Clumber House Nursing Home

Clumber House Nursing Home is a residential care home providing personal and nursing care to up to 41 people. At the time of our inspection there were 38 people using the service.

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

Systems in place to assess and monitor risk were not effective in identifying concerns we observed during the inspection which put people at risk. The manager took actions to address the concerns we raised during the inspection, and improve the management of risk.

Information relating to people’s care and support was not always reflective of observations we made during this inspection, which meant people were not consistently receiving person centred support.

There was a system in place to review accidents and incidents. However this did not always improve safety of the service and mitigate risk.

We found that support dependency for people was high at the service. this meant staff had little time for social engagement as there was not always enough staff to respond to people’s needs quickly. We spoke to the manager about our concerns and made a recommendation they review and monitor staffing levels and deployment.

Although processes were in place to assess people under the Mental Capacity Act (MCA) we found that the service was not always working inline with this. We spoke to the manager regarding our concerns and made a recommendation they reviewed information held on people.

People were not always supported to have maximum choice and control of their lives and staff did not support always them in the least restrictive way possible and in their best interests; the policies and systems in the service were not always followed to support good practice.

Auditing systems were not robust or effective to ensure the management team had oversight on identifying risk and acting on lessons learnt.

The manager was new in post and demonstrated a positive approach to make improvements in the home.

Overall people and relatives spoke positively about the service and communication from the management team.

Staff recruitment processes were followed. Staff received training appropriate to their role, with on-going training given.

Staff spoke positively about working at clumber house and felt well supported by the management team.

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 23 March 2021).

Why we inspected

This inspection was prompted by a review of the information we held about this service, concerns received about the management of the service and people’s care needs. 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 COVID-19 and other infection outbreaks effectively.

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 good to requires improvement 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.

Enforcement and Recommendations

We have identified breaches regarding how people were supported to stay safe, how the provider ensure they have oversight of , personal centred support and that suitable systems are in place to identify and reduce risk.

We recommend the provider reviewed how staffing is deployed across the service and review systems for documentation relating to the Mental Capacity Act.

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

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

Clumber House Nursing Home is a residential care home providing personal and nursing care to 39 people at the time of the inspection. The service can support up to 41 people.

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

People felt safe at Clumber House Nursing Home. People and relatives told us staff were kind and attentive. Medicines were managed safely. Risk assessments were carried out and incidents and accidents were investigated.

The provider had developed a robust policy to strengthen the infection prevention and control (IPC) practices in the home. Staff complied with the requirements to wear protective personal equipment (PPE) and regularly washed their hands. The home was clean and tidy.

Care plans had been updated and transferred onto the provider's care planning paperwork, so they reflected people's current needs. 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.

Staff knew about the safeguarding and whistleblowing procedures and were confident about speaking up. An appropriate number of staff were on duty to meet people's individual needs and new staff were recruited safely. Staff were well supported and received the training they needed.

The general manager had developed a range of effective audits and systems to monitor the quality of care at Clumber House Nursing Home.

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 19 November 2019) and there were two 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.

Why we inspected

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

We received concerns in relation to moving and handling safety. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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 requires improvement to good. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from the concerns raised. Please see the safe, effective and well-led sections of this full report.

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

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.

Clumber House is a care home providing personal and nursing care to 36 people aged 65 and over at the time of the inspection. The service can support up to 42 people.

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

People received their medicines as prescribed. However, clear and accurate records were not kept in relation to controlled drugs and medicines prescribed to thicken fluids. Recommended actions relating to fire safety and legionella had not been carried out. People told us they felt safe at Clumber House and staff were aware of safeguarding procedures. Staffing levels at the home were good.

People and relatives complimented the food at Clumber House. People were provided with appropriate modified diets, but specifics were not always recorded in care plans in line with best practice. The provider was reviewing seating arrangements to ensure people were not unnecessarily restricted in deep chairs, whilst still meeting their needs and preferences. Staff had not been recently trained to administer rescue medicines prescribed for epilepsy. The general manager arranged this training immediately.

People and their relatives were very positive about the service and said staff were kind and caring. People were treated with dignity and respect and their right to privacy was upheld. Clumber House staff could provide people with information about local advocacy services, to ensure they could access support to express their views if they needed to.

Care plans had recently been updated and people received person-centred care which was responsive to their needs. People's communication needs had been assessed. The manager managed people's concerns and complaints appropriately. Staff told us they had not been trained in end of life care.

