Clarence Road

Clarence Road is a residential care home that can provide 24-hour support and personal care for up to 15 adults with mental health needs. The care home was split across three floors and each floor was accessible by lift. At the time of our inspection 15 people were using the service.

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

People were not protected from the risks of acquiring an infection as infection control practices were not being followed. We found the home smelt strongly and this related to an area not being cleaned frequently enough to remove the smell of urine.

Health and safety concerns were present within the service. These included the incorrect disposal of personal protective equipment (PPE), the lack use of PPE in kitchen areas by staff and external contractors other than the chef. We also found hot water temperatures within bathrooms not being brought to safe temperatures.

Medicines were not managed safely the administration procedure was not being followed. The premises were in need in of repair and showed signs of wear and tear. Relatives told us the service was not homely and did not feel homely for people when they visited.

Relatives told us the communication about changes at management level were not open and transparent. Quality assurance systems were in place, but these were not effective as they did not identify some of the shortfalls identified during our inspection.

The registered manager and provider acted upon feedback from the inspection and were in the process of addressing the issues identified.

People told us they felt safe at the service and they could find a member of staff to help them. Staff rota’s showed shifts were covered. People told us they were kept informed about their medicines and why they needed to take them.

Staff demonstrated they were aware of their safeguarding responsibilities and how to report concerns. Lessons learnt took place at the service after an incident and staff confirmed they took part in meetings to learn from lessons.

Staff were supported in their role and received appropriate training. People were able to enjoy food they liked and were supported to have enough to drink. Relatives did not think the food at the service was of good quality.

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. Consent to care and treatment was requested and staff did not force people to do something they did not want to. The service worked well with external health professionals to ensure people received support when they became unwell.

Rating at last inspection and update

The last rating for this service was good (published 22 January 2020).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.

The provider took action to reduce the risk of harm people faced in relation to infection control practices and health and safety concerns, however, their quality assurance systems were not effective to ensure shortfalls were identified and prompt action was taken.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Clarence Road on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to infection control, safe management of medicines, safe premises and governance within the service.

We served 2 warning notices due to there not being effective governance procedures to monitor the quality and safety within the service.

Please see the action we have told the provider to take at the end of this report.

Follow up

We have requested an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect

Clarence Road is a residential care home that can provide 24-hour support and personal care for up to 15 adults with mental health needs. The care home was split across three floors and each floor was accessible by lift. At the time of our inspection 15 people were using the service.

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

Risk was well managed and reviewed very well to ensure people were safe from the risk of harm. Recruitment checks were in place to ensure staff were suitable and safe to work at the service.

The service was clean and free from malodour. The risk of infection was taken seriously, and measures were put in place to keep areas at risk clean.

Staff had received training and regular support to enable them to carry out their role. The registered manager and staff looked for opportunities to use their skills to provide an environment where people were looked after by well experienced staff. A relative felt staff were exceptional and well trained in their role.

People’s health and well- being was well monitored and managed. People told us they were either supported to attend or went independently for health appointments or reviews. People were provided with a varied and healthy diet and were encouraged to make healthy food and drink choices.

Staff were kind, understanding, and compassionate. People liked the staff team as did their relatives. A relative expressed their gratitude towards the staff for showing patience and empathy while supporting their family member.

People were accepted for who they were and able to express themselves without fear of discrimination. The registered manager and staff treated each person with dignity and respect.

People were supported by a registered manager and staff who knew people’s personal and individual needs extremely well and were committed to providing a service to meet their care and social needs. People’s communication needs were met.

End of life wishes were considered in a respectful manner and discussed when people were happy to do so.

Complaints and compliments were captured and used to help improve the service.

The registered manager provided excellent leadership to staff and motivated them to be the best they could be in the working environment. People and their relatives liked the registered manager and had a good relationship with them. Quality assurance systems were effective and helped the registered manager and other managers monitor the quality of care people received and make improvements where needed.

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.

