Clarence House

Clarence House is a residential care home providing personal care to up to 20 People. The service provides support to people with varying needs, including some people living with early onset dementia. At the time of our inspection there were 15 people living in the home. The home had a large lounge with separate dining room, a conservatory and activity room which people could use. A laundry and kitchen were located on the ground floor and there was lift and stair access to the upper floors.

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

Staff kept the building clean and tidy and maintenance checks were in place and up to date. Staff were observed wearing appropriate personal protective equipment (PPE) as stated by the latest available guidance. Recruitment procedures were in place and staff told us checks were done prior to them starting their employment. There were sufficient staff to care for people. One staff member said, “We all muck in and have enough of us around to support people.” Safeguarding training was mandatory, staff were aware of the processes to follow to enable people to be safe. Risks were assessed in detail and monitored to ensure individuals safety and promoted their independence within a risk framework. People received their medicines safely.

The registered manager had a training programme to support staff to improve their skills and knowledge. 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. The management team had systems to reduce the risk of malnutrition and monitor people’s food and drink intake to ensure people received appropriate care.

We observed staff spent time with people and comments found staff to be caring and treated people with respect and dignity. One person said, “They are all lovely people.”

Activities were varied and people had choices. A relative said, “There is always something going on in the afternoons.”, There was complaints process which people and relatives were aware of and they had information about the procedure to follow.

The management team had auditing systems to maintain ongoing oversight of the service and make improvements where necessary. Quality assurance processes ensured people were able to give their views of the service.

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 requires improvement (published 24 October 2022 ).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service. We carried out an announced inspection of this service on 11July 2023.

We undertook this comprehensive inspection to check they had followed their action plan and to confirm they now met legal requirements. This report covers our findings in relation to the key questions, safe, effective, caring, responsive and well led.

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

We found no evidence during this inspection that people were at risk of harm from this concern.

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.

Follow Up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Clarence House is a residential care home providing personal care to up to 20 People. The service provides support to people with varying needs including some people living with early onset dementia. At the time of our inspection there were 14 people living in the home. The home had a large lounge with separate dining room, a conservatory and activity room which people could use. A laundry and kitchen were located on the ground floor and there was lift and stair access to the upper floors.

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

The provider now carried out a range of audits, however not all systems and processes were in place for identifying and monitoring action taken in response to any issues found. We have found the provider in ongoing breach of the regulation.

Staff supported people safely however risks to people were not always documented. We have made a recommendation about assessing risks to people.

The provider had not taken timely action to address all fire safety risks. We have made a recommendation about this.

People’s views on the service they received was captured and acted upon, staff working at the home and people living in the home were happy and told us they were well supported.

People received medicines from staff who were competent to do so and had been recruited safely. Staff protected people from the risk of abuse and neglect.

Staff were well trained and received an induction to their role once recruited. Team meetings and supervisions took place to support staff to meet people’s needs. When people moved into the home information on their needs was captured quickly to ensure they were supported effectively.

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 Care Quality Commission website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 22 February 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of most of the previously breached regulations. However, we found a continued breach of regulation 17 good governance.

At our last inspection we recommended the provider reviewed the latest guidance for infection prevention and control and updated their practices accordingly. At this inspection we found the provider had acted on this and improvements had been made.

Why we inspected

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.

We carried out an unannounced comprehensive inspection of this service over four dates in October and November 2021. Breaches of legal requirements were found. We undertook this targeted inspection to check whether the Warning Notices we previously served in relation to Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We inspected and found the warning notices had been met and action had been taken to address other breaches found at the previous inspection, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe, effective and well-led.

The inspection was carried out to follow up on action we told the provider to take at the last inspection and to check they had followed the action plan they had provided, to address breaches of regulation of safe care and treatment, safeguarding adults, suitably recruited and trained staff, gaining appropriate consent to care and treatment and having suitable oversight and governance arrangements in place. This inspection is to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe, effective and well led which contain those requirements.

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 inadequate to requires improvement based on our findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Clarence house 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 governance and oversight of actions required and completed to address concerns at this inspection.