We have made a recommendation about end of life care

A new general manager had been in post for three weeks on the first day of the inspection. The manager was in the process of registering with us. We identified shortcomings in quality systems and processes. These were being reviewed to improve all aspects of the service and required embedding over time. Records were not always contemporaneous relating to the monitoring of fluid intake. People, relatives, staff and professional visitors had confidence in the new management structure.

Rating at last inspection and update:

The last rating for this service was requires improvement (published 22 November 2018). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safe medicines management, health and safety and governance.

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 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.

Clumber House Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Clumber House is registered to provide accommodation with personal care for up to 36 people. The accommodation is located over two floors and there is currently a large lounge and dining room on the ground floor. The provider had built an extension which includes additional lounges and bedrooms, however this is not currently in operation. On the day of our inspection there were 29 people living in the home.

At our last inspection in September 2017 we found the provider was in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as the provider’s quality assurance systems were not effective and had not picked up the issues we identified as part of the inspection. We also made a few recommendations about a generic risk assessment for the property, updating medication policies and recording spot checks as part of the quality assurance systems.

At this inspection we found that there was a continued breach of Regulation 17 in relation to documentation and quality assurance systems and there was also a breach of Regulation 12 in relation to safe care and treatment. The service was rated requires improvement overall and this is the fourth time that the service has received this rating. You can see what action we have taken at the back of this report.

Clumber House has a registered manager in post. 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.

Risks to people were not always clearly considered or documented in care plans with appropriate risk assessments in place.

The registered provider did not have effective systems in place to assess and monitor the quality and safety of the service. Some of the issues which were identified as part of this inspection, had not been picked up by provider’s audits.

Staff had completed safeguarding training and safeguarding incidents were appropriately raised by staff. However, we found two instances where incidents had not been referred to the local safeguarding team.

Medication was being stored and administered safely. Regular medication audits were being conducted and any issues identified were addressed. There was scope for improvement in documentation around covert medication.

Registered providers are required to send notifications in relation to events or changes which occur in the home. We found that the provider had not sent all the necessary notifications as required by the regulations.

Staff recruitment was safe and appropriate checks were completed to ensure that staff were safe to work with vulnerable people. There were sufficient staff to meet the needs of the people living in the home and they were recruited safely.

Most of the care plans reflected people’s life history and their needs and were person centred. People and their relatives told us that the care they received was responsive to their needs. However, we found where there were changes or incidents that care plan evaluations had not been updated to reflect these issues.

People and their relatives felt confident that issues raised would be addressed. Complaints were recorded and dealt with in accordance with the provider’s complaints policy.

People and their relatives were positive about the staff working in the home, as well as the care they received whilst living there.

People’s privacy and dignity were respected by all staff members.

The provider was acting in accordance with the Mental Capacity Act 2005 to ensure that people were receiving the right level of support with their decision making. People were involved in the care plans and had signed their consent to care where able. Where people lacked capacity, appropriate paperwork was in place to ensure that decisions were made in their best interests.

Staff members confirmed they received regular training and supervision and we verified this in the provider’s records.

We saw regular checks on the property were undertaken and the premises were safe without restricting people’s ability to move about freely.

People had access to activities within the home and told us that they were happy with the activities on offer.

The last inspection took place on 7 April 2016. At that inspection we identified one breach of the relevant regulations in respect of fit and proper persons employed. At this inspection, we found that improvements had been made in this area, however we found the provider was in breach of a different regulation.

Clumber House is registered to provide accommodation with nursing and personal care for up to 36 people. It is located in a residential area of Poynton in Cheshire East. There are currently 32 single bedrooms at the location. There are two floors connected via passenger lift and two lounges on the ground floor. On the day of our inspection there were 30 people living in the home.

The home has a registered manager who had been registered since November 2012. 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.

We found that the arrangements for the administration, storage and disposal of medication were not always safe. Topical creams were not dated when opened and there were no clear guidelines and policies in place in relation to PRN (medication given as required) medication. Medicine competencies were checked periodically but there was no system in place to ensure that this was done on a regular basis.

We asked staff members about training and supervision. They all confirmed that they received regular training and supervision throughout the year, however when we checked the records, we found that there was no process for checking when training needed updating and no clear plan in place as to when this would be carried out.

