Claremont Parkway

Claremont Parkway is a care home that provides nursing and personal care for up to 61 older people. At the time of our inspection there were 40 people using the service including those living with dementia. The care home accommodates people in one purpose built building.

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

People, their relatives and staff told us Claremont Parkway was a safe place to live and work. Risks to people were regularly assessed and reviewed. This meant people could take acceptable risks, enjoy their lives and live safely. Accidents, incidents and safeguarding concerns were reported, investigated and recorded. There were enough appropriately recruited staff to meet people's needs. Trained staff safely administered medicines and prompted people to take them. The home used Personal Protection Equipment (PPE) effectively and safely and the infection prevention and control policy were up to date.

People and their relatives said effective care was provided, they were not subject to discrimination and their equality and diversity needs were met. Staff received good training and were supervised. People and their relatives thought staff provided good care that met people's needs. Staff encouraged people to discuss their health needs, any changes to them and concerns were passed on to the management and appropriate health care professionals. People were protected by staff from nutrition and hydration risks and were encouraged to choose healthy and balanced diets that also met their likes, dislikes and preferences.

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. People felt respected and staff acknowledged their privacy, dignity and confidentiality.

Staff were responsive to people and their needs were assessed, reviewed and care plans were in place that included any communication needs. People were provided with person-centred care. People had choices, and were encouraged to follow their routines, interests and maintain contact with relatives, friends and interact with others living at the home so social isolation was minimal. People and their relatives were given suitable information about the home to make their own decisions regarding whether they wished to move in. Complaints were recorded and investigated.

The home's management and leadership were visible with a culture of openness, positivity and honesty. The provider's vision and values were clearly set out, understood by staff and followed by them. Areas of staff and management responsibility and accountability were identified, at all levels and a good service maintained and regularly reviewed. Thorough audits took place and records were kept up to date. Where possible community links and working partnerships were established and kept up to further minimise social isolation. The provider met Care Quality Commission (CQC) registration requirements. Professionals told us the service was well managed and met people's needs in a professional, open and friendly way.

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 the service was requires improvement, published (1 June 2021) and there were 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.

At our last inspection we recommended the provider kept their dependency tool under review to ensure it was accurate and there were enough staff available to meet people's needs. At this inspection we found the provider had acted on our recommendations and they had made improvements by adopting the use of a dependency tool at the service, which calculates the care hours required per person across a 24 hours.

Why we inspected

We carried out an unannounced focused inspection of this service on 9 March 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led which contain those requirements.

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.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Claremont Parkway on our website at www.cqc.org.uk

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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

¿ Overall the environment was good, however, a detailed upgrade to the home is planned to begin mid January 2022, where there are planned replacements for bedroom furniture, beds and easy chairs. There will be an extensive redecoration programme which will ensure all areas can be cleaned and disinfected effectively.

The provider refurbishment will only need to be put hold if there is another outbreak of COVID-19 in the home.

¿ Safe arrangements were in place for visitors and professionals to the service. This included a confirmed negative lateral flow test, vaccination against COVID-19, COVID passport, hand sanitisation and wearing a mask. There was a personal protective equipment (PPE) station by the main entrance that also offered gloves, masks and aprons for people if required.

¿ Staff had a separate entrance to use that meant they did not have to pass through the main areas of the service and went straight to an area where they were able to change their clothes before starting their shift.

¿ Isolation, cohorting and zoning was used to manage the spread of infection. This meant people self-isolated in their bedroom’s rooms where necessary.

¿ There was plenty of PPE including masks, gloves, aprons and hand sanitiser available. PPE stations were located around the service and outside people’s rooms where they were isolating.

¿ A regular programme of testing for COVID-19 was in place for staff and people who lived in the service. This meant swift action could be taken if anyone received a positive test result.

¿ We saw cleaning schedules and four hourly high touch point cleaning during the day and twice at night to ensure the service was kept clean and hygienic.

¿ Policies, procedures and risk assessments related to COVID-19 were up to date which supported staff to keep people safe. All staff had completed training in relation to infection control, and recently received training about the correct use of PPE including donning and doffing. There are further training refreshers planned for early January 2022 to ensure staff knowledge is kept up to date.

The home is purpose built and set out in wings across two floors with communal areas and dining on each floor. Floors are accessed by a lift or stairs. One of the wings specialises in providing care to people living with dementia.

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

Risks to people’s health were not always mitigated. The provider and management team had not consistently maintained effective oversight in this area.

We were not reassured that there was consistently enough staff to meet people’s needs. We have recommended that the provider keeps their dependency tool and staff numbers under review to ensure there are enough staff deployed across all shifts.

People did not consistently feel involved in the care planning process. However, they were making their own decisions and choices around their daily care and were encouraged to share ideas for service improvement which were acted on by the provider and management team.

People were protected from the risk of abuse. Staff were trained in recognising signs of abuse and people spoke positively of the atmosphere in the home and found staff kind and caring. Relatives spoke positively of the home and were kept well informed of accidents and incidents. People were supported to stay in regular contact with families throughout the pandemic.

