Clarendon Hall Care Home

Clarendon Hall is a purpose-built residential care home that provides accommodation, nursing and personal care to a maximum of 49 people, including people living with dementia. At the time of inspection 42 people were living at the service.

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

Staff supported and engaged with people positively. Staff knew people well and knew how to report any concerns.

People had support from safely recruited staff. Staff received training in safeguarding and followed clear guidance which helped to protect people from abuse. Care plans included risk assessments for known risks and staff followed support plans to help keep people safe.

People were involved in reviewing their care plans and risk assessments. People told us they felt safe.

Staff had positive links with healthcare professionals which promoted people's wellbeing. Records confirmed the registered manager worked in partnership with stakeholders.

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

Rating at last inspection

The last rating for this service was good (published 27 January 2020).

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of people’s safety. This inspection examined those risks.

We use targeted inspections to follow up on Warning Notices or to check 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 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 found no evidence during this inspection that people were at risk of harm from this concern.

The overall rating for the service has not changed following this targeted inspection and remains good.

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

Follow up

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

Clarendon Hall is a purpose-built care home that is registered to provide personal and nursing care to older people. The care home accommodates up to 52 people and on the day of inspection 38 people were using the service.

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

Since the last inspection, there had been improvements in medicines management, record keeping and quality monitoring. The quality of care records in relation to consent had improved. Recruitment records contained appropriate references and checks. Where people required support with their medicines this was managed safely and the standard of recording on medicine administration records had improved.

The provider’s quality monitoring system had been completed more consistently. Audits were effective and more regular infection and prevention audits were put in place during the inspection. New monitoring systems had been introduced and shortfalls were addressed. All feedback was used to make continuous improvements to the service.

People received an extremely responsive service. People's care needs were thoroughly assessed. Their care was personalised to their preferences and routines, which enabled them to live their lives in the way they wanted. People were supported to have a comfortable, dignified and pain-free death by staff who worked closely with end of life health care professionals.

The service was continuously developing their excellent activities programme. People stayed as active as possible with a range of innovative, meaningful activities offered each day. People developed strong connections with others living at the service and within the community. Staff supported people to achieve their wishes and dreams.

People were happy with the care provided as staff were kind, caring, attentive and respectful. Staff had developed positive relationships with people. Staff were motivated and positive about their role and demonstrated the provider's values of ‘kindness in care.’ People were encouraged to make their views known and the service responded by making changes.

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.

People and relatives said the service was safe. Staff knew how to recognise abuse and were confident in reporting any concerns. Risks to people had been assessed and mitigated. Staff had the skills and knowledge to meet people’s needs. The management team supported staff through supervision, team meetings and annual appraisals.

Staff supported people to access appropriate healthcare services, followed professional advice and provided consistent care. People were encouraged to eat a healthy diet and any concerns were raised with the relevant healthcare professionals. Staff provided support at meal times in a sensitive and patient way.

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 7 January 2019) and there was one breach 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 regulations.

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.

At the last inspection in October 2016, the service was rated Good. At this inspection we found some concerns with the quality of the service. Medicines were not consistently managed in a safe way and improvements were needed with aspects of the recruitment process and the care recording systems. We have rated the service Requires Improvement.

Clarendon Hall Care Home accommodates up to 52 people. The building is purpose built with lift and stair access to the first floor. Accommodation consists of single occupancy rooms over two floors. There are communal areas on the ground floor, including a dining room and a range of sitting rooms. At the time of this inspection 44 people were using the service.

Clarendon Hall Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a registered manager in post. A registered manager is a person who has registered with the 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.

There were shortfalls in the administration and recording of some people’s medicines. People had not always received their medicines as prescribed due to stock control or administration practices.

Staff demonstrated a good awareness of safeguarding procedures and knew who to inform if they witnessed or had an allegation of abuse reported to them. The registered manager was aware of their responsibility to liaise with the local authority where safeguarding concerns were raised and such incidents were managed well.

The provider's systems to assess, monitor and improve the quality of the service provided had not been effective in identifying and addressing all the issues highlighted during our inspection, although the area director acted during the inspection to speak with senior staff, implement new supplementary recording systems and direct senior staff to complete additional audits.

People told us they enjoyed the food. A choice of food and drinks was always available. Improvements were needed with regular weight monitoring when there was increased risk identified and with the records to support the action staff had taken when people experienced poor or reduced intake. We have made a recommendation about improving the recording of people’s weights and their food and fluid intake.

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. There were some inconsistencies with consent records as it was not clear if some people had legally appointed attorneys to make decisions on their behalf. We have made a recommendation to improve consent recording and staffs understanding of this.

