This inspection was carried out on the 7 April 2015. Claremont Court is a service that is registered to provide accommodation and nursing care for 57 older people some of whom are living with dementia. Respite care is also provided. This provides temporary relief to those who are caring for family members, who might otherwise require permanent placement in a service outside the home. The registered provider is Carebase (Claremont) Limited. Accommodation is provided over three floors. The top floor is primarily for people who are more independent where some people are living with dementia, the middle floor is for people who are all living with dementia and the ground floor is for people who mostly have advanced dementia and have more physical needs. On the day of our visit 52 people lived at the service.
On the day of our visit there was a registered manager in day to day charge. 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 2014 and associated regulations about how the service is run.
There was not always guidance for staff in relation to the safe administration of people’s medicines. Where people needed an ‘As required’ medicine there was no information for staff on when this should be given. There was no guidance from the pharmacy on the best way to give covert medicines where people were receiving them. This is a breach of regulation 12 of the The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Medicines were stored appropriately and audits of all medicines took place.
Staff did not always have the most up to date guidance in relation to their role. The service’s mandatory training had not been completed by all of the staff and nurses were not up to date with their clinical knowledge which included wound and catheter care.
One to one meetings were not regularly undertaken with staff and their manager and appraisals had taken place for all staff. This is a breach of regulation 18 of the The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
There were not sufficient numbers of staff deployed to meet people’s needs. People were left on their own in the lounge for periods of time which was a risk to their safety. These are a breach of regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
People and relatives said they felt their family members were safe from abuse. However two relatives said that they were concerned that their family member was left on their own for too long.
The service was not always clean. There was a risk of infections spreading where soiled laundry had not been kept separate from un-soiled laundry. This is a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Risk assessments for people were up to date and detailed. Each risk assessment gave staff information on how to reduce the risk. These included risks of poor nutrition, choking and falls. Staff had a good understanding of each person’s risks.
There were complete pre-employment checks for all staff. This included full employment history and reasons why they had left their previous employment. This meant as far as possible only staff with the mix of skills and competencies were employed.
Staff had knowledge of safeguarding people and what to do if they suspected abuse.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes . Staff had knowledge of their responsibilities under the Mental Capacity Act 2005 (MCA), and the Deprivation of Liberty Safeguards (DoLS). However the registered manager had not submitted DoLS applications to the local authority for people in the service who’s liberty may need to be deprived. Where people lacked capacity and had bed rails, applications had not been to the local authority in relation to their liberty being deprived. These are breaches of regulation 11 and 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Staff gave examples of where they would ask people for consent in relation to providing personal care. We saw several instances of this happening during the day.
People were not offered a choice of meals. Menus were not available in a format big enough for people to see. Those people who needed support to eat did not always receive this in a timely way. This is a breach of regulation 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
People and their relatives said that the food was good. We saw that there was a wide variety of fresh food and drinks available for people throughout the day.
People had access to external health care professionals as and when they required it.
There were times when staff were not considerate of people living at the service. One person’s radio had not been tuned in properly to a radio station for most of the morning which meant that they had not been able to listen to anything. This is a breach of regulation 9 of the Health and Social Care Act 2008 (Regulated Activities)
People and relatives felt that staff were kind. People were treated with kindness and compassion by staff throughout the inspection. Staff acknowledged people warmly and sat talking with people. Where people were anxious staff responded in a caring and reassuring way.
We saw that staff knew and understood people’s needs in relation to the care that they received.
People were not always treated with dignity and respect. People were being alternately supported to eat during meal times and staff were seen to stand over people to put food into their mouths. This is a breach of regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Staff knocked on people’s doors and waited for a response before entering and personal care was given in the privacy of people’s own rooms or bathrooms.
We were not provided with any evidence of how complaints had been addressed however there was a complaints policy which people and relatives had knowledge of.
People’s personal history, individual preferences, interests and aspirations were all considered in their care planning. Care plans provided staff with information so they could respond positively, and provide the person with the support they needed in the way they preferred.
Care plans were reviewed every month to help ensure they were kept up to date and reflected each individual’s current needs. We found instances where a change had occurred and care was changed to reflect this. Staff responded to people’s needs as and when they needed it.
There was a programme of activities in place and an activities coordinator who worked part time at the service. People were also supported to access the outside community.
Audits of systems and practices carried out were not always effective. Where concerns had been identified these were not always addressed. This is a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Staff said they felt supported and were listened to by the registered manager. Regular staff meetings took place and staff contributed to how the service ran. Meetings were minuted and made available to all staff.
Annual surveys were sent to the relatives who were very complimentary of the service.
You can see what action we told the provider to take at the back of the full version of the report.