Clare Court Care Home

Clare Court Care Home is a nursing home providing accommodation, personal and nursing care to up to 80 people. The service provides support to older adults and people living with dementia. At the time of our inspection there were 61 people using the service. The home is split into three floors. The ground floor accommodates people who require residential care, the middle floor provides support to people living with dementia and the top floor accommodates people with nursing care needs. However, there were people on all floors living with dementia. Everyone had en-suite facilities in their rooms. People shared lounges and a separate dining area on each floor. There was also a communal garden area.

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

The management team had not always investigated how serious injuries had occurred at the time of the injury. Risk assessments did not always provide enough guidance to robustly manage risks. Relatives of people receiving care and staff felt staffing levels were not always adequate. We found evidence of the inappropriate use of low-level restraint without assessment and guidance for staff. We saw significant improvements in medicines management.

People’s care was not always person centred and did not always reflect their wishes. Monitoring and recording of food and fluid consumption for people at risk of losing weight was not adequate. People enjoyed the food served to them. We saw improvements in staff induction training and support.

We saw and heard evidence about examples of both poor and good practice with regard to promoting dignity respect and independence. We saw examples of staff not respecting people’s privacy and not treating them in a dignified way. Some people and relatives told us staff were respectful of their privacy and dignity.

People and their relatives told us they felt there was not enough for them to do. This particularly impacted people who were mainly cared for in their rooms.

Systems to monitor the care people received and ensure they were safe and well, were not effective. Opportunities to learn when things had gone wrong had been missed.

People were not always supported to have maximum choice and control of their lives and staff did not always 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.

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 08 September 2022) 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 the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part by notification of an incident involving a person who was using the service . The information shared with CQC about the incident indicated potential concerns about the management of risk of falls. This inspection examined those risks.

You can see what action we have asked the provider to take at the end of this full report.

The provider has put together an action plan based on the concerns found at this inspection and has stated they are working to address all areas of concern. The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

Enforcement

We have identified continued breaches in relation to lack of personalisation of people’s care, management of people’s safety, staffing levels and deployment and systems and processes to monitor overall quality of care. We identified a new breach in relation to protecting people from the risk of abuse. We found the service was no longer in breach with regard to how it was supporting people in line with the Mental Capacity Act (MCA) 2005.

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.

Special Measures

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.

Clare Court Care Home is a nursing home providing personal and nursing care to up to 80 people. The service provides support to older adults and people living with dementia. At the time of our inspection there were 57 people using the service. The home is split into three floors. The ground floor accommodates people who require residential care, the middle floor provides support to people living with dementia and the top floor accommodates people with nursing care needs. However, there were people on all floors living with dementia. Everyone had en-suite facilities in their rooms. People shared lounges and a separate dining area on each floor. There was also a communal garden area.

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

We found a number of risks to people’s health and safety around the home which had not been identified by the management team. Staff who could administer medication had not all completed their competencies to ensure they were still practicing safely. Some errors in recording of people’s medicines were found. People at risk of losing weight had not had their food and fluid intake measured adequately to ensure the risk was mitigated. The management team had struggled to recruit staff and some agency staff had been needed. Some people and their relatives were concerned about this and wanted a stable staff team.

People and their loved ones were not always involved in their care planning. Care plans lacked information to support staff to provide more person-centred care. Staff had not received adequate supervision and many of the staff we spoke with felt unsupported by the management team. More adaptations to the home were needed to meet people’s health care needs. People and relatives spoke highly of the food, but improvements could be made to support people living with dementia to make choices about what they wanted to eat.

Systems and processes had failed to identify many of the concerns we found during the inspection. In some cases, risk had been identified but insufficient action had been taken to mitigate it. For example health and safety audits had noted carpets were odorous and needed replacing, but action was not taken to do this in a timely way. The management team had not ensured staff had completed all the mandatory training in line with organisational policy.

People were not supported to have maximum choice and control of their lives and staff did not always 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.

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 January 2022) 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 the provider remained in breach of regulations. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We received concerns in relation to medicines and managing choking risk. As a result, we undertook a focused inspection to review the key questions Safe, Effective and Well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating of the service has remained requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. We found the provider had taken effective action to improve care for people with choking risk. We found some concerns with regard to medicines management. Please see the Safe Effective and Well Led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to health and safety, training and supervision of staff, assessing mental capacity, person centred care and the governance systems 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 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.

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.

Clare Court is a residential care home providing accommodation, nursing and personal care to 65 people, most of whom were older people including those living with dementia at the time of the inspection. The home is set in a large purpose-built building which can support up to 80 people over three floors.

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

Risks to people were not always assessed and some care plans were not up to date and accurate. Care plans were not always in place and not always accurate and followed. People did not always receive their medicines as prescribed and medicine storage was not always in line with NICE guidance.

People and relatives spoke positively of the home and staff. They told us people were safe and their needs known. Infection control procedures were in line with government guidance and staff continued to be recruited safely.

A lack of managerial oversight meant systems to monitor the quality and safety of the service were not always sufficient and had not identified the areas for improvement found at this inspection.

People were supported to have maximum choice and control of their lives and staff them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Rating at last inspection

The last rating for this service was Good (published 06 October 2018).

Why we inspected

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.

We received concerns in relation to people losing weight and medicines not being properly administered. 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.

We have found evidence that the provider needs to make improvement. Please see the Safe and Well-led sections of this full report.

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 Clare Court 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 monitor the service 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 the safe care of people and the oversight of documents and records at this inspection.

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. 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.

The home is registered to provide accommodation and personal care, for a maximum of 80 people and there were 70 people living at the home on the first day of the inspection and 71 people on the second day of the inspection.

A registered manager was in place. A 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.

People felt safe living at the home. Staff were available to people and demonstrated good knowledge about people living at the home.

People were cared for by staff who were trained in recognising and understanding how to report potential abuse. Staff knew how to raise any concerns about people’s safety and shared information so that people’s safety needs were met.

People were supported by staff to have their medicines and records were maintained of medicines administered. Staff maintained good hygiene and used protective clothing when appropriate.

Staff attended regular training to ensure they kept their knowledge updated to support people living at the home. The principles of the MCA (Mental Capacity Act) had been applied. Deprivation of liberty safeguarding (DoLS) applications had been made and reviewed appropriately. Staff understood the importance of gaining people’s consent to care and supporting people’s choices.

People enjoyed a good choice of meals with menus reflecting people’s cultural heritage. People were supported to access professional healthcare outside of the home, for example, they had regular visits with their GP and any changes to their care needs were recognised and supported by staff.

People said staff were caring and treated them with respect. We saw people were relaxed around the staff supporting them and saw positive communication with staff. Staff showed us that they knew the interests, likes and dislikes of people and people were supported to enjoy various activities. We saw that staff ensured that they were respectful of people’s choices and decisions.

People knew how to raise concerns and felt confident they could raise any issues should the need arise and that action would be taken as a result.

People, relatives and staff were positive about the overall service and complimented the registered manager and the improvements made under their management. The registered manager demonstrated clear leadership and staff were supported to carry out their roles and responsibilities effectively, so that people received care and support in-line with their needs and wishes. The quality of service provision and care was monitored by the management team and actions taken where required.