Claremont Lodge

Claremont Lodge is a care home in Salford operated by Claremont Lodge Care Limited. Claremont Lodge is registered with CQC to provide care for a maximum of 18 people. There were 11 people using the service at the time of the inspection.

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

At our last inspection we identified concerns regarding the safe maintenance of the premises. We found improvements had been made during this inspection.

There were enough staff to care for people safely and correct staff recruitment procedures were followed. Staff understood about safeguarding and how to report concerns.

Audits were undertaken to monitor the quality of service, including at provider level which had been a concern at the last inspection. There were systems in place to seek feedback from people living at the home, including the use of satisfaction surveys and staff/residents’ meetings. Out of hours spot checks were also undertaken.

Rating at last inspection

The last rating for this service was requires improvement (published October 2021) and the provider was in breach of regulations relating to good governance and premises/equipment. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, enough improvement had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out a focused inspection of this service in September 2021. Breaches of regulations 15 and 17 were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve. We also issued a warning notice for regulation 17 in relation to Good Governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected (Effective, Caring and Responsive) we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Claremont Lodge 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. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

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

We found the premises were not well maintained. This included some windows being in a poor state of repair and there was damage to the flooring and ceiling in the sluice room following a leak. There was lots of chipped paintwork on people’s bedroom doors and handrails. Some people’s bedroom furniture was broken, including drawer handles which were hanging off. Other areas of the home presented an infection control risk and were difficult to clean effectively such as raised flooring, cracked sinks and a damaged upstairs toilet.

Both the five-year electrical installation and annual gas safety check had expired at the time of our inspection. Further improvements to the building were also required following the recent fire risk assessment. Arrangements had been made for this work to be completed.

People told us they felt safe living at Claremont Lodge. Safeguarding allegations were reported to the local authority for further investigation. People received their medication as prescribed and staff wore appropriate personal protective equipment (PPE) throughout the day. There were enough staff to care for people safely and correct recruitment procedures were followed.

At the time of the inspection, the home was without a registered manager, although a manager had been in post since May 2021 and had submitted an application to registered with CQC. We found improvements were required to provider level governance systems, particularly regarding the environment and we were told no recent audits had been undertaken to ensure to premises were safely maintained.

Staff meetings took place which enable staff to discuss their work to drive improvements, although we noted topics of discussion at a recent meeting had included long delays regarding maintenance work being completed and the home appearing ‘tired’.

Staff said they enjoyed their work and spoke of a positive culture at the home. People told us the home was well-led since the new home manager had commenced their employment.

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 October 2019).

Why we inspected

The inspection was prompted in part due to concerns received about the upkeep of the premises and the environment potentially being unsafe. A decision was made for us to inspect and examine those risks.

Prior to this inspection we reviewed the information we held about the service. No areas of concern were identified in the other key questions (effective, responsive and caring). We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control (IPC) measures under the Safe key question. We look at this at 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.

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

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

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Claremont Lodge is a residential care home providing personal and accommodation for up to 18 people. The home is owned by Claremont Lodge Care Limited.

This inspection was carried out on 14 October 2019. At the time of the inspection there were 14 people living at Claremont Lodge.

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

Appropriate systems were in place to manage risk relating to people’s skin, mobility and nutritional needs. Systems were in place to safeguard people from abuse and staff were knowledgeable about the signs of abuse.

Staffing were sufficient to meet people’s needs and the feedback we received was that there were enough staff to support people safely. Medicines were administered safely. The home was clean and generally odour-free. Accidents and incidents were recorded and monitored, processes were in place to learn from these to reduce or prevent recurrence.

Staff received appropriate induction, training and supervision. People were supported to eat and drink enough to maintain a balanced diet and people were complimentary about the food. Staff worked with professionals to support people’s well-being and health.

Refurbishment plans were in place to modernise the environment, as parts appeared tired and dated. We were informed this was scheduled to be completed by December 2019. We have made a recommendation about the environment.

