Background to this inspection
Updated
12 July 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection was carried out by one inspector and began on the 11 June 2018 and was unannounced. The inspection continued on the 12 June 2018 and was announced.
Before the inspection we looked at notifications we had received about the service. A notification is the means by which providers tell us important information that affects the running of the service and the care people receive. We also spoke with local commissioners to gather their experiences of the service.
The provider had completed a Provider Information Return prior to our inspection. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During our inspection we spoke with three people who used the service and four relatives. We spoke with the registered manager, four care staff, the activities co-ordinator and cook. We reviewed seven peoples care files and discussed with them and care workers their accuracy. We checked three staff files, care records and medication records, management audits, staff and resident meeting records and the complaints log. We walked around the building observing the safety and suitability of the environment and observing staff practice.
We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experiences of people who could not talk with us.
After our inspection we requested additional information in relation to the Mental Capacity Act 2005 which we reviewed alongside information collected at inspection. The registered manager provided this.
Updated
12 July 2018
The inspection took place on the 11 June 2018 and was unannounced. The inspection continued on the 12 June 2018 and was announced.
At our previous inspection in May 2017 we found breaches in regulation of safe care and treatment and good governance. People had not been protected from the risk of avoidable harm and medicines had not been administered safely. We also found that systems and processes to safeguard people were not being followed. Also systems and processes had not been effective in monitoring and reducing risks to people related to their health and welfare. We asked the provider to take action to make improvements and this action has been completed.
Following the last inspection we asked the provider to complete an action plan to show us what they would do and by when to improve the key questions, is the service safe and is the service well led, to at least good.
Clarence House is a ‘care home’. People in care homes receive accommodation and nursing or 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. The home is registered to provide care for up to 29 people. At the time of our inspection 23 older people, some of whom were living with a dementia, were residing at the service.
The home 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.
Assessments had been completed that identified risks to people such as malnutrition, dehydration, skin damage and falls. Actions in place to manage risk to prevent avoidable harm were understood by the staff team and being followed. Risks were reviewed at least monthly and included input from people and their families. When risks were being managed people’s freedom and choices had been respected.
People had their medicines ordered, stored, administered and recorded appropriately. When people had medicines prescribed for ‘as and when required’, protocols were in place with detailed information to enable medicines to be administered appropriately. A new process for topical creams had been introduced which included a body map and clear instructions for care staff as to where creams needed to be applied and how often. Staff had completed records to demonstrate this had taken place in accordance with people’s prescriptions.
Staff had completed safeguarding training and understood their role in identifying and reporting concerns. Accidents and incidents were reviewed by the registered manager who understood their role in reporting safeguarding concerns to external agencies when appropriate.
Auditing processes had been strengthened and included the registered manager evaluating risks to people weekly. Auditing tools had been reviewed and were effective in highlighting areas where improvements were needed. When actions were identified they took place in a timely way.
People were supported by staff who had undertaken a recruitment process that included checks on their suitability to work with vulnerable people. Staffing levels were regularly reviewed and met people’s care needs. Staff had inductions, on-going training and support that enabled them to carry out their roles effectively.
Prior to admission, assessments had been completed with people to gather information about their care needs and choices. The information had been used to develop person centred care plans that reflected people’s individuality and included end of life wishes. Staff had a good knowledge of people and their communication needs and provided care with kindness, patience and empathy. People had their privacy, dignity and independence respected.
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. A complaints process was in place and people felt if they raised concerns they would be listened to and actions taken.
People had access to healthcare when needed and working relationships with health and social care professionals enabled effective sharing of information and care and support outcomes for people.
The management of the home was visible and provided proactive leadership promoting an open and transparent culture. Staff described great teamwork and spoke enthusiastically about their roles.