areas of the home were not cleaned thoroughly, and other areas needed decorative repair.

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 25 September 2019).

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.

Enforcement

We have identified breaches in relation to risks of abuse and harm to people, poor upkeep of the building, a lack of staff and a lack of leadership at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Clarendon Beechlands is an 18-bed residential home providing personal care to 18 people at the time of the inspection. The care home supports people in an adapted building.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible life outcomes for themselves that include control, choice and independence.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

Risks to people had been assessed and People were supported with their medicines in a safe way. Recruitment checks had been carried out to ensure staff were suitable to work with people at the service. Medicines were stored and administered safely. Staffing levels were adequate to provide good levels of care.

We made recommendations the provider consider areas around people’s independence, complaint responses and infection control.

Training relevant to people’s support needs had been undertaken by staff. The staff team felt involved in the running of the home and were supported by the registered manager. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Staff had supervision from the registered manager to ensure they met people’s needs. There was enough staff on duty to respond to people’s health and care needs.

People were provided with a varied menu which met their dietary and cultural needs. Staff promoted people’s privacy and dignity.

People were involved in making decisions about their care and support and their consent about the care and services offered was obtained. People were supported by a staff team who were kind and caring and treated them in a considerate and respectful manner.

Staff were knowledgeable about the range of needs people had and care plans were well detailed with people’s support needs. People were encouraged to develop some of their independence skills. However, staff had concentrated on increasing peoples social care and pastimes which were seen positive areas of change and had a beneficial effect on people’s outlook.

There was a complaints process in place and management had responded to complaints. Staff had considered people’s end of life choices and made reference to this in care plans.

There were systems in place to monitor the quality and safety of the service being provided. People’s views of the service were sought through regular meetings, surveys and informal chats. The registered manager understood their roles and responsibilities as a registered person. They worked in partnership with other agencies to ensure people received care and support that was consistent with their assessed needs.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

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.

Clarendon Beechlands provides accommodation and personal care for 18 people who have specific mental health needs. The accommodation comprises of eighteen single en-suite rooms. There were 18 people living in the service at the time of our inspection visits.

A registered manager was 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.

At the last inspection of the service on 6 April 2016 we asked the provider to make improvements in care plans and risk assessments which were not sufficiently detailed to ensure staff had adequate information to ensure people were cared for safely. We received an action plan from the provider which outlined the action they were going to take. This advised us of their plan to be compliant by July 2016. At this inspection we found that improvements had been made to care plans and risk assessments. These now covered all aspects of people’s needs and included safety when outside the home, travel, finances, health and daily routines.

At the last inspection we also asked the provider to take action to ensure that quality assurance systems were put in place, to assess and monitor the quality of care effectively, to affect changes and protect people from harm. At this inspection we found that improvements had been made and a robust quality assurance system had been developed to drive improvement in the home.

There were appropriate arrangements for the recording and checking of medicines to ensure people’s health and welfare was protected against the risks associated with the handling of medicines.

Care records were personalised and each file contained information about the person's likes, dislikes, preferences and the people who were important to them. Care plans also included information that enabled the staff to monitor the well-being of people. There were systems in place for staff to share information through having detailed daily records for each person.

Staff worked within the principles of the Mental Capacity Act 2005 and had a good understanding of their responsibilities in making sure people were supported in accordance with their preferences and wishes. Staff knew people's individual communication skills and abilities and showed concern for people's wellbeing in a caring and meaningful way. They were observant of people and responded to their needs quickly.

New staff received an induction which included working alongside more experienced staff. This helped them get to know people’s needs and establish a relationship before working with them on a one to one basis. Staff felt there were enough staff to keep people safe and ensure people could attend activities and have planned trips out from the home.

Staff worked as a team to ensure people received the appropriate level of observation to keep them and others safe. The provider had recruitment procedures that ensured staff were of a suitable character to work with people at the home. Staff had received training in the areas considered essential for meeting the needs of people in a care environment safely and effectively.

Staff knew people's individual communication skills and abilities and showed concern for people's wellbeing in a caring and meaningful way. Staff were observant of people and responded to their needs quickly.

The provider ensured all notifications required by law had been sent to us in accordance with the legislation.

Clarendon Beechlands provides accommodation and personal care for 18 people who have specific mental health needs. The accommodation comprises of eighteen single en-suite rooms. There were 18 people living in the service at the time of our inspection visits.

There was no registered manager when we inspected, however an acting manager had been appointed and had commenced the registration process with us. 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.

Checks undertaken to ensure the quality and safety of service provision, were not robust which meant a number of shortfalls not being identified or addressed.

Some quality checks were in place, however these did not cover the assessment and monitoring the quality of care to ensure care plans and risk assessments were up to date.

There were not always enough support staff on duty to provide everyone with all of the support they needed. Support staff knew how to respond to documented concerns so that people were kept safe from harm; however some new people that recently moved into the home did not have all the information support staff required to keep them safe. Medicines were managed safely and background checks had been completed before new support staff were appointed.

Support staff did not always respond appropriately to people who had specific communication needs. People had been supported to eat and drink enough and they had been helped to receive the regular healthcare assistance they needed.

Support staff understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) to allow, as much as possible, people to have an effective choice about how they lived their lives.

The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards (DoLS) under the MCA and to report on what we find. These safeguards are designed to protect people where they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. The acting manager had not taken all of the necessary steps to ensure that people’s legal and human rights were protected, as we could not be assured people living in the home had full capacity to make decisions.

People were spoken with by support staff respectfully; however, some support staff did not always recognise people’s right to privacy and dignity. For example by knocking on doors before entering private rooms.

Support staff had consulted some people about the care they wanted to receive and had recorded the results in individual care plans. People were regularly asked about their food choices and what activities they would like to undertake. People had been consulted about the development of the service. However their care plans to guide and direct support staff on how to provide care did not always reflect person centred care or promote people’s independence.

Complaints had been investigated and responded to appropriately.

Tests to ensure that the environment was safe were undertaken regularly. There was a business continuity plan to ensure the effective running of the service in an emergency. Individual evacuation plans had not been produced for all those living in the home, and were not readily available in an emergency.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Care plans and assessments of potential risk were not sufficiently detailed with information to keep people safe.

You can see what action we told the registered persons to take at the end of the full version of this report.

One person told us 'The staff are great, they helped me to fix my new TV to the wall.' Another person told us 'I have been playing my guitar all morning. I like doing this. I play love songs.' We found not all people experienced care, treatment and support that met their needs and protected their rights. The needs were not met of people whose behaviour could impact adversely on other people. We found that there were no social activities organised for people using the service.

People were protected from the risk ofphysical and emotional abuse and staff knew how to raise any concerns. We found that the staff had, or were shortly due to have, training in the safeguarding of vulnerable adults, and knew how to raise concerns. However, we found some records relating to people's finances were inaccurate.

Although the provider had introduced audits in relation to finances, medication, care plans and incidents, we found that some of the audits did not contain action plans to address deficits. We also found that actions taken as a result of these audits were not documented. We found that records relating to people's care and treatment were accurate, appropriate and fit for purpose.

The service is managed by an appropriate person. We found the manager had undertaken training relevant to their role and provided a sufficient level of support to staff.

We asked two people how they looked after their money. They told us staff helped them to look after their money. One person told us they signed to say how much cash they had. We found that there were systems for protecting people from financial abuse. We found some gaps in financial recording that had not been identified by the provider's checks.

The registered manager had introduced audits which she was beginning to use to assess and monitor the quality of the service.