During a routine inspection

About the service

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.

During a routine inspection

This inspection took place on 24 and 25 July 2018 and was unannounced.

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

During a routine inspection

Claremont Parkway provides care for up to 66 people who require nursing and residential care. The home provides a permanent home for up to 22 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 waiting 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.

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.

During an inspection looking at part of the service

We carried out an unannounced comprehensive inspection of this service on January 2016 and rated the service as overall good.

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.

During a routine inspection

This unannounced inspection took place on the 14 and 21 January 2016.

Claremont Parkway provides accommodation for persons who require nursing or personal care for up to 66 older people.

A registered manager was in post. 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.

People’s needs were safely met. There were sufficient numbers of appropriately trained and experienced staff on duty. People were protected by robust recruitment procedures from receiving unsafe care from staff that were unsuited to the job. People were safeguarded from abuse and poor practice by staff that knew what action they needed to take if they suspected this was happening.

People’s care needs had been assessed prior to admission to Claremont Parkway and they each had an agreed care plan. Their care plans were regularly reviewed, were up-to-date and reflected their individual needs.

People received their personal care from staff that knew what was expected of them when caring for older people, including those with nursing and dementia care needs, and they carried out their duties effectively. People’s individual preferences for the way they liked to receive their care and support were respected. Staff were attentive to each person’s individual needs and acted upon required changes to their care and treatment.

People’s healthcare needs were met by nurses and care staff and when necessary by other external community based healthcare professionals. Medicines were secured stored, administered in a timely way, and appropriately managed.

People enjoyed a varied diet, with enough to eat and drink. Those that needed support with eating and drinking received the help they required. People’s diets and nutritional needs were assessed, monitored and acted upon.

People, and where appropriate, their representatives or significant others, were provided with the information and guidance they needed to make a complaint or express their views about the quality of their care. Timely action was taken to resolve complaints.

People benefited from receiving a service that was regularly audited for quality by the registered manager and by the provider.

People, and where appropriate, their representatives or significant others were assured that if they were dissatisfied with the quality of the service they would be listened to and that timely remedial action would be taken to try to resolve matters to their satisfaction.

During a routine inspection

This unannounced inspection took place over two days on the 6 and 7 November 2014. Claremont Parkway provides accommodation for persons who require nursing or personal care for up to 66 older people. There were 60 people in residence during this inspection, some of whom had dementia care needs.

A registered manager was not in post. 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.

Staff safely met people’s essential care needs but improvements were needed to ensure people received consistently good quality care. There were systems in place to regularly assess and monitor the delivery of the service although they were not always effectively monitored.

Suitable arrangements were in place for the safe storage, management and disposal of medicines. The arrangements for ensuring medicine stocks were replenished in a timely way had not always been effective. Some people had experienced delays in receiving their medication.

People were cared for by staff that had been trained to provide the care they needed. People’s rights were protected. The registered manager and staff were aware of their responsibilities as defined by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

Staff were able to demonstrate that they understood what was required of them to provide people with the care they needed. People’s views about the quality of their service were sought and acted upon. People were treated with dignity and their right to make choices was upheld. Staff were caring, friendly, and attentive. There were activities to keep people entertained and constructively occupied if they chose to participate in them.

People’s healthcare needs were met and they had enough to eat and drink. People enjoyed their food and there was variety of meals to suit people’s tastes and nutritional needs. People’s care plans reflected their needs and choices about how they preferred their care and support to be provided.

During a routine inspection

Our inspection looked at how the people who lived in the home were involved in decisions about their care and welfare at the home. We saw that the care plans for the people in the home had undergone a review and had been updated into a new structure introduced by the Provider. Some records would benefit from clarification relating to best interest decisions.

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.

During an inspection looking at part of the service

We did not speak to people who used the service on this follow up inspection. We focussed our time on an interview with the Registered Manager at the home and on reviewing the improved recording and auditing systems implemented since our last full inspection.

During a routine inspection

We returned to the home to ensure staff had made improvements to two outcome areas and saw improvements in both. We observed staff talking with and assisting people throughout the day. This was done with the people's privacy and dignity in mind and showed the staff's awareness of peoples individual support needs.

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.

During a routine inspection

There were 60 people living at Claremont Parkway when we visited on 9 July 2012. We spoke with eight people living at the home and five relatives about their experiences.

There were Recreational and Leisure Co-ordinators who ran the activities. People said there were activities on offer for people to take part in such as games and craft activities. We saw on the day of our visit people enjoying making bookmarks using flowers from the garden.

People and relatives said they could approach the manager, deputy manager and staff if they had any concerns.

People we spoke with said the staff were very good. One person said, �all the staff work very hard� and, �they care for me, I wouldn�t want to go anywhere else�.

Five people living at the home and three relatives we spoke with said there were not enough staff. One person said they often had to wait around ten to fifteen minutes before staff could support them with moving from the bed to a chair as it required two staff. Another person said that there were not enough staff and when they used their call bell, they had to wait their turn.

During a routine inspection

People with dementia or limited communication are not always able to tell us what it is like living in a care home. Because of this, we carried out a structured observation for an hour in one of the communal rooms. This helped us gain insight into the experiences of people living in the home. We saw that people were treated with respect and involved in making choices about food and personal needs. People we spoke with said they felt safe living at the home.