We have made three recommendations, one to ensure action is taken to risk assess fire safety in the building, another to ensure records reflect risk and how staff mitigate that risk and lastly to ensure a governance and oversight system is implemented.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Requires improvement’ and will remain in special measures. We do this when services remain as 'Inadequate' in any Key Question over two consecutive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review. 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, 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.

Clarence House is a residential care home providing personal care for up to 20 people, at the time of the inspection the home was supporting 15 people. The home supported people over three floors with main communal areas to the ground floor. There was a lift and stairs to all floors and all rooms were ensuite. One room was shared with consent and of the choice of the occupants.

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

People were at risk of receiving unsafe care as safeguarding procedures and risk management systems were not effective. There was not enough safely recruited staff to meet people’s needs and medicines were managed by staff who were not suitably competent to do so. We have made a recommendation to ensure the latest infection prevention guidance is implemented.

Staff had not received the provider’s mandatory training to support people and new admissions to the home were not appropriately assessed to ensure the home could meet their needs. 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. Whilst minimal support was required to support people with their nutrition and hydration, we have made a recommendation about keeping accurate records to monitor associated risks. People were mostly referred to specialist services as required.

We have made a recommendation about protecting people’s privacy when having confidential conversations. Staff showed people respect. People enjoyed staff company and we saw positive interactions between staff and people living in the home.

We have made a recommendation to ensure care plans include the required information to show staff how to support people in a way that reflected their needs and preferences. We have also made a recommendation to ensure the provider implements their own complaints procedure and a recommendation to ensure people had opportunity to discuss their choices at the end of their life.

The provider did not have an effective system of quality audit and governance to show continuous improvement. Management were not clear about their responsibilities and had not met their responsibilities to notify the commission of certain events including serious injury. The registered manager had worked with professionals to identify concerns and actions to drive up the quality of the service.

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

This service was registered with us on 12/10/2019 and this is the first rated inspection.

Why we inspected

The inspection was prompted in part due to concerns raised about staffing, medicines and notification of a specific incident. During the inspection we were informed the person involved in the specific incident had died. This incident may be subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of falls, managing risk and referral for medical attention when required.

We have found evidence that the provider needs to make improvements. Please see all key question sections of this full report.

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.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We found breaches to eight of the regulations. Breaches were associated with risk management, safeguarding, staffing, safe recruitment, good governance, consent and the Mental Capacity Act, person-centred care and the submitting of notifications as a requirement of registration.

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

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 work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures: 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 of 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

About the service

Clarence House is registered to provide care for up to 20 older people or people living with dementia. It is a detached home in Lytham St Annes. Bedrooms are situated on all floors and are all en-suite. There is a choice of communal lounges and seating areas. There are gardens and parking. At the time of our inspection 15 people lived at Clarence House.

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

People were safe and cared for. There were enough staff to meet people’s care and support needs. Staff interacted with people in a friendly and respectful way. One person told us, “They [staff] really love me. I can ask for help and know they are there for me.” Staff knew how to keep people safe from the risk of abuse and who to contact if they suspected people were being harmed. Staff assessed and helped people manage avoidable risks. They supported people with their medicines according to national guidelines.

The home was clean and hygienic. This reduced the risk of infection outbreaks. The infection prevention and control policy was up to date. Staff followed infection control guidance and encouraged people to do the same. The building was maintained, and equipment serviced as required. Actions had been or were being taken on any defects or improvements recommended.

People said staff involved them in decisions about the home such as, meals, routines, leisure and social events. The registered manager had a thorough recruitment system and monitored the service to check on the quality and to make sure staff were providing good care. They understood and acted on legal obligations, including conditions of CQC registration and those of other organisations. They worked in partnership with other services and organisations to keep people safe and improve their well-being.

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

Why we inspected

This was a planned inspection as the home had not received an inspection since registration. This service was registered with us on 22 November 2019 and this was the first inspection. The home has not yet received a comprehensive inspection and therefore has not received an overall rating.

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 coronavirus and other infection outbreaks effectively.

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.