Clarence House

Updated 5 August 2023

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.

This was a targeted inspection to check whether the provider had met the requirements of the Warning Notice in relation to Regulation 12: Safe care and treatment and Regulation 17: Good governance, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

We inspected and found there were improvements to ensure people received safe care, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

As part of this inspection we looked at the infection control and prevention 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 2 inspectors.

Service and service type

Clarence House 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. Clarence House 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 provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

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 all this information to plan our inspection.

During the inspection

We spoke with 6 people who used the service about their experience of the care provided. We received written feedback from 6 relatives. We spoke with 9 members of staff including the registered manager, senior care staff, chef, housekeeping and care staff.

We reviewed a range of records, these included 9 people's care records and multiple medication records. We looked at 2 staff records in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

Updated 5 August 2023

About the service

Clarence House is a residential care home providing accommodation for up to 29 people who require personal care. Clarence House had been adapted to provide care to people across 2 floors accessible by a lift and stair lift. At the time of our inspection there were 19 people using the service.

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

Following our previous inspection, the provider and registered manager took the decision to restrict new admissions into the service and focus on improving the safety and quality of care for people already using the service. At this inspection, we found improvements had been made.

Since our last inspection improvements had been made to assessments of potential risks to people’s health, safety and wellbeing. Where risks to people’s skin integrity had been identified, care plans contained guidance for staff to follow and reduce the likelihood of harm. The registered manager acknowledged this work was ongoing and further improvements would be made.

The service had put new systems in place to ensure the safe storage and administration of medicines. Governance systems had been introduced to ensure the registered manager was able to identify areas of improvement and these had been effective.

A ‘no blame’, lessons learned, process had been introduced and had been effective at identifying what went wrong, how it went wrong and what actions could be taken to prevent it from happening again.

We received mixed feedback from relatives who felt there had been some improvements, however, did have concerns regarding the ongoing stimulation for people using the service. The registered manager was aware of this and told us staff had been recruited to focus on activities and were due to commence employment imminently.

Improvements had been made to recruitment procedures, and staff had been recruited safely into the service.

The home was clean on the day of inspection, and infection prevention and control standards had improved. The registered manager told us they now had more than 2 housekeepers to ensure the home was consistently clean to prevent the risk of the spread of infections.

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.

Staff told us they found the registered manager approachable and supportive. Relatives were not always aware of when to raise their concern and did not always feel listened to. The registered manager was aware of this and showed us questionnaires that were due to be sent out to seek feedback about the service. The ‘how to complain’ process was resent to relatives, this was also visible when visiting the home.

Whilst we saw improvements were being made to provide a safe and well-led service, the service will need additional time to ensure their systems and processes become embedded and remain robust.

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 requires improvement (published 27 April 2023) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended the service refers to current guidance to improve staff recruitment, infection control, staff training and effective care planning. At this inspection we found these areas had improved.

At our last inspection we recommended the provider refer to good practice guidance to ensure people were provided with enough stimulation, at this inspection we found the service still needed to improve.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 8 March 2023. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, safeguarding adults at risk and good governance of the service.

We undertook this targeted inspection to check whether the Warning Notice we had served in relation to Regulation 12 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed and remains requires improvement.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We inspected and found there were improvements to ensure people received safe care, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.