Clarendon Nursing Home

Clarendon Nursing Home is a residential care home providing personal and nursing care to up to 51 people. The service provides support to adults living with dementia. At the time of our inspection there were 50 people using the service.

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

People were kept safe. Staff knew how to raise safeguarding concerns and were aware of the processes to follow in order to keep people safe. People told us they were kept safe and that they felt safe.

Care and support plans were person centred and developed to ensure people’s needs were met appropriately.

Risk management strategies were in place to assist staff to help people to manage these risks and to identify triggers for expressing feelings or an emotional reaction.

Staffing levels were appropriate to ensure people's needs were met in a safe, timely and consistent way.

The service was following safe infection prevention and control procedures to keep people safe.

The administration of medicines was managed in a safe way and people received their medicines safely.

The service was flexible and adapted to people's changing needs and wishes and promoted their independence. Risk assessments were carried out and risk management plans helped staff as well as the person to minimise risks but included positive risk taking.

The provider created a culture where staff were able to develop and improve their practice. They were provided with the right training and support to make sure they could fulfil their roles appropriately.

People were encouraged and supported to lead as fulfilled a life as possible. They were supported to follow their hopes and aspirations.

People and their families described care as very good and people were well-supported and treated with dignity and respect. We received consistently positive feedback about the caring nature of staff and their empathetic approach. People, their relatives and staff referred to the trust, kindness, understanding and sensitivity to their individual needs as reasons why they felt the service was good.

People's individuality was respected. People were involved in decisions about their day to day lives and staff respected people's choices. People had their dignity and privacy respected and were supported to maintain their independence.

People's diversity and their unique individual needs were well-respected by staff. The staff team knew people extremely well and were able to provide appropriate support discreetly and with compassion.

People's privacy was respected, and people were supported to maintain contact with relatives and friends.

There was clear evidence of collaborative working and good communication with other professionals in health and social care sector. People's health care needs were being met and they had access to healthcare services where needed.

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.

Robust processes were in place to manage and respond to complaints and concerns.

Clarendon Nursing Home was well led. The provider's ethos and values put people at the heart of the service. This vision was driven by the leadership of the nominated individual and of the registered manager. The nominated individual is responsible for supervising the management of the service on behalf of the provider. The staff team were empowered to contribute fully to support a person-centred model of effective care. This helped people using the service, with complex needs, to achieve their maximum potential and quality of life.

There was a comprehensive and effective governance system in place.

People, relatives and staff were confident about approaching the registered manager if they needed to. They recognised that their views and feedback were valued and respected and consistently used to support quality service development. A wide range of comprehensive audits took place to ensure the quality of the service was maintained.

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 28 August 2019).

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.

Follow up

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

We found the following examples of good practice.

The provider had appropriate arrangements in place for all visitors to help prevent the spread of Covid 19. Visitors were required to have their temperatures taken, undertake a rapid flow test and complete a Covid 19 risk assessment which included screening for symptoms of Covid 19 before being allowed to enter the home. They were required to wear a face covering when visiting, and wash hands before and after mask use.

The provider had appropriate arrangements to test people and staff for Covid 19 and was following government guidance on testing. This ensured that people and staff were tested for Covid 19 so that appropriate action could be taken if any cases were identified.

The provider ensured that all their staff received appropriate training and support to understand and to manage Covid 19. This included best practice for infection control and the use of PPE.

Staff received appropriate guidance on how to support people with dementia to understand the pandemic and Covid 19. The provider made appropriate support services available to staff in order to support their mental wellbeing through the pandemic and if they became unwell and when they returned to work. Specific risk assessments for BAME staff were in place to help ensure their individual needs were accounted for.

The provider made good provision for people using the service to maintain links with family members, relatives and friends. People were supported to have visits from their relatives and friends via window visits or in a specially constructed pod. Two metre social distancing was observed. Visits were staggered and restricted to 30 minutes; these areas were cleaned between visits.

Further information is in the detailed findings below.

Clarendon Nursing Home is a care home which can support up to 51 people in one adapted building. At the time of this inspection, the service was providing personal and nursing care to 50 people.

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

The quality and safety of the service had improved for people since our last inspection. Medicines storage facilities had been improved to make sure these were now kept safely. People were supported to take their prescribed medicines when they needed these.

There were now enough staff to support people safely. Staffing levels had increased since our last inspection. The provider checked that staffing levels met people’s needs at all times.

Staff now had regular opportunities to have one to one meetings with their line manager, to support them in their role. Staff had been provided relevant training to help them meet the range of people’s needs. The provider carried out checks on staff, prior to them starting work, to make sure they were suitable to support people.

People said they were safe at the service. Staff had been trained to safeguard people from abuse. Staff knew how to manage and minimise identified risks to people. The provider carried out health and safety checks of the premises and equipment to make sure they were safe.

The premises were generally clean and tidy. The provider took action after our inspection to improve this further. Staff followed good practice when providing personal care and when preparing and handling food which reduced hygiene risks.

People’s care records gave staff the information they needed about people and the care they required to help them deliver support which met their needs. Staff knew people well and understood how their needs should be met. Staff were warm and kind with people. They supported people in a dignified way which maintained their privacy and independence. 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.

People were supported to stay healthy and well and helped to eat and drink enough to meet their needs. Recommendations from healthcare professionals were acted on so that people received the relevant care and support they needed in relation to their healthcare needs. When people became unwell, staff sought assistance for them promptly.

