Archived: Clovelly House Residential Home LTD

Clovelly House Residential Home LTD is a residential care home providing personal care and accommodation up to a maximum of 48 people. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 28 people using the service.

Clovelly House Residential Home LTD is a large care home comprising of separate residential houses linked together. Upper floors are accessed via a lift. The home has access to a large and well-maintained garden and has access to a nearby high street with shops and cafes.

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

There had been significant improvement since the last inspections in April and August 2021. We saw improvements in safeguarding and incident reporting procedures, risk management, staffing levels, ensuring people received person centred care and overall governance.

We have made a recommendation around ensuring the environment is suitable for people’s assessed needs.

There were now enough staff deployed to meet people's needs and ensure their safety. Appropriate recruitment procedures ensured prospective staff were assessed as suitable to work in the home.

People told us they were happy with the care and support they received. Staff said they were happy working at Clovelly House and felt well supported by the management team. They received appropriate training for their roles.

Medicines were managed and administered safely.

Care plans provided appropriate guidance to enable staff to deliver person centred care in line with people's preferences.

People were protected from the risks associated with the spread of infection. The service was clean, and action was being taken to prevent a new outbreak of COVID-19.

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.

There was an increased oversight of quality of care at Clovelly House and the provider was working closely with external parties such as the local authority to implement and sustain improvements. A new registered manager was in place.

Good practice had been developed throughout the service, but further time was needed for the service to demonstrate that the improvements that had already been made had been fully embedded and could be sustained.

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 30 July 2021) and there were multiple breaches of regulations. A further targeted inspection took place on 17 August 2021 to check on specific concerns. No change was made to the rating following that inspection.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 30 July 2021. 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

We carried out an unannounced comprehensive inspection of this service on 1 April 2021. Breaches of legal requirements were found. Enforcement action was taken and conditions were imposed on the provider’s registration around safeguarding, assessing risk, person centred care and governance. We also imposed a condition to restrict admissions without written agreement from CQC.

We undertook this inspection to check that the conditions had been met and to confirm they now met legal requirements.

Follow up

We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Clovelly House Residential Home Ltd is a residential care home providing accommodation and personal care to 33 people at the time of the inspection, most of whom were living with dementia. The service can support up to 48 people.

Clovelly House is a large care home comprising of separate residential houses linked together. The home also has access to a large spacious and well-maintained garden.

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

We received concerns around safeguarding and safe care and treatment. This was a targeted inspection that considered safe care and safeguarding people from abuse. Based on our inspection of these areas we were not assured that people were protected from these risks.

We found incidents of a safeguarding nature which had not been reported to the local safeguarding authority or CQC.

We were not assured that people were being safely supported with moving and handling. Not all staff were trained appropriately before providing support to people in this way.

We found one instance of multiple night staff sleeping whilst on duty.

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 30 July 2021) and there were multiple breaches of regulations. Conditions were imposed on the providers registration around safeguarding, assessing risk, person centred care and governance. We also imposed a condition to restrict admissions without written agreement from CQC. As this was a targeted inspection where specific concerns were examined, the overall rating for the service has not changed and remains in special measures.

Why we inspected

We undertook this targeted inspection to check on specific concerns we had about people’s welfare, safe care and safeguarding people from abuse. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific 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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified continued breaches in relation to safe care and treatment and safeguarding people from abuse at this inspection.

At our previous inspection in April 2021, we imposed conditions on the provider’s registration. They came into effect on 27 August 2021 following a period to allow for the representations and appeals period to conclude.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. We will work with the local authority to monitor progress. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service remains 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.

Clovelly House Residential Home Ltd is a residential care home providing accommodation and personal care to 41 people at the time of the inspection, most of whom were living with dementia. The service can support up to 48 people.

Clovelly House is a large care home comprising of separate residential houses linked together. The home also has access to a large spacious and well-maintained garden.

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

Feedback from relatives on the care provided at Clovelly House was positive such as kind and caring staff, clean and well-maintained environment and a responsive management team. However, we found significant concerns throughout the inspection which impacted on safety and quality of care and people’s well-being.

Seclusion was used at the service, for example locking people in a bedroom or communal lounge. 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.

Safeguarding procedures were not well established at the service. Allegations of abuse and incidents of a safeguarding nature were not always reported to the local safeguarding authority or CQC. Not all staff understood what whistleblowing meant and how to report concerns.

Accidents and incidents were not always appropriately reported or investigated. Learning was not always identified.

Some staff spoke of a bullying culture where they felt unable to report concerns without repercussion for their employment at the service.

Staff were not deployed across the home in a way that met people's needs adequately and communal areas were left unattended for significant periods of time which placed people at risk of harm.

Not all people were receiving care which was personalised to their needs and preferences. We saw instances of where people were taken to other people’s bedrooms for significant periods of time, without sufficient reason. We observed some kind and caring interactions, however we also observed people were left for long time periods with little stimulation or staff engagement.

The home was clean and well-maintained and infection prevention measures were in place to manage the risk of COVID-19. However, we observed staff not always wear personal protective equipment (PPE) in line with national guidance.

People's personal risks were assessed and risk assessments provided staff with information on how to minimise known risks, however, we observed people were not always safely supported with moving and handling, which placed people and staff at risk of harm.

