Archived: Claydon Lodge Care Home

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

People told us they felt safe. Staff knew how to recognise abuse and knew how to report it. Risks were assessed and staff knew what to do to reduce any risk of avoidable harm. There were enough staff with the right skills and experience to meet people’s needs. People received their medicines at the right time and in the right way.

The service was clean and hygienic. Staff followed infection control guidance so that risks of infections were reduced. The registered manager carried out checks and audits to make sure polices were being followed and staff practice was safe and meeting people’s needs.

People, relatives and staff felt supported by the registered manager and deputy manager. Staff received ‘supervision’ and told us managers were approachable and inclusive. Care and support was person centred. People and relatives were very happy with the service.

Staff knew people well and had developed positive relationships with people. Staff morale was high, many staff had worked at the service for several years. They were motivated to achieve good outcomes for people.

The registered manager and staff worked in partnership with other professionals such as GP’s, community nurses and the local authority. The service had achieved the Derbyshire County Council Dementia Premium Award and Dignity Award. This meant they had been assessed as meeting the standards required, staff had the right skills, and the environment was adapted to support people living with dementia.

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.

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 24 February 2020)

Why we inspected

We received concerns in relation to the management of medicines and about the management of risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We found no evidence during this inspection that people were at risk of harm from this concern.

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 Claydon Lodge Care Home 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.

We found the following examples of good practice

¿ People had been supported to keep in contact their relatives and friends through video technology and telephone calls.

¿ Staff and people living at the service continued to receive a Covid 19 test as part of the governments whole home testing scheme.

¿ Measures were in place for symptomatic people to be isolated and where this was not practicable, a risk assessment was completed, ensuring that other people were kept safe for the duration of the isolation period.

¿ Personal protective equipment (PPE) was readily available throughout the home and worn by staff following government guidance. PPE training had been completed by the registered manager and their infection control lead and cascaded to other staff. This included competency checks to ensure staff understanding.

¿ The registered manager had increased provisions for cleaning throughout the day, with hotspots such as handles and rails being cleaned more frequently.

¿ There was a core group of staff available to support people living at the home, no external staff had been required which reduced the risk of transmission of the infection.

¿ All staff assessed as vulnerable had been supported with individual risk assessments. This included consideration of staff from black, Asian and minority ethnic groups or those who had existing health conditions, to ensure they were supported effectively.

The facilities are located over two floors with a lift to access the first floor. There is a secure garden to the rear of the property. The home is in a residential area and has access to local facilities and transport.

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

Quality monitoring systems were carried out in the home, although these were not always effective to ensure they identified where improvements within the environment were needed and to review how care was delivered.

People were safe and protected from harm and abuse. Staff knew how to recognise potential abuse and how to report this. Risks to people were assessed, managed and reviewed to minimise potential harm. People’s medicines were managed safely by staff who were trained to do this. There were sufficient staff working in the service, who had been safely recruited to work with people.

Staff were provided with opportunities to gain the skills and knowledge they needed to support people effectively. People enjoyed the food that was prepared and were helped to maintain a balanced diet.

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. When people were not able to make decision about their care, their capacity was assessed to ensure a best interest decision was made. Where restrictions were identified, applications were made to ensure these restrictions were lawful.

People were supported by staff who were respectful and kind towards them. Staff knew people well and cared for people in a dignified manner. People’s privacy was respected, and their independence was promoted. Family and friends continued to play an important role in people’s lives and were made to feel welcome.

People were involved in the assessment and planning of their care. The staff responded to people’s changing needs to ensure they continued to receive support that was individual to them. There were opportunities for people to participate in activities they enjoyed. People knew how to raise any concerns or issues and the provider acted on this. There was a positive culture within the home and staff felt supported by the management team.

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 January 2019) 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.

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.

What life is like for people using this service:

The registered manager had completed audits on the home to support quality checks, however for some areas, these had not identified where improvements needed to be made. This was in respect to medicines management, some risks and some areas of the home to maintain hygiene standards.