The home was staffed by a consistent team of suitably qualified and experienced staff who met the needs of the people living there.

We saw that the service had a safeguarding policy in place. This was designed to ensure that any safeguarding concerns that arose were dealt with openly and people were protected from possible harm. All the staff we spoke with confirmed that they were aware of the need to report any safeguarding concerns. However we did note that training in this area had not been updated.

We looked at recruitment files for the most recently appointed staff members to check that effective recruitment procedures had been completed. We found that appropriate checks had been made to ensure that they were suitable to work with vulnerable adults.

There was a flexible menu in place which provided a good variety of food to the people using the service. People were positive about the food that was provided.

We observed caring, positive relationships between staff members and the people living in the home.

We found that that care plans provided clear guidance to staff on how to support the people living at Clumber House. The plans were updated regularly and were clear. Where additional monitoring of people’s needs was required, records were consistently kept.

The provider had a quality assurance system in place and regular audits were being completed, however we found that some processes were not in place in relation to training to ensure that people remained up to date. We saw that many of the policies held by the home did not include up to date guidance and legislation or were missing information to guide staff on the correct procedures. The registered manager continually sought feedback from people living in the service, relatives and staff in order to improve the service. Staff members and relatives we spoke with were positive about how the home was being managed.

The service was previously inspected on the 18 June and 16 July 2015. We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the following: we found people who lived in the home were not treated with dignity and respect; people's records of care and treatment were not maintained securely; the registered person did not notify the Commission without delay of incidents specified in the relevant regulation; people were given care and treatment without their consent and the registered provider had not established and operated effective systems to investigate, immediately upon becoming aware of, any allegation or evidence of abuse. We issued a warning notice in relation to two of these breaches.

We found that the provider had taken appropriate action to address the areas of concern. The registered provider had established a safeguarding incident recording file that captured any safeguarding incidents involving people who live at the home. We viewed three Deprivation of Liberty Safeguards (DoLS) applications the registered provider had submitted, which had been subsequently granted by the local authority.

The service had a registered manager in place; however on the day of our inspection the manager was unavailable due to taking annual leave. 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 and associated Regulations about how the service is run.

During this inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

We found that registered provider had failed to ensure that the people using the service were protected against the risks of unsafe or inappropriate recruitment practice, as some key records did not contain satisfactory information about any physical or mental health conditions relevant to the person’s capability to perform tasks.

The deputy manager was present during our inspection and engaged positively in the inspection process. The deputy manager was observed to be friendly and approachable and operated an open door policy to people using the service, staff and visitors. During the inspection we found Clumber House Nursing Home to have a warm and relaxed atmosphere and overall people living in the home appeared happy and content.

Feedback received from people using the service we spoke to was generally complimentary about the standard of care provided.

Staff were supported through regular on-going training, supervision and appraisal. A training plan was in place to support staff learning. There were however, gaps in the Mental Capacity Act 2005 (MCA) and Safeguards (DoLS) training. After the inspection, the registered manager confirmed in an e-mail that all staff will complete this mandatory training by the end of April 2016.

A process was in place for managing complaints and the home's complaints procedure was displayed so that people had access to this information. People and their relatives told us they would raise any concerns with the manager.

Medicines were ordered, stored, administered and disposed of safely. People using the service had access to a range of individualised and group activities and a choice of wholesome and nutritious meals.

Records showed that people also had access to GPs, chiropodists and other health care professionals (subject to individual need).

Quality assurance systems were in place in assessing, monitoring and improving the quality and safety of services provided.

A staffing dependency tool to help calculate the required staffing levels at Clumber House Nursing Home had not been implemented. We received a mixed response from people in regards to the staffing levels. One person commented; “I have a buzzer to press if I need them [staff] sometimes they take a while to respond.” The registered provider has not yet introduced the Care Certificate new minimum standards to new and existing staff. The programme of activities was not publicised in order to inform people of the activities that had been organised. We have made recommendations about these areas in the report.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The summary is based on our observations, including a SOFI during the inspection, speaking with people using the service, their relatives; the staff supporting them and from looking at records.

Is the service safe?

