Clarence House Care Home

Clarence House Care Home is a residential care home providing personal care to up to 41 people. The service provides support to older and younger people, some of whom may be living with dementia, a physical disability or a sensory impairment. At the time of our inspection there were 20 people using the service.

Clarence House Care Home is a converted period building overlooking the sea. Whilst the service can accommodate people over all three floors, at the time of the inspection, only two floors were being used. All rooms contain washing and toileting facilities and the home has several communal areas including gardens overlooking the sea.

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

We found significant improvements had been made at the service since our last inspection in March 2021. People who used the service, and their relatives, told us the care delivered was achieving positive outcomes for people. People told us they felt cared for and listened to and we saw several examples of where their health and wellbeing had improved.

The people we spoke with described an improved service that was caring, proactive and compassionate. The health and social care professionals who provided us with feedback described the service as responsive and the registered manager as professional and knowledgeable. There had been changes made to the governance systems and these had helped drive the improvements along with an enthusiastic management team who had encouraged an open and communicative culture.

Whilst risks were being managed in practice, we did find some concerns that required action. We found the provider had identified some of these via their own quality monitoring systems and actions were in place to address them. Where this had not been the case, we saw the registered manager acted promptly to rectify the issues following the feedback given.

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 21 April 2021) and there were four breaches of regulation relating to safe care and treatment, staffing, safeguarding and governance. We took enforcement action and imposed conditions on the provider’s registration meaning they had to submit monthly reports to demonstrate the actions they were taking to drive improvements. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. The conditions we imposed were removed following this inspection.

This service has been in Special Measures since 26 November 2020. 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 undertook this focused inspection to check the provider 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 of Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last comprehensive 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 Clarence House Care Home on our website at www.cqc.org.uk.

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.

Clarence House Care Home is a residential care home providing personal care to up to 41 older people, some of who are living with dementia. There were 21 people living at the service at the time of the inspection visit.

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

People were not receiving consistently safe standards of care, from sufficient levels of staff with the necessary skills and attributes to provide good care. The condition of the care environment was poor, people were not being protected from accessing risk items and areas of risk within the service, and we identified areas of concern in relation to infection prevention and control practices. People were raising concerns with staff and members of the management team for example in relation to their medicines, and these were not being acted on. People raised concerns with inspectors, which resulted in onward referrals being made to the local authority safeguarding team. We received some additional concerns from speaking with people’s relatives.

Timely action was not being taken to address risks, concerns and shortfalls identified through checks and audits completed by members of the management team. This did not ensure people were protected from harm, or that they were receiving consistent standards of care and support. In the absence of a registered manager at the service, the registered provider holds accountability for the safe running of the service.

Rating at last inspection (and update)

The last rating for this service was Inadequate with breaches of regulation relating to safe care and treatment, staffing and the governance and oversight of the service including in the submission of notifications to CQC. (Published 26 November 2020). At this inspection enough improvement had not been made and the provider was still in breach of regulations and remained placed in special measures.

Why we inspected

We carried out an unannounced focused inspection of this service on 01 October 2020. 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, staffing, good governance and submission of notifications to CQC.

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.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed remained Inadequate. 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 Clarence House Care Home on our website at www.cqc.org.uk.

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.

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 repeated breaches in relation to safe care and treatment, staffing and the governance and oversight of the service. We also identified a breach in relation to protecting people from risks abuse and harm at this inspection.

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 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 overall rating for this service remains ‘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.

Clarence House Care Home is a residential care home that provides personal care. It is registered to provide care and support for up to 41 older people. At the time of the inspection 31 people, some of who lived with dementia, were receiving personal care. Accommodation was over three floors of a period building which had been adapted.

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

The provider’s quality monitoring and auditing systems were not robust enough to identify and rectify the concerns we found at this inspection.

Areas for improvement identified during the last inspection were not all rectified. This meant the provider had not implemented the right changes to ensure improvements were made.

The registered manager was not always aware of areas of concern about peoples’ care needs. This had placed people’s health and safety at risk. This had been due to poor documentation and also guidance within care plans.

Staff did not always report, document and monitor people’s needs as required to ensure appropriate care and support were in place. This meant that people were at an increased risk as we could not be sure if appropriate actions such as repositioning had always taken place.

