Archived: Clarendon Care Home

People’s experience of using this service: People were happy living at Clarendon Care Home. They told us their needs were met in a personalised way by staff who were competent, kind and caring.

Individual and environmental risks were managed appropriately, which meant people were kept safe from avoidable harm.

Medicines were managed safely and people received the personal care they required. They were involved in the development of their personalised care plans that were reviewed regularly. People's rights and freedoms were upheld. People were empowered to make all their own choices and decisions.

Staff were well trained, felt listened to and worked well together. A quality assurance system helped the management continually seek and implement improvements that would benefit people.

The service met the characteristics of Good in all areas. More information is in the full report.

Rating at last inspection: At the last inspection the service was rated Requires Improvement. (Report published 18 April 2018). The overall rating has improved.

Why we inspected: This was a scheduled/planned inspection based on the service’s previous rating.

Clarendon Care Home is registered to provide accommodation for up to 20 older people. There were 18 people, some living with dementia, at the home at the time of the inspection. It is situated in a residential area of Southsea. The home is an adapted building with bedrooms provided over two floors in single of shared double occupancy rooms. Stair lifts provide access between the floors. There are two communal lounges, a dining room and appropriate toilet, bathing and shower facilities. Externally there is a level enclosed courtyard style garden.

Clarendon is a ‘care home’. People in care homes receive accommodation and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

A registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The previous inspection of the service in November 2016 had identified six breaches of the Health and Social Care Act 2008 and associated Regulations in relation to safe care and treatment respect and dignity, good governance and statutory notifications. Whilst improvements had been made these have not been sustained over the longer term and we found three continuing breaches of regulations.

A quality assurance process was in place. However, this had not identified the areas of concern we found during this inspection and ensured that improvements were sustained over time.

Medicines, including tablets and prescribed topical creams were not always stored or administered safely.

Individual risks to people were not always managed safely and all risks posed by the environment had not been assessed.

Improvements were required to the laundry room where staff did not have hand washing facilities and cleaning equipment was not stored so as to reduce the risk of infection.

On most occasions people were treated with dignity and their right to privacy was respected although staff were using one bedroom as a ‘walk through route’ to get to an outside laundry area and some staff used inappropriate terminology when talking to people.

We discussed these and some other minor issues with the registered manager who was responsive to the issues raised and undertook to take action.

Recruitment practices ensured that all pre-employment checks were completed before new staff commenced working in the home although full information about applicant’s previous employment was not always known. Staff were suitably trained and although they felt supported in their work.

Where necessary Deprivation of Liberty Safeguards (DoLS) applications had been made. Equality and diversity was seen to be actively supported with people being able to express themselves.

People received the personal care they required and were supported to access other healthcare services when needed. Staff worked well as a team and with external professionals.

People received a varied diet and meal times were sociable unrushed occasions.

People felt safe and staff knew how to identify, prevent and report abuse. Staff offered people choices and respected their decisions. People were supported and encouraged to be as independent as possible. People were encouraged to maintain relationships that were important to them.

Staff were ware of people's individual care needs and preferences although these were not always documented in care plans. People had access to healthcare services and were referred to doctors and specialists when needed.

People and external health professionals were positive about the service people received.

People and relatives were able to complain or raise issues on a formal and informal basis with the registered manager and were confident these would be resolved. This contributed to an open culture within the home.

Plans were in place to deal with foreseeable emergencies and staff had received training to manage such situations safely.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are currently considering our regulatory response.

Clarendon Care Home is registered to provide accommodation and care for up to 20 older people, some of whom live with dementia. It is situated in a residential area of Southsea, Hampshire. At the time of this inspection, there were 17 people living at the service. The home is purpose built and accommodation is provided over two floors in single and double occupancy rooms. A stair lift provides access between the floors. There are two communal lounges and a dining room.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found that people were at risk of harm because guidance on how to minimise risks was not sufficient and monitoring of risks was not always effective.

We identified issues with the handling of topical creams and found some gaps in the administration records of medicines.

Some people required aids to support continence. People were prescribed continence aids, which met their individual needs. However, we found packs of pads throughout the service, which were not named for the individual and were being shared communally.