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. However, some consent to care forms had not been completed, particularly regarding the use of restrictive devices such as bed rails, sensor mats and chair alarms. The registered manager arranged for these to be completed after the inspection.

Observations showed people received kind and considerate care, feedback we received about the care provided was positive. Staff were attentive to people’s needs. People’s privacy and dignity were respected and promoted.

People received personalised care according to their wishes and preferences. Complaints and concerns were recorded, responded to and monitored. People were supported at their end of life when the time came. The home had a long-standing staff team, some of whom had worked at the home for many years. Staff told us they enjoyed working at the home and that team work was a strength.

Systems were in place to ensure quality performance and risks were monitored. People, relatives and staff were involved in the management of the home and their views were sought through the use of meetings and satisfaction surveys. The home worked in partnership with community organisations.

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 in March 2017 (published April 2017).

Why we inspected

This was a planned inspection based on the previous rating and in line with our timescales for re-inspecting services previously rated as Good.

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.

Claremont Lodge is registered to provide personal care and accommodation for 18 people. The home is situated in a residential area of Salford, close to local amenities and a park. Accommodation is in mainly single rooms with shared lounges and dining room.

Our last full comprehensive inspection of Claremont Lodge was in August 2015 where the home was given an overall rating of ‘Good’. Since that inspection, we received concerns in relation to falls management and therefore conducted a focussed inspection in April 2016, looking specifically at this area. At this inspection the home was rated ‘Requires Improvement’ overall. The key question for Well-led was also rated as ‘Requires Improvement’, whilst the key question for Safe was rated ‘Inadequate. This inspection looked at any improvements made since our previous visit to the home.

At the time of this inspection there were 16 people living at Claremont Lodge.

People living at the home told us they felt safe. The staff we spoke with had a good understanding of safeguarding, whistleblowing and how to report any concerns.

We found medication was ordered, stored and administered to people safely. There were also audits of medicines to ensure there were no shortfalls in practice.

Staff were recruited safely with references from previous employers sought and DBS (Disclosure Barring Service) checks undertaken. This would ensure that staff were suitable to work with vulnerable adults.

There were sufficient staff working at the home to meet people’s needs. Feedback from people living at the home, visitors and staff was that staffing levels were sufficient.

Staff received an induction when they started working at the home, as well as receiving appropriate training and supervision to support them in their role.

The home worked within the requirements of the MCA (Mental Capacity Act) and DoLS (Deprivation of Liberty Safeguards). We saw appropriate assessments had been completed if there were concerns about a person’s capacity. DoLS referrals had been made as necessary to the local authority. Staff spoken with displayed a good knowledge about MCA/DoLS and what action they would take if they had concerns about a persons capacity.

We saw people received enough to eat and drink, with people also making positive comments about the food provided at the home. The staff we spoke with knew about people whose were at risk with regards to their nutrition such as if they had lost weight or were at risk of choking. Where people had suffered weight loss, the home followed guidance from other professionals such as dieticians.

All of the people we spoke with during the inspection, including people living at the home and visiting relatives made positive comments about the care provided.

People told us they felt staff treated them with dignity and respect and promoted their independence where possible. We saw people being offered choices about how they wanted their care to be delivered.

People felt the home was responsive to their needs and we saw examples of staff doing this during the inspection when assisting people to walk around the home, administering medication and helping people to transfer in and out of their seat.

Each person living at the home had their own care plan, which was person centred and captured information about peoples life history. This would help ensure staff had appropriate information available to them in order to provide person centered care.

There was a complaints procedure in place which allowed people to voice their concerns if they were unhappy with the service they received. We looked at any complaints that had been made and saw an appropriate response had been provided to the complainant.

All of the people we spoke with told us they felt the service was well-led and that they felt listened to and could approach management with concerns.

There were systems in place to monitor the quality of service such as audits, resident meetings, staff meetings, accident/incident monitoring and the sending of satisfaction surveys. These systems would help to ensure the quality of service was able to continually improve.

Staff told us they enjoyed their work and liked working at the home and told us they felt there was an open and positive culture. The staff told us they felt the home manager was supportive and could raise concerns as needed.

We last inspected Claremont Lodge on 11 and 12 August 2015. At that time the service was rated as ‘Good’. Claremont Lodge is a care home registered with the Care Quality Commission (CQC) to provide personal care and accommodation for up to 18 people. At the time of our inspection the service had full occupancy.

Claremont Lodge is situated in a residential area of Salford, Greater Manchester and is close to local amenities and a park. Accommodation is mainly provided in single rooms with shared lounges and a dining area. Claremont Lodge is an older building with some of the décor worn and traditional in presentation.

During this inspection we found two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 in regard to safe care and treatment and good governance. We are currently considering our enforcement options.

At the time of our inspection there was a registered manager in post. 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.

We looked at care plans and associated documentation and found a variety of issues. These included a lack of pre-admission assessments, baseline assessments that did not provide sufficient information to demonstrate how identified risks were mitigated and existing risk assessments that were contradictory and not easy to understand. We also found newly emerging risks were not always recognised and responded to effectively.

We found the service did not always complete their own pre-admission assessment to ensure they could meet peoples' individual needs before they were admitted into Claremont Lodge. This meant the risks to the health and safety of people who used the service were not always fully assessed which exposed people to a risk of avoidable harm.

The service had failed to recognise and respond to changes in a persons physical health, and failed to update relevant care plans and associated risk assessments for a condition that was likely to deteriorate.

We found confidential personal identifiable records relating to people who used the service were not stored securely.

We found the way in which accidents and incidents were recorded across two separate systems was inconsistent and fragmented.

Systems for audit, quality assurance and questioning of practice were ineffective. In particular for falls, medication and care plans.

Registered managers are required by law to notify CQC of certain events in the service such as serious injuries, deaths or events that stop the service from operating. Records we looked at confirmed the registered manager had failed to notify CQC of an event that stopped the service from operating.

Documentation was arranged in chronological order and was up to date and accurate reflecting peoples' current needs.

We found files contained a number of assessments including mobility, communication, moving and handling, skin integrity, nutrition and a falls risk assessment.

We saw evidence of regular reviews of risk assessments and care plans.

Criminal Record Bureau (CRB) checks, now known as Disclosure and Barring Service (DBS) checks had been undertaken to ensure staff were suitable with vulnerable people.

We found people were now protected against the risks of unsafe or inappropriate care arising from poor and inadequate record keeping.

Our inspection was co-ordinated and carried out by an inspector, who addressed our five questions; 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 using the service, their relatives, the staff supporting them and from looking at records.

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

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. Safeguarding procedures were in place and staff were able to demonstrate how to safeguard people they supported. One visiting relative told us 'I have spoken to a number of families who are all happy with the home. The staff are excellent, I have a good feel about the place.'

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints and concerns. This reduced the risks to people and helped the service to learn from such incidents.

The home had policies and procedures in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had been submitted. Staff knowledge of this legislation was uncertain, however the manager assured us that further training had been scheduled.

At the time of our visit, the service had just started the refurbishment of the kitchen and we were assured by management that suitable temporary arrangements were in place to meet the nutritional needs of people whilst work was on-going. Overall, we found the home to be safe, however we asked the service to immediately address the general condition of the gardens which were over grown and unkempt and to ensure that clutter was removed from hallways as it posed a hazard to people who used the service.

Because of concerns raised regarding the quality of the refurbishment work undertaken, we returned to the home on Friday 23 May 2014. We found the kitchen refurbishment had been completed to a satisfactory standard.

We found equipment was maintained and serviced regularly therefore not putting people at unnecessary risk.

The registered manager set the staff rotas that took account of people's care needs when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure that people's needs were always met.

Recruitment practice was safe. Policies and procedures were in place to make sure that unsafe practice were identified and people were protected. During our visit we were informed all policies were being reviewed by the service.

We found medication practices were safe and thorough.

We found people were at risk because accurate and appropriate records were not always maintained.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to record keeping.

Is the service effective?

