27 April 2022
During an inspection looking at part of the service
People’s experience of using this service and what we found
Medicines records were not always accurate, and medicines and equipment were not always managed safely. Infection prevention control (IPC) practices were not always robust. Risks relating to fire were not always appropriately managed. Safeguarding processes and procedures were in place but were not always being followed. However, people at the home told us they felt safe. Staffing levels in the home was adequate, though some improvement was required in relation to recruitment records. We made a recommendation that the provider improves their recruitment processes. Management told us they were working to improve the issues we identified.
People’s needs had not always been assessed and necessary health related risk assessments and care plans were not always in place. The management were in the process of improving this. 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. After our site visit the management were reviewing this information and making necessary referrals.
Staff completed an induction once recruited, and staff were supported by the management, however not all staff had completed appropriate training. We witnessed incorrect moving and handling practices during our inspection, and we made a recommendation that the provider reviews their practices and processes relating to moving and handling. The environment needed some improvement to meet the needs of the people living there, and the management advised they were making these changes. People did not have oral healthcare plans in place, and people were not registered with a dentist, however, management told us they were in the process of trying to rectify this. Feedback on the food people received was positive.
Various governance issues were identified during our inspection, including issues around records and audits. Although the manager was aware of their responsibility under the duty of candour, they had not always reported necessary incidents to CQC and the local safeguarding team. Since the inspection the manager has left the service. A consistent approach to working in partnership with other health care professionals, making necessary referrals and, ensuring follow ups was not always adhered to. Staff meetings and meetings for/with people that use the service were taking place, and surveys were being conducted. Staff and people spoke positively about the service, though people did not always receive good outcomes as detailed in this report. Staff were aware how to report poor practice.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was good (published 09 December 2020). At our last inspection we recommended that the provider reviews their documentation around recruitment. At this inspection we found improvements relating to recruitment were still required. We also made a recommendation around monitoring, assessing and improving the service, we found that at this inspection we had further concerns around the governance of the service.
Why we inspected
We received various concerns about the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. 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 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 report.
We looked at IPC 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.
You can see what action we have asked the provider to take at the end of this report. The provider had taken some action to mitigate risks and was working on making further improvements.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Clitheroe Care Home on our website at www.cqc.org.uk.
Enforcement and Recommendations
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.
We have identified breaches in relation to IPC, medicines, environmental concerns (including fire), safeguarding service users, person centred care, failure to/and delay of sending appropriate notifications to CQC and good governance.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request 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.