Clapham Lodge Care Home

Clapham Lodge Care Home is a residential care home providing personal care to up to 27 people. The service provides support to people who have a diagnosis of a dementia, Parkinson's disease and other conditions which included diabetes. At the time of our inspection there were 20 people using the service.

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

Systems to identify and mitigate people’s risk of falls was not effective, records were incomplete and there was no evidence of actions taken to prevent repeated incidents. People told us there were times when the care staff were under pressure. The deployment of care staff added to this pressure as additional tasks, such as cooking, routinely fell to them. Staff told us the administration of medicines did not feel safe, as they were constantly interrupted. Staff were recruited safely.

The service was not effectively managed, records were not fully completed, complaints were not recorded, and CQC was not notified of significant events. There was a lack of oversight and governance by the manager. Checks and audits were not effective to monitor the quality and safety of the service. Systems were not in place to demonstrate the service operated effectively to ensure compliance with the regulations. People and staff and had limited opportunity to feedback about the service.

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.

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 good (published on 6 December 2018).

Why we inspected

The inspection was prompted in part due to concerns received about accidents and incidents, staffing levels, medicines management and infection control practices. A decision was made for us to inspect and examine those risks.

We undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of 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.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We have identified breaches in relation to safe care and treatment, good governance and failure to notify CQC of significant events at this inspection

Please see the action we have told the provider to take at the end of this report.

Follow up

We met with the provider to discuss the findings of this inspection and how they will make changes to ensure they improve their rating to at least good. We will request an action plan from the provider to further understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

People who lived at Clapham Lodge Care Home told us that they were very happy living there. People and their relatives felt that they were treated with dignity and respect by the staff and were all, without exception, very complimentary about the management of the home. One person said, “It’s got a real homely feel to it. The minute I walked in here it just felt right. It’s a lovely, happy place.”

People felt safe and were supported in person-centred ways to live the lives they wanted to. Staff supported people to have contact with the wider community outside of the home and to engage in meaningful activities.

People had access to healthcare as they needed and staff supported them to attend appointments that were important for their wellbeing.

People’s dietary needs and preferences were met. People had been involved in developing and redesigning the menu. This meant that hot meals were also now provided at tea / dinner time.

Relatives were invited to visit the home without any restrictions. People’s independence was of utmost importance to the staff and management team. One person was being supported to return home following a stay at the care home.

The home was well managed by a passionate and dedicated staff management team who placed people at the centre of the support. A healthcare professional [admission avoidance community matron] told us that the staff and registered manager ensured the wellbeing of people at the home was, “most important to them” and, “they’re [staff] lovely with them [people].”

More information can be seen in the main body of the report for each Key Question below.

Rating at last inspection: Requires improvement (report published 24 November 2017).

About the service: Clapham Lodge Care Home is a residential care home that accommodates a maximum of 27 people. At the time of this inspection 25 people lived at the home. Older people who lived with dementia, Parkinson's disease and other conditions which included diabetes, were supported with personal care and accommodation in a homely service that was tailored to people’s individual preferences.

At the time of this inspection, the provider had developed the service with an extension to the building with new rooms for people. These were not registered with us at the time of the inspection but the provider planned to do this. People who lived at the home had already chosen their preferred bedrooms in the new build section of the home. Rooms had been personalised as people had chosen.

Why we inspected: This was a scheduled and planned comprehensive inspection based on the previous rating. We inspect all services rated as ‘Requires improvement’ every 12 months to ensure that we regularly monitor and review the quality and safety of the service people receive. We saw that improvements had been made to the service people received since our last inspection. Records about people had improved and measures which ensured that people’s dietary needs were met safely had been implemented.

Clapham Lodge is a residential care home offering personal care and accommodation for older people including people who are living with dementia and Parkinson’s disease. The service is currently registered to provide accommodation for a maximum of 26 people. At the time of the inspection 23 people were using the service. The provider had carried out extensive building works in keeping with the original building to extend the property. The extension had been built with wide corridors, an additional lift, private dining area, lounge and bedrooms with views of the surrounding fields and the South Downs National Park. A viewing window had also been created. The provider told us how the new build has been named after a person who previously lived at the service. The new build was yet to be completed and therefore there was no one living in that part of the home.

