Clarendon Mews Care Home

Clarendon Mews Care Home is a residential care home that provides personal and nursing care for up to 47 people. At the time of the inspection the service was supporting 41 people.

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

The provider had improved the systems to oversee and monitor all aspects of the service. However, some monitoring records had gaps where staff had not recorded when they had carried out night checks as specified in people's care plans. We also found gaps where staff had not consistently recorded when they had assisted people at risk of developing skin pressure damage to move position, as specified in the care plans. The provider confirmed the care monitoring systems would be further strengthened so that any gaps in monitoring people’s care and support could be quickly identified and acted upon.

The systems to safeguard people from abuse or improper treatment had been improved. All staff had received refresher safeguarding training. The provider informed the local safeguarding authority and the Care Quality Commission (CQC) of safeguarding concerns. Records showed investigations followed the local authority and providers safeguarding policies.

Incidents of safeguarding and serious injuries had significantly reduced. The systems to investigate and follow up incidents, accidents and falls had been improved to identify and mitigate the risks of repeat incidents. This demonstrated a commitment to lessons learnt, to continuously improve the safety and care of people living at the service.

An electronic personal care monitoring system had been introduced and most people’s care records had been transferred onto the system. We found the care plans that had been transferred onto the system were very detailed.

Risks associated to people's eating and drinking were clearly recorded and up to date. Practical measures had been put in place to reduce choking risks. All staff involved with supporting people to eat and drink had received specialist training on Dysphagia (choking risks). We observed staff sensitively supporting people that required additional support to eat and drink, whilst enabling people to maintain as much independence as possible.

Staff were trained in the safe administration of medicines and their competency was assessed before they administered medicines to people. Medicines were stored securely and administered to people as prescribed.

People's needs were assessed and people and / or their representatives were involved in the care planning and review process. Throughout the inspection we saw positive interactions between staff and the people using in the service. We observed people move freely around the environment. One person said, “They [staff] put their arms round me when I am mardy (upset). It shows that someone cares.” Relatives were very complimentary of the caring attitude of the staff team.

Staff were safely recruited recruitment files evidenced the provider applied for Disclosure and Barring Service (DBS) checks, to include a criminal conviction check and appropriate pre employment checks had been completed.

Why we inspected

This was a planned focused inspection based on the previous rating.

The last rating for this service was Inadequate (published 6 January 2021) and there were multiple breaches of regulation. We imposed conditions upon the provider's registration certificate.

The provider completed an action plan after the last inspection to show what they would do and by when to improve and meet the breaches in regulations: Regulation 10 Dignity and respect; Regulation 12 Safe care and treatment; Regulation 13 Safeguarding service users from abuse and improper treatment; Regulation 17 Good Governance and Regulation 18 Staffing.

We undertook this inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Caring and Well-Led which contain those requirements.

At this inspection we found enough improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 6 January 2021. 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.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Inadequate to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Clarendon Mews Care Home 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.

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.

Clarendon Mews Care Home is a residential care home providing accommodation and personal care to up to 47 people, many of whom are living with dementia. The accommodation is on three floors with a large lounge and dining area on the ground floor and smaller communal areas on the other floors. There is an accessible and secure garden at the back of the property. At the time of our inspection 46 people were living in the service.

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

The provider failed to have adequate systems in place to assess, monitor and mitigate the risks to people's health, safety and welfare. They had not kept up to date with relevant legislation to keep people safe.

Systems to safeguard people from abuse or improper treatment were ineffective. People did not always receive safe care. At times people sustained emotional and physical harm from the care they received.

A lack of quality assurance processes meant there was ineffective management oversight of people's care and welfare needs. Audits were not in place to identify care which did not meet people's needs and care plans not being up to date.

The local authority were not always informed of safeguarding incidents. The provider failed to investigate or follow up incidents, accidents and falls appropriately. Opportunities to learn lessons and mitigate risk were missed.

People did not always receive their medicines as prescribed and medicines were not stored, managed or administered safely.

People's needs were not adequately assessed before they moved to live in the service. People and their representatives were not sufficiently involved in the care planning and review process.

Staff had not received specialist training in areas required to keep people safe and meet their care needs.

Records and risks associated to people's eating and drinking needs were not up to date although practical measures had been put in place to ensure risk was reduced at mealtimes.

Staff had police checks from the Disclosure and Barring Service in place before they started work. Effective processes were in place for maintenance and health and safety issues.

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 20 September 2017).

