Claremont

Claremont is a residential care home providing personal care to 4 people at the time of the inspection. The service can support up to 4 people.

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

Right Support:

Risks to people were not always managed. There were not always staff trained on duty to administer emergency medications should they be required. Improvements had been made in relation to fire safety. People had developed positive relationships with the staff. People were not supported to have maximum choice and control of their lives and did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. We continued to find capacity assessments and best interests not in place.

Right Care:

Improvements had been made to staff practice and staff understood their responsibilities under safeguarding. Some improvements had been made to supporting people with their access to the community and activities, however this needed to be embedded for all.

Right Culture:

There had been an improvement in the culture of the service. We received positive feedback from people and their relatives. Further work was required to ensure all people living at the service were promoted to have good outcomes. Staff felt supported in their roles.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 06 February 2023) and there were 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, sufficient improvement had not been made in all areas and the provider remained in breach of some regulations.

This service has been in Special Measures since 10 February 2023. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This focused inspection was carried out to follow up on action we told the provider to take at the last inspection. This report only covers our findings in relation to the key questions of safe, effective and well led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has improved to requires improvement based on the findings of this inspection. Please see the safe, effective 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 inspection, by selecting the 'all reports' link for Claremont on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to risk management, consent and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Claremont is a residential care home providing accommodation and personal care to people with a learning disability and/or Autism. The service can support up to four people, three people were living at the service at the time of inspection.

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

Governance systems were not robust and failed to improve the quality and safety of the service. Records were not always accessible, accurate or up to date. The provider did not actively engage people and their relatives in decisions about the running of the service.

Medicines were not safely managed. We could not be assured people had received their medicines as prescribed due to missing signatures on medicine administration records and lack of stock checks. Some medicines and topical creams did not have the appropriate medicines administration records in place to ensure people were receiving their medicines as prescribed.

Risk to people’s safety were not always mitigated. Fire procedures were not effective which put people at risk of harm. Care plans and risk assessments were not always accessible to staff to guide them in how to deliver care and reduce risks to people.

Infection control procedures were not always followed, clinical waste was not disposed of safely and COVID-19 procedures had not always been followed when professionals visited the service.

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. However, clear records were not always kept regarding capacity assessments and best interest decisions.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture. People and their relatives were happy with the care they received.

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 29 October 2019). We carried out an inspection to look at infection control on 17 December 2020, this was a targeted inspection so did not receive a rating.

Why we inspected

We received concerns in relation to the management and leadership of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. 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 changed from good to requires improvement. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Claremont on our website at www.cqc.org.uk.

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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to medicines, risk management, recruitment and governance.

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 for the provider to understand what they will do to improve the standards of quality and safety at the service. 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.

We found the following examples of good practice.

Where safe to do, risk assessments had been implemented to support people to continue accessing the community. This included working with people to feel comfortable in wearing personal protective equipment (PPE).

Additional cleaning of all frequent touch surfaces was in place and recorded by staff.

Restrictions on visits were in place at the time of inspection. The provider was in the process of purchasing an outdoor seating area to support outdoor visits. Measures were in place to allow safe professional visits such as, temperature checking, PPE and track and trace information.

Further information is in the detailed findings below.

Claremont is a care home providing personal care for up to four people who have a learning disability and/or autism. At the time of our inspection three people lived at the service.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service

We received positive views from relatives and healthcare professionals about the support provided to people. Care and support was tailored to each person's needs and preferences. People and their relatives were fully involved in developing and updating their planned care.

People were supported with activities and interests to suit them and to aid their independence. Staff knew people’s likes and dislikes well.

People were supported with their communication needs and staff demonstrated effective skills in communication. Recruitment checks were in place to ensure staff were suitable to work at the service. Staff had received training and support to enable them to carry out their role. Relatives and professionals felt that staff were skilled to meet the needs of people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. People received their medicines on time and their health was well managed. Some changes to medicines policies and paperwork were being made. Staff had positive links with health care professionals which promoted people’s wellbeing.

Relatives and staff told us the registered manager was approachable. All feedback was used to make continuous improvements to the service. The provider had systems in place to safeguard people from abuse and staff demonstrated an awareness of safety and how to minimise risks.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 11 April 2017)

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.

Claremont House is in a residential area of the town of Goole in East Yorkshire. The property is on three floors and has all single accommodation, some with en-suite bathrooms. The service provides care and support to adults with a learning disability. At the time of our inspection the service was providing support to four people. It offers rehabilitation, learning with living skills and activities that are educational, occupational and recreational. There is on street parking and access to the town via public transport.

The registered provider is required to have a registered manager and on the day of the inspection there was 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.

At this inspection we found that the registered provider had made sufficient improvement to the service to meet the requirements of the regulations. We found the overall rating for this service to be ‘Good’. The rating is based on an aggregation of the ratings awarded for all 5 key questions.

