Clarendon Court Care Home

Clarendon Court Care Home is a residential care home providing accommodation and personal care for up to 42 people, including people living with dementia. At the time of the inspection 29 people were living at the service, with 3 people currently inpatients at hospital. The service is in a residential area of Nottingham city, in one building set out over 4 floors. The ground floor has a communal dining area and lounges.

CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

Clarendon Court was well led by a manager who showed strong leadership qualities. The staff team were skilled, competent and kind. They understood people and their identified needs well.

Risks associated with people's care and support and the environment were safely managed. People were protected from the risk of harm. Opportunities to learn from incidents were shared across the staff team to ensure improvements in service delivery were made.

Medicines were received, stored, administered and disposed of safely by staff trained and competent in this area. The home was clean and hygienic. The manager was following best practice guidance in infection control standards.

There were sufficient staff deployed across the service to meet people's needs and ensure their safety. Safe recruitment practices were followed, and staff were trained and competent to carry out their roles.

People were supported with their health needs and had access to external services. Care plans contained personalised health information. The service was well adapted and being refurbished to meet people's needs.

The provider and manager operated effective governance systems to ensure the quality, safety and improvement of people's care when needed. Audit systems were robust, and there were opportunities for people, relatives and staff to get involved in service improvements.

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 and update

The last rating for this service was Inadequate (published 28 December 2022.) and there were breaches 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.

This service has been in Special Measures since 28 December 2022. 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 inspection was carried out to follow up on action we told the provider to take at the last inspection.

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 carried out an unannounced inspection of this service on 20 and 21 July 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, safeguarding service users from abuse and improper treatment, good governance and oversight and ensuring the employment of fit and proper persons.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Inadequate to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Clarendon Court Care Home on our website at www.cqc.org.uk.

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

Clarendon Court Care Home is a residential care home providing accommodation and personal care for up to 54 people, including people living with dementia. At the time of the inspection 31 people were living at the service. The service is in a residential area of Nottingham city, in one building set out over four floors. The ground floor has a communal dining area and lounges. The three upper floors do not provide separate facilities for dining or lounge areas for people.

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

Staff had not been effectively deployed across the service to meet people’s identified needs. We observed people who were at risk of choking, eating whilst unobserved by staff. People were not always moved as required to prevent risk of skin damage.

Safeguarding policies within the service were not dated. Some staff were not implementing the provider safeguarding and record keeping training and policies, placing people using the service at risk of harm.

Risk assessments did not always reflect people's health care needs and were at times contradictory. Care plans were not regularly reviewed and updated to identify the support people required.

There was inadequate quality monitoring in place, to ensure the concerns we identified had been picked up prior to inspection. There was no robust analysis of the call bell system in the service for themes and trends when people had experienced falls or other significant events.

People were not always supported to have maximum choice and control of their lives although staff supported them in the least restrictive way possible and in their best interests; the environment of the building did not support this practice; although we saw that policies, systems and training for staff supported their understanding of how this should be implemented.

Medicines were administered and managed safely, and staff had completed medicines training. Medicines were being audited regularly with improved recording systems in place.

Staff were kind and caring, they interacted with people in ways which showed they understood people well. People told us staff were patient and understanding towards them.

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 report published (29 April 2022.)

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 the provider remained in breach of regulations.

Why we inspected

This was a focused inspection to check whether the provider had met the requirements of the previous breaches found in Regulation 12 (Safe Care and Treatment), Regulation 17 (Good Governance), Regulation 18 (Staffing) and Regulation 19 (Fit and proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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.

During inspection we found there was a concern with safeguarding and risk management, so extended the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

The overall rating for the service has remained Inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well Led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

Enforcement and Recommendations

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 and will take further action if needed.

We have identified breaches in relation to Regulation 12 (Safe care and treatment), Regulation 13 (Safeguarding service users from abuse and improper treatment), Regulation 17 (Good governance) and Regulation 19 (Fit and proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we have asked the provider to take at the end of this full report.

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 request an action plan from the provider to understand what they will do to improve the standards of quality and safety. 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.

Special Measures:

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.

Clarendon Court Care Home is a residential care home providing accommodation and personal care for up to 54 people, including people living with dementia. At the time of the inspection 38 people were living at the service. The service is in a residential area of Nottingham city, in one adapted building set out over four floors.

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

We found significant concerns around how the service was managed, there was ineffective risk management and oversight of people's care. Infection control was not robustly implemented across the service, leaving people at risk. Medicines management was not safely managed, leaving people at risk of not receiving their medication as prescribed. Care plans and records for people were inconsistent and in need of review. There was a risk people may not receive consistent safe care due to low staff numbers, poor record keeping and a lack of guidance for staff.

People living at the service were not always receiving their medicines safely and as prescribed for them. Systems and processes in place to manage medicines safely were inadequate.

People were not protected from the risk of infection. We found poor infection control practice at the service. Staff were not adhering to current guidance in infection prevention and control.

There were insufficient numbers of appropriately trained staff deployed to ensure people's safety and wellbeing. Relatives and staff told us they felt there were insufficient staff within the service to support people effectively.

Staff were not recruited safely. We found a lack of appropriate recruitment checks prior to staff commencing their employment.

There was a lack of robust managerial oversight of the home. There were no effective audits of some aspects of care delivery. Care and support plans for people were not person centred or reflective of people's current level of needs.

Staff we spoke with were knowledgeable about people as individuals. We observed people to be happy living at Clarendon Court, supported by kind and caring staff.

