Archived: Claremount House

Claremount House is a residential care home providing personal and nursing care for up to 26 people. The service accommodates people in one adapted building and provides support to older people, people living with dementia and people with mental health needs. At the time of our inspection there were 16 people using the service.

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

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 were protected from the risk of abuse. Everyone told us the service was safe and staff received training so they understood how to keep people safe. Risks associated with people’s care were managed safely. Sufficient numbers of staff were on duty to meet people’s needs. The service used a high volume of agency staff, but they were regular workers and knew people well. Relatives were consistently positive about the staff. The service had effective systems for learning lessons when things go wrong. People's medicines were well managed. The service followed safe infection, prevention and control procedures.

The registered manager provided clear direction and good leadership. Feedback about the service was consistently positive. All of the relatives we spoke with would recommend the home to others. Staff felt valued and supported, and were confident people received good care. Systems and processes for monitoring quality and safety were effective.

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 24 March 2020).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Claremount House 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.

Claremount House is a residential care home providing personal and nursing care for up to 26 people. At the time of the inspection there were 21 people in the home, some of whom were aged over 65 years and were living with dementia, and others who were younger and had mental health needs. The home is purpose built with bedrooms located over two floors and communal areas on the ground floor.

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

People and relatives were happy with the care provided which they said had improved since the last inspection. A relative said, “Things had gone downhill when [CQC] last came, but they’re settling down now. It’s much calmer and there are more staff.”

There were enough staff to meet people’s needs and keep them safe. Regular bank and agency staff were used to ensure continuity of care whilst the provider recruited a permanent staff team. Staff were recruited safely and received the induction, training and support they needed to fulfil their role. Effective communication systems ensured staff knew people’s needs and how to meet them.

People and relatives were involved in planning and making decisions about their care. Care records had improved and reflected people’s needs. Medicines were managed safely. Staff were aware of risks to people and knew how to manage them. Safe systems were in place to manage any allegations of abuse and complaints.

The home was clean and well maintained. Infection control had improved although additional facilities were needed in some bathrooms and toilets for the safe disposal of clinical waste. The manager was taking action to address this.

Communal areas had been redecorated and refurbished providing a comfortable and homely environment. Some work had begun on refurbishing bedrooms, with people and relatives involved in choosing colour schemes. However, this work needed to be progressed as many of the bedrooms remained stark with few personal effects or homely touches to make the room comfortable for the person occupying it. The provider was taking action to address this.

Staff were kind, caring and compassionate. They treated people with respect and maintained their privacy and dignity. People enjoyed a variety of activities and had started to go out into the community. People had access to healthcare services and their nutritional needs were met.

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.

Leadership and management had improved. People, relatives and staff praised the manager who had been in post since November 2019 and is in the process of registering with CQC. A relative said, “[Manager’s] only been here a short time but has proved herself; very pro-active, all the time looking at how things can be improved.”

Quality assurance systems were effective. Senior managers carried out regular reviews and provided assurances that actions were being taken to address these. The provider recognised these improvements need to be sustained and developed further to ensure the service is consistently well-led.

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 (published 27 August 2019) and there were multiple breaches of regulation.

This service has been in Special Measures since 27 August 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

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.

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

People were not safe. There were not enough staff to give people the care and support they needed or to keep the home clean. Standards of cleanliness were poor and infection control procedures were not followed.

People were not protected from abuse; some people were subject to inappropriate restraint due to environmental restrictions that were in place. Risks were not assessed or managed appropriately. Lessons were not learned when things went wrong. Medicines were not managed safely.

People were not supported to have maximum choice and control of their lives and staff did not 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. Staff did not receive the induction and training they needed to equip them with the skills and competencies to do their job. Some staff had received supervision but others had not. Complaint records for 2019 were missing.

Staff were recruited safely and people’s healthcare needs were met.

People’s nutritional needs were not met. People and relatives said they liked the staff. However, there were inconsistencies in staff practices resultant from a poor culture which meant people were not always well treated. Some staff were kind and caring, whereas others were not. People’s privacy and dignity was not maintained.

People did not receive person-centred care and care records did not fully reflect their needs. There was a lack of activities for people and those who should have had one-to-one time with staff did not receive it.

The service was not well-led. Leadership was poor and ineffective; staff lacked direction and support and were left to their own devices. Many of the staff who knew people well had left and the high use of new and agency staff, who were not familiar with people’s needs, had impacted negatively on the service. The provider’s quality assurance systems were not effective in identify and addressing issues. The service has a history of not sustaining improvements.

Following this inspection we contacted the infection control team and fire authority to make them aware of our concerns. We made referrals to the local authority safeguarding team and informed the commissioners from the local authority and clinical commissioning group (CCG) of our findings. We had discussions with the nominated individual to gain assurances about the immediate actions they were taking to address the issues we found. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

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 Good (published 11 April 2017).

Why we inspected

The inspection was prompted in part by a specific incident and other concerns. The specific related to unsafe moving and handling. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident. The concerns we received related to infection control, wound care management, staffing and management of the service. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make significant improvements. Please see all sections of this full report.

Enforcement

We have identified 9 breaches in relation to safe care and treatment, staffing, safeguarding people, complaints, consent, dignity and respect, nutrition, person centred care and governance at this inspection.

