Archived: Clann House Residential Home

Clann House is a residential care home providing personal care and accommodation for up to 34 predominantly older people. There where 32 people living in the service on the day of our visit. Accommodation is spread over two floors. Clann House is an older style property on the outskirts of Lanivet village, which is near Bodmin.

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

People were relaxed and comfortable with staff and had no hesitation in asking for help from them. Staff were caring and spent time chatting with people as they moved around the service.

There were sufficient staff on duty to meet people’s needs. However, there was a high use of agency staff. The registered manager informed us they were in the process of recruiting additional staff and had had some difficulties with recruitment during the early part of the pandemic.

The building was clean, and there were appropriate procedures to ensure any infection control risks were minimised.

Cleaning and infection control procedures had been updated in line with Covid-19 guidance to help protect people, visitors and staff from the risk of infection. During the summer months some families had met people in the garden and new arrangements were in place for families to meet in a safe area of the home during the winter months.

People received their medicines safely and on time.

The service had suitable safeguarding systems in place, and staff knew how to recognise and what to do if they suspected abuse was occurring.

Care plans included risk assessments and guidance for staff on how to meet people’s support needs. Risk assessment procedures were satisfactory so any risks to people were minimised.

The service was managed effectively. There were had appropriate audit and quality assurance systems in place.

Why we inspected

We undertook this targeted inspection to check on specific concerns we had received about staffing levels, medicine management, safeguarding incidents not being reported or followed up and recruitment practices. There was also concerns over the management of the service. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We found no evidence during this inspection that people were at risk of harm from these concerns.

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 Clann House on our website at www.cqc.org.uk.

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.

Clann House is a residential care home providing personal care and accommodation for up to 34

predominantly older people. Accommodation is spread over two floors. Clann House is an older style property on the outskirts of Lanivet village, which is near Bodmin.

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

The service had suitable safeguarding systems in place, and staff knew how to recognise and what to do if they suspected abuse was occurring.

Risk assessment procedures were satisfactory so any risks to people were minimised.

Staff were recruited appropriately. Overall, satisfactory recruitment procedures were followed in line with interim guidance issued by CQC during the Covid 19 Pandemic.

The building was clean, and there were appropriate procedures to ensure any infection control risks were minimised.

Assessment and care planning systems were satisfactory. Care plans outlined people’s needs and were reviewed when people’s needs changed.

People said they received support from staff which was caring and respectful. Care promoted people’s dignity and independence. People were involved in decisions about their care.

The team worked well together and had the shared goal of providing a good service to people who lived at the service.

The service was managed effectively. The service had appropriate audit and quality assurance systems. People, relatives and staff had confidence in the management of the service.

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 Requires Improvement (published 30 March 2020). 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 the regulations.

Why we inspected

We undertook this targeted inspection to follow up on actions taken after enforcement action was taken, subsequent to our report published on 22 October 2020. Our report published on 30 March 2020 found improvement in the operation of the service. This inspection wanted to check suitable action had been taken regarding outstanding regulatory breaches, and previously noted improvements had been sustained.

CQC have introduced targeted inspections to follow up enforcement action. They do not look at an entire key question, only the part of the key questions we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of the key question.

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.

Clann House is a residential care home providing personal care and accommodation for up to 34 predominantly older people. At the time of the inspection 24 people were living at the service. Accommodation is spread over two floors. Clann House is an older style property on the outskirts of Lanivet village.

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

Although there had been some improvements to the service since our previous inspection there were still areas of concern which could impact on people’s experiences. Everyone had care plans in place, but these were not consistent in quality. Some were brief and lacked detail on how people needed and preferred to be supported. Others were not up to date and did not include information provided by other agencies.

Staff were not always proactively supporting people. Some people living at Clann House were routinely refusing support to bathe or shower. There was a lack of guidance for staff on the action they could take to persuade people when they were reluctant to accept support in this area. One person’s oral health care records stated ‘no toothbrush’ for eight consecutive days.

Monitoring records were in place to highlight when specific aspects of people’s well-being, such as their weight, indicated they were at risk of deteriorating health. These were generally completed but there was not always evidence action was taken in response to concerns highlighted by the records.

Because of their health condition some people could exhibit distressed behaviours and were often unpredictable. Not all staff had received training in supporting people when they were agitated or were confident supporting people at these times. We have made a recommendation about this in the report.