Medicines were not always managed safely. The stock was not correct to reflect some people’s prescribed needs and the storage conditions had not been recognised as being incorrect to keep medicines at the correct temperature. There was sufficient staff to support people, however some people were not always monitored in line with their risk assessments to ensure their safety.

People enjoyed the meals and their dietary needs had been catered for. This information was detailed in their care plans. The care plans were being developed to provide more information about people and their care needs.

People enjoyed the atmosphere of the home. The registered manager had a visual presence and staff felt supported by them and the provider. Staff had received training to support their role and received supervision to continue this support.

People had good health care support from professionals. When people were unwell, staff had raised the concern and taken action with health professionals to address their health care needs.

Staff followed guidance provided to manage people's nutrition and pressure care.

Staff were aware of people's life history and preferences and they used this information to develop positive relationships and deliver person centred care. People felt well cared for by staff who treated them with respect and dignity.

There was a range of activities on offer and staff encouraged people to participate in things of interest to the individual. The registered manager was looking how they could develop this area further.

The environment had been considered to support people living with dementia. There was signage to support people to orientate the building and encourage their independence.

The registered manager worked in partnership with health and care professionals and the local community. They had displayed the latest rating at the home and on the website. When required notifications had been completed to inform us of events and incidents, this helped us the monitor the action the provider had taken.

More information is in the detailed findings below.

We identified one breach of the Health and Social Care Act (Regulated Activities) Regulations 2014 around governance and the environment. Details of action we have asked the provider to take can be found at the end of this report.

Rating at last inspection: Good (report published July 2016)

About the service: Claydon Lodge is a care home that provides personal care for up to 45 people, some of whom are living with dementia. At the time of the inspection 34 people lived at the service. Most people lived there permanently, and some people spent short periods there to provide respite to their main carers. The home was established over two floors with a range of communal areas on each floor. These included dining spaces, an activities room and smaller lounge spaces.

Why we inspected: This was a planned inspection based on the rating at the last inspection. At this inspection we found that improvements had been made to the environment and people’s health care needs. However, we also identified some areas which required Improvement.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Claydon Lodge provides accommodation and personal care for up to 45 older adults, including people who may be living with dementia. At the time of our visit, there were 36 people living in the home. There was a registered manager at this service. 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 our last inspection in August 2014, people were not always protected from receiving unsafe care. This was because there were not always sufficient staff and the home was not always kept clean and hygienic. Following that inspection, the provider told us what action they were going to take. At this inspection we found that the required improvements had been made to ensure sufficient staffing and they had mostly been made to establish safe systems of cleanliness and hygiene at the service. Further minor improvements required were assured by the manager through their revised management checks and related action plan for this. This showed that equipment and systems improvements help to protect people from any risk of infection through cross contamination.

People felt safe in the home and they were protected from the risk of harm and abuse. The provider’s arrangements for staff recruitment and deployment at the service helped to ensure people’s safety in care.

Robust needs assessment and care planning approaches helped to mitigate risks to people’s safety associated with their health conditions, equipment used for their care and their medicines.

Staff were trained and supported to understand and deliver their role and responsibilities for people’s care. People received effective care from staff who monitored their care and nutritional needs associated with their health conditions.

People were supported to access external health professionals when they needed to and staff followed health professionals’ instructions for people’s care when required. Shared health plans helped to promote a consistent and co-ordinated approach to people’s care and their related wishes and choices when they moved between services.

Staff followed the Mental Capacity Act 2005 (MCA). People’s consent or appropriate authorisation was obtained for their care when required, which helped to ensure their rights and best interests.

Staff were kind and caring and understood the importance of ensuring people’s rights and choices in care. People were treated with respect by staff who promoted their dignity, privacy, choice and independence. People and their relatives were appropriately involved and informed in the care provided.

Staff understood peoples’ communicate needs but did not always supported people to participate in home life or engage in activities in a way that was personalised and meaningful to them. Staff were usually visible and they often responded promptly when people needed assistance, although this was not consistently achieved.

Relevant adaptations and adjustments were not consistently considered in relation to people’s diverse needs associated with their dementia and sensory care requirements.

