We carried out a review of the data available to us about Claydon House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Claydon House, you can give feedback on this service.
Claydon House is registered to provide nursing care and accommodation for up to 49 people. There were 33 people living at the service at the time of the inspection. People that lived at Claydon House were mainly older people with a range of care and support needs that included diabetes and heart conditions. Several people lived with dementia and could show behaviours requiring support from appropriately trained staff.
People’s experience of using this service and what we found
People who lived at the service were protected from the risk of harm and abuse. People told us they felt safe and this view was supported by relatives and loved ones. Staff had received training in safeguarding and were able to tell us the steps they would take if they suspected abuse. Care plans contained risk assessments relevant to people and their care needs. These included diabetes, wound care and living with dementia. 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. Medicines were administered safely by appropriately trained staff. Infection prevention and control measures were in place and the service was seen to be clean and well maintained throughout. Lessons were learned following accidents and incidents.
The registered manager had developed a positive culture at the service. Everyone spoke well of the registered manager who was a visible presence throughout the home. Robust auditing processes were in place, all of which were either carried out by the registered manger or had their full oversight. People and relatives were fully engaged with the service. There were a variety of ways that people and relatives could provide feedback about the service including regular meetings, questionnaires and daily interactions with managers. There were business plans in place for the future of the service and the registered manager had developed positive relationships with other health and social care professionals.
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 1 November 2017)
Why we inspected
The inspection was prompted, in part, due to concerns received about the provider’s approach to visiting, responding to concerns and risks of a closed culture. A closed culture is where a poor culture can lead to harm and abuse. A decision was made to inspect and examine the concerns across a number of Caring Homes’ services.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
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.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Claydon House on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Claydon House is registered to care for 49 people. There were45people living in the home when we inspected. People cared for were all older people. They were living with a range of complex needs, including stroke and heart conditions. Many people needed support with their personal care, eating and drinking and mobility needs. People living at Claydon House were also living with dementia. The manager reported they provided end of life care at times. There was one person receiving end of life care when we inspected.
Claydon House is a large house, which had been extended. People in the older building had residential and nursing care needs. People on the Admiralty wing extension were living with dementia. There were a choice of sitting and dining rooms on each floor. A passenger lift was provided between floors. The Admiralty wing had accommodation over three floors, two of the floors directly connected with the older building. Each floor had its own sitting/dining room. There was a passenger lift between floors. All rooms were en-suite and most included showers. Additional baths and toilets were also provided. There was a garden, which was wheelchair accessible.
There was a registered manager in post. They had been in post for approximately three years. A registered manager is a person who has registered with the CQC to manage the home. 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. The provider for the home was Caring Homes Healthcare Group Limited, a national provider of care. The home was supported by an area manager from the provider.
Claydon House was last inspected on 27 and 29 April 2015 when the overall rating for the service was Good.
This inspection found that the overall rating remains good but the lack of progress with maintenance issues and the decoration of the older part of the building means that the well-led question continues to require improvement. At the last inspection we found the service required improvement under the well-led question, this was in relation to record-keeping. This had been addressed by this inspection
There were quality assurance systems in place that monitored people’s care. We saw that the manager completed audits and checks were in place which monitored safety and the quality of care people received. These included yearly satisfaction surveys sent to people, families and health professionals. However we found that there were areas that despite being identified through environmental audits and resident surveys that had not been progressed in a timely way by the provider.
Action had been taken following accidents or incidents to prevent further occurrences. Risks associated with people's care needs and the environment had been assessed and measures put in place to prevent avoidable harm. People received their medicines as prescribed by their doctor. People were supported to maintain their health and had access to health professionals. People were supported by staff who understood how to keep them safe and could raise concerns if they needed to.
There were enough staff to meet people's needs. The provider followed safe recruitment practice. People were supported by staff who had received training and support to meet their needs. Staff felt supported and their competency in their role was checked. People were supported to have enough to eat and drink. Where people had dietary requirements, these were met and staff understood how to provide these. People were supported in line with the requirements of the Mental Capacity Act (2005). People's mental capacity to consent to their care had been assessed where there was a reasonable belief that they may not be able to make a specific decision.
Staff at all levels treated people with kindness and compassion. Dignity and respect for people was promoted. People were supported to maintain their independence. The care needs of people had been assessed and were regularly reviewed to ensure they continued to be met. Staff had a clear understanding of their role and how to support people who used the service.
