Claremount House is a residential care home providing personal and nursing care for up to 26 people. At the time of the inspection there were 26 people in the home, some of whom were aged over 65 years and were living with a diagnosis of dementia, and others who were younger and had mental health needs. The home is purpose built with bedrooms located over three floors and communal areas on the ground floor. People’s experience of using this service and what we found
People were not safe. There were not enough staff to give people the care and support they needed or to keep the home clean. Standards of cleanliness were poor and infection control procedures were not followed.
People were not protected from abuse; some people were subject to inappropriate restraint due to environmental restrictions that were in place. Risks were not assessed or managed appropriately. Lessons were not learned when things went wrong. Medicines were not managed safely.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Staff did not receive the induction and training they needed to equip them with the skills and competencies to do their job. Some staff had received supervision but others had not. Complaint records for 2019 were missing.
Staff were recruited safely and people’s healthcare needs were met.
People’s nutritional needs were not met. People and relatives said they liked the staff. However, there were inconsistencies in staff practices resultant from a poor culture which meant people were not always well treated. Some staff were kind and caring, whereas others were not. People’s privacy and dignity was not maintained.
People did not receive person-centred care and care records did not fully reflect their needs. There was a lack of activities for people and those who should have had one-to-one time with staff did not receive it.
The service was not well-led. Leadership was poor and ineffective; staff lacked direction and support and were left to their own devices. Many of the staff who knew people well had left and the high use of new and agency staff, who were not familiar with people’s needs, had impacted negatively on the service. The provider’s quality assurance systems were not effective in identify and addressing issues. The service has a history of not sustaining improvements.
Following this inspection we contacted the infection control team and fire authority to make them aware of our concerns. We made referrals to the local authority safeguarding team and informed the commissioners from the local authority and clinical commissioning group (CCG) of our findings. We had discussions with the nominated individual to gain assurances about the immediate actions they were taking to address the issues we found. The nominated individual is responsible for supervising the management of the service on behalf of the provider.
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 11 April 2017).
Why we inspected
The inspection was prompted in part by a specific incident and other concerns. The specific related to unsafe moving and handling. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident. The concerns we received related to infection control, wound care management, staffing and management of the service. A decision was made for us to inspect and examine those risks.
We have found evidence that the provider needs to make significant improvements. Please see all sections of this full report.
Enforcement
We have identified 9 breaches in relation to safe care and treatment, staffing, safeguarding people, complaints, consent, dignity and respect, nutrition, person centred care and governance at this inspection.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will continue to work with the local authority and clinical commissioning group to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.