St Clare House

St Clare House is a residential care home providing accommodation and personal care for up to 29 older people who may be living with a physical disability, mental health needs and/or dementia. At the time of our inspection, 28 people were using the service.

People’s experience of using this service and what we found

People gave very positive feedback about the service and the care and support staff provided. However, there were inconsistencies in how risks were identified and managed.

People’s care plans and risk assessments had not been reviewed and updated as their needs changed. Whilst people’s medicines were mostly managed safely, action was needed to ensure good practice guidance was consistently followed. There were some environmental risks, which needed to be addressed. For example, to ensure robust window-opening restrictors were in place and to check and make sure all areas of the service were thoroughly cleaned.

We could not be certain people were supported to have maximum choice and control of their lives or that staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. We made a recommendation in relation to the Mental Capacity Act 2005.

The provider and registered manager were extremely responsive to feedback and took immediate action to address concerns. Whilst no one had been harmed because of the concerns we found, we spoke with the provider and registered manager about developing their approach to auditing to ensure issues would be proactively identified and addressed in future.

People felt safe living at the service. Staff were safely recruited, and sufficient numbers of staff were deployed to meet people’s needs.

The registered manager was very approachable and with people, their relatives and professionals to help ensure people’s needs were met and improve their quality of life. They were committed to providing person-centred care and promoted a person-centred culture within the service.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk.

Rating at last inspection

The last rating for this service was good (published 19 December 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service. This was a focussed inspection. This report only covers our findings in relation to the Key Questions safe and well-led.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed to requires improvement. This is based on the findings at this inspection. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Clare 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.

St Clair House is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were safeguarded from harm and abuse; any issues were reported to the relevant authorities to make sure people’s rights were protected. Care and treatment was planned and delivered to maintain people’s health and safety. Staffing levels and people’s dependency were monitored to ensure there were enough staff provided to meet people’s needs, in a timely way. Recruitment, medicine management and infection control were robust.

Staff undertook training in a variety of subjects and were provided with supervision and an annual appraisal. This helped to maintain and develop the staff’s skills. People’s dietary needs were monitored and reviewed, if staff were concerned advice and guidance was sought from health care professionals to maintain people’s dietary needs. The service was well-presented, homely and maintained.

People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were cared for by kind, attentive staff and their privacy and dignity was maintained. Information was provided to people in a format that met their needs. People’s diversity was respected and promoted at the service. Confidential information was stored in line with data protection legislation.

People’s care and support was monitored and reviewed. Health care professionals were contacted for help and advice and staff acted upon what they said to maintain people’s wellbeing. End of life care was provided at the service.

Quality monitoring checks and audits were undertaken, any issues found were acted upon to make sure the service remained a pleasant place for people to live. People, staff and visitors were asked for their views and there was a complaints procedure if required. The management team implemented improvements to benefit all parties.

Further information is in the detailed findings below.

St Clare House is registered to provide care and support for up to 29 people, some of whom are living with dementia. The service is located on Bourne Street in Hull. Accommodation is provided on two floors with communal areas provided on each floor. There is a small car park at the front of the service for visitors to use.

The service has 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.

Staff understood they had a duty to protect people from abuse and knew they must report concerns or potential abuse to the management team, local authority or to the Care Quality Commission (CQC). This helped to protect people.

We found minor environmental issues; a bathroom window required restrictors to be fitted to help maintain people's safety. In two bathrooms seating required replacing to maintain infection control. Denture cleaning tablets for two people needed to be stored securely to prevent the risk of ingestion. These issues were dealt with thoroughly during the inspection.

We observed that the staffing levels provided on the day of our inspection met people’s needs. Staff were aware of the risks to people’s wellbeing and what action they had to take to minimise risks. Staff were trained in a variety of subjects to develop and maintain their skills. Training was updated, as required and supervision and appraisals occurred to help support the staff.

People’s nutritional needs were assessed and monitored by staff. Their preferences and special dietary needs were known and were catered for. Staff encouraged and assisted people to eat and drink, where necessary. A pictorial menu was provided to choose their food which was served on coloured crockery to encourage people living with dementia to eat. Advice from relevant health care professionals was sought to ensure that people’s nutritional needs were met.

Staff supported people to make decisions for themselves, they reworded questions or information to help people living with dementia understand what was being said. People chose how to spend their time.

People who used the service were supported to make their own decisions about aspects of their daily lives. Staff followed the principles of the Mental Capacity Act 2005 when there were concerns people lacked capacity and important decisions needed to be made.

Staff were attentive, kind and caring. There was a programme of activities provided to help stimulate people.

We found minor issues in two bathrooms and with the storage of denture cleaning tablets. These issues were quickly addressed. There was pictorial signage in place to help people find their way to the toilets and bathrooms. The environment was decorated in different colours to help people living with dementia to find their way around. General maintenance occurred and service contracts were in place to maintain equipment so it remained safe to use.

A complaints procedure was in place. This was explained to people living with dementia or to their relations so that they were informed. People’s views were asked for, feedback received was acted upon.

The registered manager undertook a variety of audits to help them monitor the quality of the service. Issues found were addressed quickly and thoroughly. The registered provider and registered manager were proactive in supporting people living at the service, their relatives, visitors and staff. There was a positive ethos at the service and they actively implemented ways to improve the care and support people living with dementia received.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service and the staff who supported them, and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

' Is the service caring?

The service is caring. At the last inspection on 7 July 2014 we issued a compliance action for this care and welfare of people who use services. We were concerned that the provider had not always used all of the information they had about people who used the service when producing care documents such as care plans, patient passports of behaviour management plans. During this follow up inspection we found improvements had been made in this area.

' Is the service responsive?

