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Archived: Clarendon Nursing Home Requires improvement

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Reports


Inspection carried out on 29 April 2015

During an inspection to make sure that the improvements required had been made

We carried out an unannounced comprehensive inspection of this service on 8 and 9 July 2014. Breaches of legal requirements were found. This was because call bells were sometimes out of peoples reach. The provider did not monitor the call bell system or check how long it took staff to attend to people. People’s care and care records were task based and did not focus on people as individuals with little information about people’s choices, their likes and dislikes and what they liked to do with their time. People were not always provided with the encouragement or support they needed to be involved in stimulating activities or follow their interests and hobbies.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on the 29 April 2015 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Clarendon Nursing Home’ on our website at www.cqc.org.uk’

Clarendon Nursing Home provides nursing care for up to 51 people who have various complex needs including mental health, learning disabilities and dementia. There were 43 people living at the home when we visited. There was a registered manager in place. 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 our focused inspection on the 29 April 2015, we found that the provider had followed their plan and legal requirements had been met.

Most people had access to call bells in their rooms or had pendants that they could carry with them and allowed them to call staff if they needed to. Risk assessments were in place for those people who did not have call bells.

A system had been developed to monitor staff response time to call bells on each floor of the service.

Improvements had been made to people’s care records which now contained information that focused on people as individuals. People’s life history, hobbies and interests, likes and dislikes were noted together with details of how they would like to be cared for. However, sometimes what was written in people’s care plan was not always carried out in practice, we spoke with the manager about how they were going to make this better.

More one to one activities were available for people to help stop them from feeling lonely or socially isolated. Staff had begun to put people at the centre of their care rather than focusing on the task alone. We observed staff encouraging people to join in with activities and engage with people at lunchtime.

Inspection carried out on 8 and 9 July 2014

During a routine inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

We carried out this unannounced inspection on 8th July 2014 and returned on 9th July 2014.

At the last inspection in August 2013 the service had met the regulations we looked at.

Clarendon Nursing Home provides nursing care for up to 51 people who have various complex needs including mental health, learning disabilities and dementia. There were 47 people living at the home when we visited. There was a registered manager in place. 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.

Most people we spoke with were positive about many aspects of the care they received at Clarendon Nursing Home and thought they were well looked after. People told us they felt safe at the service, but said they often had to wait a long time for staff to assist them. They told us care staff were very busy and often did not have the time to talk with them.

We saw some people’s call bells were out of reach or not working and some people had to wait for long periods before staff attended to them. The provider confirmed call bell response times were not recorded or routinely monitored.  Without regular recorded checks, the provider was unable to confirm staff attended to people in a timely way. This was a risk to people’s welfare and safety and you can see what action we have told the provider to take at the back of the full version of the report.

We found that people’s healthcare needs were assessed. However, we saw care was mainly based around completing tasks and did not take account of people’s individual preferences. We were concerned that some people may have felt isolated as there was not enough meaningful activities for people that took into account their social needs, interests and wishes. You can see what action we have told the provider to take at the back of the full version of the report.

Systems and processes were in place to protect people from foreseeable harm, and act on concerns in order to keep people safe. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes and hospitals. We found there were no DoLS authorisations in place at the time of our inspection.

People told us they felt safe at Clarendon Nursing Home. The staff we spoke with understood the procedures they needed to follow to ensure that people were safe. They were able to describe the different ways that people might experience abuse and the correct steps to take if they were concerned that abuse had taken place.

Staff were up-to-date with a range of core training and received regular supervision and support. Staff told us they felt supported by the manager.

Staff supported and assisted people in a kind and helpful manner treating them with dignity and respect. We saw that people’s healthcare needs were attended to and healthcare professionals were contacted as and when necessary.

Staff felt supported by their manager and said the registered manager was open to suggestions from staff and visiting professionals on how to improve the service. We saw that appropriate action was taken in response to incidents and steps were taken to reduce the risk of incidents reoccurring.

Inspection carried out on 13 August 2013

During a routine inspection

On the day that we visited there were 43 people living at Clarendon Nursing Home. Many of them had a degree of dementia or short term memory loss. However, some of them were able to talk with us and they told us that they were very happy living there. They told us that the staff were “very kind”, and “very helpful”. Visitors told us that they always felt welcome in the home and that staff kept them informed about any changes in their relative’s health. By using the Short Observational Framework for Inspections we were able see that those people who found it difficult to communicate with us showed signs of positive engagement with staff and their surroundings.

People told us that they were free to spend their days as they wanted to, joining in with activities or occupying themselves. Those people who were mobile were free to walk around the home as they wished and out into the garden. The home had a designated area for people who wished to smoke.

Care was planned and delivered in line with people’s individual care needs. Families were involved in discussions about how people liked to be supported. Regular reviews made sure any changes were identified and addressed.

Staff recruitment procedures were in line with the regulations and checks ensured that those judged as being unsuitable to be working with vulnerable people were prevented from doing so. A training programme was in place for staff to help them meet the needs of the people that they were supporting.

Inspection carried out on 27 November 2012

During an inspection to make sure that the improvements required had been made

At our last visit to this home we had raised some concerns about the way that people were supported at mealtimes. The manager of the home sent us an action plan about how they would address the issues in order to become compliant with the regulations.

People and their relatives that we spoke with at this inspection told us that they were generally very happy with the service. People had a choice about how they spent their days and those that were mobile were free to walk around as they wished. Their relatives told us that they were always kept informed about what was going on and about any changes in peoples care.

We received several positive comments about the food served in the home. These included ”the food is very good and there is a choice”, and “the food seems ok”. One relative told us “my friend says the food is lovely”.

Everyone agreed that the staff were kind although some people considered that there were not always enough of them, particularly at the weekends.

Some comments were received about a lack of things to do. We were told that this is being addressed and a new activities organiser is in the process of being recruited.

Inspection carried out on 30 April 2012

During an inspection in response to concerns

Those people who were able to talk to us were all very positive about the service. Comments included "I'm quite happy here", "I have a nice room" and "staff are really helpful and kind".

However, some of the people who use this service, have dementia and are limited in their ability to communicate. So we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us to understand the experience of people who are not able to talk to us.

We saw several examples of good engagement between people and the staff in the home however there were also other areas where we considered that improvements were needed. This was particularly related to making sure that mealtimes are a pleasurable occasion for everyone.