People had access to activities so that they could follow their interests and remain active if they wanted to. Staff felt supported. Where necessary the provider's disciplinary procedures had been implemented. People and their relatives felt the service was well led. They felt the registered manager was approachable and that they would deal with any concerns they may have. The registered manager had a good over sight of the service.
We inspected Claydon House on 27 and 29 April 2015. The inspection was unannounced. Claydon House is registered to care for 49 people. There were 39 people living in the home when we inspected. This was because the first and second floors of the older part of the building were undergoing up-grading, so the rooms on these floors were vacant while the improvements were taking place. People cared for were all older people. They were living with a range of complex needs, including stroke and heart conditions. Many people needed support with their personal care, eating and drinking and mobility needs. People living at Claydon House were also living with dementia. The manager reported they provided end of life care at times. No one was receiving end of life care when we inspected.
Claydon House is a large house, which had been extended. People in the older building had residential and nursing care needs. People on the newer Admiralty wing extension were living with dementia. Due to building works people were only living on the ground and lower ground floor of the older building; mainly people with nursing needs lived on the ground floor and people with residential care needs on the lower ground floor. There were a choice of sitting and dining rooms on each floor. A passenger lift was provided between floors. The Admiralty wing had accommodation over three floors, two of the floors directly connected with the older building. Each floor had its own sitting/dining room. There was a passenger lift between floors. All rooms were en-suite and most included showers. Additional baths and toilets were also provided. There was a garden, which was wheelchair accessible.
There was a registered manager in post. They had been in post for approximately 18 months. A registered manager is a person who has registered with the CQC to manage the home. 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. The provider for the home was Caring Homes Healthcare Group Limited, a national provider of care. The home was supported by an area manager from the provider.
The manager had worked to make improvements across a range of areas since they came in post, however some areas relating to documentation had not yet been completed in full. This was because some parts of some people’s care needs were not documented and others were not always documented when their needs changed, although staff told us in detail how they met these people’s needs. Other people’s needs were fully documented and reflected what staff told us. The manager reported they had identified a need to support staff further with improving documentation. They had plans in place and were progressing this.
People told us they felt safe in the home. Staff were knowledgeable about safeguarding policies and how to recognise different types of abuse. The service ensured risks to people were identified and action taken to reduce risk, for example risk of falls and skin damage. Staff acted in a safe way when the fire alarm was activated. They followed the provider’s policies to ensure people were safeguarded in the event of a fire.
People were satisfied with staffing levels. There were enough staff on duty to support people at busy times of the day such as meal times, and to support people with 1:1 time. Staffing levels were regularly reviewed to ensure appropriate numbers of staff were available when people’s dependency changed. The provider had safe systems for the recruitment of staff.
Medicines were given out in a safe way. Medicines were kept securely and there were full records of medicines administration.
People reported staff were trained and able to meet their needs. Staff supported people in an effective and safe way, for example when they needed to be supported in moving. New staff reported positively on induction to their roles. Staff were provided with the training they needed. Supervision systems ensured individual staff training needs were identified.
Staff were aware of their role in supporting people who lacked capacity and of the Deprivation of Liberty Safeguards. Where decisions needed to be made in a person’s best interests, these took place and involved all relevant parties.
People’s medical needs were promptly addressed, including involvement of a range of healthcare professionals, for example the community psychiatric nurses. People who were assessed as being at nutritional risk were identified and supported in the way they needed to maintain or increase their weight.
People were positive about the meals. There were systems to ensure people who were living with dementia could choose what they wanted to eat. Where people could not support themselves independently to eat their meals, they were fully supported by staff.
People said the staff were caring and supported them in the way they wanted. We saw staff supporting people who were frail and/or living with dementia in a way which encouraged them in making choices and being independent. Staff were consistently respectful to people and ensured their privacy and dignity.
Staff were responsive to people. They ensured they got to know people, before they developed their care plans. Staff were aware of people’s individual needs, developing care plans which responded to these needs, for example in relation to changes in their mobility.
A wide range of activities were provided to people. These included individual and large group activities. Activities were available seven days a week and there were regular trips out of the home
People felt they could raise issues with the manager and if they did, the manager would take action. Records of complaints made by people showed the manager and provider took action where issues were reported to them.
