Archived: Clarkson House Residential Care Home

Clarkson House Residential Care Home is a residential care home providing accommodation and personal care for up to 28 people aged 65 and over. At the time of the inspection there were 14 people using the service.

We found the following examples of good practice.

Staff had received training in handwashing, Infection Prevention and Control (IPC) and use of personal protective equipment (PPE). National guidance was followed on the use of personal PPE and regular Covid 19 testing was taking place. There were supplies of PPE readily available to staff and visitors.

There were procedures and risk assessments to manage and minimise the risks Covid 19 presented to people who used the service, staff and visitors. The systems in place allowed people to be admitted to the home safely.

National restrictions on visiting were in place at the time of the inspection and alternative measures such as video calls were being used.

The home was clean and uncluttered. Communal areas had been reorganised to promote social distancing.

Further information is in the detailed findings below.

Clarkson House Residential Care Home is a residential care home providing accommodation and personal care for up to 28 people aged 65 and over. At the time of the inspection there were 17 people using the service.

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

At this inspection we found the evidence supported the overall rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns.

Safe systems of recruitment were in place. There were sufficient staff to meet people’s needs and staff received the training and support they needed to carry out their roles. Risks to people were identified and well managed. Care records were person centred, reviewed regularly and updated when people’s needs changed.

The provider was meeting the requirements of the MCA and people were involved in decisions about their care. The home was clean, some areas of the home needed repair and redecoration. There was a planned on ongoing programme of redecoration and updating of furnishings.

Medicines were managed safely. People were positive about the food on provided and were supported with their health needs.

People were positive about living at the home. They told us staff were kind and caring. Staff and managers knew people well and we saw interactions were warm and friendly. People enjoyed the activities on offer and improvements were being made to the range of activities.

Everyone was positive about the way the home was being managed and the recent improvements that had been made. There were good systems in place to monitor the quality of the service provided.

There was a system for dealing with complaints. The provider had notified CQC of significant events such as DoLS authorisations and safeguarding concerns.

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 Requires Improvement (published August 2018).

Why we inspected

This was a planned inspection based on the previous rating. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Clarkson House Residential Care Home on our website at www.cqc.org.uk.

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.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. The manager was first registered in October 2010.

At the last inspection of December 2017, the service was found to be in breach of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. This was in respect of Regulation 10 10(1). Privacy and dignity. Regulation 12(2)(a). Risk assessments were not undertaken to a sufficient level to protect people. Regulation 18(2)(a). Staff were not adequately trained and Regulation 17(a), (b), (c) and (e). Governance and record keeping processes were ineffective in monitoring people's needs and preferences, assessing the safety of the premises, medicines and acting on people's feedback. The service sent us an action plan to show how they were going to meet the regulations and we found that the regulations were met at this inspection. At this inspection we found further breaches in the regulations and we have told the provider what action to take in the body of the report.

The home was clean, tidy and homely in character. Not all equipment was maintained to a safe standard.

Not all notifications had been made to the Care Quality Commission in a timely manner.

We recommended that the service look at best the best practice guidelines of the National Institute for Health and Clinical Excellence (NICE) for the administration of medicines.

Staff had been trained in safeguarding topics and were aware of their responsibilities to report any possible abuse.

Recruitment procedures were robust and helped ensure new staff were safe to work with vulnerable adults.

The administration of medicines was safe. Staff had been trained in the administration of medicines and we saw all records had been suitably maintained.

Electrical and gas appliances were serviced regularly. Each person had a personal emergency evacuation plan (PEEP) and there was a business contingency plan for any unforeseen emergencies.

There were systems in place to prevent the spread of infection which helped to protect the health and welfare of staff and people who used the service.

People were given choices in the food they ate and they told us it was good. People were encouraged to eat and drink to ensure they were hydrated and well fed.

New staff received induction training to provide them with the skills to care for people. Staff files and the training matrix showed staff had undertaken sufficient training to meet the needs of people and they were supervised regularly to check their competence. Supervision sessions also gave staff the opportunity to discuss their work and ask for any training they felt necessary.

We observed there were good interactions between staff and people who used the service. People told us staff were kind and caring.

We saw from our observations of staff and records that people who used the service were given choices in many aspects of their lives and helped to remain independent where possible.

We saw that the quality of care plans gave staff sufficient information to look after people accommodated at the care home and they were regularly reviewed. Plans of care were individual, person centred and reviewed regularly to help meet their health and social care needs.

We observed people were treated with respect and dignity.

People’s age, gender, sexuality and religion were respected.

We saw that people could attend activities of their choice and families and friends were able to visit when they wanted.

Audits, meetings and surveys helped the service maintain and improve their standards of support.

