Archived: Claremont House

Claremont House is a residential care home providing personal care to 13 people at the time of the inspection. The service can support up to 16 people. The service is set across two floors with a lift and stairs to the first floor. There are some communal spaces such as a combined lounge and dining area, garden and reception area. The office is located inside the service. Each bedroom has a private toilet and sink and there are shared bathrooms available.

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

People’s care plans gave lots of information about how to safely support the person. However, risk assessments were not robust enough to ensure people were safe. Staff were still learning how to best use an electronic care planning and recording system. Staff knew people well but needed further development to be confident in their understanding of people’s conditions, and how this impacted their lives.

People had the opportunity to be involved in a variety of activities and more options were being planned but not yet in place. People had experienced a lot of positive changes since the last inspection but monitoring systems did not always identify concerns and did not yet drive improvement in the service.

Medicines were safely administered but records required further development to imbed best practice. People were supported to access all relevant health and social care professionals to meet their needs.

People were very happy living at the service and told us they felt safe because the staff were kind and caring. Relatives also told us they thought their family members were safe as the staff knew them well and knew how to support their needs. Staff had a good understanding of how to keep people safe and had received training in safeguarding adults.

Staff treated people with respect and showed patience and compassion when supporting them and delivering care. Interaction was good and people were chatting a lot and laughing. There was a warm and welcoming atmosphere in the service that made it feel like home. The service was clean and odour free and had recently been decorated making a pleasant environment.

People told us staff encouraged them to do what they could for themselves but that they could ask for help if they needed it. Relatives told us they and their family members were involved in care reviews. Staff gave people lots of choice about daily decisions such as for food or drink or how they spent their time.

People really liked the food and drink and there were many choices available. People could access anything they wanted, and a variety of snacks and drinks were accessible to people throughout the day and night.

People and their relatives were happy that any complaints would be managed quickly and effectively. They told us the registered manager was very approachable and they would be happy to speak with them if needed. One relative told us, “I am happy with how they look after [my family member], I think they are well cared for. I think [staff] do a brilliant job.”

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.

We have made a recommendation about staff training and development.

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: The last rating for this service was requires improvement (published 06 December 2019) and there were multiple breaches of regulation. 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 some regulations. However, we found enough improvement had not been made in other areas and the provider was still in breach of other regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach of regulation in relation to the safe assessment of risks. We also identified a breach about quality assurance systems to ensure the registered manager and provider had good oversight of the delivery of care. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Claremont House is a residential care home providing personal care to 15 people aged 65 and over at the time of the inspection. The service can support up to 16 people. The home is set across two floors with a lift and stairs to the first floor. There are some communal spaces such as a combined lounge and dining area, garden and reception area. The office is located inside the home. Each bedroom has a private toilet and sink and there are shared bathrooms available.

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

Most people told us they felt safe and relatives confirmed they believed their family member to be safe and comfortable at the home. One person had complained to the registered manager of poor treatment from staff supporting them.

The provider did not sufficiently check staff history, prior to employment to ensure staff were safe to work in the service. Staff did not always safely manage people’s medicines and the management team did not always identify errors.

People did not always experience good cleanliness in the home and the environment was not suitable in décor and design to meet everyone’s needs. People’s needs were assessed but the information was not always fully recorded meaning staff were not fully aware of people’s preferences.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible but processes were in place to agree what was in people’s best interests; the policies and systems in the service supported this practice. People told us they had enough to eat and drink but there was limited choice available.

People did not feel staff supported them to maintain or develop their independence. People gave positive feedback about staff supported people to promote their privacy and dignity when washing and bathing.

People did not feel activities were person centred and did not enjoy staff repeatedly asking them what they liked. Relatives were encouraged to visit but other ways of preventing social isolation were not in place.

People’s views on how well staff treated them varied, some felt staff were 'brilliant' and other people felt staff did not always listen to them. Relatives and health professionals were involved in regular reviews of people’s care.

People felt happy to complain but the outcomes of these complaints were not always given. People were supported well with end of life wishes.

Most people said they did not know who the registered manager was. However, their relatives gave very positive praise about the registered manager and the improvements they had made since being in post. People were not given information about outcomes of incidents when things had gone wrong.

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

Rating at last inspection

The last rating for this service was good (published 27 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the safe management of medicines, failure to notify the commission of serious incidents and cleanliness, décor and suitability of the environment. We also found breaches in relation to poor record keeping and assessment of risks, lack of personalised care and unsafe staff recruitment processes at this inspection.