Medicines were managed, stored and disposed of safely by trained staff who received regular supervision and training.

The home was clean and well maintained. The manager was committed to improving the home and quality of care provided, this was supported by the provider. Policies and procedures reflected current guidance including government guidance in preventing the spread of COVID -19. A refurbishment plan had commenced which included improvements in dementia care.

The management and staff team had worked in partnership with other healthcare professionals.

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 20 November 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made or sustained and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to staffing numbers and infection control. As a result, we undertook a focused inspection to review the key questions of safe 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. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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.

We have found evidence that the provider needs to make improvements. Please see the safe and well sections of this report.

Following our inspection, the provider took action to mitigate risks to people and updated us on recruitment progress.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Claremont Parkway on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified breaches in relation to the safety and managerial oversight of the service at this inspection.

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 for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Claremont Parkway is registered to provide accommodation for persons who require nursing or personal care, diagnostic and screening procedures and treatment of disease, disorder or injury for up to 66 older people. At the time of inspection 49 people were using the service.

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

The provider did not have sufficient systems in place to identify when care was not delivered in line with best practice. Staff did not always completed care in line with people’s care plans and risk assessments.

Some people did not have appropriate care plans or risk assessments in place to promote person centred care. Records for people’s food and fluid intake had not been consistently completed.

Feedback from people, relatives and staff was varied regarding staffing levels. Some felt there were enough staff to keep people safe whilst others felt additional staffing was needed. On the day of inspection there were enough staff to meet people’s needs.

Appropriate employment checks had been carried out to ensure staff were suitable to work with vulnerable people and arrangements were in place to safeguard people against harm. People said they felt safe.

People had their medicines managed in a consistent and safe way and received their medicines on time. Staff received appropriate training and checks to endure they were competent to administer medicines.

The home was clean, and the environment was well maintained. Staff understood how to prevent and manage infections.

People's privacy and dignity was maintained, and their independence encouraged. They were supported by staff who knew them well and cared for them in a respectful and kind way.

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.

People had good health care support from external professionals. When people were unwell, staff had raised the concern and acted with health professionals to address their health care needs. People had access to a range of activities and leisure pursuits.

Staff felt supported by the registered manager, and people using the service knew how to complain and felt that any issues raised were acted upon.

The provider had displayed the latest CQC rating at the home. When required notifications had been completed to inform us of events and incidents.

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 3 October 2018) and there were two 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 12 and 9.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the systems and oversight for governance management.

This is the third consecutive time the service has been rated Requires Improvement and the provider had not sustained improvements in the well led domain since 2017.

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 following this report being published 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This was the fourth comprehensive inspection carried out at Claremont Parkway. At the last inspection in July 2017 the service was rated as Requires improvement. At this inspection we found there continued to be areas that required improvement.

Claremont Parkway is registered to provide accommodation for persons who require nursing or personal care, diagnostic and screening procedures and treatment of disease, disorder or injury for up to 66 older people. The home provides a permanent home for up to 20 people. The home also works in partnership with the local NHS hospital (Kettering General Hospital) to provide care for up to 46 people who are admitted to the home for assessment for discharge from hospital. Medical and therapy staff from the hospital work in the home alongside nursing and care staff from Claremont Parkway to provide all care. The home consists of two floors, communal areas and gardens in the town of Kettering, Northamptonshire. On the day of our visit, there were 52 people using the service, however, five of these people were in hospital.

The service had 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 and associated Regulations about how the service is run.

During our previous inspection in July 2017 the provider had been in breach of Regulation 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Meeting nutritional and hydration needs. We asked the provider to complete an action plan to show what they would do and by when to improve the nutrition and hydration of people using the service. During this inspection the provider met the requirements of this regulation. People were supported to have enough to eat and drink to maintain their health and well-being.

During this inspection, the provider had not ensured that there were enough staff to provide managerial, maintenance or kitchen duties. This had resulted in the provider failing to ensure all measures were taken to check fire and water safety and maintain adequate records in relation to safeguarding and complaints. The provider had not ensured that all notifications required such as safeguarding or injuries had been reported to the Care Quality Commission (CQC).

People received care from staff that required additional training and support to carry out their roles.

People living in the home permanently require more support and opportunity to build a homely community due to the busy nature of the constant admissions and discharges relating to the temporary residents.

There was a very positive culture within the home where staff communicated well and people’s needs were met.

Staff understood their roles and responsibilities to safeguard people from the risk of harm. Risk assessments were in place and were reviewed regularly; people received their care as planned to mitigate their assessed risks.

The provider had ensured there were enough nursing and care staff to meet people’s care needs. Safe recruitment processes were in place.

People were supported to access relevant health and social care professionals. There were systems in place to manage medicines in a safe way.

Staff demonstrated their understanding of the Mental Capacity Act, 2005 (MCA). Staff gained people's consent before providing personal care. People were involved in the planning of their care which was person centred and updated regularly.

People were encouraged to make decisions about how their care was provided and their privacy and dignity were protected and promoted. People had developed positive relationships with staff. Staff had a good understanding of people's needs and preferences.

