The Clough Care Home

The Clough Care Home is a detached property with large gardens, located in a quiet residential area in Bolton. There are 30 rooms, two of which are shared. The Clough provides accommodation and support for up to 32 older people. On the day of the inspection there were 23 people using the service.

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

Systems for safeguarding people from harm were robust. Staff completed regular safeguarding training and were aware of how to report any safeguarding concerns or poor practice witnessed. Risk assessments were completed for each individual and kept up to date with regular reviews. Health and safety certificates were in place and regular checks completed. Medicines were managed safely and appropriate infection control measures were in place at the home.

Staff were recruited safely and adequate numbers of staff were deployed to meet people’s needs. Staff training was on-going throughout their employment.

People told us they were looked after kindly and their privacy and dignity were respected. Care plans included clear information about people’s preferences and needs and people’s choices were respected. People were supported to be as independent as possible.

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.

Some staff expressed concerns about the management of staffing issues, although most felt management was proactive and helpful. The concerns were addressed immediately by the registered manager.

Complaints and concerns were responded to appropriately and honestly. Audits and quality checks were completed and any issues addressed appropriately. The service communicated well with relatives and friends and worked productively with other agencies and professionals.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 4 September 2019).

Why we inspected

We received concerns in relation to poor care standards. As a result, we undertook a focused inspection to review the key questions of safe, caring and well-led only.

Prior to the inspection 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.

The overall rating for the service has remained good. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, caring and well-led sections of this full report.

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 The Clough Care Home on our website at www.cqc.org.uk.

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.

The Clough Care Home is a detached property with large gardens, located in a quiet residential area in Bolton. There are 30 rooms, two of which are shared. The Clough provides accommodation and support for up to 32 older people. On the day of the inspection there were 28 people using the service, two of whom were currently in hospital.

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

At the last inspection there was a breach of regulation 12 (Safe Care and Treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had failed to manage medicines properly and safely and systems had failed to identify missing documentation relating to health and safety. At this inspection we found enough improvement had been made and the provider was no longer in breach of regulation 12.

Medicine systems were safe. All necessary health and safety records were in place and general and individual risks were documented and addressed as required.

There were appropriate systems to keep people safe from the risk of abuse and there were enough safely recruited staff to meet people’s needs. Staff had a thorough induction and training was plentiful and on-going.

The home was clean and fresh throughout and infection control measures were in place. There was ample room for people with restricted mobility to move about. A very pleasant large garden area was available for people to utilise in good weather

Prior to admission a full assessment of people’s needs was completed. A new electronic care plan system helped ensure information about people’s support needs was kept up to date.

The dining experience was pleasant, food was nutritious, drinks were plentiful and people were given lots of choices. People’s special diets were adhered to and weights were monitored as needed and issues followed up as required.

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.

There was an equality and diversity policy and procedure in place and staff undertook training in this area. People were encouraged to express their opinions via regular themed surveys and meetings. Staff were seen to respect people’s dignity and privacy.

Staff members assisted with activities, such as games and exercises during the day. There were also externally sourced entertainers who visited the home to provide some stimulation.

There was information about how to complain in the entrance to the home, and a complaints/compliments box for people to use.

Advance care plans were included within care files to ensure people’s wishes for when they were nearing the end of their lives had been documented.

A system of monthly audits had been implemented and these helped the service to identify and address any issues. The manager was approachable and supportive to people who used the service, relatives and staff.

Appropriate referrals were made to other agencies, such as dieticians and speech and language therapy teams (SALT). The home was part of the Bolton Care Excellence scheme, which aims to improve the health, care and experience of the people of Bolton.

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)

At the previous inspection (published 18 September 2018)) the service was rated Requires Improvement. This was because there was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014, relating to poor recording and unsafe medicines management. 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.

During the last inspection of The Clough in July 2017 we found a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because environmental risks had not always been identified and standards of infection control did not effectively prevent the spread of infection. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions ‘is the service safe?’ and ‘is the service well led?’ to at least good. At this inspection we found improvements in these areas but we found further breaches of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014, relating to servicing records and poor medicines administration. You can see what action we told the provider to take at the back of the full version of the report.

The Clough Care home provides accommodation and personal care for up to 32 older people in a residential area of Bolton. At the time of our inspection there were 30 people living in the home.

Following the retirement of the previous registered manager the service had appointed a new manager who was in the process of applying to the Care Quality Commission (CQC) to become the registered manager. 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 2008 and associated Regulations about how the service is run.

People told us they felt safe at The Clough, and the staff we spoke with demonstrated a good understanding of safeguarding and whistleblowing procedures. There were few incidents of alleged abuse but where these had been raised there was appropriate recording and follow up action taken.

There were enough staff on duty and staff were encouraged to spend time with the people who used the service. Staff were well trained and had access to refresher training to ensure that their knowledge was up to date and in line with current best practice. The service made appropriate checks during the recruitment process to ensure that new staff had the right attributes and character to work with vulnerable people. All new staff received a full induction and systems were in place to provide supervisions for staff. However not all staff had had a recent supervision although the manager was addressing this at the time of our inspection.

We saw risks were considered, including generic and environmental risks. Where identified, appropriate action was taken to minimise the risks. There was consideration of people’s needs prior to and immediately following people’s admission to The Clough and plans of care were regularly reviewed to ensure that changing needs were identified. Care records showed that the service worked in partnership with social workers and health care professionals and that people had access to healthcare services, including general practitioners (GPs), district nurses, and dieticians as necessary.

People told us that they enjoyed the food provided. The cooks understood the needs and preferences of people who used the service, and were aware of any specific dietary requirements. Where necessary, food and drink intake was monitored, and we saw hot and cold drinks were provided throughout the day.