People told us they enjoyed the food and were involved in planning the menus. Staff monitored people's weight to ensure they were receiving enough to eat. However, where concerns were identified, action had not always been taken to ensure people had adequate fluids.

Although staff were routinely recording accidents and incidents these were not effectively analysed and investigated to identify any trends or patterns.

Staff were kind and compassionate when they spoke with people. However, social interaction between staff and people mostly occurred when staff completed tasks for people. Care practices did not always respect people's dignity, promote their independence or enhance people's well-being.

The atmosphere in the main part of the service was warm; however, we found, that people lacked social stimulation and that few opportunities to engage in activities offered. The range of activities available to people was inadequate and not always meaningful, specifically where people had dementia care needs.

Systems and processes to ensure good governance were not being effectively operated. Records relating to managing the health and care needs for people were not always being updated or completed by staff. People's fluid intake was not being recorded as instructed in the care plan. Wound care records were not accurate according to the care required in the care plans.

The service had a system of induction but it was not in line with current best practice. This is completion of a nationally recognised induction training programme. We discussed this with the manager who told us staff were being enrolled onto a diploma level programme and an assessor visited on the day of our inspection.

We saw that some staff had only received one or two supervision’s in the last 12 months. However, the staff told us they felt they supported each other well and found the registered manager and provider approachable and supportive.

The Care Quality Commission monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The staff had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Staff sought people's consent about arrangements for their care.

People told us they felt safe at the service and that staff treated them respectfully. Staff understood local safeguarding procedures. They were able to speak about the action they would take if they were concerned someone was at risk of abuse.

People had access to healthcare professionals when required. This included GPs, dentists, district nurses and opticians.

Pre-employment checks were completed before new staff began work. All of the staff that we spoke with told us they enjoyed their work.

The views of people, relatives, health and social care professionals were sought as part of the quality assurance process.

Everyone told us that the registered manager was approachable and that she responded promptly to any issues they had raised.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we have told the provider to take at the back of the full version of the report.

At this visit there were 19 people living at the home. During our inspection we spoke with the registered manager, three members of staff, two people who lived at the home and one relative. We reviewed information in care records, spoke with people about consenting to their care and choices offered to them. We found the provider had ensured they acted in accordance with the legal requirements when supporting people who did not have the capacity to consent.

This is what we found.

Is the service safe?

People had been cared for in an environment that was safe, clean and hygienic. Appropriate recruitment and selection processes were in place. This meant people were cared for by staff who had the appropriate skills and experience which was intended to ensure their care and welfare.

People's ability to make informed decisions had been assessed. However, people who were unable to make informed decisions did not have appropriate information within their care records to support the making of best interest decisions.

CQC monitors the operation of the deprivation of Liberty Safeguards (DOLS) which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People told us that they were very happy with the care they received. They told us that staff were always available to support them and meet their needs. From our observations and from speaking with staff we saw they had a good understanding of the care needs of people.

One person told us, 'I love being here'.; the staff are all so lovely and really know what I want and need, even when I get a bit muddled and don't really know myself.'

Staff had received appropriate training to meet the needs of people living at the home.

Is the service caring?

People were supported by kind and attentive staff. We saw staff ensured that people gave consent to treatment such as personal care support, support with nutrition and assistance with mobility and the use of mobility aids. These needs were supported in a calm, dignified and respectful way.

One relative told us, 'The carers are lovely, all the staff are. My (relative) is very happy and settled here, which is all I can ask for.'

Is the service responsive?

People's needs were assessed and reviewed regularly which ensured their needs were met. People and their representatives were encouraged to participate in care planning and review. The registered manager regularly spoke with people and their representatives to ensure their needs were being met.

People had access to activities which were important to them and had been supported to maintain relationships with their friends and relatives.

Is the service well-led?

People told us how they had been able to participate in making decisions about how the home had recently been redecorated. They told us how their opinions had been listened too and how these had informed changes at the home.

Staff had a good understanding of the care needs of people who lived at the home and quality assurance processes were in place. Staff were clear about their roles and responsibilities and told us that management were supportive of their roles.