Archived: Clyde Court Nursing Home

We last inspected Clyde Court Nursing Home in November 2016. During that inspection we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service received an overall rating of ‘Requires Improvement’ and we took enforcement action.

Clyde Court Nursing Home is situated in the Didsbury area of Manchester. The home is registered with the Care Quality Commission (CQC) to provide accommodation to a maximum of 41 people who require nursing or personal care. At the time of our inspection, 33 people were accommodated at the home. Accommodation is over three floors and there is lift access. .

At the time of this inspection, the service had a registered manager. However, due to circumstances beyond their control, they were only present for day one of the inspection visit. For the remaining two days, the inspection was supported by the registered provider and deputy manager. 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.’

During this inspection we identified four breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 in respect of: safe care and treatment, consent, person-centred care, and good governance. We also made a recommendation in regards to equality and diversity. We are currently considering our enforcement options.

Not all aspects of the service were safe. For example, clinical risk assessments and guidance completed by Speech and Language Therapy (SaLT) for people considered at high risk of choking were not always followed. We also found unsafe practice which potentially left the home vulnerable to unwanted visitors and provided a route for people who used the service to leave unnoticed by staff. This was because people living at Clyde Court were able to answer the front door unsupervised.

People’s medicines were managed in a safe way and we found systems in place which sought to ensure the safe storage, administration, ordering and disposal of medicines. This included medicines classed as a controlled drug.

Improvements had been made around systems for the prevention and control of infections and work had been completed to improve the physical environment.

We reviewed staffing levels and found these to be adequate to meet the needs of the people living in the home.

Policies and procedures for the safe recruitment and selection of staff were robust.

Accidents and incidents were recorded over two separate systems. This meant information was not captured consistently and it was not always clear what remedial actions had been taken to reduce the likelihood of such events occurring again in the future.

Staff received training which enabled them to carry out their roles effectively. Training included moving and handling, health and safety, safeguarding, first aid and infection control. Registered nurses had access to continuous professional development opportunities.

Mental capacity assessments had not been completed in line with the requirements of Mental Capacity Act 2005. We found examples of assumptions being made regarding people’s capacity to make decisions based on people’s age or medical diagnosis rather than an assessment that the person had been determined to lack capacity to make the decision independently.

The mealtime experience was pleasant and people told us they enjoyed the food at Clyde Court. All meals were freshly prepared and people were offered a variety of choices.

People who used the service and their relatives told us staff were caring. We also observed a number of positive interactions. Staff treated people with kindness and explanations were provided before undertaking care tasks with people.

The home was engaged in the 'Six Steps' End of Life Care Programme. This meant that for people who we were nearing the end of their life, they could choose to remain at the home to be cared for in familiar surroundings by people they know and could trust.

People who used the service at Clyde Court were from diverse backgrounds and the home benefited from a workforce that was representative of the local community.

We saw that a number of people were able to maintain community links by attending a local day centre and some people were regularly taken out by their family members. Communal activities within the home were provided and these ranged from armchair exercises, bingo, films nights and an entertainer who frequently visited the home. However, activities provided on a one-to-one basis were limited, particularly for people that were isolated on account of needing to be cared for in their own rooms.

People's care and support was not always delivered in a person-centred way and did not take sufficient account of their needs, likes, dislikes and personal preferences.

We looked again at systems for governance and quality assurance. We saw a new system had been established and there was a variety of audit tools in place which looked at areas such as infection control, nutrition, building maintenance, mealtimes and observational audits. There was a medicines audit tool but the template document in use was out of date and referred to the CQC’s old methodology and way of inspecting pre the changes implemented in 2014. Overall, we recognised that some improvements had been made in respect of the number of audits being completed but further work was required to ensure remedial actions were clearly documented.

This inspection took place over three days on 9, 11 and 16 November 2016. The first day was unannounced, which meant the service and the staff did not know in advance that we were coming. The second and third day was by arrangement.

At the comprehensive inspection of Clyde Court on 4 and 12 March 2015 we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (HSCA). We issued the provider with four requirements stating they must take action to address these breaches.

Following that inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to these breaches. This inspection was undertaken to check that they had followed their plan, and to confirm that they now met all of the legal requirements.

At the time of the inspection, the service had a manager registered with the Care Quality Commission (CQC). 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.

The registered manager was not present for all the days of the inspection due to annual leave and other personal commitments. The registered manager was supported with the running of the home by a clinical lead and two residential deputy managers.

We found some working practices poor in relation to the control of infection. Checks to prevent the spread of infection were either not carried out or not fit for purpose.

We looked at how the home ensured people received their medication safely. Medicines were administered by either a nurse or a senior member of staff, trained and competent to do so. We looked at how medicines were monitored and checked by management to make sure they were being handled properly and we were confident that systems were safe. The service had good protocols in place for ‘when required’ medicines.

The service carried out risk assessments in relation to people’s health and care needs and measures were identified to minimise risks wherever possible.