Generally untoward incidents were reported to the local authority and CQC in line with local processes and legal requirements. However, we did identify occasions when this had not been completed.

An activity co-ordinator had spoken with people to find out what their interests were. This meant they were able to provide activities and pastimes which were meaningful and enjoyable for people. Links with the local community had improved and this aspect of the service was being further developed.

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.

A new manager had been appointed since our last inspection and was in the process of applying for registration. They told us they recognised there were improvements which still needed to be carried out but they were committed to progressing the service.

Staff told us they felt well supported and changes made had been an improvement. The service had taken on new staff and recruitment was continuing. When necessary agency staff were used to cover gaps in the rota.

The provider, nominated individual and managers from the providers other services had visited Clann House regularly since the previous inspection. They continued to support the new manager and were available for advice when required. Necessary resources were made available.

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 inadequate (report published 22 October 2019) and there were multiple breaches of regulation. This was the third consecutive inspection the service had been rated less than good.

Following the inspection, the service was placed in ‘special measures’ and we took enforcement action. 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.

After the last inspection the provider continued to submit monthly action plans to show what they would do and by when to improve. This was a condition of registration imposed following an inspection in November 2018 when the service was found to be in breach of regulation and rated as requires improvement.

At this inspection not enough improvement had been made and the provider was still in breach of regulations.

The last rating for this service was inadequate (published 22 October 2019). The service has now improved to requires improvement. This service has been rated requires improvement or inadequate for the last four consecutive inspections. The service is no longer in special measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Enforcement

We have identified breaches in relation to the identification and management of risk including risk of abuse, providing care in line with people's needs and preferences and the governance and oversight of the service.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Clann House is a residential care home providing personal care and accommodation for up to 34 predominantly older people. At the time of the inspection 28 people were living at the service. Accommodation is spread over two floors. Clann House is an older style property on the outskirts of Lanivet village.

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

The service had been short staffed and was heavily dependent on a number of agencies to help fill gaps in the rota. There had been several occasions during the weeks preceding the inspection when there had not been enough staff to meet people’s needs. Although the service was fully staffed on the day of the inspection we found care was task based and staff had little time to spend talking to people or engaging them in activities. When staff were supporting people they were gentle and reassuring in their approach.

Systems for managing medicines and ensuring people were supported in line with advice and guidance from external healthcare professionals were not robust. When monitoring records completed by staff indicated people’s health was deteriorating action was not taken to address the issues.

Accidents and incidents were not consistently recorded or escalated to the provider, the local authority or CQC.

People did not have access to meaningful occupation. We observed some people spent their day disengaged and asleep or withdrawn. There were limited opportunities to go out on trips or drives. These were restricted to people who were independently mobile.

Records showed people had limited opportunities for baths or showers and oral care was not regularly completed.

Staff told us they received training and supervision and were well supported. However, they said the staff shortages had been ‘stressful’ and had impacted on the quality of care they were able to provide.

People’s needs were assessed when they started using the service. Ongoing reviews and assessments were not consistently completed.

There was limited information about people's preferences for end of life care. Only a few staff had received training in this area. We have made a recommendation about this in the report.

There had been a lack of oversight of the service. The provider was based in a different part of the country. They had five other locations which were also some distance away. This meant the registered manager did not have access to peer support from other managers in the organisation. They told us they were well supported by the area manager who visited regularly. However, the systems in place to monitor the service and drive improvement had failed to identify and address shortcomings.

Following our previous inspection we issued positive conditions requiring the service to provide CQC with monthly reports to evidence they had completed audits into specific areas and describe any actions taken as a result of those audits. The areas covered were medicines, including stock management, premises and staff training. While we found improvements had been made to the premises and staff training was mainly up to date we remained concerned about the management of medicines. Other areas of the service had deteriorated since the previous inspection.

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 (last report published in June 2019) and we issued a positive condition as that was the second consecutive time the service had been rated requires improvement. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

This inspection was planned to follow up on action we told the provider to take at the last inspection. The inspection was brought forward due to concerns received about the management of pressure sores and low staffing. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the full report.

Since the inspection the provider has made arrangements for more robust oversight of the service. The service is working with external healthcare professionals and other agencies to try and make the necessary improvements.