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 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 continue to work with the local authority and clinical commissioning group 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 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.

Claremount House is registered to provide accommodation, nursing and personal care for up to 26 people with mental health needs and people living with dementia. The accommodation is arranged over two floors and all of the bedrooms are singles with en-suite toilets. There are three comfortable lounge/dining areas on the ground floor and an accessible garden area for people to use.

On the day of the inspection there were 22 people using the service and two people were in hospital.

There was a registered manager in post. 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.

Our last inspection took place on 10 December 2015. At that time, we found the provider was not meeting the regulations in relation to dignity and respect and assessing and monitoring the quality of the service. We told the provider they needed to make improvements and found on this inspection the necessary improvements had been made.

We found staff were being recruited safely and there were enough staff to take care of people and to keep the home clean. Staff were receiving appropriate training and they told us the training was good and relevant to their various roles. Staff told us they felt supported by the registered manager and deputy manager and were receiving formal supervision where they could discuss their on-going development needs.

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

People who used the service and their relatives told us staff were loving, attentive and caring. We saw people were treated with respect and compassion. They also told us they felt safe with the care they were provided with. We found there were appropriate systems in place to protect people from risk of harm.

Staff knew about people’s dietary needs and preferences. People told us there was a choice of meals and the food was good. We also saw there were plenty of drinks and snacks available for people in between meals.

Care plans were up to date and risk assessments were in place and showed what action had been taken to mitigate any risks which had been identified. People who used the service and relatives told us they were happy with the care and support being provided. We saw people looked well groomed and well cared for.

People’s healthcare needs were being met and medicines were being managed safely.

Activities were on offer to keep people occupied both on a group and individual basis.

We saw there were systems in place to monitor the quality of the service. When areas for improvement had been identified action had been taken to address those shortfalls.

People who used the service were asked for their views and were able to influence the way the service was managed.

Our last inspection took place on 20 January 2014 and, at that time, we found the regulations we looked at were being met.

Claremount House is registered to provide accommodation, nursing and personal care for up to 25 people with mental health needs. The accommodation is arranged over two floors there are two lounge/dining rooms and a quiet lounge on the ground floor and all of the bedrooms are single occupancy. At the time of our visit there were 24 people using the service.

There is a registered manager at the service. 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.

People who used the service told us they felt safe with the care they were provided with. We found there were appropriate systems in place to protect people from risk of harm.

Recruitment processes were robust and thorough checks were always completed before staff started work to make sure they were safe and suitable to work in the care sector. Staff told us they felt supported by the registered manager and that training was on offer.

There were enough staff on duty to make sure people’s care needs were met, people told us they liked most the staff and found them kind and caring. However, on our inspection we saw people were not always treated with dignity and respect. Activities and trips out were arranged to keep people occupied.

We found people had access to healthcare services to make sure their health care needs were met. Safe systems were in place to manage medicines so people received their medicines at the right times. We did identify problems with the Pharmacy dispensing medication in a timely way, which the registered manager was going to take up with the Clinical Commissioning Group.

We found the service was meeting the legal requirements relating to Deprivation of Liberty Safeguards (DoLS).

We found the home was well maintained bedrooms had been personalised and communal areas were comfortably furnished.

People told us if they needed to complain they would speak to the registered manager.

We found the organisation and leadership of the staff on the shift we saw was poor and resulted in people’s dignity being compromised.

We found some of the quality assurance systems were working well, but others needed to be improved to ensure people receive a consistent quality service.

We found two breaches of regulations and you can see what action we told the provider to take at the back of the full version of the report.

During our visit we spoke with a number of people who lived at the home. Some people, due to their complex care needs, were not able to comment on their opinion of the service. Two people living in the home gave us their views and we spoke with two relatives and five members of staff. These are some of the things they told us:

'I like it here.'

'The staff are lovely.'

'The new manager has made changes for the better.'

'A lot of things have improved since the new manager started, it's better for the people living here.'

We found people's capacity to consent to care and treatment was being addressed through the care planning system. We found people's care plans were up to date and easy to follow.

We found staff were telling us about incidents that happened in the home and were involving the safeguarding team appropriately.

The medication system was being managed safely and people's care files were being brought up to date to make sure they reflected people's current needs.

'It's lovely here.'

'The staff are very kind and the food is lovely.'

'I am very satisfied with the care my relative gets.'

'The activities person is very good and works really hard to involve people.'

'We have had a few problems, but think we are getting there now with our relatives care.'

'Some staff are better than others, some just seem to ignore people.'

We found that there was a nice atmosphere in the home and there were activities being provided during both morning and afternoon. We saw that people enjoyed the activities and were kept occupied and stimulated.

We saw that peoples' care needs were met in a timely manner and that there were enough staff on duty to meet peoples' needs, however, in the written care plans it was difficult to find up to date information about people's current needs.

When we looked around some of the bedrooms we saw that peoples' possessions were well cared for and rooms were very personal and homely.

We found that staff had not been reporting incidents to safeguarding or to ourselves as they should have been and the medication system was not being managed safely.

'The staff are kind and help me with the things I need help with.'

'The food is smashing.'

'The activities organiser is very enthusiastic.'

'The home looks better than it did, but some of the furniture is starting to look shabby already.'

'I like the staff.'