The interior of the home was comfortable and homely, with people being encouraged to bring their own items and belongings to personalise their rooms. People were encouraged to participate with gardening as desired to further personalise their outdoor space.

There was a registered manager 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.

Records did not always provide sufficient detail in relation to peoples’ specific needs and therefore did not always reflect the positive care and support that we observed. This is an area in need of improvement. This related to a person who required a soft diet as well as a person who required their fluid intake to be monitored. When this was raised with the registered manager they responded to this immediately which meant that the risks to these people were reduced.

People were safeguarded from the risk of abuse. Staff knew how to recognise the signs of abuse and how to report concerns. There was a sufficient number of staff deployed to meet people’s needs. Staff had received training, supervision and appraisals and staff meetings were held. Recruitment procedures were in place.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager had not submitted applications to the Local Authority for people who may be being deprived of their liberty. Staff sought and obtained people's consent before they helped them. Consent forms were seen for people.

Medicines were administered safely despite some gaps in documentation staff were able to demonstrate that people were given their medicines safely. Staff could clearly describe how and when people’s medicines should be given and how medicines are stored safely. Staff giving medicines to people had received training and supervision to support them to do this. Monthly audits of the medicines were completed by the registered manager.

People knew how to raise a complaint and their views were listened to and responded to comprehensively and in a timely manner, with positive outcomes.

Feedback provided by people at residents meetings and surveys was listened to and positive changes to the service were made as a result of listening to people.

The registered manager was very welcoming and evidently caring about people who lived here and they knew people well. People, staff and visitors were seen to have an open and transparent relationship with the registered manager. There was a friendly and welcoming atmosphere at the home and people told us that they were happy using the service and that they felt safe and secure.

People were able to participate in a range of interactive and stimulating activities, with a number of people actively engaging and enjoying the one to one discussions and group games that were offered.

People had a choice of foods provided and wine was offered with the lunch time meal for those who wished to partake. The meal time experience was interactive with many people joining others to dine, with staff available to support people as required. We saw for two people that the documentation regarding their eating and drinking needs was not always in place and staff therefore did not always follow correct procedures regarding the complex nutritional needs of these people. The registered manager addressed and corrected these concerns immediately following the inspection.

The registered manager and provider told us that the ethos of the service was to ensure that people felt that “they don’t live in our workplace, we work in their home”. This was displayed within the home and observations that we made supported this ethos. Staff were enthusiastic and motivated and openly communicated with people and visitors to the service, while remaining respectful of people’s choices, preferences and dignity. People were happy living at Clapham Lodge and would happily recommend the service to others.

The provider was supportive of the registered manager and visited the service regularly and carried out quality checks of the service provided.

We met with nine of the 24 people who lived at Clapham Lodge Care Home. They told us that they liked living at the home and that they felt the staff were very caring. We were told ‘’I enjoy being here, there is always something to do and I like the food’’. Another person said ‘’I am very happy here, if I want anything I only have to ask’’.

People told us about their life at the home and the activities they participated in. We looked at a five incident records. We found that events had been properly and timely recorded and had been responded to appropriately. This gave us a good insight into how the home was run and provided us with evidence that the home met people's needs and expectations.

We talked with five staff who were employed to work in the home, including the manager. Staff told us that they felt people were well looked after and experienced a good quality of life. Staff also told us that they felt well supported in their jobs with access to appropriate training and guidance from their manager. We found that the home had systems in place for monitoring the quality of care and support the home offered.

People told us about their life at the home and the activities they participated in. We looked at a sample of care records and found them to be comprehensive and up to date. This gave us a good insight into how the home was run and provided us with evidence that the home met people's needs and expectations.

We talked with four staff who were employed to work in the home, including the registered manager. Staff told us that Clapham Lodge Care Home was a nice place to work. They told us that they felt people were well looked after and experienced a good quality of life. Staff also told us that they felt well supported in their jobs with access to appropriate training and guidance from their manager. We found that the home had systems in place for monitoring the quality of care and support the home offered.