Clitheroe Care Home

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

Medicines records were not always accurate, and medicines and equipment were not always managed safely. Infection prevention control (IPC) practices were not always robust. Risks relating to fire were not always appropriately managed. Safeguarding processes and procedures were in place but were not always being followed. However, people at the home told us they felt safe. Staffing levels in the home was adequate, though some improvement was required in relation to recruitment records. We made a recommendation that the provider improves their recruitment processes. Management told us they were working to improve the issues we identified.

People’s needs had not always been assessed and necessary health related risk assessments and care plans were not always in place. The management were in the process of improving this. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. After our site visit the management were reviewing this information and making necessary referrals.

Staff completed an induction once recruited, and staff were supported by the management, however not all staff had completed appropriate training. We witnessed incorrect moving and handling practices during our inspection, and we made a recommendation that the provider reviews their practices and processes relating to moving and handling. The environment needed some improvement to meet the needs of the people living there, and the management advised they were making these changes. People did not have oral healthcare plans in place, and people were not registered with a dentist, however, management told us they were in the process of trying to rectify this. Feedback on the food people received was positive.

Various governance issues were identified during our inspection, including issues around records and audits. Although the manager was aware of their responsibility under the duty of candour, they had not always reported necessary incidents to CQC and the local safeguarding team. Since the inspection the manager has left the service. A consistent approach to working in partnership with other health care professionals, making necessary referrals and, ensuring follow ups was not always adhered to. Staff meetings and meetings for/with people that use the service were taking place, and surveys were being conducted. Staff and people spoke positively about the service, though people did not always receive good outcomes as detailed in this report. Staff were aware how to report poor 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 good (published 09 December 2020). At our last inspection we recommended that the provider reviews their documentation around recruitment. At this inspection we found improvements relating to recruitment were still required. We also made a recommendation around monitoring, assessing and improving the service, we found that at this inspection we had further concerns around the governance of the service.

Why we inspected

We received various concerns about the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. 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, effective and well-led sections of this report.

We looked at IPC 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.

You can see what action we have asked the provider to take at the end of this report. The provider had taken some action to mitigate risks and was working on making further improvements.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Clitheroe Care Home 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 IPC, medicines, environmental concerns (including fire), safeguarding service users, person centred care, failure to/and delay of sending appropriate notifications to CQC and good governance.

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 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.

We found the following examples of good practice.

Prior to the inspection, we received information about an outbreak of COVID in the home and that staff were being told they had to work despite having symptoms of COVID and positive test results. We looked at records, including rotas, group text messages, test dates and test results. We also spoke with the regional manager, the manager and with three staff who were currently isolating. We were satisfied appropriate action had been taken to ensure people and staff were safe. Staff confirmed they had been sent home on receiving a positive test. We discussed maintaining an accurate staffing rota as we noted some errors in the recording of attendance and absence; the regional manager addressed this immediately.

There were enough stocks of personal protective equipment (PPE). PPE stations and hand sanitiser were available throughout the home which helped ensure staff and visitors had access to it when required. Staff were able to don and doff their PPE safely and had received training in the use of PPE, infection control and hand hygiene. We observed staff and management were using PPE correctly and there were procedures in place to support staff with its use. The regional manager was due to put signage in place to remind staff about the correct application and removal of PPE.

There were sufficient staff to provide continuity of support should there be a staff shortage. During the outbreak and isolation period, some staff were living in the home and only designated care, housekeeping and catering staff were included on the rota. This minimised people’s contact with different staff and reduced the risk of spread of infection.

There was a good standard of cleanliness in all areas seen. However, we noted an unpleasant odour in an area on the first floor; the regional manager addressed this. Additional housekeeping staff were in place and the frequency of cleaning had been increased. There were policies and procedures to maintain good practice in relation to infection control and to provide safe and kind care.