Why we inspected

The inspection was prompted in part by notification of a specific incident following which a person using the service died. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of people’s eating support needs and specifically the risk of choking. We undertook a targeted inspection to examine those risks. We inspected and found there were widespread concerns with management oversight, evidence of people being physically restrained and lack of incident reporting to relevant authorities. We widened the scope of the inspection to become a focused inspection which included the key questions of Safe, Caring and Well-Led.

Since the inspection the provider has worked at pace and taken prompt action to start mitigating the risks. They have engaged a consultancy firm to support them make immediate improvements and have provided the CQC with a comprehensive action plan. They are working transparently and co-operatively with all agencies including the police, local authority and clinical commissioning group.

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 coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Clarendon Mews on our website at www.cqc.org.uk.

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 identified breaches of regulation in relation to safe care and treatment, safeguarding people from abuse and improper treatment, treating people with dignity and respect, governance arrangements, staffing and failing to submit relevant notifications to the CQC.

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

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Clarendon Mews provides residential care for up to 45 people many of whom are living with dementia. Accommodation is provided over three floors with access via stairwells and passenger lifts. The majority of communal living areas are located on the ground floor, with smaller seating areas located on the first and second floor. There is a garden which is accessible and secluded. At the time of our inspection there were 38 people using the service.

At the time of our inspection visit the registered manager had left the service and had applied to CQC to deregister. 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 providers told us the manager was in the process of applying to be the next registered manager.

People made many positive comments about the caring nature of the staff. They used words like ‘tender’ and ‘loving’ to describe them. People said the staff always had time for them. Staff knew the people they supported well and valued them as unique individuals. All the interactions we saw between staff and people were positive and personalised.

The staff team recognised the importance of physical touch and comfort to some people using the service. The manager ensured that every person (who wanted this) got at least five hugs a day. We saw staff use touch as a way to communicate with people and provide them with reassurance and support.

Personalised care plans helped to ensure staff knew people’s life histories and what was important to them and made them feel good. If people had a particular interest or talent staff supported them to develop this so they felt fulfilled. Staff used innovative methods to support people who were living with dementia ensuring they were cared for in a calm and happy atmosphere. Relatives of people living with dementia said the staff were skilled at communicating and working with their family members.

People were encouraged to make decisions about their care and support. The routine at the service was flexible and people chose what they did and when. People told us they could get up and go to bed when they wanted and choose whether or not to take part in activities and meetings

People told us they felt safe and the service and trusted the staff. They said that if anyone using the service became distressed the staff gently reassured them, took them for a walk, or diverted their attention in other ways. People could be sure that any concerns about their welfare would be addressed and improvements made where necessary.

People had risk assessments so staff knew the risks facing them and how to keep them safe. There were enough staff on duty to provide people with the care and support they needed. Call-bells were answered promptly and staff continually engaged with people and included them in activities and social events. Staff managed medicines safely and people had them when they needed them.

People told us the staff were skilled and provided them with good quality care. Staff were trained to meet people’s needs safely and effectively. The service’s training programme helped to ensure staff had the knowledge and confidence they needed to carry out their roles and responsibilities effectively. Staff understood the importance of people consenting to their care and support in line with the Mental Capacity Act 2005.

People made many positive comments about the food served and told us mealtimes were friendly and sociable events. We saw lunch being served and the food was plentiful and well-presented. If people needed support to eat their meals staff provided this. Staff ensured people had prompt access to GPs and other health care professionals when they needed it.

People had the opportunity to take part in a range of group and one to one activities. People told us when they came to the service staff asked them about their hobbies and interests so that suitable activities could be provided for them. During our inspection visit we saw people play table tennis, attend an art class, and have games of dominos. People said staff took them out to the shops or the pub if they wanted this.

The interior of the premises had been decorated to provide people with interesting things to look band sensory items to touch. The garden was popular with people as it was secure, level and easy to access. We saw a number of people use the garden either on their own or with staff accompanying them. The design and decoration of the premises helped to provide a stimulating environment for people.

All the people we spoke with said were satisfied with the quality of the service which they said they would recommend to others. They told us the service had a friendly atmosphere and visitors were welcome at any time.

People told us the manager, providers, and staff asked them for their views at meetings and on a one to one basis and listened to what they said. For example, at the July 2017 residents meeting people asked for a water feature for the gardens. By the time of our inspection visit the providers had purchased one and it was at the service waiting to be installed.

People and staff said the service had improved since the new providers took over. The premises were being refurbished and the gardens landscaped. Other positive changes included higher staffing levels and improvements to the dining experience for people.

At the time of our inspection visit the previous registered manager had left the service and applied to CQC to deregister. A new manager was in post and was in the process of applying to CQC to be the next registered manager.