Charts used by staff to monitor people’s care and support were not always completed. These included repositioning charts for people with poor skin integrity and fluid charts for people at risk of dehydration. This placed people’s health at risk of harm because the provider could not be assured that the appropriate care was being delivered by staff as required. People may not have received care and support to keep them safe.

Medicines were not always being managed safely at the home. We could not be sure that people were always receiving their medicines as prescribed.

People told us staff provided good care. However, there were not always enough staff to ensure people’s needs were met in a timely manner. This had an impact on people’s dignity and did not meet their care and support needs. This included supporting people’s independence to be able to go to the toilet when they needed or to have a shower when they wanted.

People’s care plans we looked at, lacked detail and information to ensure people were kept safe. We found where risk assessments were required for people’s known risks, these had not always been completed. This meant that people were placed at unnecessary risk because there was no guidance for staff to support the risks.

People lacked regular good interaction from staff due to staffing levels. People were not always involved in decisions about their care.

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 4 April 2019) and there was a breach of regulation17 good governance. 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 sustained and the provider was still in breach of regulations.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm that they had met the legal requirements. This report only covers our findings in relation to the key questions safe and well-led which contain those requirements.

The inspection was prompted in part due to concerns received about staffing levels, medicine errors and several safeguarding’s raised with the local authority in relation to poor care.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from requires improvement to inadequate. 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 Clarence House 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 have identified breaches in relation to the safe management of medicines and care, Staffing, good governance and reporting incidents to CQC as required. This puts people at an increased risk of harm.

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

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will set up a meeting 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.

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.

• Clarence House Care Home is a residential care home that was providing personal care to 36 people aged 65 and over at the time of this inspection. Some of those residing at Clarence House Care Home were living with dementia. It is registered to provide care and support for up to 41 older people.

• This was the service’s first inspection under a new provider.

People’s experience of using this service:

• The provider’s quality monitoring auditing system was not robust enough to identify and rectify the concerns we found at this inspection and what they themselves had previously identified.

• Good practice guidance and the provider’s own policy and procedures had not been followed in relation to the management and administration of controlled medicines.

• Although people received a person-centred service, care plans that lacked detail and recent reviews put people at risk of receiving care and support that did not meet their needs, particularly as a high number of agency staff were being used within the service.

• We saw that people were involved in making day to day decisions about the care and support they received. However, people’s involvement in the planning of their care was not evident.

• The individual risks to people had been identified and managed but written assessments of the risks lacked detail and reviews. This put people at risk.

• We have made two recommendations to the provider about care plans.

• Accidents and incidents were recorded and actioned but full analysis was not completed to fully mitigate future risk.

• The risks associated with the environment and working practices had been managed.

• Staff recruitment was safe and there were enough staff to meet people’s needs.

• The provider had systems in place to help protect people from the risk of abuse and infections.

• People were happy with the care and support they received as were their family members.

• Staff demonstrated respect for people and interacted in a kind and meaningful way.

• People’s independence was encouraged and virtual assistive technology was being employed to further enhance this.

• People experienced positive, social and engaging mealtimes and their nutritional needs were met. They had access to healthcare professionals.

• Staff were supported, inducted and received ongoing training to further improve the service people received. People told us they had confidence in the staff’s abilities to support them.

• There was an open and transparent culture within the service and suggestions and opinions on the service was encouraged, investigated and listened to.

• Staff worked well together and shifts were well organised.

• The environment was safe and warm. Refurbishment was ongoing.

• 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. Accessible information was available to those that lived at the service and others in order to make informed decisions.

• Activities were provided that people enjoyed.

• Improvements to the service continued however we did not yet see the full impact of these at this inspection. The service met the characteristics of good in three key questions however concerns about the management of controlled medicines and issues with care planning meant the service was in breach of the Regulations in two of the key questions.

• For more information on our inspection findings, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk.

Rating at last inspection:

• This was the service’s first inspection under its new provider. The regulated activity of ‘accommodation for persons who require nursing or personal care’ was registered with the CQC on 12 June 2018.

Why we inspected:

• This was a planned comprehensive inspection based on the service’s new registration.

Follow up:

• We will continue to monitor the service to ensure people receive safe, high quality care. Further inspections will be planned for future dates taking into consideration the overall rating for the service.

• Please see the ‘action we have told the provider to take’ section towards the end of the report.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk