Clarence House

Clarence House is a residential care home providing accommodation for up to 29 people who require personal care. Clarence House had been adapted to provide care to people across 2 floors accessible by a lift and stair lift. At the time of our inspection there were 19 people using the service.

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

Following our previous inspection, the provider and registered manager took the decision to restrict new admissions into the service and focus on improving the safety and quality of care for people already using the service. At this inspection, we found improvements had been made.

Since our last inspection improvements had been made to assessments of potential risks to people’s health, safety and wellbeing. Where risks to people’s skin integrity had been identified, care plans contained guidance for staff to follow and reduce the likelihood of harm. The registered manager acknowledged this work was ongoing and further improvements would be made.

The service had put new systems in place to ensure the safe storage and administration of medicines. Governance systems had been introduced to ensure the registered manager was able to identify areas of improvement and these had been effective.

A ‘no blame’, lessons learned, process had been introduced and had been effective at identifying what went wrong, how it went wrong and what actions could be taken to prevent it from happening again.

We received mixed feedback from relatives who felt there had been some improvements, however, did have concerns regarding the ongoing stimulation for people using the service. The registered manager was aware of this and told us staff had been recruited to focus on activities and were due to commence employment imminently.

Improvements had been made to recruitment procedures, and staff had been recruited safely into the service.

The home was clean on the day of inspection, and infection prevention and control standards had improved. The registered manager told us they now had more than 2 housekeepers to ensure the home was consistently clean to prevent the risk of the spread of infections.

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.

Staff told us they found the registered manager approachable and supportive. Relatives were not always aware of when to raise their concern and did not always feel listened to. The registered manager was aware of this and showed us questionnaires that were due to be sent out to seek feedback about the service. The ‘how to complain’ process was resent to relatives, this was also visible when visiting the home.

Whilst we saw improvements were being made to provide a safe and well-led service, the service will need additional time to ensure their systems and processes become embedded and remain robust.

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 27 April 2023) and there were breaches of regulation. 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.

At our last inspection we recommended the service refers to current guidance to improve staff recruitment, infection control, staff training and effective care planning. At this inspection we found these areas had improved.

At our last inspection we recommended the provider refer to good practice guidance to ensure people were provided with enough stimulation, at this inspection we found the service still needed to improve.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 8 March 2023. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, safeguarding adults at risk and good governance of the service.

We undertook this targeted inspection to check whether the Warning Notice we had served in relation to Regulation 12 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed and remains requires improvement.

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 there were improvements to ensure people received safe care, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Clarence House 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.

Clarence House is a residential care home providing accommodation for persons who require personal care and support to up 29 people. The building had been adapted and care was provided over two floors with stairs and a stair lift as access. There were 23 people living at the home at the time of inspection.

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

Clarence House had been through a period of change with a new provider, new management team and ongoing building adaption and design improvements. This had led to some staff leaving and the registered manager stepping into roles such as housekeeper, cook and care assistant to cover. This meant the registered manager had been unable to maintain overall governance of the home, and the provider did not have robust systems in place to ensure they were meeting the health and social care regulations. This had led to shortfalls found during the inspection.

Staff were kind and caring and treated people with dignity and respect. The managers and staff knew people well. However, risks to people had not always been anticipated and managed safely, and medicines had not always been stored and managed safely. This had placed people at risk of harm. Systems to learn lessons when things went wrong had not always been effective.

The local safeguarding policy had not always been followed and incidents had not always been reported to the local safeguarding team. This meant external scrutiny had not always been possible to ensure people were safe.

Recruitment systems had not always been robust to ensure staff had been recruited safely into the service. We have made a recommendation about recruitment. The home was clean; however, only one member of staff was responsible for cleaning communal areas and all people’s rooms. This meant there was a risk not all areas could be consistently cleaned to prevent the spread of infections. We have made a recommendation about infection control.

Staff had received training to support people safely however, some had not received specific training to support people with certain medical conditions. We have made a recommendation about staff training. Care plans did not always reflect the person and sometimes had more information contained within reviews rather than in the care plan. This had led to staff not always being aware of people’s needs. We have made a recommendation about effective care planning.

We observed some people enjoying activities; however, others were not always able to. We have made a recommendation about a wider activities programme.

People’s needs and choices had been assessed before they moved into the home. People told us they enjoyed the food and were supported when they required a special diet. The home worked with healthcare professionals to provide care and support to people. The home was undergoing improvements to the layout and design. Old carpets were in the process of being replaced.

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.

People, relatives and staff told us the registered manager was supportive and always had time to listen and act on concerns they may have. The registered manager and provider told us they are committed to making improvements to the home and had begun working with external agencies to start improvements by the end of the inspection.

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

Rating at last inspection

This service was registered with us on 17 January 2022, and this is the first inspection. The last rating for the service under the previous provider was good, published on 12 July 2018.

Why we inspected

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

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 and Recommendations

We have identified breaches in relation to the safe care and treatment of people using the service, the governance of the service and safeguarding people from abuse. 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 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.