These shortfalls lead to a breach in relation to provider and registered manager oversight of the service delivery. This was a breach of regulation and we have imposed positive conditions on the providers registration to drive improvement in these areas.

The provider had failed to notify the CQC of serious incidents. This was a breach of regulation and we issued a fixed penalty notice. The provider accepted a fixed penalty and paid this in full.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Claremont House is a residential home in Leighton Buzzard, providing care and accommodation for up to sixteen older people who require personal care. There were fourteen people living at the home at the time of our inspection, some of whom lived with dementia.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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 who lived at the home were safe because improvements had been made in the management of their medicines and in the way infection control was managed. Improvements had also been made in the staffing levels and there were now enough staff to meet people’s needs. Staff were trained in safeguarding and they knew how to keep people safe from avoidable harm. There were risk assessments in place to manage risk posed to people and the provider had robust policies and procedures for the safe recruitment of staff.

There were also improvements in the support that staff received in that there were now regular supervision meetings and appraisals of staff’s performance. Improvements had also been made in the management and understanding of the Mental Capacity Act 2005 and the associated Deprivation of Liberty. We found that staff were trained, skilled and understood their roles. They received an induction into the service at the start of their employment and supported people to eat a healthy and balanced diet.

People’s care needs had been identified prior to them living at the home, and appropriate care plans were in place to ensure that their needs were met in a consistent way. People’s care plans were reviewed as appropriate and they were supported in a personalised way by staff that were caring and friendly. Staff respected people’s privacy and dignity.

We found that improvements had been made in the way the service was managed, and in the quality of the service. There was a new registered manager in post, and they and the staff team were knowledgeable in their roles and responsibilities. There was also an improved quality assurance system in place to monitor and manage the quality of the service provided and in addition, the provider had an effective system in place for handling complaints. However, improvements were still required around the management of records particularly risk assessments. People’s personal risk assessments did not conform to current health and safety guidance on risk assessments. The environmental risk assessments were also not robust because they did not contain sufficient detail to guide staff on managing risk.

Claremont House is a residential home in Leighton Buzzard, providing care and accommodation for up to sixteen older people who require nursing or personal care. There were fifteen people living at the home at the time of our inspection some of whom lived with dementia.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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 who lived at the home were not always safe because their medicines were not managed appropriately, and the staffing levels were not always sufficient to meet their needs. They were exposed to risks of cross-contamination because of some poor practices around the management of infection control. Some parts of the home also appeared dated and needed to be refurbished. The provider however had safe recruitment processes in place and the staff were trained in safeguarding people from abuse. There were risk assessments in place to manage risked posed to people by aspects of their care and the home environment.

The service was not always effective because appraisals of staffs’ performance were not completed. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The requirement of the Mental Capacity Act 2005 and the associated Deprivation of Liberty were also not met. The staff were however trained, skilled and understood their roles. They received an induction into the service at the start of their employment and supported people to eat a healthy and balanced diet.

Staff were caring and friendly in their interactions with people and they respected people’s privacy and dignity. However, people were exposed to avoidable hazards around the home which was not reflective of a service that was caring.

The service was responsive to people’s needs. People’s care needs had been identified prior to them living at the home, and the appropriate care plans put into place. Their care plans were reviewed as appropriate and they were supported in a personalised way. The provider had an effective system in place for handling complaints.

The service was not always well-led. Some of the failings we raised during our last inspection had not been fully addressed. There were further failings noted within this and improvements were required in the quality assurance system in place.

We observed good interactions between people and staff. People looked relaxed and comfortable in the company of staff. A health care professional said, 'This home provides very good care. If I had a mother or father who needed care, I won't have any hesitation to place them here.'

We found that the home had adequate arrangements in place for obtaining consent from people in relation to their care, support and treatment.

People were provided with a choice of suitable and nutritious food and drink in sufficient quantities to meet their needs. The home had systems in place to reduce the risk and spread of infection. Appropriate personal protective equipment was readily available for staff use. A staff member said, 'We are never short of gloves and aprons. There is always an adequate amount available for us to use.'

We found that the premises were safe and adequately maintained. However, the garden was unkempt, which meant that people's well-being may not be promoted. The equipment used in the home was safe and fit for its purpose. This meant that people were not at risk of unsafe equipment.

We found that the home had processes in place to ensure that complaints were appropriately addressed. Some amendments to the complaints policy were needed to ensure that information was current.