People and staff made favourable comments about the management of the home. The manager had a well organised system for audit of service provision. Where issues were identified, action plans were in place and being progressed. Staff said the culture of the home was supportive to them. A member of staff reported “I think it is amazing here I like the staff and the residents.”
We inspected Claydon House on 27 and 29 April 2015. The inspection was unannounced. Claydon House is registered to care for 49 people. There were 39 people living in the home when we inspected. This was because the first and second floors of the older part of the building were undergoing up-grading, so the rooms on these floors were vacant while the improvements were taking place. People cared for were all older people. They were living with a range of complex needs, including stroke and heart conditions. Many people needed support with their personal care, eating and drinking and mobility needs. People living at Claydon House were also living with dementia. The manager reported they provided end of life care at times. No one was receiving end of life care when we inspected.
Claydon House is a large house, which had been extended. People in the older building had residential and nursing care needs. People on the newer Admiralty wing extension were living with dementia. Due to building works people were only living on the ground and lower ground floor of the older building; mainly people with nursing needs lived on the ground floor and people with residential care needs on the lower ground floor. There were a choice of sitting and dining rooms on each floor. A passenger lift was provided between floors. The Admiralty wing had accommodation over three floors, two of the floors directly connected with the older building. Each floor had its own sitting/dining room. There was a passenger lift between floors. All rooms were en-suite and most included showers. Additional baths and toilets were also provided. There was a garden, which was wheelchair accessible.
There was a registered manager in post. They had been in post for approximately 18 months. A registered manager is a person who has registered with the CQC to manage the home. 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. The provider for the home was Caring Homes Healthcare Group Limited, a national provider of care. The home was supported by an area manager from the provider.
The manager had worked to make improvements across a range of areas since they came in post, however some areas relating to documentation had not yet been completed in full. This was because some parts of some people’s care needs were not documented and others were not always documented when their needs changed, although staff told us in detail how they met these people’s needs. Other people’s needs were fully documented and reflected what staff told us. The manager reported they had identified a need to support staff further with improving documentation. They had plans in place and were progressing this.
People told us they felt safe in the home. Staff were knowledgeable about safeguarding policies and how to recognise different types of abuse. The service ensured risks to people were identified and action taken to reduce risk, for example risk of falls and skin damage. Staff acted in a safe way when the fire alarm was activated. They followed the provider’s policies to ensure people were safeguarded in the event of a fire.
People were satisfied with staffing levels. There were enough staff on duty to support people at busy times of the day such as meal times, and to support people with 1:1 time. Staffing levels were regularly reviewed to ensure appropriate numbers of staff were available when people’s dependency changed. The provider had safe systems for the recruitment of staff.
Medicines were given out in a safe way. Medicines were kept securely and there were full records of medicines administration.
People reported staff were trained and able to meet their needs. Staff supported people in an effective and safe way, for example when they needed to be supported in moving. New staff reported positively on induction to their roles. Staff were provided with the training they needed. Supervision systems ensured individual staff training needs were identified.
Staff were aware of their role in supporting people who lacked capacity and of the Deprivation of Liberty Safeguards. Where decisions needed to be made in a person’s best interests, these took place and involved all relevant parties.
People’s medical needs were promptly addressed, including involvement of a range of healthcare professionals, for example the community psychiatric nurses. People who were assessed as being at nutritional risk were identified and supported in the way they needed to maintain or increase their weight.
People were positive about the meals. There were systems to ensure people who were living with dementia could choose what they wanted to eat. Where people could not support themselves independently to eat their meals, they were fully supported by staff.
People said the staff were caring and supported them in the way they wanted. We saw staff supporting people who were frail and/or living with dementia in a way which encouraged them in making choices and being independent. Staff were consistently respectful to people and ensured their privacy and dignity.
Staff were responsive to people. They ensured they got to know people, before they developed their care plans. Staff were aware of people’s individual needs, developing care plans which responded to these needs, for example in relation to changes in their mobility.
A wide range of activities were provided to people. These included individual and large group activities. Activities were available seven days a week and there were regular trips out of the home
People felt they could raise issues with the manager and if they did, the manager would take action. Records of complaints made by people showed the manager and provider took action where issues were reported to them.
People and staff made favourable comments about the management of the home. The manager had a well organised system for audit of service provision. Where issues were identified, action plans were in place and being progressed. Staff said the culture of the home was supportive to them. A member of staff reported “I think it is amazing here I like the staff and the residents.”