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 11 February 2021) This was a focused inspection to check whether the provider had met the requirements of the previous breaches found in Regulation 12 (Safe Care and Treatment), Regulation 17 (Good Governance) and Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in regards to concerns we found at the previous inspection in relation to staff deployment, assessing and managing risks and governance of the service. We were unable to follow these up in a timely manner, due to the Covid-19 pandemic. 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 the provider remained in breach of regulations 12, 17 and 18. We found a breach in regulation 19 at this inspection.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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 provider took immediate action to mitigate some of the risks identified during this inspection; ensuring COVID-19 best practice and government guidance was implemented. Training and guidance from external teams was sought.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Requires Improvement to Inadequate based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement and Recommendations

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 and will take further action if needed.

We have identified breaches in relation to staff deployment and recruitment, safe care and treatment, assessing and managing risks and governance of the service. Please see the action we have told the provider to take at the end of this report.

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.

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. 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.

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.

Clarendon Court Care Home is a residential care home providing accommodation and personal care for up to 54 people, including people living with dementia, in one adapted building. At the time of the inspection 32 people were living permanently at the service and three people were receiving respite care.

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

There was a risk people may not receive consistent safe care due to poor record keeping and lack of guidance for staff. People’s individual care plans and risk assessments had either not been developed, or updated, when changes occurred. There was ineffective risk management and monitoring of people’s care and treatment needs.

Staff deployment was not sufficient for the dependency needs of people and the layout of the service had not been considered in assessing how many staff were needed. Staff, people and visiting professionals expressed concerns about staffing levels. Staff were clear about their role and responsibilities, but, expressed that poor staffing levels impacted on their ability to consistently fulfil their duties.

Additional domestic hours were required to ensure infection prevention and control measures and cleaning standards were effectively maintained. Best practice and government guidance in managing the current COVID-19 pandemic was not fully adhered to.

We found some shortfalls in relation to medicines management. Medicines were not consistently dated when opened, the storage of refrigerated medicines was not effectively monitored and protocols for medicines prescribed ‘when required’ were not consistently completed.

The provider’s internal governance, systems and processes had not fully identified the shortfalls in the expected care standards identified prior to this inspection.

Relatives told us they considered their family member to receive safe care but raised concerns about communication. Relatives did not feel involved or consulted in their family member’s care.

Safe staff recruitment checks were completed before staff commenced their employment. Staff were knowledgeable about people’s individual needs. Staff were aware of their responsibility to protect people from avoidable harm.

A new manager commenced in December 2020, they had developed an action plan of improvements required and had started to take action. Staff training and support were areas where improvements were being made. Staff were positive and complimentary about the managers support and leadership style.

People, relatives and staff received opportunities to give feedback and this was used to develop 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 24 April 2019).

Why we inspected

We received concerns in relation to how people’s health, care and welfare needs were being met, how people were protected from avoidable harm and the deployment of staff. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

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 coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the Safe and Well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

The provider took immediate action to mitigate some of the risks identified during this inspection; COVID-19 best practice and government guidance was implemented.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Clarendon Court Care Home on our website at www.cqc.org.uk

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 three breaches in relation to staff deployment, assessing and managing risks and governance of the service. Please see the action we have told the provider to take at the end of this report.

Follow up

We will work alongside the provider and 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.

Clarendon Court is a new-build residential home on the outskirts on Nottingham City, providing personal care and support for a maximum of 54 people of a mixed age range. On the date of our inspection, there were 29 people using the service. It is located in a quiet residential area, with access to a good range of local amenities.

The home can support people living with dementia, learning disability, physical disability, alcohol dependency (past or present) Schizophrenia, and other specialist care categories.

People’s experience of using this service:

The people that we spoke with told us that Clarendon Court is a good place to live, and that staff treated them with respect and kindness.

People’s health and social care needs were identified and managed well by the management and staff team. There were very positive relationships with professional teams, which supported people’s overall wellbeing.

The environment was safe, clean and suitable for people’s needs. Staff were well trained to use any equipment necessary to support people to maintain their independence. The home was situated within a well-maintained garden area, and with good access to the local community for people.

People were supported to take their medicines by well trained and knowledgeable staff, who understood their preferences of how they wished to take them.

People received enough to eat and drink, and were involved in choices about what they wished to eat. The lunchtime experience was relaxed and people were given a choice about what time they wished to eat and were offered support if this was required.

People were supported by sufficient staff, and the manager ensured that the staff were trained in all areas that were deemed necessary in order to support people’s needs effectively.

The management team showed evidence of ongoing quality monitoring across all aspects of the home. Any concerns or suggestions for improvement which were raised by residents, their families or staff were addressed.

The home showed an good level of leadership, by encouraging people who use the service to be involved in their care. The residents meeting was led and chaired by the residents, and supported by a voluntary sector organisation, who offered advocacy to people who required this.

People are 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’s end of life care and wishes had been developed into exceptionally meaningful care plans, that respected people’s faith and support needs as they neared the end of their lives.

People were supported to maintain contact with the community, through meaningful activities, in which they were supported to be as independent as possible. People received responsive care and support which was personalised to their individual needs and wishes. Staff were innovative in finding ways to improve people's lives and help them to achieve their goals and expectations.

The management team had robust action plans in place for keeping people safe and providing a well led service. Documentation in care plans was clear, person centred and regularly reviewed with the person and their family or advocate if appropriate.

Rating at last inspection:

The service had not previously been inspected

Why we inspected:

This was the first scheduled inspection following the homes registration on 16/10/2017.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.