Enforcement

We have identified breaches in relation to the management of medicines, keeping people safe from identified risks, infection control, learning from poor experiences and events, reporting concerns outside of the organisation, systems for auditing and monitoring the service, staffing and a lack of effective oversight of the service.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

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.

Clann House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Clann House accommodated up to 34 people. At the time of the inspection 32 people lived at the home.

The service did not have a registered manager, although the current manager had submitted an application to be registered with the Care Quality Commission. 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.

At the last inspection, in November 2017, the service was rated as ‘Requires Improvement.’ This was because we had concerns about the management of medicines and because mental capacity assessments were not being completed. The registered persons had not always submitted statutory notifications to the Care Quality Commission when they were required to do so. There were insufficient systems to assess, monitor and improve the quality of the service.

At this inspection we found that satisfactory action had been taken in respect of mental capacity assessments, and we had no evidence to suggest the registered persons did not notify us of relevant events required by law. However, we still had concerns about the operation of the medicines system. We also did not subsequently think audit systems were satisfactory. This was because the systems in place did not identify the problems we found with the medicines system. The registered persons did not take appropriate action to ensure the system worked effectively.

The service was viewed by people we spoke with as very caring. We received positive comments about the service. For example we were told, “They are lovely here and very respectful, “ and “They are very good and very helpful.” Relatives told us, "They are friendly and patient,” and “They are very caring and seem to look after everyone here and are very good to all the families to. They are really, really good.” A staff member told us, “Care is really good. I don’t have any issues, “ Care is amazing, really good,” and “Staff are lovely.”

Everyone we observed looked well cared for. People were clean and well dressed.

The service provided a range of activities. An activities co-ordinator was employed. There were limited external activities available. The service had a vehicle but the rear wheelchair ramp was not working. We have recommended that the registered provider reviews activities provision including current transport arrangements.

People told us they felt safe. For example people told us, “Yes. It is important to feel safe,” “I do and have always done,” and “They do all they can to help us all. They are very good and most kind.” The service had a suitable safeguarding policy, and staff had been appropriately trained to recognise and respond to signs of abuse.

People had suitable risk assessments to ensure any risks of them coming to harm were minimised, and these were regularly reviewed. Health and safety checks on the premises and equipment were carried out appropriately.

There were enough staff on duty to meet people’s needs. Recruitment checks were satisfactory. For example, the registered provider obtained two written references and a Disclosure and Barring check to ensure the person was suitable to work with vulnerable adults.

Staff members received an induction. The registered provider was aware of the Care Certificate. This is a set of national standards for staff coming into the health and social care sector. There was evidence some, but not all staff had completed this although it was the provider’s policy for staff without care qualifications to do so. Although staff had attended most training which is required by health and safety law, not all staff had received an appropriate level of first aid training, or training to care for someone who was having an epileptic seizure. This could put people at serious risk.

We had concerns about how the medicines’ system was managed. Medicines were stored securely, and there were satisfactory systems to dispose of medicines which were no longer required. Staff who administered medicines received suitable training. Some people self-administered their medicines. Records about the administration of medicines were mostly satisfactory. However, we found some cases where medicines were not administered but were signed to state they had been administered. Records also showed that some prescribed medicines had not been administered because there were not sufficient stocks.

The service was clean and hygienic. The building was suitable to meet the needs of the people who lived there. The building was well laid out, pleasantly decorated and homely. However, we had concerns about the water supply to some areas of the building. There was limited flow of water from some taps, in some people’s bedrooms. This made is difficult for people to have a wash. The supply also affected the upstairs bathroom, so people had to use facilities downstairs. There were also problems with heating in some bedrooms. Although some electric or fan heaters had been provided, the lack of appropriate heating resulted in these rooms feeling cold on the day of the inspection.

There were suitable assessment processes in place before someone moved into the service. These assisted in helping staff to develop care plans. We were told staff consulted with people, and their relatives, about their care plans. Care plans were regularly reviewed.

People enjoyed the food and were provided with regular drinks throughout the day. Support people received at meal times was to a good standard. Comments about food included: “The food is amazing and I am fussy with food,” and “They do us a lovely roast on Sunday and usually a choice of two mains.”