The staff we spoke with demonstrated a good understanding of consent and choice. Where people lacked the capacity to consent to their care and treatment the appropriate authorisation to carry out their care had been sought and agreed by the relevant authority.

Staff communicated well with each other during their shifts, and any issues of concern were recorded and passed on at handover between shifts to ensure that needs were not overlooked and to allow consistent delivery of care.

People told us that they were supported by considerate and caring staff and throughout our inspection we saw staff demonstrate a caring attitude and a willingness to go above and beyond what would normally be expected from their caring role. People were not overlooked, and staff were vigilant to their needs, treating people with respect. They recognised the need for both privacy and confidentiality; information held about people was stored securely when not in use. This care extended to support for people at the end of their life, and we saw a number of thank you cards from relatives complimenting the staff for the end of life care and support provided.

Care plans provided appropriate information about individuals to enable care staff to meet their needs, but they were not always written in a way which reflected the person-centred way we saw care was delivered.

Although the service did not employ an activity co-ordinator we saw some evidence of organised group activities, and throughout our inspection we saw people enjoyed the attention of care staff either in one to one or small group conversations. People had formed friendships within the service, and staff demonstrated a good understanding of people’s hobbies and interests. The service provided a kind and caring environment considerate of the needs and wishes of the people who lived at The Clough.

Staff understood their roles and responsibilities, and those we spoke with told us that they felt well supported and well managed. We saw that there were systems of quality assurance, including audits and regular feedback from people who used the service, which was used to improve the quality of service delivery.

We saw that there was good support from the provider, and evidence of partnership working with the local authority and across other homes within the group.

The inspection took place on the 20 July and was unannounced.

There was a registered manager at this home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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 October 2014 we saw improvement was needed around people’s mealtime experience. At this inspection we found this experience had improved.

We saw some areas at the home which needed improvement from regular cleaning to reduce the risk of infection. The management team had completed environmental checks, however these had not identified the areas for improvement. We discussed this with the registered manager and they agreed the areas needed improvement. Staff infection control procedures were in the process of being updated to ensure people were not put at risk. The management team were looking at ways to improve the patio area to ensure people remained safe.

Staff we spoke with were aware of how to recognise signs of abuse, and systems were in place to guide them in reporting these. They were knowledgeable about how to manage people’s individual risks, and were able to respond to people’s needs. People told us they were supported in a safe way and had their medicines as prescribed.

People and their relatives told us staff knew how to meet their needs. Staff had up to date knowledge and training to support people. Staff respected people's rights to make their own decisions and choices about their support. People's permission was sought by staff before they helped support them. Staff gave people choices in a way they could understand by using appropriate communication methods. When people did not have the capacity to make their own specific decisions these were made in their best interests by people who knew them well and had been authorised to do this.

People had food and drink they enjoyed and had choices available to them, to maintain a healthy diet. People said they had access to health professionals when they needed to. Relatives were confident their family member was supported to maintain their well-being.

People said they were happy living at the home and were supported by patient and kind staff. Relatives told us they were happy with the care their family member received. They told us staff were caring and promoted people’s independence. People living at the home were able to see their friends and relatives as they wanted. We saw staff treated people with dignity and respect and had a good knowledge of people’s rights. They knew people well, and took people’s preferences into account and respected them.

People and their relatives were included in how care was provided. They knew how to raise complaints and felt confident that they would be listened to and action taken to resolve any concerns. The registered manager had a complaints process in place to ensure people were listened to and action could be taken if required.

The management team had identified people needed more interesting things to do. They had asked for ideas from people, families and staff and were in the process of making the improvements. People and their relatives were encouraged to attend regular meetings, to share their views about the quality of the service. The management team had actioned suggestions made by people, their families and staff where possible, and were making improvements.

The provider had systems in place to monitor the quality of care and treatment people living at the home received. These were not always effective at identifying improvements such as ensuring bathrooms were clean. Where improvements had been identified there was a plan in place which was regularly reviewed to ensure they were made in a timely way.

We looked at four care plans which contained relevant health and personal information. Most of the records were completed appropriately, although there were a small number of inconsistencies. Reviews were undertaken regularly and changes noted.

We spoke with four staff members who all demonstrated an awareness of safeguarding issues and were able to give examples of when they would report concerns. We discussed a recent safeguarding concern with the manager of the home. This had highlighted some issues including some procedures not being followed correctly and some poor recording. The manager agreed to put some actions into place immediately to address these issues.

The four staff members with whom we spoke felt they were well supported by team members, senior staff and the provider. Staff meetings were held regularly, training was on-going and communication was constant between staff and management.

Satisfaction questionnaires were sent out regularly and there was constant dialogue between staff and people who used the service to ensure their views were sought. Audits were carried out and issues raised by these were addressed in a timely way.

We looked at six care plans and saw that they contained relevant medical and health information, personal preferences and social history, evidence of partnership working, risk assessments and monitoring charts. We saw that the care plans were regularly reviewed and updated.

We spoke with four people who used the service, one told us 'I feel safe, I've nothing to worry about.' Another person told us 'we are very well looked after.' We spoke with three visitors and one said 'staff are very friendly and approachable' whilst another told us 'staff all go out of their way to help.'

We saw there were relevant policies and procedures around safeguarding and spoke with three members of staff who demonstrated an understanding of the issues. The staff with whom we spoke were confident to report any issues they may encounter.

We saw that recruitment and induction procedures were robust and staff employed had relevant qualifications and skills and training was ongoing.

We saw that the home had procedures in place to quality assure the service, including customer satisfaction questionnaires and regular residents' meetings. Any issues raised or complaints were taken seriously and followed up appropriately.