It was not always clear to us that people's health and care needs were assessed with them, and that they were involved in writing of their plans of care. Though regular reviews were undertaken we saw no recorded evidence of any consultation with people who used the service or their representatives. However, people told us they had been involved in writing their plans of care which reflected their current needs.

Visitors confirmed they were able to see people in private and that visiting times were flexible. One relative told us; 'I'm made to feel welcome by staff.'

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, 'I'm happy with the place, I have no concerns.' 'The care of X is fine, they are getting him doing more than I could.' 'I'm completely satisfied with the care my X gets. I would and have recommended the place.'

People who used the service, their relatives and friends completed a satisfaction survey. People told us where shortfalls or concerns were raised these were addressed by the service.

People's preferences, interests, aspirations and diverse needs had not always been clearly recorded, however, we found care and support had been provided in accordance with people's wishes.

Is the service responsive?

People completed activities in and outside the service. We were told the service intended to introduce an activity coordinator to implement a formal programme of activities for people who used the service.

People knew how to make a complaint if they were unhappy.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. We spoke with two visiting care professionals who were happy with the service and assistance they received. We were told; 'No concerns for the safety of residents. I have no concerns, staff are friendly and pleasant with residents.'

The service had some quality assurance systems in place to monitor the quality of services provided.

Staff told us they were clear about their roles and responsibilities and felt valued and supported by management.

We spoke to two visiting health professionals one of whom told us; 'No concerns, staff are very friendly and helpful. I have witnessed them using equipment and staff really try their best. Hand on heart the staff are very good'.

One visiting relative said 'I feel my X are very safe here. There could be more activities and motivation but they are cared for well enough. The place is in need of modernisation but the staff are definitely caring and supportive'.

We spoke to staff who were able to demonstrate a good awareness of safeguarding issues and explain how they would raise any concerns.

We looked at staff training records which demonstrated training in Infection Prevention and Control had been undertaken.

We found there was a range of training that staff had undertaken, which was appropriate to their job role and responsibilities.

Staff we spoke with told us: "I feel very supported by the manager and seniors. They are helping me do my level 3 NVQ at the moment' (National Vocational Qualification).

We found that incidents and accidents were fully recorded with action taken to avoid repeat incidents. Clear instructions were displayed on the staff notice board informing staff what action to take in the event of an incident.

One person who used the service told us; 'I find it excellent here, the food is good. My bedroom is very clean and comfortable. I have no worries at all'.

A relative of a person who used the service told us; 'My X is always clean and well looked after. I've been around a few homes and the level of staff care here has been brilliant'. Another relative said 'I'm happy with the standard of care here, it is homely and not at all clinical if you know what I mean'.

One member of staff told us; 'I get loads of support from the manager, recently I've done mental health training, infection control, first aid and moving and handling. I get regular supervision where we cover all sorts of things like training, holidays or any problems".

We found that effective systems were place to monitor the quality of the service provided.

One relative told us; 'I'm aware of the complaints policy here, but if there was anything I wasn't happy with I would speak to the staff or the manager'. Another relative said; 'If I had any complaints I would have spoken to the management, but the girls have been fantastic, I can't thank them enough'.

We spoke with visiting relatives, they told us that they were very satisfied with the care that their relatives received. One relative said; 'I come at different times, I have no worries with anything, we like the atmosphere here and I have no concern, she always looks cared for'.

When we spoke with two people who used the service, comments included: 'I am very well looked after here and I don't tell lies', 'I have no complaints at all', 'The food is very good, we don't have a lot to do, but I enjoy a good sing song and the staff treat me very well, I can't complain'.

The environment was clean and organised but in areas, in need of remedial decoration work. We noted that cleaning regimes were in place and daily check lists were completed for all areas of the home. Individual bedrooms and communal areas were clean, tidy and free from malodours.

We found that medicines were safely administered.

We sampled six staff personal files. We found that they were well maintained and contained the required information to demonstrate that staff had been safely and effectively recruited.

Care files did not demonstrate that suitable arrangements were in place, to ensure that the provider was acting in accordance with the consent of people who used the service.