The service is responsive. The concerns found during the last inspection on 7 July 2014 had been addressed by the provider and people who used the service were cared for appropriately and safeguarded from abuse.

' Is the service safe?

The service is safe. At the last inspection on 7 July 2014 we issued a compliance action for this safeguarding people who use services from abuse. We were concerned that the service had not always reported incidents that had occurred within then home to the local authority safeguarding team or the Commission as required. During this follow up inspection we found improvements had been made in this area.

' Is the service effective?

The service is effective. People's health and care needs were assessed with them, and they were involved in writing their plans of care when possible. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

' Is the service well led?

The service is well led. The service had quality assurance systems in place and records we looked at showed that identified shortfalls were addressed promptly.

The provider consulted with people about how the service was run and took account of their views.

Staff told us they were clear about their roles and responsibilities. This helped to ensure that people received a good quality service at all times.

What people who used the service and those that matter to them said about the care and support they received.

A person who used the service told us, 'Yes I feel safe here they staff look after us all really well.' Another person said, 'It's nice living here, everyone is friendly and we all get on.'

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Due to the complex needs of the people who used the service we were unable to gain some people's views. We therefore used a number of different methods to help us understand their experiences. This included observing how staff supported people, speaking with staff and checking records. If you want to see the evidence supporting our summary please read the full report.

' Is the service safe?

We found that multi-agency safeguarding procedures and protocols were available for staff to follow to help ensure vulnerable people who used the service were protected from abuse. The provider adhered to the local authority adult protection procedures and staff undertook training on this aspect of their roles, to ensure they knew how to recognise and report potential safeguarding concerns.

We found evidence that incidents which put people at risk of harm, had not always been reported appropriately and discussed with the local safeguarding team and Care Quality Commission (CQC) in a timely manner. We found that staff had failed to follow professional advice for a person that placed them at potential risk of harm.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to safeguarding people from harm and learning from incidents and events that affect people's safety.

' Is the service effective?

We saw that individual plans of care had been developed for people that addressed their associated health and social care needs. There was evidence people's support was regularly reviewed and evaluated. One person who had recently moved into the home told us, 'I have been happy, the staff are lovely, they come when I ring.' Their social worker told us there had been, 'No problems so far the staff are friendly and welcoming.

Whilst people had received assessments of their needs to enable their care and support to be delivered in line with their individual wishes and feelings, there was evidence risk assessments needed to be more accurately maintained to enable staff to gain a clear understanding about their needs.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to of the law in relation to assessing people's needs and involving them in the planning their care.

' Is the service caring?

People were supported by kind and attentive staff. We observed staff provided support to people in a friendly and cheerful manner. We saw staff interacted positively with people and had a good understanding of their individual needs and preferences. We observed staff provided support sensitively to people, involving them when assisting them and taking time to provide reassurance when using the hoist to move them. We saw support to people requiring assistance to eat their meals was provided by staff in a manner that preserved people's personal dignity.

' Is the service responsive?

People who used the service, their relatives and other professionals involved with the service completed regular survey of their views. We were told by some relative's that staff were not always immediately available and we were not able to find evidence that staffing levels had been reviewed following a recent potentially serious incident. We spoke with the provider about this and saw they took prompt action to address this shortfall and would be monitoring this in the future.

' Is the service well led?

Staff who we spoke with had a good understanding of people's needs and told us they enjoyed their work. There was a quality assurance system in place, to ensure the quality of the service was monitored by the provider; together with action plans to cover areas highlighted from analysis of these. The service cooperated with the local authority and safeguarding teams, to ensure people were protected from harm. We saw evidence of actions taken to investigate concerns that had been made and where possible resolve them.

What people who used the service and those that matter to them said about the care and support they received:

Comments from people who used the service included, "The staff look after me well, they are very friendly and know their job.'

Comments in surveys were overall positive and included: 'Dad appears quite happy and that is what is most important.' Whilst another relative had stated, 'We are all really happy at the level of care xxxx receives.'

We saw a recent comment in the compliments book that stated, 'After one year of visiting I continue to be impressed by the excellent care the residents are given.'

People who used the service told us they were able to make choices on a daily basis and this included when they got up in the morning, the menu options and what activities they joined in with. Comments included, "I am here for respite, but it has been fine and I would come back", "The staff have been lovely and I have no concerns" and "The staff are very respectful, always knock before coming into my room and they are all polite."

People who used the service told us they were happy with the level of care and support they received. We also spoke with relatives who told us they felt the care was of a very good standard. Comments included, "I have no concerns whatsoever", "I am always made welcome and they seem to really know how to support my dad", "I'm quite happy with the care and support offered" and "They do a good job."

People who used the service told us they felt safe in the home.

Prior to our visit we spoke with the local authority contracting team who told us they had no concerns regarding the home. We liaised with the local authority safeguarding team who confirmed there were two ongoing investigations and the outcome of which would be shared with the Care Quality Commission (CQC). They also told us that incidents had been reported to them in a timely way.

People who used the service told us they were able to make choices and had the opportunity to take part in appropriate activities. Comments included, 'I like it here", "It's a smashing place" and "We do different activities such as carpet bowls and painting."

We saw that choice was offered to people with the use of picture menus and person centred planning. Staff spoke to and engaged positively with people who used the service.

People who used the service told us the environment was always clean and tidy. Relatives told us, "It is always spotlessly clean - if there are any accidents then this is attended to immediately by staff."

People told us they were consulted and their views sought about various issues including the food offered, the environment and the support they received. People also said any complaints were listened to and acted upon.

Prior to our visit we spoke with the local authority contracting and commissioning and safeguarding teams. They told us they had no concerns or ongoing investigations in relation to the home.