People told us they thought the deputy manager was approachable and supportive.

Clarkson House is situated in the Tameside area and has access to local bus routes into Ashton Town Centre. The home provides 24 hour residential care and support for up to 28 people. Some people are living with dementia. On the day of inspection 20 people were using the service.

The service had a registered manager. 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. The registered manager was also the registered provider.

Improvements were needed in the management of medicines. Risks to people arising from their health and support needs were not always assessed and risks to the premises and environment were not all in place. The registered provider kept records of accidents and incidents which had occurred. However, they had not monitored the accidents and incidents since May 2016.

Required test and maintenance certificates were in place, though the gas safety certificate was out of date. Fire drills were carried out but not all staff took part. The registered provider did not have personal emergency evacuation plans (PEEPs) in place for everyone who used the service, or a business contingency plan.

Staff we spoke with understood the principles and processes of safeguarding. Staff knew how to identify abuse and act to report it to the appropriate authority. Staff said they would be confident to whistle blow [raise concerns about the service, staff practices or provider] if the need ever arose.

The registered provider followed safe processes to help ensure staff were suitable to work with people living in the service. Gaps in employment were checked (but not recorded), references were sought and a Disclosure and Barring Service (DBS) was in place.

Staff did not always receive the training they needed to support people effectively, for example in areas such as diabetes and epilepsy care.

Policies were in place to ensure people’s rights under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were protected. Where appropriate, the service worked collaboratively with other professionals to act in the best interests of people who could not make decisions for themselves. However, there was no recorded evidence of who had a DoLS authorisation in place and when the renewal was needed.

People were supported to maintain a healthy diet, and people’s dietary needs and preferences were catered for. People told us they had a choice of food at the service, and that they enjoyed it. However there was no record of people’s dietary needs, likes and dislikes in the kitchen.

The premises were clean and tidy, however needed updating in some areas.

Staff were not always treating people with dignity, respect and privacy. Staff supported one person to use the toilet however the door was open and exposed the person. Another staff member was supporting a person to eat but did not speak to this person once during their meal. The cook did not blend people’s food separately which did not provide a dignified and appetising meal for people who required soft or pureed food.

Procedures were in place to support people to access advocacy services and four people were using this service at the time of inspection.

People had their health and social care needs assessed and plans of care were developed to guide staff in how to support people. We found care plans needed to become more person centred as they did not always record people’s support needs and preferences.

There was evidence of activities provision. People were happy with the activities on offer in the service but expressed a wish to attend external activities.

The service had an up to date complaints policy. Complaints were recorded with a full investigation and an outcome for the complainant.

Staff told us they felt supported by the registered manager.

Quality assurance and governance processes were not always effective and had not identified the issues we found during the inspection. Feedback from staff and people using the service was not consistently sought or acted on.

We identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the full version of the report.

We checked four care records and saw that where people did not have capacity, care plans were signed on their behalf. We saw that the home worked closely with other health and social care professionals to achieve the best outcome for each person. This meant that people's choices were considered and decisions were made in their best interests.

Before people came to live at the home they received an assessment of their needs and a care plan was introduced based on information given. Care plans were reviewed regularly and other health and social care professionals were involved in the care and treatment. This assured us that people received a service which covered all their needs.

We found the property to be clean and well maintained. Maintenance contracts were up to date and regular health and safety checks were carried out. This showed us that the premises were maintained to an appropriate standard.

The staff rota showed there were enough staff on duty at all times with a contingency to deal with planned and unplanned leave. Staff described the support for each person and training was up to date. This showed us that continuity of care was provided by staff who were familiar with people's care needs and appropriately trained.

The complaints policy was clearly displayed in the reception area of the home and we reviewed the complaints log. We saw that all concerns were logged and dealt with according to the home's complaints policy which included information about how to contact the Care Quality Commission.

"The staff are alright with me. I can have a chat and a good laugh with them."

"There is always something to do. We have someone who visits to do exercises and I enjoy doing that."

"The staff treat me very well. I have a disability and the staff are really aware of what help I need. They give me help that is specific to my disability."

During our observations we saw that staff supported and encouraged people to be involved in their care, they took time to listen to people, and we saw them respond in an appropriate manner.

We saw staff interacting with the people who used the service. Staff spoke with people in a patient and friendly way and the people who used the service seemed relaxed in their company.

When we spoke with staff they told us they felt well supported by the manager and confirmed that they received ongoing training and development opportunities. During this visit we saw that training was taking place for a small group of staff.

We saw that the manager was continually developing the quality monitoring systems and was actively promoting the involvement of people who use the service by one to one consultation and using service user surveys.