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

Rating at last inspection

The last rating for this service was good (published 3 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Clarence Road provides residential care and support for up to 15 adults with mental health needs across three floors of the building. At the time of our inspection 15 people were living in the service, but one person was receiving in-patient support whilst in hospital.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People’s risks were managed and care plans contained appropriate and detailed risk management plans with input from health and social care professionals, which were updated regularly when people’s needs changed. Staff worked closely with people and met them regularly to ensure they were aware of their needs.

The service had a robust recruitment process and staff had the necessary checks to ensure they were suitable to work with people using the service. Sufficient numbers of staff were employed to keep people safe and meet their needs.

People who required support with their medicines received them safely from staff who had shadowed senior staff and completed training in the safe handling and administration of medicines. Staff completed appropriate records when they administered medicines and these were checked by staff and audited monthly to minimise medicines errors.

People and their relatives told us they felt safe using the service and staff had a good understanding of how to protect people from abuse. All staff had received training in safeguarding adults from abuse and had a good understanding of how to identify and report any concerns. Staff were confident that any concerns would be investigated and dealt with.

Improvements in the environment and furniture had been made since the last inspection.

New staff completed an induction programme and a six month probation period. Staff members also took part in a training programme to support them in meeting people’s needs effectively. New staff shadowed more experienced staff before they started to carry out care tasks independently and received regular supervision from management. They told us they felt supported and were happy with their input during the supervision they received.

Staff demonstrated a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff were aware of the importance of asking people for consent and the need to have best interests meetings in relation to decisions where people did not have the capacity to consent. The provider was aware when people had restrictions placed upon them and notified the local authority responsible for assessment and authorising applications.

People had regular access to healthcare services and staff discussed people’s appointments during handover meetings and were aware when they were due. Staff worked closely with other health and social care professionals, such as the community mental health team, district nurses and psychiatrists. We saw evidence of this in communication records and people’s care plans.

Staff were aware of people’s dietary needs and food preferences and people were involved in decisions about the food they wanted to eat.

We observed positive interactions between people and staff, including the registered manager, throughout the inspection. People and their relatives told us staff were kind and compassionate and knew how to provide the care and support they required. All staff understood the importance of getting to know the people they worked with and showed concern for people’s health and welfare in a caring manner.

People were spoken with and treated in a respectful and kind way and staff respected their privacy and dignity, and promoted their independence. People were also supported to access independent advocates where necessary.

People were supported to follow their interests and encouraged to take part in a range of activities to increase their health and well-being and reduce social isolation. People were involved in planning how they were cared for and supported. An initial assessment was completed from which care plans and detailed risk management plans were developed. Care records were person centred and developed to meet people’s individual needs and discussed regularly during weekly or monthly key work sessions.

The provider made sure there was an accessible complaints procedure in place and people and their relatives knew how to make a complaint and were able to share their views and opinions about the service. The provider listened to all complaints and made sure people were confident their complaints would be taken seriously. There were also surveys in place and weekly house meetings to allow people the opportunity to feedback about the care and support they received.

There were effective quality assurance systems in place to monitor the quality of the service provided and understand the experiences of people who used the service. The registered manager followed a daily, weekly, monthly, quarterly and annual cycle of quality assurance activities and learning took place from the result of the audits.

People and their relatives felt comfortable approaching the registered manager, who had a visible presence throughout the service. Staff spoke highly of the working environment and the support they received from management. Staff were confident they could raise any issues or concerns, knowing they would be listened to and acted upon.

The service assessed people's individual needs and preferences to ensure their care was appropriate. People told us they were involved in their care planning and were offered choices. People said their wishes were respected including if they changed their mind. Staff told us that all the people using the service had the capacity to make their own decisions about their day to day care. Staff were able to explain how they obtained people's consent.

People were generally positive about the food in the home. One person said, "we have lovely food." Another person said, "it's sometimes good and sometimes not." We found that the home provided well balanced and healthy meals. People were involved in planning the daily menus. The staff monitored people's weight and any nutritional needs.

People using the service and staff members told us there were sufficient members of staff on duty at the home. We saw that staff did not seem rushed and were able to engage people in a relaxed and sensitive way.

The provider had a complaints policy and encouraged people to raise concerns with staff. People told us they knew how to make a complaint. One person said, "I can say something any time I want."