Overall, there were safe systems in place to manage risks to people’s health and safety. One person’s risk management plan was amended during the inspection to provide more detailed guidance for staff around their safety when eating and drinking. Accidents and incidents were reviewed to identify any actions that could be taken to prevent a reoccurrence and keep people safe.

The environment was clean and tidy and staff had access to personal protective equipment to help prevent the spread of infection. Health and safety checks were undertaken and there were appropriate procedures in place in the event of an emergency.

Staff had received training in how to safeguard people from the risk of abuse. They knew what to do if they had concerns.

Sufficient numbers of staff were employed to meet people’s needs. Overall, staff were recruited safely, but improvements were needed to ensure appropriate references were obtained.

Staff supported people to access health professionals when required and people could remain in the service for end of life care if this was their choice. People’s individual needs were identified and met. The quality of person-centred information was inconsistent and the area director implemented an additional audit programme to improve the overall quality of the records.

Staff received appropriate training which was updated when needed. Staff felt well supported and gaps in the supervision and appraisal programmes were being addressed. Staff said they enjoyed their work, there was good teamwork and a positive culture within the service.

A wide range of activities were provided and people had good access to the local community. People praised the wellbeing coordinator and told us how much they enjoyed the activities and entertainment.

People and relatives spoke highly of the staff who they described as kind and caring. We saw staff had developed good relationships with people and knew them well. Staff treated people with respect and maintained their privacy and dignity.

People, relatives and staff spoke positively about the registered manager and the way the home was managed. There were systems in place to enable people to share their opinion of the service provided and the general facilities at the home. People knew how to make a complaint and we saw complaints raised had been dealt with appropriately.

We identified one breach of regulation in relation to safe care and treatment. You can see what action we have told the provider to take at the end of the full version of this report.

Clarendon Hall is a purpose built home and is registered to provide accommodation for nursing and personal care for up to 52 people, some of whom may be living with dementia. Accommodation is provided on two floors with lift and stair access. All rooms are for single occupancy and some of these have en- suite facilities. The service is located on the outskirts of Grimsby, with public transport facilities close by. There is ample car parking available. At the time of our inspection there were 40 people using the service.

There was a registered manager in place. 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.

People told us they felt safe and trusted the staff. Training had been provided for staff about how to keep people safe from harm. Staff were employed following a robust recruitment and selection process, to ensure they were safe to work with vulnerable people and did not pose a risk to them.

Staff demonstrated a positive understanding for the promotion of people’s personal dignity and privacy, whilst involving them in making choices about their lives. Staffing levels were assessed according to the individual needs and dependencies of the people who used the service. People’s private records and information was maintained in a confidential manner.

The registered manager and staff were following the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS); they ensured people were not being deprived of their liberty in an unlawful way.

People told us they enjoyed their food and their nutritional status was monitored to ensure risks from malnourishment and dehydration were acted on with involvement of specialist health care professionals when required.

People told us that staff were caring and kind and they were happy with the support that was delivered to them. People were provided with a good variety of opportunities for social stimulation and interaction to enable their wellbeing to be promoted. People and their relatives were involved in the planning of their support which was reviewed on a regular and on-going basis. A complaints policy was in place to ensure people could raise any concerns about the service when required.

People told us the leadership at the service was approachable and supportive and they were encouraged to give their views and opinions about the service to enable it to continually improve. The registered provider promoted an open and transparent organisation and staff were supported through regular training, supervision, team meetings and annual appraisals to help them to develop their careers. The service had an effective auditing system to assess and monitor the quality of the service provided.

The registered manager was aware of their responsibilities and submitted notifications about incidents affecting the health and welfare of people who used the service to the CQC as required.

We observed staff offered choices about support that was provided to ensure people's dignity was maintained. Relatives and people who used the service told us they were regularly consulted about their individual wishes and feelings, to ensure these were promoted.

People told us their health needs were well met and that staff took prompt action to involve external professionals when this was required. A visiting district nurse told us the service worked well with her team and followed advice that was given.

People told us they were, "Happy" with the care that was provided and that staff were, "Helpful and kind." People said they felt, 'Comfortable' and "Safe." Relatives told us that concerns were taken seriously and that action was taken to address shortfalls that were required.

We found the service had an in house programme of induction and mandatory training for staff to follow, to ensure they were equipped with the skills needed to carry out their jobs.

We saw evidence that range of systems were available to enable the provider to monitor the quality of the service that was delivered. We found that regular audits and monthly reports were carried out, on key performance indicators such as accidents, complaints, medication and use of bed rails.