We undertook a tour of the building and looked at communal areas, bathing areas and after gaining permission some of the resident's bedrooms. The home and its facilities were very well maintained and clean. The bedrooms viewed looked comfortable and had been personalised by the person living in the home or their families. Bedroom doors had key locks should people choose to use them and the main doors were alarmed and secure. The building presented as being clean and comfortable and people told us they were able to personalise their rooms and they felt happy and safe and secure within the home. This meant that the premises protected people's rights to privacy, dignity, choice, autonomy and safety.

We saw that risks to people's health and wellbeing had been identified for areas such as falls and nutrition and risk assessments were in place to manage these so the people who lived at the home were safeguarded from unnecessary hazards.

There were appropriate procedures in place should anyone need to be subject to a Deprivation of Liberty Safeguard (DoLS) application or plan. DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests.

Is the service effective?

The care plans had been written to ensure that they focused on the person's individual assessed needs and on how they could be met. The care plans focused on providing support to an individual in different aspects of their daily life, for example how the person was to be supported with promoting their independence and any issues regarding their health so that they were kept as healthy as possible.

Visits from other health care professionals, such as doctors and district nurses were recorded so staff members would know when these visits had taken place and why and if any immediate changes needed to be made to the daily care plan.

Is the service caring?

We received positive comments about the home and staff members from the people living in the home and the three visitors we spoke with. Comments included; "It is super, X is very happy here and she has been made to feel at home. We have noted such a great improvement in her in the short time she has lived here" and "this is a fine place to live in, wonderful staff and services".

We observed that staff interacted well with the people they were caring for. They took time to ensure that they were fully engaged with the individual and checked that they had understood all communications. Before carrying out interventions with the people using the service staff explained what they needed or intended to do and asked if that was alright rather than assume consent. They also spoke to people informally and acknowledged them with a smile as they passed through the home and went about their daily tasks

The relationships we saw were warm, respectful, dignified and with plenty of smiles and laughter. The staff members we spoke with could show that they had a good understanding of the people they were supporting and they were able to meet their various needs.

Is the service responsive?

People told us that they had residents meetings and were able to discuss the running of the home. Comments included; "the home is good and we are told about everything that is going on", "staff make sure we are provided with all the information about the home. For instance they told us that one lounge would not be in use for some of the time today as they are cleaning the carpet".

The staff members we spoke to could show that they had a good understanding of the people they were supporting and they were able to meet their various needs. We also observed that they were interacting well with people and were responsive to their individual needs.

People told us that the activities co-ordinator discussed peoples wishes and arranged activities and interests accordingly.

Is the service well-led?

Information about the safety and quality of service provided was gathered on a continuous and on-going basis via audits and feedback from the people who used the service and their representatives, including their relatives and friends, where appropriate. The home manager 'walked the floor' regularly in order to check that the home was running smoothly and that people were being cared for properly.

The staff members we spoke with made very positive comments about the way the home was run. Comments included; "We are very happy that the manager is here, she supports us well and now we know the home is very well run. I am so glad she is here".

In this report the name of a registered manager appears who was not in post and not managing the home at the time of our visit. Their name appears because they were still a registered manager on our register at the time of our inspection. An interim manager was in post during our inspection.

We spoke with six people who used the service and they told us that they were involved in the care they received. However six people who used the service told us collectively, 'We feel invisible, we have no staff leadership; we don't know what's going on'.

People told us they were satisfied with the care and support they received at the home. One person said, 'I am satisfied with my care'. We noted that not all of the care plans were up to date and they required more detail about people's needs.

We saw staff treating people in a kind and respectful manner but were hurried whilst carrying out their duties. People told us that the staff were mostly good and friendly to them. Two people commented, 'They're so busy' and 'The poor girls are short staffed'.

We found that records required to be shared with other organisations and to protect the safety and wellbeing of people who used the service had not been completed.

We found that records to protect people against the risk of unsafe or inappropriate care had not been completed.

We spoke to three relatives who were all very pleased with the care that their family members were receiving. One told us; "They get looked after well here. We don't have to worry anymore."

We spoke to five members of staff including the manager and the deputy manager. They all said that they enjoyed working at the home and had lots of support and training to do their jobs. We looked at the training records and saw that that all the staff had yearly mandatory training and additional training according to their job roles.

We looked at the safeguarding policies and procedures and found that adequate arrangements were in place to protect people from the risk of harm or abuse.

We looked at the quality assurance processes in place and saw that the home regularly carried out audits to check systems such as medication administration and infection control to maintain the health and safety of the people who live in the home.