The provider’s infection prevention and control policies and procedures were up to date and a monthly audit had been carried out. A Covid-19 Response Plan and business contingency plan were in place and were being followed. The management team were working closely with the local authority and clinical commissioning group and other partners including the community nurses.

Visiting was subject to government restrictions and the area was in national lockdown. In line with visiting guidance and outbreak management guidance, all visits had been restricted and were only allowed in exceptional circumstances. Policies reflected this. People were supported to maintain contact with their relatives in different ways including the use of social media and telephone calls. A safe visiting area in the lounge area was planned for when visiting restrictions were eased. We were told this would incorporate shielding and isolation processes to ensure visitors and residents were protected. During the current outbreak, people were not being admitted to the home. We were told this would be reviewed at a later date in line with guidance.

Clitheroe Care Home is a residential home which provides accommodation and personal care for up to 28 older people, people with a physical disability, sensory impairment and people living with dementia. Accommodation is provided over three floors, with a passenger lift and stair lift providing access to all floors. At the time of the inspection, 23 people were living at the home.

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

People told us they were well cared for and felt safe in the home. Risks to people’s safety and well-being were assessed and staff were provided with information about how to support people safely. Staff completed safeguarding training and knew the correct action to take to protect people from the risk of abuse.

We have made recommendations that the provider improves documentation in support of recruitment decisions and to the recording of when medicines have been given or the reason if they have not. We have also made a recommendation that the provider improves their quality monitoring systems.

People told us there were enough staff to respond to their needs. Staff told us they always had time to spend with people and enjoyed being able to provide high quality care. Staff had managed well during the pandemic and followed safe infection control practices.

There had been several changes of manager since the last inspection. Although they had no concerns about the care of their family members, relatives had felt unsettled by all the changes and the lack of communication from the provider about these. A new manager had been appointed and had started work at the home on the day prior to this inspection. They had started the process to register as manager with CQC.

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 31 March 2020).

Why we inspected

This inspection was prompted in part by a number of safeguarding alerts raised with the local authority and whistleblowing concerns shared with CQC. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We found no evidence during this inspection that people were at risk of harm in relation to the concerns raised.

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.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Clitheroe Care Home is a residential home which provides accommodation and personal care for up to 28 older people, people with a physical disability, sensory impairment and people living with dementia. Accommodation is provided over three floors, with a passenger lift and stair lift providing access to all floors. At the time of the inspection, 27 people were living at the home.

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

People felt safe at the home and most people and relatives were happy with staffing levels. The provider recruited staff safely and staff understood how to protect people from the risk of abuse. People received their medicines as and when they should. Staff followed appropriate infection control procedures and people told us the home was always clean. Risks to people’s health and wellbeing were managed well and the safety of the home environment was checked regularly.

Staff supported people to achieve good outcomes. Staff were well trained and able to meet 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. Staff supported people with their dietary and healthcare needs and referred them for specialist support when they needed it. The environment had been adapted to enable people to remain as independent as possible.

People liked the staff who supported them and told us staff were kind, caring and respectful. Staff encouraged people to be independent and make decisions about their care when they could. Staff respected people's right to privacy and dignity. They were aware of people’s diverse needs and what was important to them.

Staff provided people with care that reflected their needs, risks, abilities and preferences. Staff knew people well and encouraged them to make choices when they could. Staff reviewed people's care needs regularly and updated documentation when people's needs changed. Concerns and complaints were managed appropriately. People were very happy with the wide range of activities and entertainment provided at the home.

Management and staff understood their responsibilities and provided people with care which resulted in good outcomes. They worked in partnership with community agencies to ensure people received the support they needed. People’s views were sought about the service and acted upon. People, relatives and staff felt the service was managed well. Management completed regular checks to ensure people received high quality, safe care.

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

Rating at last inspection

The last rating for the service was good (published 6 December 2017). Since this rating was awarded, the registered provider of the service has changed. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected

This was a planned inspection based on the service’s date of registration.

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.