Archived: Clemsfold House

Updated 5 February 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 8, 9 and 18 October 2018. The first day was unannounced and the inspection team consisted of three inspectors, a specialist medicine’s advisor and an expert-by-experience. An expert-by experience is a person who has personal experience of using or caring for someone who uses this type of care service. Their area of expertise included services for older people living with dementia. The second and third day of inspection consisted of three inspectors.

Prior to the inspection, we reviewed the information we held about the service. This included information from other agencies and statutory notifications sent to us by the manager about events that had occurred at the service. A notification is information about important events which the provider is required to tell us about by law. The provider had also completed a Provider Information Pack (PIR) since the last inspection. This shared what they had been doing since the last inspection to support people living at the home. We used this information to decide which areas to focus on during our inspection.

We spoke with five people who lived at the home to gain their views of the care they received. We also spoke with two people's relatives. Due to the nature of some people's complex needs, we were not always able to ask people direct questions about the care they received. To obtain these, 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. We spent time observing the care and support that people received during the morning, at lunchtime and during the afternoon over the course of the inspection.

During the inspection we spoke with the deputy manager, the manager and the regional operation's director. We also spoke with three agency care staff two permanent care staff, the activities coordinator and the chef. We provided feedback throughout the inspection and at the end of the inspection to the providers' nominated individual and the operations director.

During the inspection, we observed medicines being administered to people. We reviewed a range of records about people's care which included seven care plans. We also looked at three care staff records which included information about their training, support and recruitment records. We reviewed audits, minutes of meetings with people and staff, policies and procedures, accident and incident reports, Medication Administration Records (MAR) and other documents relating to the management of the home such as quality audits and checks.

Updated 5 February 2019

This comprehensive inspection took place on 8, 9 and 18 October 2018 and was unannounced.

Services operated by the provider had been subject to a period of increased monitoring and support by commissioners. As a result of concerns raised, the provider is currently subject to a police investigation. The investigation is on-going and no conclusions have been made. We used the information of concern raised by partner agencies to plan what areas we would inspect and to judge the safety and quality of the service at the time of the inspection. Between May 2017 and October 2018, we have inspected a number of Sussex Health Care locations in relation to concerns about variation in quality and safety across their services and will report on what we find.

Clemsfold House is a care home which provides residential care. People in care homes receive accommodation and personal care as a 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.

Clemsfold House provides accommodation and personal care for up to 48 older people. At the time of our inspection there were 19 older people living at Clemsfold House. Most people were living with dementia. People had their own bedrooms and shared communal areas such as a lounge and dining area.

There was no registered manager at the time of this inspection. The service is required by a condition of its registration to have a registered manager. A registered manager is a person who 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. A manager and deputy manager had started their employment in August 2018 and were in day to day management of the home. The home had been without a registered manager since March 2018. The manager, present at this inspection, had applied to register with the Commission. A regional operations director also joined the inspection over the three days.

At the last inspection in November 2017, the service was found to be in breach of legal requirements and was given a rating of 'Requires Improvement'. The provider wrote to us after the inspection to inform us the actions they were taking. At this inspection we found that the quality and safety of care provided to people had deteriorated further and we identified seven breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During this inspection, the provider told us they had planned to close the home temporarily to address maintenance and environmental issues. The provider informed people, their relatives and the local authority of this after our inspection had been completed.

At the last inspection, systems to assess and monitor the service were in place but these were not sufficiently robust as they had not ensured the delivery of consistently good quality and safe care across the service. At this inspection we found the provider had failed to ensure the necessary improvements had been made to improve the quality and safety of care provided.

We observed poor examples of care and treatment over the three days of the inspection. This included unsafe moving and handling techniques and a lack of appropriate support for people assessed as needing a pureed and/or a specialist diet, which placed them at risk from harm.

People who experienced weight loss had not always been referred to the appropriate health professionals to seek their expertise. Care records did not always demonstrate people’s health needs were being met.

Consent was not always sought from people by staff before carrying out personal care. The Mental Capacity Act was not consistently applied to protect people’s rights.

A caring culture had not been promoted consistently across the service and activities and occupation were not consistently person-centred.

Staff had received safeguarding adults training. However, they failed to demonstrate their competence and understanding of this in practice as people had not always been protected from harm. Incidents were not always escalated and investigated to ensure actions were taken and lessons learnt to keep people safe in the future.

Medicines were not always managed safely. DNACPR status records were contradictory which meant there was a risk of the incorrect action being taken if a person became significantly unwell.

Recruitment practices for permanent staff remained safe however the provider was highly reliant on agency care support. Premises were not always adapted to meet the needs of people to ensure they could enjoy the outside area of the home.

We identified gaps in training and competencies. When training had been provided, staff had not always implemented the learning when supporting people.

The provider asked people and their relatives views on the care they received using various methods including satisfaction surveys. Infection control measures were in place to mitigate the risk of cross infection.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not, enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We imposed conditions on the provider’s registration. The conditions are therefore imposed at each service operated by the provider. CQC imposed the conditions due to repeated and significant concerns about the quality and safety of care at a number of services operated by the provider. The conditions mean that the provider must send to the CQC, monthly information about incidents and accidents, unplanned hospital admissions and staffing. We will use this information to help us review and monitor the provider’s services and actions to improve, and to inform our inspections.