We inspected Clann House on 19 and 20 November 2018.The inspection was unannounced. The service is for elderly people, some of whom may have physical disabilities, mental health needs or dementia. Respite care and day care was also provided.Clann House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Clann House accommodated up to 34 people. At the time of the inspection 32 people lived at the home.
The service did not have a registered manager, although the current manager had submitted an application to be registered with the Care Quality Commission. 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.
At the last inspection, in November 2017, the service was rated as ‘Requires Improvement.’ This was because we had concerns about the management of medicines and because mental capacity assessments were not being completed. The registered persons had not always submitted statutory notifications to the Care Quality Commission when they were required to do so. There were insufficient systems to assess, monitor and improve the quality of the service.
At this inspection we found that satisfactory action had been taken in respect of mental capacity assessments, and we had no evidence to suggest the registered persons did not notify us of relevant events required by law. However, we still had concerns about the operation of the medicines system. We also did not subsequently think audit systems were satisfactory. This was because the systems in place did not identify the problems we found with the medicines system. The registered persons did not take appropriate action to ensure the system worked effectively.
The service was viewed by people we spoke with as very caring. We received positive comments about the service. For example we were told, “They are lovely here and very respectful, “ and “They are very good and very helpful.” Relatives told us, "They are friendly and patient,” and “They are very caring and seem to look after everyone here and are very good to all the families to. They are really, really good.” A staff member told us, “Care is really good. I don’t have any issues, “ Care is amazing, really good,” and “Staff are lovely.”
Everyone we observed looked well cared for. People were clean and well dressed.
The service provided a range of activities. An activities co-ordinator was employed. There were limited external activities available. The service had a vehicle but the rear wheelchair ramp was not working. We have recommended that the registered provider reviews activities provision including current transport arrangements.
People told us they felt safe. For example people told us, “Yes. It is important to feel safe,” “I do and have always done,” and “They do all they can to help us all. They are very good and most kind.” The service had a suitable safeguarding policy, and staff had been appropriately trained to recognise and respond to signs of abuse.
People had suitable risk assessments to ensure any risks of them coming to harm were minimised, and these were regularly reviewed. Health and safety checks on the premises and equipment were carried out appropriately.
There were enough staff on duty to meet people’s needs. Recruitment checks were satisfactory. For example, the registered provider obtained two written references and a Disclosure and Barring check to ensure the person was suitable to work with vulnerable adults.
Staff members received an induction. The registered provider was aware of the Care Certificate. This is a set of national standards for staff coming into the health and social care sector. There was evidence some, but not all staff had completed this although it was the provider’s policy for staff without care qualifications to do so. Although staff had attended most training which is required by health and safety law, not all staff had received an appropriate level of first aid training, or training to care for someone who was having an epileptic seizure. This could put people at serious risk.
We had concerns about how the medicines’ system was managed. Medicines were stored securely, and there were satisfactory systems to dispose of medicines which were no longer required. Staff who administered medicines received suitable training. Some people self-administered their medicines. Records about the administration of medicines were mostly satisfactory. However, we found some cases where medicines were not administered but were signed to state they had been administered. Records also showed that some prescribed medicines had not been administered because there were not sufficient stocks.
The service was clean and hygienic. The building was suitable to meet the needs of the people who lived there. The building was well laid out, pleasantly decorated and homely. However, we had concerns about the water supply to some areas of the building. There was limited flow of water from some taps, in some people’s bedrooms. This made is difficult for people to have a wash. The supply also affected the upstairs bathroom, so people had to use facilities downstairs. There were also problems with heating in some bedrooms. Although some electric or fan heaters had been provided, the lack of appropriate heating resulted in these rooms feeling cold on the day of the inspection.
There were suitable assessment processes in place before someone moved into the service. These assisted in helping staff to develop care plans. We were told staff consulted with people, and their relatives, about their care plans. Care plans were regularly reviewed.
People enjoyed the food and were provided with regular drinks throughout the day. Support people received at meal times was to a good standard. Comments about food included: “The food is amazing and I am fussy with food,” and “They do us a lovely roast on Sunday and usually a choice of two mains.”
The service had well established links with external professionals such as GP’s, Community Psychiatric Nurses, District Nurses, and social workers. However, records were not always sufficient to demonstrate that people, wanted, needed, and routinely saw some medical professionals such as opticians and dentists.
Some people lacked mental capacity. Where necessary suitable measures had been taken to minimise restrictions. Where people needed to be restricted, to protect themselves, and/or others, suitable legal measures had been taken. No physical restraint techniques were used at the service. Staff had received suitable training about mental capacity.
The service had a satisfactory complaints procedure. People we spoke with felt they could raise a concern or complaint, and these would be responded to appropriately.
The manager was respected and liked by people, relatives and staff we spoke with. The manager had a hands on approach. One person told us, "The people in charge are very good and she’ll (the manager) will do anything to help you and is always there.” Staff also said team working at the service was good, and team members were supportive and communicated well with each other.
We have concerns about the absence of effective quality assurance systems. This is because systems should have picked up concerns we found about the operation of the medicines system and taken suitable action to improve the system. The system in place did not do this. We were also concerned quality assurance systems had not picked up other issues of concern raised in this report for example problems with heating and water supply, and shortfalls in training provision.
We found breaches of regulations. 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.