Staffing levels for Clyde Court were adequate for the needs of the people living in the home. The atmosphere during the three day inspection was on the whole relaxed and pleasant. Staff did not appear hurried or under pressure when undertaking care duties, although meal times were seen to be less structured and chaotic. We observed a care worker checking a mobile phone on more than one occasion during the meal time serving which was against company policy.

We found staff were recruited safely. Suitable checks were made to ensure people recruited were of good character and had appropriate experience and qualifications. Staff had received appropriate training and supervision to support them in their roles.

We found accident and incident records at the home were completed and evidence showed people were monitored effectively following an accident. However we found that following a fall, body maps were not always completed.

The home had undergone some improvements since our last inspection however more work was needed to be done to ensure people's safety was not compromised. One carpet within the home was loose and caused a trip hazard. A number of repairs to fixtures and fittings had been identified during home audits but these had not yet been addressed. The environment could be improved to better meet the needs of those people living with a diagnosis of dementia.

Discussion with the registered manager showed they had an understanding of the principles of the MCA and DoLS, and we saw that if it was considered that people were being deprived of their liberty, the correct authorisations had been applied for. There were policies in place relating to the MCA and DoLS. Where people did not have the capacity to make decisions about their care, meetings were held with people, their relatives, and health and social care professionals to help ensure that any decisions were made in the best interests of people using the service.

Staff we spoke with confirmed they understood the meaning of mental capacity and were able to give us examples of when people were able to make decisions about their care. They recognised the importance of allowing people to make those decisions. We were satisified that the provider had taken action since the last inspection to achieve compliance in this area.

Staff knew how to maintain people’s dignity and respect their privacy although some care practices of staff and other health professionals compromised this.

People had access to activities, however we received mixed feedback with regards to the activities provided. People were not always protected from social isolation.

People told us they knew how to complain if they were unhappy and records showed the service responded appropriately to complaints they had received. We saw evidence of compliments received by the service in the form of thank you cards from family members of people who had used the service.

Audits to measure the quality of care provision had been introduced but were not always completed or acted upon. Completed questionnaires and surveys were on file but there was little evidence to show this information had been used to improve the provision of care at the home.

We saw no evidence of regular staff meetings and there had been no resident or relative meetings for over six months.

Staff felt supported by the registered manager however the residential and nursing aspects of care were run very separately and there was no overarching management of these to align the two.

We found the home in breach of the regulation in relation to good governance as there were not effective systems in place to monitor the quality of the service.

The overall rating for this service is ‘requires improvement’. During this inspection we found three breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

During this inspection we spoke with six people who used the service and two relatives who were present on the day of our visit.

People who used the service told us about the food: 'I get more than enough. Sometimes too much now'. 'There has been a big improvement'. And: 'Oh if I want something the staff will make it'.

We found during this inspection that the quality and amount of food provided to people who used the service had improved. Fresh food was now sourced from local suppliers and the menus offered variety and choices.

There was a system in place to audit both the quality of the food and drink provided as well as a further system to monitor the nutritional intake of each person who used the service on a daily basis.

During our discussions the majority of staff spoken with raised concerns in respect of the quality and quantity of the food provided to people using the service. We found there was no system in place to demonstrate checks (audits) were carried out to ensure the planned menus were being adhered to and that the quality and quantity of the food provided to people using the service was adequate and appropriate.

People using the service spoke positively about the food and the care and support they were provided with. Comments received included:

'I think the food is mainly quite good. Although sometimes it would be good if there was a little more of it.'

'The food is good. I like most of the meals but they do try to make you something else when the menu does not appeal to you.'

'I am looked after really well. They (staff) are all very kind and considerate.'

'The staff are very polite and treat me decently.'

'My views seem to be important and I am able to control my own life as much as possible. I decide when I get up and go to bed, what to eat and where to eat it and what I do with my time.'

'My [relative} was very poorly when they came to Clyde Court. Thanks to the care and treatment provided by the staff they are now much improved.'

We found that people were being appropriately supported in respect of their medicines needs and were cared for by adequate numbers of appropriately trained staff. The provider was making suitable checks to monitor the quality and safety of the services provided. A complaints procedure was in place that clearly explained how people could make a complaint.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. However there had been some confusion in respect of the date of when an alleged safeguarding incident had been reported to the provider. The provider may wish to consider reviewing their arrangements to ensure staff are aware of the exact nature of of incidents and the timelines involved.

'The care I have been provided with here has been first class, and the staff are so nice'.

'I have been looked after really well since I came to live here'.

'The nurses and care staff are lovely and take great care of us all.'

'I visit the home regularly, at different times, and have no concerns at all about how my relative is being cared for'.

'The meals are really good, they know as well what you like and don't like'.

'I enjoy most of the meals, there is good variety and you can always have something else if you are not keen on what is on the menu'.

'I visit regularly and my relative seems to enjoy the food'.