Archived: Clemsfold House

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.

Clemsfold House is a residential care home. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Clemsfold House is registered to accommodate a maximum of 48 people. At this inspection the registered manager told us that they would only provide accommodation to a maximum of 31 people due to part of the building not being in use and changing the rooms to single occupancy. The provider had not taken action to ensure that their registration information reflected the service they provided. This had not been identified by the quality monitoring systems in place. The registered manager told us that all but one person was living with dementia or impaired memory.

We carried out an unannounced comprehensive inspection of this service on 15 and 18 November 2016 where it was awarded an overall rating of ‘Good’ and rated as ‘Good’ in all domains.

The home was not due for another comprehensive inspection however the registered manager notified us of two events that had occurred. One of these related to a person who fell and required hospital admission for treatment. The information supplied led us to review our inspection plans and we decided to bring this comprehensive inspection forward.

Since our last inspection of Clemsfold House, 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. Clemsfold House had been the subject of one safeguarding concern about a person sustaining a serious injury following a fall. Our inspection did not examine specific incidents and safeguarding allegations which have formed part of these investigations. However, 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. Since May 2017, 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.

During our inspection the registered manager was present. 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.

Quality assurance processes were in place that included regular audits of the service by the registered manager and representatives of the provider. These had not identified the failings we found at this inspection. Within the quality audits that had taken place it had been identified that mental capacity assessments for people were not decision specific. It was recorded that this had been acted upon and addressed. However, four people’s assessments that we looked at were still not decision specific. Prior to the inspection the registered manager had notified us of events including potential safeguarding matters in line with her legal responsibilities. However, at the inspection, despite people telling us that they felt safe, we identified two instances where a service user who lived at the home had assaulted other service users.. These had not been reported to the local authority safeguarding team. This would have enabled an independent investigation of the incidents to ensure people living at the home were cared for safely. This had not been identified within the quality monitoring systems in place at the home.

People’s records were not always accurate and in parts contained conflicting information. As a result, there was a risk that people would receive care that was not appropriate or in line with their needs and wishes. Again, this had not been identified within the quality monitoring systems in place at the home.

There was a system for reviewing accidents and incidents to prevent or minimise re-occurrence and to learn from mistakes. The registered manager had sought advice from a GP when people fell and reviewed their risk assessments and care plans, but referrals to other relevant specialists had not taken place in line with the provider’s policy. As a result, full and robust action had not been taken to reduce the risks associated with falls.

The provider had shared learning from safeguarding situations at other homes they operated and the registered manager had used this to review aspects of service provision at Clemsfold House. However, the evidence at this inspection confirmed that the provider had not fully embedded or sustained learning as a result of feedback and situations that had occurred at other locations they operated.

There were sufficient numbers of staff on duty to meet people’s needs. Training had been provided to staff that included equality and diversity and dementia awareness. But at times there was limited interaction with people who lived with dementia as staff focused on tasks and missed opportunities to involve or communicate with people. There were dedicated activity staff employed and an activity programme in place but care staff at times did not provide stimulation for people they were supporting. Efforts had been made to make the environment homely and suitable for people but there were aspects that would benefit from further attention. We have recommended further development based on current best practice guidance for people living with dementia.

Equality, diversity and Human Rights (EDHR) featured as core principles within the provider’s policies, procedures and mission statement. The registered manager and staff demonstrated understanding of these. Some information had been provided in suitable formats for people in order that they could communicate and be involved in making decisions about their care. Development of this would enhance people’s rights further. We identified that the service had not consistently applied the Mental Capacity Act 2005 Code of Practice in order to ensure that people's rights to consent and decision-making were protected.

People said that they enjoyed the meals that were provided. However, some people did not receive consistent personalised support to eat their meals.

People said that they were happy with the support they received to manage specific health needs. There were clear lines of communication with GP’s and district nurses who visited the home that helped to ensure people’s health needs were responded to. People’s nutritional and dietary needs were met. Medicines were managed safely and effective infection control measures were in place.

Staff said that they were fully supported and everyone spoke highly of the registered manager. The registered manager demonstrated an open and honest demeanour and it was apparent that she had a high visible presence in the home. People said that they were treated with kindness by staff who understood their needs and respected their privacy. There were systems in place to support people to raise concerns. Relatives said that they were made welcome whenever they visited.

There were regular meetings between representatives of the provider and the various departments within the organisation in order information could be shared and the provider could retain oversight of the company. The provider had made a public commitment to work with outside agencies with the aim of improving service delivery.

At this inspection, we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 Regulations.

Clemsfold House is a residential care home registered to provide accommodation, care and support for up to 48 older people some of whom may have a diagnosis of dementia. At the time of our visit the registered manager told us the maximum they would accommodate was 28. This was because they had closed one part of the home and made some double rooms into single occupancy. There were 26 people in residence at the time of our visit. We will work with the provider to ensure that their registration information is updated to reflect this change.

The service has a registered 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.

People spoke highly of the home. They told us that the staff were kind and that they enjoyed living there. Relatives had confidence in the care provided and said that the home was welcoming.

People told us that they felt safe at the service and that staff treated them respectfully. Staff understood local safeguarding procedures. They were able to speak about the action they would take if they were concerned that someone was at risk of abuse. Risks to people’s safety were assessed and reviewed. People received their medicines safely.

People had developed good relationships with staff and had confidence in their skills and abilities. There was an established team of staff at the home, which offered continuity of care for people. Staff had received training and were supported by the management through supervision and appraisal. Staff were able to pursue additional training which helped them to improve the care they provided to people.

People were involved in planning their care and in making suggestions on how the service was run. Staff understood how people’s capacity should be considered and had taken steps to ensure that people’s rights were protected in line with the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS).

People enjoyed the meals at the service and were offered choice and flexibility in the menu. Staff monitored people’s weight to ensure that they were receiving enough to eat. Where concerns were identified, action had been taken.

Staff responded quickly to changes in people’s needs and adapted care and support to suit them. Were appropriate, referrals were made to healthcare professionals, such as the GP, community nurses or community psychiatric nurse (CPN) and their advice followed.

A variety of activities were provided, to suit group and individual interests.

There was strong leadership within the home. The registered manager and provider monitored the delivery of care and had a system to monitor and review the quality of the service. Suggestions on improvements to the service were welcomed and people’s feedback encouraged.