Clough House

Clough House is a residential home providing accommodation and personal care for up to 14 adults. There were 14 people living at the service at the time of the inspection. Some of the people lived with dementia or mental health needs and required support with their physical needs.

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

People told us they felt safe and protected from the risk of abuse and avoidable harm by staff who understood how to recognise, respond and report concerns. Risk assessments were in place to monitor and minimise the potential risk of avoidable harm to people during the delivery of their care. People were safely supported to receive their medicines as prescribed. People were supported by staff who had been safely recruited. Staff had received training and guidance in the prevention and control of infections including COVID-19.

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. However, the provider needed to ensure all people who required restrictions for their protection had authorisations in place. They took immediate action to rectify this. We have made a recommendation about monitoring those who need authorisations.

People's care and support had been planned in partnership with them, their specialist professionals and their relatives where possible. Staff had received training that was suitable to meet the needs of people in the home. Staff supported people in line with national and best practice guidance.

People shared positive comments about the caring nature of the staff team. They said staff were kind and caring. People were treated with dignity and respect and their right to privacy was upheld. We observed person- centred approaches to care and people told us they were treated with dignity.

The provider had made significant improvements to the quality monitoring, governance and leadership arrangements at the home. People told us their experiences had improved including the culture in the home. They had addressed shortfalls found at the last inspection. The service worked in partnership with a variety of agencies to ensure people received all the support they needed. Staff were positive with how the service was managed and the culture and morale within the staff team had significantly improved.

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 8 June 2019) and there were multiple breaches 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.

Why we inspected

The inspection was prompted, in part, due to concerns received about care practices in the home. A decision was made for us to inspect and examine those risks. This inspection was also carried out to follow up on action we told the provider to take at the last inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and caring sections of this full report.

We undertook a focused inspection to review the key questions of safe, effective caring and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them.

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 has changed from requires improvement to 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 Clough House on our website at www.cqc.org.uk

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 coronavirus and other infection outbreaks effectively.

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.

Clough House is in a residential area of Leyland, close to the town centre and on the outskirts of Preston. The home provides accommodation for up to 14 people who need support with personal care needs, including those who are living with dementia. Accommodation is provided in single rooms, although one double room is available for those who wish to share facilities. The upper floor is served by two stair lifts, one at either end of the premises. There are communal areas available, including lounges and a dining area. Car parking facilities and outdoor seating is provided. At the time of our inspection there were 12 people living at the home.

People’s experience of using this service:

The views of people we spoke with varied. We received some positive feedback about the service provided. However, some people thought improvements could be made. The provider had systems to act on allegations of abuse and people felt they or their loved ones were safe living at Clough House. However, new staff were not recruited safely.

A system was in place for the reporting and recording of accidents and incidents, although medical advice had not always been sought when required. Relevant information had not been recorded. We made a recommendation about this.

The provider lacked oversight of the service, as they failed to carry out robust checks to ensure people received care and support in accordance with their wishes. The premises needed upgrading and modernising and some areas of the home needed a thorough clean.

The management of medicines was satisfactory. However, some creams were not stored safely.

Plans of care were detailed and person-centred. They reflected people's assessed needs well and had been consistently reviewed. Any changes in need had been recorded. People thought the provision of activities was satisfactory.

People's needs and choices were assessed before they moved into Clough House and the policies of the home indicated they were given choices, with their wishes being respected. However, we found people were not supported to have maximum choice and control of their lives and restrictions were imposed in some aspects of daily life. This did not promote choice, independence and respect.

Although people’s views varied in relation to the number of staff on duty, we found assistance was provided in a timely manner and therefore staffing levels were satisfactory at the time of our inspection. New staff received an in-depth induction programme and a broad range of training had been completed by staff, who were regularly supervised and observed at work. However, annual appraisals had not been introduced at the time of our inspection.

The provider had policies for the management of complaints and systems for recording complaints had been introduced. Feedback had been obtained from those who used the service and their relatives. Team meetings had been held for those who lived at the home and the staff team. Staff members said they felt able to approach the managers with any concerns, should they need to do so.

Rating at the last inspection:

This service was rated as good at the last inspection (published 21 December 2016).

Why we inspected:

This was a scheduled inspection based on the previous rating. However, we were aware of several recent safeguarding concerns in relation to restricted choice, lack of dignity, institutional practices and poor recruitment practices.

Enforcement:

We have identified breaches in relation to safe care and treatment, premises and equipment and good governance. Please see the action we have told the provider to take at the end of this report.

Follow up:

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will monitor the progress of the improvements, working alongside the provider and local authority. We will return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

Clough House is registered to provide personal care and accommodation for 14 people. It is a small home situated in a conservation area in Leyland. Accommodation is provided in single bedrooms and one double room. There are sufficient bathrooms and toilets, and various aids provided to support people living in the home to maintain their independence. The upper floor can be accessed by two stair, lifts sited at each end of the building. There are outdoor seating areas for residents use.

A registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 in 30 January 2014, we found the provider was meeting the requirements of the regulations inspected.

At this inspection we found the registered manager had systems in place to record safeguarding concerns, accidents and incidents and take appropriate action when required. Staff had received safeguarding adults training and understood their responsibilities to report any unsafe care.

We found recruitment checks were carried out to ensure suitable people were employed to work at the home and there were sufficient staff to meet people’s needs. This was confirmed by talking with staff members and looking at records of staff recruitment.

Staff received training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and social needs.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions.

Risk assessments had been developed to minimise the potential risk of harm to people who lived at the home. These had been kept under review and were relevant to the care and support people required.

Care plans were in place detailing how people wished to be supported. People who received support or where appropriate their relatives were involved in decisions and consented to their care. The registered manager and staff told us about important details regarding people's care and support that weren't always recorded in care plans. We have made a recommendation about this.

Staff responsible for assisting people with their medicines had received training to ensure they had the competency and skills required. People told us they received their medicines at the times they needed them.

During the inspection visit we observed regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration. We observed the lunch time meal which was relaxed and organised. People who required support to eat their meals were supported by staff who were caring and patient. This was confirmed by talking with people who lived at the home. The cook had information about people’s dietary needs and these were met.

We found people had access to healthcare professionals and their healthcare needs were met.

People who lived at the home knew how to raise a concern or to make a complaint. The complaints procedure was available and people said they were encouraged to raise concerns. No one we spoke with had raised a concern, but they were confident the registered manager would take appropriate action to resolve any issues.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included satisfaction surveys, spot checks, meetings and care reviews. We found people were satisfied with the service they received.

The registered manager and staff were clear about their roles and responsibilities and were committed to providing a good standard of care and support to people in their care.

People told us they lived in a clean environment. 'It's kept lovely, not too posh but very homely. It's nice though because when you share facilities with people, hygiene is very important'. 'One thing even my family comment on is that there is never any unpleasant smells. It's kept very clean'.

People were given good opportunities to give their views as to whether the service and accommodation provided met with their needs and expectations. High standards of quality monitoring were carried out to ensure people's health welfare and safety.