The service had well established links with external professionals such as GP’s, Community Psychiatric Nurses, District Nurses, and social workers. However, records were not always sufficient to demonstrate that people, wanted, needed, and routinely saw some medical professionals such as opticians and dentists.

Some people lacked mental capacity. Where necessary suitable measures had been taken to minimise restrictions. Where people needed to be restricted, to protect themselves, and/or others, suitable legal measures had been taken. No physical restraint techniques were used at the service. Staff had received suitable training about mental capacity.

The service had a satisfactory complaints procedure. People we spoke with felt they could raise a concern or complaint, and these would be responded to appropriately.

The manager was respected and liked by people, relatives and staff we spoke with. The manager had a hands on approach. One person told us, "The people in charge are very good and she’ll (the manager) will do anything to help you and is always there.” Staff also said team working at the service was good, and team members were supportive and communicated well with each other.

We have concerns about the absence of effective quality assurance systems. This is because systems should have picked up concerns we found about the operation of the medicines system and taken suitable action to improve the system. The system in place did not do this. We were also concerned quality assurance systems had not picked up other issues of concern raised in this report for example problems with heating and water supply, and shortfalls in training provision.

We found breaches of regulations. 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.

The service is required to have a registered manager and at the time of our inspection there was no active registered manager in post. 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 and associated Regulations about how the service is run. The registered manager had left the organisation in May 2017 but no steps to cancel the registration had been taken. The manager told us they would be applying to be the registered manager and were awaiting preliminary checks to be completed.

People told us they were happy with the care they received and believed it was a safe environment. There were several staff vacancies and agency workers were frequently used to maintain staffing levels. The manager also regularly covered care shifts. This meant they had less time to spend completing managerial duties. We identified gaps in staff training and noted there was no plan for staff supervision in place. Agency workers were required to complete an induction to familiarise themselves with the service. This had not been completed by all the agency staff. Recruitment was on-going and the manager told us they were confident the situation was improving. Recruitment checks were carried out before new staff started work. There was an induction process in place to help ensure staff had the relevant skills and knowledge required for the role.

People received their medicines on time and as prescribed. Staff supported people to access healthcare services such as occupational therapists, GPs, chiropodists and dieticians. Relatives told us staff always kept them informed if their family member was unwell or a doctor was called. Records in respect of the care and support people received were accurate and up to date. Care plans were regularly reviewed.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA). The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). DoLS applications had been submitted for some people. There was no evidence any capacity assessments had been completed before submitting the applications. This was not in line with the legislation laid down in the MCA.

The atmosphere was friendly and relaxed. People had good and meaningful relationships with staff and staff interacted with people in a caring and respectful manner. During the inspection we frequently saw staff stopping to exchange a few words with people and enquire after their well-being.

Staff knew how to recognise and report the signs of abuse. There was an up to date safeguarding policy in place and information on local reporting procedures was available to staff. Any risks in relation to people’s care and support were identified and recorded. The records guided staff on the actions they should take to protect people from any identified risk. There were systems in place to help ensure staff were kept informed of any changes in people’s needs.

There was a daily choice of menu and people told us they enjoyed their meals. People had access to a varied and healthy diet. When necessary food and fluid records were kept to help ensure people received enough to eat and drink.

People had limited opportunities to take part in organised activities. There was no activity co-ordinator in place at the time of the inspection. The manager told us this position was being advertised. Visits by external entertainers were infrequent although there were plans to develop this area of the service. Staff had not received training in providing meaningful activities for people living with dementia. We have made a recommendation about this in the report. During the inspection we saw people were supported to occupy themselves. We saw people knitting, using adult colouring books and reading daily newspapers.

Staff had a positive attitude and told us they enjoyed their jobs and worked well together. The manager was supported by the organisation's senior management team and senior care workers. Audits of various aspects of the service were completed. This included medicines, the environment, equipment and money. There had been no infection control audit since February 2017.

People and their relatives were not asked for their views on the service. No quality assurance questionnaires had been circulated to families since June 2016. Residents meetings were not arranged. There was no other formal means of gathering people’s views in place. Staff meetings were not being held. The service had not notified the Care Quality Commission (CQC) of all significant events which had occurred in the service.

We identified breaches of the Regulations. You can see what action we have asked the provider to take at the back of the full report.