Clare Mount

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last inspection this domain was not inspected; however, we last inspected this domain in July 2022 and we rated this key question good. At this inspection the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of legal regulation in relation to the need for people to consent to care and treatment.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

The home had received input from local authority teams to improve their documentation in relation to assessments of people’s needs and, therefore, we noted improvements in this area. However, it was not clear in the documentation how people and their relatives had been facilitated to be fully involved in their assessments. People now had communication care plans, but we did not always observe good communication between people and staff and we did not observe the facilitation of good communication with people with specific needs. For example, we did not observe staff using any pictorial communication aids.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Staff did not always have a good understanding of good practice and guidance.The majority of people living at Clare Mount had dementia or other cognitive impairment. We found staff were not skilled in providing effective care to people who required enhanced support and this meant they were caring for people when they did not fully understand people’s individual needs. People who were in receipt of 24 hour 1 to 1 care were fully supervised by staff at all times and we observed this was restrictive for the person and there was no meaningful interaction and activity for the person.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

Relatives told us they were kept updated about their loved ones changing health needs. We observed staff generally worked well together but were not always proactive at engaging with people and promoting independence and choice. The registered manager had been working closely with other stakeholders and was working towards improvements with significant input from local authority teams. This support with systems had improved records and information to guide staff; however, this had not always improved the delivery of care to people living at the home.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

We were not assured that people’s risks were always managed appropriately to ensure their health and wellbeing. People were not always supported to live healthier lives as systems and processes were not robust to ensure staff identified and escalated concerns about people’s health needs. Monitoring charts were not always completed or accurately recorded meaning there was a risk that any deterioration in people’s conditions would not be noted and acted upon. For example, records suggested people were not repositioned in line with their care plan to mitigate the risk of skin breakdown. Another person required hourly checks due to their risk of absconding from the home; however, we found records were not completed in line with their assessed need.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive andconsistent, or that they met both clinical expectations and the expectations of people themselves.

People’s care plans did not include their goals or aspirations, or any information about positive outcomes to achieve. Although the provider had systems for oversight, it was not evident that these were being effectively used to review and improve people’s care. This included risks associated with people’s specific needs, and to ensure appropriate action and learning was taken in response to incidents and falls.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

At this inspection, concerns remained relating to the registered manager and staff’s understanding of consent and the Mental Capacity Act 2005 (MCA). Since the last inspection the service has been supported in this area by the local authority teams. Mental capacity assessments were now in place for people; however, their completion was not always accurate and we found discrepancies and a lack of understanding by staff. We found some people did not have consents to care and treatment recorded, some people’s consents had been signed by people who did not have the legal authority to do so, and we found one instance where the person had capacity but a relative had signed consents on their behalf.