Archived: Clinton House Nursing Home

Updated 25 November 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This unannounced inspection took place on I November 2016. The inspection team consisted of three inspectors and a specialist advisor. The specialist advisor had a background in working in mental health services, physiotherapy and in the management of acute health care services.

We reviewed the Provider Information Record (PIR) before the inspection. The PIR is a form that asks the provider to give some key information about the service, what the service does well and the improvements they plan to make. We also reviewed information we held about the home including previous reports and notifications. A notification is information about important events which the service is required to send us by law.

During the inspection we spoke with three people who were able to express their views of living at the service. Not everyone was able to verbally communicate with us due to their health care needs. However, we observed care practices for six hours during the inspection. We used the Short Observational Framework Inspection (SOFI) for an additional one and a half hours. SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us. We also conducted a complete tour of the premises.

We spoke with seven care staff, a nurse, the clinical lead and the manager. We also spoke with two visitors. We looked at six records relating to the care of individuals, medicines records, staff training records and records relating to the running of the home. We gave feedback to the head of operations and the provider over the telephone at the end of the inspection. During a separate visit to the provider’s head office on 2 November 2016, carried out by a fourth inspector, we looked at 10 staff recruitment files.

Updated 25 November 2016

Clinton House is a care home which offers care and support for up to 46 predominantly older people. At the time of the inspection there were 28 people living at the service. Some of these people were living with dementia. The building is a detached house over two floors with a recently added extension on the ground floor comprising of five new en suite rooms. Clinton House is part of the Morleigh Group of care homes.

The service is required to have a registered manager and there was one in place. However, the registered manager had been on maternity leave since August 2016. A temporary manager had covered the role for the first six weeks and another manager had been appointed nine days before our inspection. A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

We carried out this unannounced comprehensive inspection of Clinton House Nursing Home on 1 November 2016. We brought forward the planned comprehensive inspection due to concerns that had been raised with us. These concerns related to the premises and equipment, the quality of the food, lack of activities, poor care practices, staff working without the relevant recruitment checks, staff training and medicines. At this inspection we also checked to see if the service had made the required improvements identified at the inspection of 7 April 2016.

In April 2016 we found the premises and equipment were not properly maintained. We found there was hot water at 50 degrees centigrade coming from two taps in bathrooms used by people who lived at the service. At a previous inspection in February 2016 we had also found water that was too hot coming from a different tap used by people living at the service. At this inspection we found another two taps with water coming from them that was too hot. This posed an on-going risk of people scalding themselves that had not been adequately addressed by the provider, despite being asked to rectify these issues at two previous inspections.

We also found at this inspection that there was no hot water coming from sinks in the laundry room for staff to wash their hands. There were several toilets and bathrooms, used by people living at the service, with no soap or paper towels. This meant people, visitors and staff were unable to wash their hands effectively after using the toilet.

At the inspections in April 2016 we had concerns about poor recording and missing records, of the information given to staff when they started a shift. We had raised the same concerns at previous inspections in February 2016 and October 2015. This meant it was difficult to establish what information had been provided for staff at each shift change to ensure they had the right information to meet people’s needs. At this inspection we were able to see records of daily handover meetings. The information in these records was basic, although staff told us they were given detailed verbal handovers. However, on the day of the inspection an agency worker asked repeatedly during the morning if they could have a handover as they did not know what peoples’ needs were. This meant the system for providing staff with information about people’s needs at each shift was still not robust.

The care we saw provided to people during the inspection was often task orientated rather than in response to each person’s individual needs. Care plans did not always give staff guidance about how to provide the appropriate care to meet people’s needs. People were not always referred to appropriate healthcare professionals in a timely manner. This mean relevant treatment to help people was delayed. The high reliance of the service on bank and agency workers meant that people did not always receive care from staff who knew and understood their needs. There were gaps in staff training and supervision which meant staff were not fully trained or supported in their role.

Recruitment practices were not safe. Relevant employment checks, including Disclosure and Barring Service (DBS), were not completed before new staff started to care for people. The failure to complete necessary checks before allowing staff to provide care exposed people to unnecessary risk and did not protect people from the potential risk of harm from being supported by staff who were not suitable for the role. There were not always enough staff on duty to adequately meet people’s needs. Staffing levels were frequently lower that the level assessed by the service as being the number of staff needed to meet people’s needs. People did not always receive assistance in a timely manner. The call bell system was faulty and difficult for new staff to understand, which could cause delays in people receiving help.

The management of medicines was not robust. One person had not been given one of their prescribed medicines for three days. Records as to why this omission had occurred stated that the medicine was ‘out of stock’. However, it came to light on the day of the inspection that this medicine had ‘gone missing’. This meant that the person had missed three doses of their prescribed medicine and 17 tablets of Mirtazapine were unaccounted for. Records to explain this incident were inaccurate. Some people had been prescribed creams and these had not been dated upon opening and not always recorded when applied. We found creams in people’s rooms that belonged to other people. This demonstrated that prescribed creams were being shared between people.

Risks were not always identified and detailed assessments of how risks could be minimised put in place. On the day of the inspection one person nearly fell out of their wheelchair while sitting unattended. We had to intervene and ask staff to assist as they had not noticed. Records for this person showed that they were at risk of falls. However, no risk assessment had been completed to give guidance for staff or to assess the risk of them being left unattended in their wheelchair. This meant staff did not have accurate information to help ensure people were not at risk of harm.

We found management and staff were not working within the principles of the MCA. Staff were not clear on who was authorised to consent on behalf of people. The service did not fully understand DoLS legislation and how it should be applied.

The provider has overall responsibility for the quality of management in the service and the delivery of care to people using the service. The provider has repeatedly not achieved this at Clinton House Nursing Home and has been rated as Requires Improvement since the first rated inspection carried out in December 2014. The Care Quality Commission has carried out six inspections (including this one) of the service since December 2014. At each inspection there have been breaches of the regulations.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.