The provider had improved activities provision and there were now a range of activities for people to take part in, every day of the week. People were supported to maintain relationships that were important to them. People were regularly visited by local faith groups who engaged with people in a range of activities and events. People had a choice of spaces to spend time in when at home. The provider had been redecorating and refurbishing the premises to make this a more accessible and pleasant place for people to live. Some areas still required redecoration and refurbishment and the provider was acting to make these improvements immediately after this inspection.

People knew how to make a complaint if needed. The provider had arrangements in place to make sure any accidents, incidents and complaints were fully investigated which included keeping people involved and informed of the outcome. Learning from complaints and investigations was acted on and shared with staff to help them improve the quality and safety of the support they provided.

People, visitors and staff spoke positively about the management of the service, particularly the new manager. The manager made sure staff were well supported, motivated and clear about their duties and responsibilities, to help people achieve positive outcomes in relation to their care needs.

People and staff were encouraged to have their say about how the service could improve. The manager had used their feedback along with other checks, to monitor, review and improve the quality and safety of the support provided.

The provider worked proactively with other agencies to make improvements. They acted on recommendations made by others and saw this as an opportunity to continually improve the quality and safety of the service for people.

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 15 August 2018) and there was a 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 regulation.

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.

Clarendon Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Clarendon Nursing Home accommodates up to 51 people in one adapted building across three floors. One of the floors specialises in providing care to people living with dementia.

The service had 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 a 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 a good understanding of their role and responsibilities particularly with regard CQC registration requirements and their legal obligation to submit notifications of events or incidents at the service.

At this inspection we found management monitoring and oversight of the safety and quality of the service was not as effective as it should have been. We identified medicines in one clinical room had not been stored at recommended temperatures. This posed a risk to people’s health and wellbeing as their prescribed medicines may not have worked as intended. Senior staff had been aware of this issue but had not removed medicines from this room to reduce this risk to people.

We identified concerns about the numbers of staff on duty at the time of our inspection. People and staff told us at times there were not enough staff to meet people’s needs. We observed staff took longer to respond to calls bells during the afternoon. Staffing levels had not been formally reviewed when new people started to use the service or as people’s needs changed. This meant the provider could not be assured that staffing levels had been adequate at all times to safely meet the needs of all the people using the service.

We found staff were not consistently being provided opportunities through supervision and appraisal to discuss current working practices and any concerns they had about this. The provider could therefore not be assured that senior staff were promptly identifying and addressing concerns that could impact on the health and wellbeing of people using the service.

After our inspection the provider took steps to address the concerns we found. Medicines were removed from the unsafe clinical room. The provider increased staffing numbers in the afternoon. Arrangements were made to bring all outstanding supervision and appraisal meetings up to date.

Other checks and audits of the service had been more effective. When areas for improvement had been identified through these checks, senior staff acted to make any changes that were needed. Learning from incidents, safety concerns and when things went wrong, was also used to make improvements at the service to ensure people’s ongoing safety and wellbeing.

People were safe at Clarendon Nursing Home. Staff knew how to safeguard people from abuse and followed appropriate guidance to minimise identified risks to people's health, safety and wellbeing. Regular checks of the premises and equipment were carried out to ensure these were safe and posed no risks to people. Staff followed good practice to ensure risks to people were minimised from poor hygiene and cleanliness when providing personal care, cleaning the premises and when preparing, handling and storing food. The premises was clean, clear of slip and trip hazards and was a comfortable and supportive environment, particularly for those living with dementia.

The provider had appropriate recruitment arrangements in place to check the suitability of staff to support people. Staff received relevant training to meet people's needs. They were kind and caring. Staff knew people well and provided support that was dignified, respectful and which maintained people’s privacy. They encouraged people to be as independent as they could be. People were encouraged to take part in activities to meet their social and physical needs and to reduce risks to them from social isolation. People were also supported to pursue their specific interests. Staff had received training to ensure that people would receive support at the end of their life that was comfortable and dignified.

People were supported to stay healthy and well and staff encouraged them to eat and drink sufficient amounts to meet their needs. Staff supported people to take their prescribed medicines when required. Staff monitored people's general health and wellbeing and where there were any issues or concerns about a person's health, staff ensured they received prompt care and attention from the appropriate healthcare professionals.

People and their relatives contributed to the planning of their care and support. People’s needs and specific preferences for how they wished to be cared for and supported were set out in their individual support plans so staff had information about how this should be provided. Staff were aware of their duties under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). They obtained people's consent before providing support and followed legal requirements where people did not have the capacity to consent. Senior staff reviewed people’s care and support needs regularly to ensure staff had current information about these. People’s care records were well maintained, up to date and stored securely.

Staff spoke positively about the senior staff team and said they were supportive. People and staff were provided opportunities to give their views and to make suggestions for how the service could be improved. The provider maintained appropriate arrangements to deal with people’s complaints and concerns if they were dissatisfied with any aspect of the service.

Since the provider took over ownership in July 2017, they had acted to make positive changes and improvements at the service. The premises had been refurbished and updated. The registered manager told us improvements were continually being made as and when required so that Clarendon Nursing Home was a pleasant and comfortable place for people to live. The registered manager said they had been well supported by the provider in their role.

The provider worked in partnership with other agencies to develop and improve the delivery of care to people. For example, senior staff at the service worked collaboratively with local authorities funding people’s care. This helped to ensure people continued to receive the appropriate care and support they required.

At this inspection we found the provider in breach of legal requirements with regard to good governance. You can see what action we told the provider to take with regard to this breach at the back of the full version of the report.