This inspection took place on 21 and 22 November 2018 and was unannounced on the first day. At the last inspection in October 2016, the service was rated Good. At this inspection we found some concerns with the quality of the service. Medicines were not consistently managed in a safe way and improvements were needed with aspects of the recruitment process and the care recording systems. We have rated the service Requires Improvement.
Clarendon Hall Care Home accommodates up to 52 people. The building is purpose built with lift and stair access to the first floor. Accommodation consists of single occupancy rooms over two floors. There are communal areas on the ground floor, including a dining room and a range of sitting rooms. At the time of this inspection 44 people were using the service.
Clarendon Hall Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a registered manager in post. A registered manager is a person who has registered with the 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.
There were shortfalls in the administration and recording of some people’s medicines. People had not always received their medicines as prescribed due to stock control or administration practices.
Staff demonstrated a good awareness of safeguarding procedures and knew who to inform if they witnessed or had an allegation of abuse reported to them. The registered manager was aware of their responsibility to liaise with the local authority where safeguarding concerns were raised and such incidents were managed well.
The provider's systems to assess, monitor and improve the quality of the service provided had not been effective in identifying and addressing all the issues highlighted during our inspection, although the area director acted during the inspection to speak with senior staff, implement new supplementary recording systems and direct senior staff to complete additional audits.
People told us they enjoyed the food. A choice of food and drinks was always available. Improvements were needed with regular weight monitoring when there was increased risk identified and with the records to support the action staff had taken when people experienced poor or reduced intake. We have made a recommendation about improving the recording of people’s weights and their food and fluid intake.
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. There were some inconsistencies with consent records as it was not clear if some people had legally appointed attorneys to make decisions on their behalf. We have made a recommendation to improve consent recording and staffs understanding of this.
Overall, there were safe systems in place to manage risks to people’s health and safety. One person’s risk management plan was amended during the inspection to provide more detailed guidance for staff around their safety when eating and drinking. Accidents and incidents were reviewed to identify any actions that could be taken to prevent a reoccurrence and keep people safe.
The environment was clean and tidy and staff had access to personal protective equipment to help prevent the spread of infection. Health and safety checks were undertaken and there were appropriate procedures in place in the event of an emergency.
Staff had received training in how to safeguard people from the risk of abuse. They knew what to do if they had concerns.
Sufficient numbers of staff were employed to meet people’s needs. Overall, staff were recruited safely, but improvements were needed to ensure appropriate references were obtained.
Staff supported people to access health professionals when required and people could remain in the service for end of life care if this was their choice. People’s individual needs were identified and met. The quality of person-centred information was inconsistent and the area director implemented an additional audit programme to improve the overall quality of the records.
Staff received appropriate training which was updated when needed. Staff felt well supported and gaps in the supervision and appraisal programmes were being addressed. Staff said they enjoyed their work, there was good teamwork and a positive culture within the service.
A wide range of activities were provided and people had good access to the local community. People praised the wellbeing coordinator and told us how much they enjoyed the activities and entertainment.
People and relatives spoke highly of the staff who they described as kind and caring. We saw staff had developed good relationships with people and knew them well. Staff treated people with respect and maintained their privacy and dignity.
People, relatives and staff spoke positively about the registered manager and the way the home was managed. There were systems in place to enable people to share their opinion of the service provided and the general facilities at the home. People knew how to make a complaint and we saw complaints raised had been dealt with appropriately.
We identified one breach of regulation in relation to safe care and treatment. You can see what action we have told the provider to take at the end of the full version of this report.