Archived: Clipstone Hall and Lodge

Clipstone Hall and Lodge is a residential care home providing personal care to 60 people aged 65 and over at the time of the inspection. The service can support up to 90 people. The care home accommodates up to 90 people across 5 units. Each unit is purpose-built and specialises in providing care to people living with dementia.

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

People and their relatives felt the service was safe. Staff understood how to recognise and report concerns or abuse. People were protected from risks associated with their assessed health needs. Risks associated with the service environment were assessed and mitigated. There were enough staff to keep people safe. People received their prescribed medicines safely and were protected from the risk of infections.

People and relatives felt staff got the right training to meet their needs. People were supported and encouraged to have a varied diet that gave them enough to eat and drink. A health professional said staff were good at highlighting concerns about people’s health needs and getting them the support they needed. People were supported by staff to access healthcare services when required. The provider had taken steps to ensure the environment was suitable for people's 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.

People spoke positively about the staff who supported them. People also commented on how well staff knew them and supported them in the ways they preferred. People were involved in making decisions about their care, and relatives felt they were kept informed about their family member’s care. People said staff always treated them with respect. Staff had a good understanding of dignity in care and had training in this. Staff respected people's right to confidentiality.

People were regularly asked for their views about their care. Relatives were also involved in reviewing family members’ care with them. Records showed people’s views were documented and where possible, care was tailored to suit their wishes. Staff were proactive in responding to people’s individual needs and encouraged them to do things which were meaningful to them and made them happy. People were supported to maintain contact with their local community, and to continue with activities they had previously enjoyed at home.

The provider had a system in place to respond to complaints and concerns. People and their relatives were encouraged to talk about their wishes regarding care towards the end of their lives.

People and relatives felt the service was well-led. Staff felt supported in their work, and there was a positive team attitude. The management team kept a close eye on how the quality of care was, and any issues were identified quickly and resolved. The registered manager, deputy manager and provider clearly understood their roles and responsibilities in relation to managing a registered care home. The provider undertook audits of all aspects of the service to review the quality of care, and identify areas where improvements were needed.

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

At the last inspection the service was rated Requires Improvement (report published 25 April 2018). There was a breach of Regulation 12, where people’s medicines were not always managed safely, and the assessment of risks was not well managed. 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

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.

The service is provided over five units. Three units, over three floors in the Lodge and two units in the Hall.

The service had a registered manager in place at the time of our inspection. 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.

Medicines were not managed safely, and as a result a person had received out of date medicines that may not have been effective. Some people who required medicines at particular times for a health condition had not received their medicines in a timely way. This had not been picked up through the provider’s governance processes. We have made a recommendation about this.

People were not always protected from risk as there was a lack of essential information in some people’s risk assessments, and staff could not always tell us how risks to people’s safety were managed.

People were protected from the risk of abuse and staff had a good understanding of their roles and responsibilities if they suspected abuse was happening. The registered manager shared information with the local authority when needed and acted on concerns when they were raised to them. The service reviewed safeguarding issues to learn from incidents and prevent reoccurrence.

Staffing levels in the service were sufficient and the registered manager regularly reviewed staff levels to ensure that they remained safe. However, deployment of staff in one area of the service had an negative impact on some people.

The cleanliness of the service was maintained and monitored and staff were knowledgeable on how to protect people from the risks of infection. Staff had a full understanding of people’s care needs and received regular training and support to give them the skills and knowledge to meet these needs.

People were protected from the risks of inadequate nutrition and dehydration. Specialist diets were provided if required. Referrals were made to health care professionals when needed. People lived in a service which met their needs in relation to the premises and adaptions were made where required.

Staff understood the importance of obtaining consent when providing care and there were mental capacity assessments in place for people who lacked the capacity to make a decision. However prior to our inspection the registered manager had identified that the service had not always followed the principles of the Mental Capacity Act (2005) when undertaking these assessments. The registered manager had already started to address this issue by reviewing the assessments to ensure the principles of the MCA would be followed in the future

People who used the service, or their representatives, were encouraged to contribute to the planning of their care. They were treated in a caring and respectful manner by staff who delivered support in a relaxed and considerate manner.

People, who used the service, or their representatives, were encouraged to be involved in decisions about their environment, and systems were in place to monitor the quality of service provision. People also felt they could report any concerns to the management team and felt they would be taken seriously.

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