People were supported to express themselves, their views were acknowledged and acted upon and care and support was delivered in the way that people chose and preferred.

People using the service and their relatives knew how to raise a concern or make a complaint. The registered manager followed the provider’s complaints procedures to respond to complaints and use the issues raised to improve the service.

The provider used audits to assess, monitor and improve the quality of people’s care.

In this report we have made a two recommendations regarding people's access to medical care and recording staff actions following incidents.

At this inspection we found that Claremont Parkway were in breach of two health and social care regulations relating to the health and safety of the home and person-centred care. They were also in breach of one registration regulation relating to notifications of incidents. The actions we have taken are reported at the end of the full report.

This is the second consecutive time the service has been rated Requires Improvement.

Further information is in the detailed findings below.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Claremont Parkway on our website at www.cqc.org.uk

At the last full comprehensive inspection in January 2016, the service was rated Good. At this inspection we found there were areas that required improvement.

The service had 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.

There had been a change to the purpose of the home since the last inspection. Alongside the people living at Claremont Parkway there were continual admissions and discharges for two thirds of people residing at the home. The provider and registered manager worked closely with NHS staff to assess, plan and evaluate people’s care to manage their discharge to their home or another care provider.

There were not enough managers or clinical leads to provide the oversight required to continue to maintain people’s safety. There were not always enough staff deployed to ensure that people always received their personal care or meals in a timely way. We have made a recommendation about the deployment of staff. The registered manager was in the process of building a management team and actively recruiting nursing and care staff.

Some people were at risk of not receiving food that met their needs as staff were not always well informed of people’s nutritional needs or had time to read people’s plans of care.

Overall people were happy with the care they received and said that staff were kind and compassionate.

Staff had been recruited using safe recruitment practices. Staff understood their responsibilities for safeguarding people from harm and followed the provider’s policies to provide people’s prescribed medicines safely. Care plans were updated regularly and people and their relatives were involved in their care planning where possible.

People received care from staff that had received training to meet people’s specific needs. Staff were compassionate and helped to build positive relationships with people living at the home and those in transition between services.

People were treated with respect and helped to maintain their dignity. Staff were respectful of people’s wishes.

People were supported to access healthcare professionals and staff were prompt in referring people to health services when required.

Staff sought people’s consent before providing care and people’s mental capacity was assessed in line with the Mental Capacity Act 2005. The registered manager understood their responsibilities and referred people appropriately for assessment under the Deprivation of Liberty Safeguarding.

The provider and registered manager continually assessed, monitored and evaluated the quality of the service to identify areas for improvement, and implement change where required.

We identified that the provider was in breach of one of the Regulations of the Health and Social Care Act 2008 (regulated activities) Regulations 2014 (Part 3). The action we have asked the provider to take is detailed at the end of the main report.

In July and August 2016 the Commission was made aware that concerns had been raised about staffing, poor record keeping, concerns in relation to medicines, delays in responding to call bells and that people had been moved from the home without planning, consultation and involving other stakeholders.

The Commission carried out a focused inspection on 7 September 2016, this inspection sought to look at the concerns that had been raised. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Claremont Parkway on our website at www.cqc.org.uk

This service is registered to provide accommodation and personal care for up to 66 people; at the time of our inspection there were 46 people living in the home.

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.

People were supported to take their medicines as prescribed. Records showed that medicines were obtained, stored, administered and disposed of safely.

Staffing levels ensured that people received the support they required at the times they needed and records relating to care and support were completed accurately and in a timely manner.

The registered manager was approachable and was fully involved in the day to day running of the home. The organisation has used the recent move of people from the residential part of the building as a learning tool to help develop a more informed and structured approach in the future.

We talked to some of the people who lived at the home, family members who were visiting at the time of our visit and some of the care staff. The family members who spoke with us told us, 'As a family we are all very pleased.'

Another person said, 'The food is good and the care is excellent.' However, another family member told us, 'I think they need more staff.'

The staff we spoke with told us that they enjoyed their work, one staff member told us, 'It is busy, but I really enjoy it.'

We discussed safeguarding arrangements with the manager and care staff and found that the Provider had clear policy and procedures in place. Staff were aware of the arrangements, should they need to identify any concerns.

We saw that the provider had comprehensive quality assurance procedures in place. We also looked at the arrangements for dealing with complaints and found that any issues or concerns were managed in accordance with the Provider's policy. Finally, we looked at the management of information and records in the home and found that records were accessible and were stored safely and securely.

We spoke to the families of two people using the service and a number of people throughout our visit. People made the following comments 'we couldn't ask for nicer staff, they are always polite and looking to help us' another stated 'I have been visiting a lot recently, we can come and go at anytime and even make ourselves a drink when we want.'

We saw that there were sufficient numbers of staff to care for the people using the service and staff used a number of documents to ensure people's care was appropriate and safe.

We looked at the medication system and noted some errors where staff had missed signatures and not audited the medication to ensure continuing supplies and appropriate dispensing.

We looked at quality assurance and saw there is a variety used to ensure people are safe in the home.