Archived: Clarence House Residential Home

Clarence House provides residential care and support for up to 41 adults. Some people also stay at Clarence House for periods of respite or convalescence, before returning to their own homes. At the time of our inspection, 28 people were living in the home.

The service is required to have 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 registered manager had left the service in December 2015 and an acting manager was currently completing their probation with the organisation, with plans to register with the CQC upon successful completion of this. This person had been working in the home for three years and, prior to taking on the manager’s role, had been the head of care. This person is referred to as the manager throughout this report.

People were safe in the home. Staff had a good understanding of safeguarding and knew what constituted abuse. Staff knew how to keep people safe and reported any issues of concern appropriately. Although the premises and some equipment looked very ‘tired’ and well worn, staff were observant and communicated any areas of concern promptly to ensure the premises remained safe for people. Risk assessments were clear and detailed and reviewed regularly. Staff acted in accordance with the guidance and protocols that were in place to help reduce the risks for people. People received their medication on time and in the manner the prescriber intended.

Staffing levels were sufficient to meet people’s needs appropriately and all the staff on duty had the skills and knowledge to support people effectively and meet their needs in a timely manner. Appropriate and safe recruitment practices were followed, to ensure staff were suitable to work with people in a care environment.

Staff received good support from each other as well as from senior staff and management. Staff received good levels of supervision and the management team were approachable.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. The manager and head of care ensured the service operated in accordance with the MCA and DoLS procedures and staff demonstrated a good understanding of the MCA, DoLS, capacity and consent. People were supported to make their own decisions as much as possible, even where limited capacity had been identified.

People received enough food and drink to meet their individual needs and staff had a good understanding and knowledge of people’s dietary needs.

Prompt referrals were made to healthcare professionals as needed and any advice or guidance given was followed appropriately by staff. There was also consistent monitoring and appropriate communication between staff, regarding people’s healthcare needs and any changes.

People were actively involved in planning their own care as much as possible and, even when people’s capacity was limited in some areas of decision making, staff ensured they were supported appropriately to make informed choices for themselves.

The staff were kind, caring and compassionate. People were treated with dignity and respect and their privacy was always upheld. People were also supported to do as much for themselves as possible, in order to enhance and maintain their independence.

People had access to activities that complemented their interests and enhanced their wellbeing. Visitors were welcome, without restrictions. People were listened to and their complaints were welcome. Any complaints were fully investigated and actions taken to improve the quality of care provided.

There were effective systems in place to monitor the quality of the service and these were used to develop the service further. Staff and people living in the home were involved in making decisions on how the home was run.

Record keeping and management systems were in good order, with effective auditing and follow up procedures in place. Administrative support for the service was an effective and valuable asset.

An open and inclusive culture was demonstrated in Clarence House, with clear and positive leadership at all levels.

Records showed that people gave signed consent to care and treatment where they were able, with next of kin acting on their behalf where they were not. We saw that people were offered choices and staff respected the decisions people made. The records showed us that the home co-operated with other providers and we saw that staff provided the care and treatment prescribed by health professionals.

The service was clean and hygienic. Staff had been trained in infection control and we saw that gloves and aprons were available for staff. Laundry procedures ensured all linen was disinfected where necessary. Cleaning records were mostly up to date.

Staff received training appropriate to their role and they told us they felt well supported. We saw that staff had opportunities for professional development and that training events took place for them to attend.

The home had a complaints process and this was displayed in the home. Procedures were in place so that staff were made aware of any changes in mood or behaviour that might suggest people were unhappy. A relatives survey had been completed earlier in the year and was displayed in the home.

We did not obtain people's views during our visit but looked at a random selection of care plans to check whether improvements within the records had been made. We saw that people's care plans were individualised, people's consent to view these records and an improved format had been made since the previous inspection. We saw individual person centred care plans including risk assessments and preferences were now in place. We saw that where people's care needs were of an increased risk, staff sought advice from other professionals to ensure people's health and welfare were monitored appropriately.