Clement Court

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people’s needs were not always met.

The service was in breach of legal regulation in relation to people not always being treated appropriately, in a way that met their needs or reflected their preferences.

This service scored 61 (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 were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

A relative told us, “There have been issues about my relative always being in bed, my relative is prone to having bed sores. They [staff] were keeping my relative in bed to rotate them. Only this last week my relative has been out [of bed]. When my other relatives visit my relative is in bed.”

One staff member said, “I would love to [get to know people well] but I do not have time.” Whereas another staff member told us, “It’s getting their opinion and asking person centred questions.” Staff generally knew people well. A professional told us, “Staff also appear to know the residents well and typically all staff that I speak to have the correct information available.”

However, 2 relatives raised concerns with us about the fact their relative did not appear to be supported with their personal care, such as hair washing, often enough. There were differing responses about why people had not been supported out of bed. Therefore, we were not assured people were always supported appropriately. One staff member told us 1 person had been referred to a professional to try to support them to get out of bed. However, when the professional visited, the person had not wanted to engage with them. However, the home had not then attempted to have the professional return, so the person had continued to remain in bed. The staff member told us the person had been in bed for ‘at least 12 months’. We were told another person remained in bed at the family’s request. However, there was no assessment or best‑interest decision in place to evidence how this decision had been considered, which meant the provider had not ensured care was being delivered in a person-centred way.

One person’s room needed to be made more personalised, as it was bare and there was no evidence of personal items.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

People’s care plans did contain some personalised details so there was a good sense of how to support them. A relative told us, “I do feel involved [with my relative’s care plan]. They [staff] do ring and ask us.” However, there was some conflicting information at times and some care plans lacked detail, despite staff being directed to look at the care plan in relation to when to give some medications. ‘This is me’ records were in place which included basic information about people’s interests such as their favourite football team, craft activities and watching TV. In 1 example, there was a photograph of the person holding a sign about what they would like to do. However, there was no indication if the person had been supported to engage in this. These records did not capture life histories, significant relationships for people or evidence involvement from relatives and friends important to people.

The deputy manager told us they were starting to engage with relatives as part of reviews of people’s care to improve people’s care and their care plans.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

There was a menu board in the dining areas with the day’s meals displayed. However, the provider’s dining audit had identified it would be beneficial to show people the plates of food to help them make a decision. While people were offered a choice of meals, we saw the approach of showing people was not used at lunch time. Some people may have benefitted from seeing the choices as reading words or listening to options may not be suitable, depending on some people’s needs.

The provider told us they were able to provider people’s care plans in other formats should people need these, such as in other languages.

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

There were relative meetings to enable relatives to feedback if they wanted to. One relative said, “I’ve been invited [to meetings] but I’ve never been to one. I’ve never felt the need to go.”

There was a complaints process in place and relatives felt able to raise concerns if needed. A relative told us, “There have been a few issues, but they seem to be ironing them out.”

The provider had a complaints process in place. The deputy manager said, “We get back to them [acknowledgement] within 3 days, we have 28 days to deal with it. We have a complaint log, which is centralised. We ask the complainant how they want us to take it forward. Some people are happy with verbal feedback, some formal. Some residents prefer verbal, formal reply. We track it.”

The provider made sure that people could access the care, support and treatment they needed when they needed it. Relatives told us people had access to other health professionals when needed. Professionals also confirmed referrals for their support were timely. A professional said, “We do infrequently have referrals from Clement Court, and they appear to be timely in referral.” There were regular meetings with external clinicians to support the regular review and timely intervention to try to keep people well.

Staff and leaders did not always actively listen to or act on information about people who were most likely to experience unequal outcomes. This meant people’s care and day‑to‑day experiences were not always tailored in response to their individual circumstances.

One relative told us they felt their relative did not always seem to have enough stimulation whilst in their room. They said, “My relative needs to be stimulated, instead of being stuck in front of the TV and in the same 4 walls.” One staff member told us, “We have to weigh up the risks. I get frustrated when they say we have to put someone back to bed, just because they [a person] are vocal is not a good enough reason to put someone back to bed.” As people were not always given equal opportunity to access communal spaces or leave their beds in a reasonable time each day, people were not having an equity of experience or consistently positive outcomes.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

A staff member told us how they try to support someone nearing the end of their life, “We try to make sure someone is with them, sitting with them chatting to them, holding their hand.”

People had generic end of life plans in place, which referenced their ReSPECT form, if applicable. A ReSPECT form is a ‘Recommended Summary Plan for Emergency Care and Treatment’ which give information about people’s preferences when they are not able to express their wishes during an emergency.