Archived: Clova House Care Home

Clova House Care Home provides residential care for up 32 older people. At the time of our inspection, nine people lived on a unit on the first floor, which specialised in supporting people who may be living with dementia. Another 21 people lived on a residential unit which spread across the ground and first floor. The provider was supporting people in a dementia unit, but had not agreed with the Care Quality Commission to provide dementia care. This was discussed with the regional manager and will be addressed outside the inspection process.

During the inspection, we identified some areas of the service needed additional maintenance to ensure people’s safety. For example, not all fire doors automatically closed and a fire escape was not properly maintained. A fire risk assessment had been completed, but appropriate action had not been taken to address the recommendations contained within it. Staff had not received fire training to meet the provider’s fire procedures and we observed a poor response when the fire alarm sounded. We shared our observations with the local fire safety officer who visited the service in light of our concerns.

We found that medicine management systems were not always safe. The environment was not clean and infection prevention and control practices were not effective. We found mattresses and equipment contaminated with what appeared to be bodily fluids or showing evidence of ingrained dirt. Chairs and cushions were dirty. We found the provider was not compliant with Criterion 2 of The Health and Social Care Act 2008 - Code of Practice on the prevention and control of infections and related guidance.

There were gaps in staff supervision and appraisal. We found unsafe recruitment and induction procedures in relation to agency staff who were in widespread use. This meant the provider had not taken reasonable steps to ensure staff were suitable to work in the service.

We found staff lacked understanding about how positive support could be effectively used to guide people’s care and promote their emotional wellbeing and safety. People's care plans were not always clear and were not consistently followed in practice. We identified concerns regarding the support provided for people to engage in meaningful activities.

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. The manager was present on all days of the inspection.

Since our last inspection, the service had not had continuity of managers as the registered manager had been away on extended leave and an interim manager had left the service before they returned.

At the time of this inspection, the provider and manager were working with the local authority to address concerns they had about some aspects of the care provided. We found the manager had begun to implement improvements the local authority had suggested. However, we identified on-going concerns around people’s safety and wellbeing and concluded the provider had failed to ensure the manager had the support they needed in their role.

We found breaches of regulations relating to safe care and treatment, person centred care and staffing. We were concerned that the provider’s management team and staff at the service had not identified and addressed these concerns. Audits to monitor the service were in place, but had been ineffective in monitoring and maintaining standards of hygiene and promoting good infection prevention and control practices.

Concerns raised with the provider regarding poor record keeping and care plans by the local authority had been acted upon. However, some records we looked at were not consistently maintained.

We identified breaches of regulations relating to safe care and treatment, staffing, person-centred care and the governance of the service. You can see what action we told the provider to take at the back of the full version of the report.

There were safe recruitment practices in relation to permanent staff. Staff understood their responsibility to identify and respond to safeguarding concerns.

We received mixed comments on the quality of the food from people who used the service. People did not always receive effective support at mealtimes to ensure they ate and drank enough. Applications for Deprivation of Liberty had been made and the principles relating to the Mental Capacity Act 2005 were understood by the staff we spoke with. The décor in the dementia unit was not suitably adapted to reflect best practice in dementia care. People had access to community healthcare services to meet their needs, and community staff told us that communication with the senior care staff was good. We observed staff being kind and people told us they were caring, but people's dignity was not always supported.

We found people were included in decisions about how their care was provided and their preferences and wishes were respected. One person told us 'I prefer to eat my meals in my room and this is respected.' A relative told us 'Staff consult with me about how my relative would want their care provided.'

We observed that staff and service users had positive relationships and people appeared relaxed and comfortable with their surroundings. Staff and the activities they were engaged in. We saw staff spoke at a pace which met people's needs and engaged with people in a calm and patient way. One person told us 'I feel a lot more content here; I can't think there would be anywhere nicer.'

We spoke with ten people and five relatives who all expressed satisfaction with the care and support they received. One person said 'I love it. It's the best thing since home.' Another person said 'The staff are excellent: helpful and friendly.'

There were sufficient staff available. We saw people being assisted promptly and we saw that staff had time to spend socialising and engaging with people.

The provider had effective system in place to regularly assess and monitor the quality of service that people received.

Everyone we spoke with said if they were upset or had a complaint they would either speak to the staff or the manager of the home. One person told us "I would speak to staff they would sort it out."

We spoke to two relatives visiting the home. They both were very satisfied with the care at the home.

We saw staff routinely asked people before they provided any care to make sure people were happy with the support they received. This ensured people's choices were taken into account in the delivery of their care.

We spoke with staff they showed a good understating of their roles with regard to supporting people in the home with their care needs. Staff also told us they had consistent training and had regular supervision in their work. This was important to make sure staff were well supported and competent to do their work.

We also saw people had opportunities to participate in decision making within the home in their review meetings, residents meetings and make comments in satisfaction surveys. People were also aware of how to raise concerns and had a copy of the complaints procedure.