Our inspection team was made up of two adult social care inspectors. We answered our question; Is the service safe? Is the service effective. Below is a summary of what we have found. The summary is based on our observations during the inspection. Thirty-nine people were resident in the service at the time of our inspection. We looked at people's care and support plans, staff records and records relating to the management of the service. We spoke individually with the registered manager (referred to as manager in the report) the head of care, a registered nurse, and four care workers. We also spoke with seven people who used the service and a visiting relative.
If you want to see the evidence that supports our summary please read the full report.
Is the service safe?
A staff rota was in place, which had taken into account people's care needs when making decisions about the numbers, qualifications, skills and experience required.
Is the service effective?
People's health and care needs had been identified and where possible people and their representatives had been involved in the writing and review of the new care and support documentation. Their specialist care needs and support needs had been identified and guidance for staff to follow was in place.
Below is a summary of what we have found. The summary is based on our observations during the inspection. 44 people were resident in the service at the time of our inspection. We observed the care provided, looked at supporting care documentation, staff records and records relating to the management of the service. We spoke individually with the regional manager, a peripatetic manager, the deputy manager, a registered nurse, a lead care worker, three care workers, the administrator, a kitchen assistant and the chef. We spoke with ten people who used the service and five relatives/visitors.
Is the service safe?
People were treated with respect and dignity by the care staff. People told us they were safe in the service.
Staff had received training and had an understanding of their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). They knew who to contact should further guidance and support be required to ensure people's best interests. Where possible, people had been asked for their consent for any care or treatment.
There was a system in place to make sure that the provider, management and care staff learnt from events such as incidents and accidents, complaints, and concerns.
Staff had been provided with training to undertake their roles in the service, systems developed and recording and monitoring systems put in place. This helped to ensure people were not put at any unnecessary risk.
A staff rota was in place, which had taken into account people's care needs when making decisions about the numbers, qualifications, skills and experience required. However, there were not enough care staff on duty in the nursing and residential unit to meet people's care needs.
Is the service effective?
People's health and care needs had been identified and where possible people and their representatives had been involved in the writing and review of the care documentation. Their specialist care needs such as dietary requirements and support needs had been identified and guidance for staff to follow was in place. However, the care and support plans on the nursing and residential unit had not all been reviewed to ensure these detailed people's current care needs. People were able to move around the service freely and safely.
Is the service caring?
People were supported by kind and attentive staff. We saw that care staff showed patience and offered encouragement when supporting people. One visitor commented, 'We have always been treated with courtesy. The staff are always willing and look for ways to help.'
People had been asked to complete quality assurance satisfaction surveys.
People's preferences, interests, aspirations and diverse needs had been recorded. People told us care and support had been provided in accordance with people's wishes.
Is the service responsive?
There was a complaints policy and procedure in place if people or their representatives were unhappy, which was monitored by the provider. The majority of complaints which had been received since the last inspection had been responded to appropriately. People told us they had not had to raise any concerns, and they were aware who to speak with if they had any concerns and that they felt they would be listened to.
Is the service well lead?
The service had quality assurance systems to develop and improve the service provided, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continually improving.
Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the service and quality assurance processes were in place. This helped to ensure that people received a good quality service at all time.
We spoke with the manager, a nurse and a care worker.and we reviewed parts of 12 people's care records,. We also looked at meeting minutes and duty rotas to help us make our judgement.
We found that records relating to people's care were being consistently completed and were monitored for accuracy. A care worker told us, 'They check the paperwork every day and they deal with it if any is missing. They're being much more thorough'. A nurse said, 'We're trying to work as a team to make sure things are recorded.'
We specifically looked at the management of falls, the risk of pressure damage, personal care and nutrition. We found that in these areas people's needs were assessed and care delivered to meet them.
We found that the home regularly reviewed the numbers of staff required to meet the needs of people who used the service. However, we found that the numbers of staff the home deemed necessary were not present for 31% of shifts we analysed. A staff member told us, 'We are below our template at least a couple of times a week.'
We found that people's care records were inconsistently completed, and in one case, lost. This presented a risk that people may not receive safe and appropriate care.
People who used the service and their relatives told us they were satisfied with the level of care. One person said, 'I really am quite happy. I can't think of anything to complain about.' A relative said, 'Individual staff are always very happy and kind. They always phone me if there are any problems.'