People and relatives were confident to raise concerns about their care or make any complaints but the provider’s complaints procedure did not fully inform them how to do this. Complaints received by the registered manager were investigated, handled appropriately and used to inform care and service improvements.

The service was well managed and people using the service, relatives and visiting professionals were confident of this. The provider kept us informed and took appropriate action for any important events that happened at the service.

The quality and safety of people’s care, was regularly checked and analysed and used to inform service improvements.

Staff understood their roles and responsibilities for people’s care. Further improvements were being proactively sought in relation to people’s dementia care experience.

Our inspection was unannounced and in response to concerns raised. This included concerns about care, meal time arrangements and the management of complaints. We visited the service on 11 August 2014. During our inspection we also checked whether improvements had been made since the time of our last inspection visit on 6 March 2014 during which shortfalls had been identified in relation to how people's nutritional needs were being met and record keeping.

The evidence we collected helped us to answer five key questions.

Below is a summary of what we found.

Is the service safe?

People who spoke with us confirmed they received their medications as prescribed and no concerns were expressed relating to medications management.

Procedures for dealing with emergencies were in place and staff were able to describe how they would act.

The control and prevention of infection was not managed well as staff did not always follow the provider's policies and procedures that were in place. We found the sluice area of the home to be in need of cleaning. In this area we also found hand washing and drying facilities for staff to be inadequate to reduce the spread of infection.

We found there were times when staff were not available to support people in a timely manner. The provider used a staffing tool to help them to decide the staffing levels needed for the home, however this did not include the deployment of staff throughout the shift, to include the busiest periods.

We found records were maintained to support people's care needs. They were stored securely and remained confidential.

Is the service effective?

People told us they enjoyed their meals at the home and the arrangements around meal times suited their preferences. They told us they liked having privacy at meal times with no visitors allowed during this time.

Is the service caring?

One person told us, 'Care is okay, I am well looked after here.'

We found people were involved in most decisions about their care and support.

Staff on duty were seen to be kind and caring.

Is the service responsive?

People's care records included guidance for staff to help and support people in the way they preferred to be assisted.

A visitor confirmed that staff were helpful because when their relative needed medical help or advice staff contacted them and dealt with the situation.

Is the service well led?

People and visitors told us when the visiting times at the home were changed they had not been asked for their agreement. They had not been included in the decision making process.

The registered manager was in daily charge of the service. People at the home were supported by a staff team who knew how to care for them.

There were 25 people living at Claydon Lodge at the time of our inspection. We spoke with six people using the service and three staff. Some people were not able to tell us of their experiences so we observed interactions and how they were supported by staff throughout the inspection. People we spoke with told us, "They (the staff) have been very kind". Care records reflected the needs of people, they contained information about people's personal, health and welfare needs. Although we noted records were not always accurate, complete or secured safely.

The menus showed that people were afforded a choice of meal at every mealtime, but menus weren't easily accessible to people and we observed they were not informed of the choice options available at the two mealtimes we observed. Food quality was reported to vary, we did not see evidence of people's involvement in making decisions about food choices.

Medication was usually appropriately managed, stored and administered in line with accepted practice. The provider may find it useful to note some improvements in this area would ensure safer practice.

There was a complaints procedure in place. The acting manager was able to demonstrate how any complaint was recorded, investigated and resolved.

We also found that the provider did not operate systems that fully protected people against infection, and was not always obtaining appropriate consent for people's care.

We went to Claydon Lodge on 16 January 2013 to check that the improvements we asked for had been made. People we spoke with were happy with their care and one person said, "The staff are always very nice."

We found that consent was being sought from people for their care, and where people did not have the capacity to consent, appropriate arrangements were in place in for decisions to be made on their behalf.

We also found that improvements had been made to care planning systems at the home and that care files had been reviewed. We saw from their care files that information about people's needs was now detailed and accurate.

We saw that the home was clean and also that measures had been taken to reduce the risk to people from infection.

We found that training and supervision was largely satisfactory to enable staff to meet people's needs at Claydon Lodge.

There were care planning files in place, though they were not always adequately detailed and accurate. We also found that Claydon Lodge did not operate systems that fully protected people against infection, and was not always obtaining appropriate consent for people's care.