Clitheroe Care Home

Updated 7 July 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the IPC measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by one inspector and a nurse specialist advisor.

Service and service type

Clitheroe Care Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Clitheroe Care Home is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. At the time of our inspection there was a manager in post that had applied to register. However, since our inspection the manager had left the service.

Notice of inspection

This inspection was unannounced. Inspection activity started on 27 April 2022 and ended on 13 May 2022. We visited the location’s service on 27 and 28 April 2022.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the Local Authority and professionals, who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with three people who used the service and one relative about their experience of the care provided. We spoke with nine members of staff including the manager, deputy manager, general operations manager, business development manager, care workers and the provider who was also the nominated individual. The nominated individual is responsible for supervising the management of the service. We also spoke to a healthcare professional, who was visiting the service at the time of inspection. We reviewed a range of records. This included four people's care records in detail, along with various aspects of other people’s care plans. We also reviewed a variety of medication records. We looked at three staff files in relation to recruitment. A variety of records relating to the management of the service, including policies and procedures were also reviewed.

Updated 7 July 2022

Clitheroe Care Home is a care home providing accommodation for persons who require personal care for up to 28 people. At the time of the inspection 21 people were using the service. The home accommodates people across two floors in one building.

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

Medicines records were not always accurate, and medicines and equipment were not always managed safely. Infection prevention control (IPC) practices were not always robust. Risks relating to fire were not always appropriately managed. Safeguarding processes and procedures were in place but were not always being followed. However, people at the home told us they felt safe. Staffing levels in the home was adequate, though some improvement was required in relation to recruitment records. We made a recommendation that the provider improves their recruitment processes. Management told us they were working to improve the issues we identified.

People’s needs had not always been assessed and necessary health related risk assessments and care plans were not always in place. The management were in the process of improving this. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. After our site visit the management were reviewing this information and making necessary referrals.

Staff completed an induction once recruited, and staff were supported by the management, however not all staff had completed appropriate training. We witnessed incorrect moving and handling practices during our inspection, and we made a recommendation that the provider reviews their practices and processes relating to moving and handling. The environment needed some improvement to meet the needs of the people living there, and the management advised they were making these changes. People did not have oral healthcare plans in place, and people were not registered with a dentist, however, management told us they were in the process of trying to rectify this. Feedback on the food people received was positive.

Various governance issues were identified during our inspection, including issues around records and audits. Although the manager was aware of their responsibility under the duty of candour, they had not always reported necessary incidents to CQC and the local safeguarding team. Since the inspection the manager has left the service. A consistent approach to working in partnership with other health care professionals, making necessary referrals and, ensuring follow ups was not always adhered to. Staff meetings and meetings for/with people that use the service were taking place, and surveys were being conducted. Staff and people spoke positively about the service, though people did not always receive good outcomes as detailed in this report. Staff were aware how to report poor practice.

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 good (published 09 December 2020). At our last inspection we recommended that the provider reviews their documentation around recruitment. At this inspection we found improvements relating to recruitment were still required. We also made a recommendation around monitoring, assessing and improving the service, we found that at this inspection we had further concerns around the governance of the service.

Why we inspected

We received various concerns about the service. As a result, we undertook a focused inspection to review the key questions of safe, effective 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 have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this report.

We looked at IPC 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.

You can see what action we have asked the provider to take at the end of this report. The provider had taken some action to mitigate risks and was working on making further improvements.

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

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to IPC, medicines, environmental concerns (including fire), safeguarding service users, person centred care, failure to/and delay of sending appropriate notifications to CQC and good governance.

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

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.