Clairleigh Nursing Home

We found the following examples of good practice.

People and staff had been vaccinated against COVID-19 and underwent routine COVID-19 testing, in line with national guidelines. The home also checked the vaccination status of any visiting contractors, or health and social care professionals to help minimise the spread of the virus.

Staff were aware of the symptoms to look out for that may indicate a person had COVID-19. They screened visitors for the virus before allowing them to enter the home. The provider facilitated visits to people, in line with current national guidelines, which included regular visits from a friend or relative designated as their ‘essential care giver’.

Visitors were directed to wash their hands on arrival and departure from the home and were provided with appropriate PPE to wear during their visits. The home followed guidelines from the Department of Health and Social Care on admitting people to the home during the pandemic. People and staff were also supported to isolate where they tested positive for, or showed symptoms of COVID-19.

The manager knew the procedures for reporting positive test results to the local Public Health team and followed any Public Health guidance they received in response. Domestic staff maintained a clean and tidy environment within the home. They gave additional focus to 'high touch points' such as handrails or door handles when cleaning.

The provider had infection prevention and control policies and procedures in place which staff understood and followed when carrying out their duties. Staff received training in infection prevention and control. They knew the procedures for donning and doffing PPE safely and we observed them wearing appropriate PPE at all times during our inspection.

There were enough staff on duty to meet people's needs. The manager block-booked any agency staff who were working at the service to ensure they didn't work across different care settings.

We found the following examples of good practice:

¿ The provider had appropriate arrangements in place for visitors to help reduce the risk of the spread of COVID-19. On arrival, all visitors were required to wash their hands using the handwashing facilities adjacent to the home’s entrance. They were screened for symptoms of infection and required to wear personal protective equipment provided by the home during their visit.

¿ People were supported to maintain links with friends and family via telephone and video calls, and using the home’s garden facilities, including the garden house. Family garden visits were booked in advance and staff cleaned the visiting area between each visit. Staff supported people throughout visits and ensured social distancing was maintained.

¿ Staff received training in infection control which had been updated to include information on managing the risk of the spread of COVID-19 and the use of Personal Protective Equipment (PPE).

¿ The home had arrangements in place to test both people and staff for COVID-19, in line with the current guidelines on testing. Appropriate staff had been trained to carry out the tests.

At the last comprehensive inspection in March 2017 we found breaches of regulations because risks to people were not always accurately assessed or managed safely and because the provider’s systems for monitoring the quality and safety of the service were not always effective in identifying issues or driving improvements. Following that inspection the provider wrote to us to tell us the action they would take to address our concerns. At this inspection we found that staff had addressed the issues we had identified, in line with the provider’s action plan.

The service had a registered manager in post. 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.

At this inspection we found risks to people had been assessed and staff worked to manage identified risks safely. People were protected from the risk of abuse because staff were aware of the action to take if they suspected abuse had occurred. People’s medicines were securely stored and safely administered. Medicine administration records were up to date an accurate.

The provider followed safe recruitment practices. Staffing levels were determined based on an assessment of people’s needs and there were sufficient staff deployed to keep people safe. The registered manager reviewed incidents and accidents when they occurred, and acted to reduce the likelihood of recurrence. Staff were aware of the steps to take to reduce the risk of infection when supporting people.

Staff were supported in their roles through an induction, training and regular supervision. People were supported to maintain good health and had access to a range of healthcare services. Staff worked to ensure people received consistent joined up care between different services. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff sought consent from people when offering them assistance and worked in line with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) where people lacked capacity to make decisions for themselves.

The living environment at the service met people’s needs. People were supported to maintain a balanced diet and most people spoke positively about the food on offer at the service. Staff treated people with dignity and respected their privacy. People were involved in making decisions about their care and treatment. Staff treated people with care and consideration. People’s needs were assessed to ensure the home was able to meet their needs. They received care and support which reflected their individual needs and preferences.

People were able to maintain the relationships that were important to them. The provider offered people a range of activities in support of their need for social stimulation. Staff provided people with appropriate care and treatment at the end of their lives. The provider had a complaint policy and procedure in place which informed people on the steps to take to raise a concern. People and relative were aware of how to complain and expressed confidence that any issues they raised would be dealt with appropriately.

The service worked in partnership with other agencies including the local authority. People and staff told us the service was well run and spoke positively about the registered manager. Staff attended regular staff meetings to discuss the running of the service and the responsibilities of their roles. The provider had systems in place to monitor the quality and safety of the service and acted to make improvements where issues were identified. People’s views on the service were sought through meetings and an annual survey and they told us they felt improvements were being made under the registered manager.

At this inspection we identified a breach of regulations because risks to people had not always been accurately assessed or action taken to manage risks safely. We also found a further breach of regulations because the provider’s systems for monitoring the quality and safety of the service were not always effective in driving improvements and the monitoring system for conditions placed on people’s Deprivation of Liberty Safeguards (DoLS) authorisations did not always ensure conditions were met. We also found that records relating to people’s care were not always up to date or provided conflicting information about people’s current conditions.

You can see what action we told the provider to take in respect of these breaches at the back of the full version of the report.

People were protected from the risk of abuse because staff were aware of the types of abuse that could occur and the action to take if they suspected abuse. There were sufficient staff to meet people’s needs and the provider followed safe recruitment practices, although improvement was required to ensure professional references were provided by staff wherever possible and that the roles of referees were clearly identified when references were provided.

Staff were supported in their roles through an induction and training, and through regular supervision, although improvement was required to ensure all staff were up to date with training in areas considered mandatory by the provider. People’s medicines were stored securely and administered safely by trained staff.

Staff sought consent from people when offering them support and the provider worked within the requirements of the Mental Capacity Act 2005 (MCA) to ensure decisions were made in people’s best interests, where they lack capacity to made specific decisions for themselves. People were supported to eat and drink sufficient amounts and to access to a range of healthcare services when required.

People told us staff were kind and caring. Staff treated people with dignity and respected their privacy. People were involved in decisions about their care and treatment and had been consulted with regards to the planning of the care. People’s care plans were reviewed on a regular basis and reflected their individual needs and preferences. People were supported to take part in a range of activities they enjoyed and were able to maintain the relationships which were important to them.

Any complaints received by the service had been dealt with in line with the provider’s complaint’s policy and procedure which was accessible for review by people and relatives when required. The provider had systems in place to seek feedback from people and we saw examples of improvements having been made at the service in response to people’s feedback. People, staff and healthcare professionals spoke highly of the registered manager and their leadership within the service. The provider and registered manager also had a strong focus on making continuous improvements to the service.

At our inspection we found that people were involved in their care planning and their consent was sought in decisions related to their care. Care was suitably planned and records were maintained appropriately and stored securely. However, we also found that at times there weren't enough suitably qualified staff on duty and that some staff were not up to date with their training.