Archived: Cloneen Care Home

Cloneen Care Home provides care and accommodation for up to 15 older people and/or older people living with a dementia. Cloneen is a converted Victorian house in a residential area of Saltburn. There is a communal lounge and dining room on the ground floor of the home. The service is close to shops, pubs and public transport. At the time of our inspection nine people were using the service.

There was a manager in place but they were not a registered manager and their role had recently been changed to that of a full-time care assistant. However, as well as their new care role they were still responsible for managing the service. The manager was only able to carry out their management role in their own time. 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.

Before the inspection we received feedback on the service from the local authority, who raised concerns about staffing levels at the service. We were also contacted by the police, who raised similar concerns. Our judgment following inspection was that staffing levels were not sufficient as too few staff were deployed to administer medicines at night, to allow staff to have proper breaks and to properly supervise people requiring two to one support.

The registered provider’s recruitment processes reduced the risk of unsuitable staff being employed. Risks to people using the service were assessed and plans put in place to reduce the chances of them occurring. Regular checks of the premises and equipment were made to ensure they were safe for people to use. Plans were in place to support people in emergency situations.

Safeguarding policies and procedures were in place to protect people from abuse. People’s medicines were managed safely.

People were not always supported to access external healthcare professionals to monitor and promote their health. Staff received the training needed to support people effectively and were supported through regular supervisions and appraisals with the manager. Staff understood and applied the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) to protect people’s rights. People were supported to maintain a healthy diet.

People spoke positively about staff and the care they received at the service and told us they were treated with dignity and respect. Staff knew the people they supported well, which meant they could have interesting and meaningful conversations with them. We saw numerous examples of kind and caring interactions between staff and people at the service.

People were supported to access advocacy services. At the time of our inspection no one at the service was receiving end of life care. However, people’s wishes were recorded in their care plans.

People’s care was person-centred and was regularly reviewed to ensure it reflected people’s current needs and preferences. We received mixed feedback on activities at the service. Some people were content with the activities, but others said they would like to go out more. Staff thought people would benefit from being taken out more but staffing levels did not allow for this.

There was a complaints policy in place. People told us they knew how to complain about issues.

The manager and registered provider carried out a range of quality assurance checks to monitor and improve standards at the service. Staff told us they felt supported by the manager, but not always by the registered provider. We saw from records at the service that we had not always received required notifications about safeguarding incidents. We reminded the manager and registered provider of the requirement to submit notifications. Feedback was sought from people using the service and staff.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 during our inspection, in relation to staffing levels. You can see what action we took at the back of the full version of this report.

In May and June 2016 we received some information of concern. This included concerns regarding low staffing levels, equipment was out dated, there was a lack of money in the registered providers budget to purchase equipment such as pressure relieving mattresses and some concerns re care practices. As a result of the concerns we made the decision to undertake a focussed inspection of the service.

Cloneen Care Home provides care and accommodation for up to 15 older people and / or older people living with a dementia. Cloneen is a converted Victorian house in a residential area of Saltburn. There is a communal lounge and dining room on the ground floor of the home. The service is close to shops, pubs and public transport. On the first day of our inspection there were 13 people who used the service and this had increased to 14 people by the second day.

The home did not have a registered manager. 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. A manager had been appointed in June 2015 and had submitted their application to be registered, however, at the time of the inspection the registered provider was making changes to their registration which had delayed this process. Until a registered manager is in place the registered provider is breaching their registration conditions.

We looked at the arrangements in place to ensure safe staffing levels and found there were two staff on duty both day and night. In addition the manager of the service worked during the day usually Monday to Friday and the registered provider worked at the service three days a week. We raised concern that at teatime two care staff were responsible for numerous duties in addition to providing care and support to people. In addition to this one of the care staff was responsible for the administration of medicines. We observed that the design of the building could mean that people were left unattended for some time.

We spent some time in the lounge and dining area observing people who used the service and staff and saw that on occasions communal areas were unattended for periods of 15 to 20 minutes before there was a staff presence. We noted that staff were extremely busy and readily interrupted when administering medicines to people. This meant the staff member could become distracted and make a medicine error.

After our inspection we raised our concerns with the manager and registered provider who carried out a review of staffing levels and increase staffing numbers at busier times.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. Staff were able to describe how they ensured the welfare of vulnerable people was protected through the organisation’s whistle blowing and safeguarding procedures.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. The manager assured us there was money within the registered provider’s budget to purchase any equipment that people needed. We saw that a new pressure relieving mattress had been purchased for a person who was to be discharged from hospital.

Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. However, some risk assessments required further development to ensure they identified the actual risk to the person. This enabled staff to have the guidance they needed to help people to remain safe.

We saw that staff had received supervision on a regular basis and an annual appraisal.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. The manager had a chart for all staff and was aware of any gaps in training and had arranged this.

Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions. However further work was needed in the development of care plans to ensure MCA assessments were decision specific.

We found that safe recruitment and selection procedures were in place and appropriate checks had been completed on staff. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Appropriate systems were in place for the management of medicines so that people received their medicines safely.

There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. Observation of the staff showed that they knew the people very well and could anticipate their needs. People told us that they were happy and felt very well cared for.

We saw that people were provided with a choice of food and drinks, which helped to ensure that their nutritional needs were met. Staff had undertaken nutritional screening to identify specific risks to people’s nutrition. However, there were some errors in the calculation of risks, but this had not prevented staff from contacting the doctor or dietician when people had lost weight.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by family or staff to hospital appointments.