The registered provider had made sufficient improvements to the property to ensure people that used the service had their own suitable toilet and bath/shower and the staff had a separate toilet and bathroom available to them. The premises were safely maintained and there was evidence in the form of maintenance certificates, contracts and records to show this. The premises were suitable for providing care to people with a learning disability or autistic spectrum disorder.

The registered provider had made sufficient improvements with monitoring and providing staff training up-dates, so that all staff were now better trained with regard to refresher courses in safeguarding adults, medicine management and other courses relevant to their roles. We saw that people were cared for and supported by qualified and competent staff that were regularly supervised and received an appraisal regarding their personal performance.

The registered provider had made sufficient improvements in notifying the Commission of significant events as required by regulations. Notifications were sent to the Commission and so the service fulfilled its responsibility to ensure any required notifications were made.

The registered provider had made sufficient improvements to ensure audits were effectively carried out and people were consulted about their views of the service provision. There was an effective system in place for checking the quality of the service using audits, satisfaction surveys and meetings.

People were protected from the risk of harm because the registered provider had systems in place to detect, monitor and report potential or actual safeguarding concerns. Staff were appropriately trained in safeguarding adults from abuse and understood their responsibilities in respect of managing potential and actual safeguarding concerns. Risks were also managed and reduced on an individual and group basis so that people avoided injury or harm.

Staffing numbers were sufficient to meet people’s need and we saw that rosters accurately cross referenced with the staff that were on duty. Recruitment policies, procedures and practices were carefully followed to ensure staff were suitable to care for and support vulnerable people. The management of medication was safely carried out.

Communication was effective, people’s mental capacity was appropriately assessed and their rights were protected. Employees of the service had knowledge and understanding of their roles and responsibilities in respect of the Mental Capacity Act (MCA) 2005 and they understood the importance of people being supported to make decisions for themselves.

The registered manager explained how they worked with other health and social care professionals and family members to ensure a decision was made in a person’s best interests where they lacked capacity to make their own decisions.

People received adequate nutrition and hydration to maintain their levels of health and wellbeing.

People received compassionate care from kind staff who knew about people’s needs and preferences. People were involved in all aspects of their care and were always asked for their consent before staff undertook care and support tasks.

People’s wellbeing, privacy, dignity and independence were monitored and respected and staff maintained these wherever possible. This ensured people were respected, that they felt satisfied and were enabled to take control of their lives.

People were supported according to their person-centred support plans, which reflected their needs well. People had many opportunities to engage in pastimes, activities and occupation of their choosing. People were supported to maintain family connections and keep in touch with friends.

There was an effective complaints procedure in place and people’s complaints were investigated without bias. The service was well-led and people had the benefit of a culture and management style that were positive and inclusive. People were assured that recording systems used in the service protected their privacy and confidentiality, as records were well maintained and held securely in the premises.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. All staff had received training in this area and the staff we spoke with confirmed that they understood when an application should be made, and how to submit one. This meant that people were safeguarded as required.

People received an assessment which helped to ensure that the home was able to meet their needs. We saw care plans and risk assessments were in place to help ensure people's safety and welfare. Information was reviewed regularly to ensure that it was up to date and reflected any changes. People told us that they were consulted about their care. Comments included, 'I can choose when I get up and what I want to do. I help cook and clean. If I had any worries I would talk to the staff."

The home had systems in place to make sure that managers and staff learnt from events such as accidents, incidents, complaints, concerns and whistleblowing. This helped to reduce the risks to people and helped the service to continually improve.

Records were in place detailing how people should be cared for. Records were stored securely so that the information remained confidential and accessible only to those who needed them.

Is the service effective?

The home had appropriate arrangements in place for gaining people's consent. People's health and care needs were assessed with them, and they were involved in decisions regarding their plans of care. This meant that staff were able to deliver care in a way that supported people.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. A relative commented, 'I am generally happy with the way my relative is cared for but sometimes I think they need encouragement to do more."

People's preferences, interests, aspirations and diverse needs had been recorded and care and support was being provided in accordance with people's wishes. We did observe people going out and getting involved in social opportunities. However a relative said that more support would be beneficial with personal care tasks and motivating people to go out more and be involved in household tasks such as keeping their room clean.

Is the service responsive?

We saw that the home had responded to areas of improvement identified within their audits and people were confident that the home would respond to any concerns if they were unhappy.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. Staff confirmed that the management were supportive. Meetings were held so that people could air their views.

A relative told us that the manager was very approachable.

People were well cared for and enjoyed a variety of activities in the community and in the home. They also engaged in educational and occupational pastimes.

People received their medication safely and were encouraged to be independent with arranging to collect it. People were cared for by staff in sufficient numbers and there was a system in place to monitor the quality of the service provided at Claremont House.