Medicines were managed safely.

People were supported to eat and drink, the dining experience was inconsistent across the service with people not always offered choice.

Appropriate recruitment procedures ensured prospective staff were assessed as suitable to work in the home.

Following the inspection, the provider accepted that care fell below acceptable standards, advised that lessons had been learned and put steps in place to improve quality of care for people using the service.

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 30 October 2019).

A thematic infection prevention and control inspection was carried out on 14 August 2020. At that inspection, we were overall assured that appropriate measures were in place to manage the risks posed by the COVID-19 pandemic. The service was not rated at this inspection.

Why we inspected

The inspection was prompted due to concerns received about staffing levels and allegations of abuse. A decision was made for us to inspect and examine those risks.

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. We inspected and found there were wider ranging care concerns, so we widened the scope of the inspection to become a comprehensive inspection which included all five key questions.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified five breaches in relation to staffing, protecting people from abuse, safe care and treatment, person centred care and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve. 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.

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.

We found the following examples of good practice.

¿The provider had appropriate arrangements for visitors to help prevent the spread of Covid 19. All visitors were screened for symptoms of acute respiratory infection before being allowed to enter the home. They were supported to wear a face covering and maintain hand hygiene during their visit. The service had an extensive garden area with shelter to facilitate safe visiting for families, however at the time of the inspection, non-essential visiting to the home was restricted due to a local area increase in Covid 19 infection rates.

¿The provider had appropriate arrangements in place to test people and staff for Covid 19 and was following government guidance on testing. A number of staff were trained to carry out testing and the registered manager was conscious of the time impact testing had on their senior staff team and was reviewing staffing levels accordingly.

¿The provider ensured that staff received appropriate training and support to manage Covid 19. All staff had received training on Covid 19, infection control and the use of PPE. Additional domestic staff had been recruited and items such as seating, bins and lampshades had been replaced with easy to wipe versions.

Further information is in the detailed findings below.

Clovelly House Residential Home Ltd is a residential care home providing personal and nursing care to 46 people aged 65 and over at the time of the inspection. Some people were living with dementia. The service can support up to 48 people.

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

People received personalised care. Comprehensive care plans had been developed which reflected people's wishes on how they wanted to be supported.

People received care from staff who knew them well. People and relatives told us staff were kind and caring.

Risks to people's health, safety and wellbeing were assessed and management plans were put in place to ensure these were reduced as much as possible. Medicines were safely managed.

There was enough staff available to support people. Staff were safely recruited. The home was clean and well maintained.

There was an established management team in place who had a range of quality assurance processes in place to monitor care delivery. Staff told us they felt supported in their roles.

Staff had received appropriate training and supervision. Staff felt supported by the management team and were encouraged to contribute ideas for improvement of the service.

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.

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 4 April 2018).

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe section of this full report.

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 our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service had a registered manager who was also the registered provider. 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 told us they were well treated at the home and risks to their safety had been identified and ways to mitigate these risks had been recorded in people's care plans.

Staff were aware that the people they supported were vulnerable and they understood their responsibilities to keep people safe from potential abuse.

There were systems in place to ensure medicines were handled and stored securely and administered to people safely and appropriately.

The home maintained adequate staffing levels to support people.

We saw friendly, caring and supportive interactions between staff and people and staff knew the needs and preferences of the people using the service. Care plans were person centred and reviewed regularly.

People told us they enjoyed the food provided and that they were offered choices of what they wanted to eat.

People had regular access to healthcare professionals such as doctors, dentists, chiropodists and opticians.

We saw evidence of a comprehensive staff induction and on-going training programme. Staff had regular supervisions and annual appraisals. Staff were safely recruited with necessary pre-employment checks carried out.

People were supported to engage in regular activities.

Quality assurance processes were in place to monitor the quality of care delivered.

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.

Further information is in the detailed findings below.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. A relative told us, 'staff are attentive. For example, they actively encourage a person to eat.'

We spoke with four staff members. They were able to explain possible types of abuse such as physical, financial and sexual abuse. They were also able to explain how they would report a safeguarding concern.

Staff received appropriate professional development. We spoke with two care workers (one of whom had recently started working at the home). They told us that they felt supported by senior management and that supervision meetings had recently taken place.

We looked at provider records and saw that monthly resident meetings took place; offering people a chance to voice concerns or suggest improvements. The minutes of the last meeting indicated that people were generally happy with care and support provided.

People and their relatives informed us that the care needs of people had been attended to and they had access to medical services. We saw that people appeared well cared for and were dressed appropriately. Staff were constantly supervising people and engaging them in conversation. Assessments, including risk assessments had been carried out. Care plans had been prepared and these were reviewed regularly. The home had a varied programme of social and therapeutic activities and this included outings and entertainment within the home such as music sessions and arts and crafts. The manager informed us that one of the people who use the service had received a certificate from the local Member of Parliament for designing a Christmas card.

The premises were clean and there were suitable arrangements in place to prevent infections. Staff were knowledgeable regarding procedures for infection control.

People spoke well of staff. The home had a recruitment procedure. The necessary staff recruitment checks had been carried out and staff we spoke with were knowledgeable regarding their roles and responsibilities.