Clare Hall Nursing Home

Clare Hall Nursing Home is a nursing home providing personal and nursing care for up to 57 people aged over 65 years. At the time of our inspection there were 40 people using the service. Clare Hall Nursing Home provides accommodation in one large, adapted building.

People’s experiences of using the service

Since the last inspection there had been changes in the management team and the service had a new registered manager and compliance manager. New systems and processes had been introduced to monitor the service. However, the new processes were still not fully effective in identifying and addressing all of the shortfalls in a timely way. These new systems required more time to embed into practice and to drive improvements. However, staff knew people well and knew how to support people. During the inspection we observed positive interactions between staff and people.

The registered manager and nominated individual were responsive to our feedback and took action to address the issues identified during the inspection and following our visit.

People were supported by enough staff who were recruited safely. Staff told us the atmosphere and communication in the home had improved. Staff felt supported by the registered manager and told us they were approachable. The service employs several overseas workers and uses agency staff regularly. The service was in the process of starting a comprehensive risk assessment of overseas workers who live onsite. The service is currently embedding robust inductions for all agency staff.

There was mixed feedback from people and their relatives. People and their relatives told us they felt safe. There were some comments about the service being short staffed.

Staff spoken with understood how to protect people from poor care and abuse, where safeguarding concerns had been identified lessons had been learnt.

Medicines were stored and administered safely, and protocols were in place for the administration of 'as required' medicines.

The home was undergoing a refurbishment programme which meant that bedrooms were being decorated and equipped with wet rooms in most cases.

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.

Rating at last inspection

The last rating for this service was good (published 16 August 2021).

Why we Inspected

This inspection was prompted by a review of the information we held about this service.

Follow up

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

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Clare Hall Nursing Home is a residential care home providing personal and nursing care to 32 people aged 65 and over at the time of the inspection. The service can support up to 47 people. Clare Hall Nursing Home accommodates people in one large adapted building. The service provides residential as well as nursing care.

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

People appeared happy and relaxed with staff. Relatives we spoke with were very positive about the care their loved ones received; they told us they were confident people were safe and well cared for. The provider had effective systems in place to safeguard people from abuse. Risks to people were assessed and guidance was in place to reduce these risks. The provider ensured maintenance and safety checks of equipment were undertaken. People were supported by staff who were trained and supervised, however, on occasion staffing levels had fallen below the minimum number needed to support people. The registered manager and deputy were able to step in to provide direct care in these circumstances. The home was clean and smelt fresh throughout; staff were following guidelines in respect of infection control. Any incidents were reported by staff and reviewed by the registered manager.

Relatives we spoke with were positive about leadership at the home. Everyone we spoke with had contact with either the registered manager or deputy manager. Relatives told us communication was good with the service, they were updated on any changes in their relative’s care. Staff told us they were confident in their colleagues and worked well as a team. The management team had good systems in place to monitor the quality and effectiveness of the service. Audits were thorough and completed regularly, any identified shortfalls were addressed.

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The last rating for this service was good (published 14 September 2017).

Why we inspected

The inspection was prompted in part due to concerns received about staffing. A decision was made for us to inspect and examine those risks.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

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

We found the following examples of good practice.

Staff were committed to keeping people safe. They had received infection control training and used personal protective equipment (PPE) in accordance with current guidance to minimise risks to people. Staff and people were regularly tested in line with the government’s current testing programme.

Staff understood the impact the isolation could have on people and sought to support people’s emotional wellbeing. People were supported to keep in touch with family and friends by telephone and video calls. In the lounge, some people enjoyed socialising and undertaking activities at a safe distance with an activity co-ordinator. Staff gave one to one support to others who chose to remain in their rooms.

Although visitors were not currently permitted, except in exceptional circumstances, there were plans to resume visiting in the near future. Measures were in place to prevent the spread of infection by visitors. This included visitors having temperature checks, completing a health questionnaire and undertaking a COVID 19 rapid test. A dedicated well ventilated room was used, with visitors supplied with PPE and a Perspex screen used for people’s added protection.

The home was clean and well maintained. Detailed cleaning schedules were in place with increased cleaning of frequently touched areas such as door handles and light switches. Infection prevention and control audits took place with action plans to address any areas for improvement.

This inspection was unannounced and took place on 10 August 2017. The home has a registered manager in post. 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.

At the last inspection in April 2016 we found people were not safe as there were not enough staff to meet their needs and the provider did not follow safe staff recruitment procedures. We also found people were at risk of having their human rights breeched because the principles of the Mental Capacity Act 2005 (MCA) were not always being followed.

At this inspection we found there was sufficient staff to meet people’s needs, keep people safe and respond to their requests for assistance. We found the risks of abuse to people were minimised because the provider had a robust recruitment procedure. We also found staff had received training on the principles of the MCA. People’s rights were protected because staff worked in accordance with the MCA.

People felt safe at the home and with the staff who supported them. One person said, “Always feel very safe.” Training for all staff made sure they were able to recognise and report any suspicions of abuse. Staff said they felt confident they could report abuse and it would be managed appropriately.

There was a full programme of activities including a strong relationship with the local community village church and local school. People had access to extensive grounds which were used for events which involved the local community. People and their relatives told us they enjoyed the gardens and during the inspection we saw people sitting and chatting in the sunshine.

People received effective care and support from staff who were well trained and competent in their roles. Staff monitored people’s health and made referrals to healthcare professionals according to their individual needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The organisation’s philosophy was, “Our home aims to provide its service users with a secure relaxed and homely environment in which their care, well-being, and comfort is of prime importance.” These principles could be seen throughout the home and during the inspection. One relative said, “It has become home from home for me. We love to sit in the gardens and there is a very peaceful ‘arbour’ of trees we like to sit in.”

People were cared for by kind and patient staff who respected their privacy and dignity and helped them to maintain their independence.

People benefitted from a management team who were open and approachable and had systems in place to seek people’s views. People were always asked for their consent before staff assisted them with any tasks and staff knew the procedures to follow to make sure peoples legal and human rights were protected.

There were systems in place to monitor the care provided and people’s views and opinions were sought regularly. Suggestions for change were listened to and actions taken to improve the service provided. All incidents and accidents were monitored, trends identified and learning shared with staff to put into practice.

Further information is in the detailed findings below

This inspection was unannounced and took place on 28 April and 4 May 2016.

The home has a registered manager who began working after the last inspection on 4 March 2015. 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.

At the previous inspection we found concerns because people were not always being listened to and they had a lack of activities. Both these areas had improved at this inspection.

People and relatives told us they felt safe but we found there were risks to their safety. We found problems with staff levels and recruitment. There were times people were not kept safe or had their needs met because there were not enough staff or they had not been deployed in the best way. People were at risk because the provider was not always keeping the appropriate records for staff members or completing the correct checks. Staff were supervised and did receive enough training to meet people’s needs.

Staff were aware of their responsibility to protect people from avoidable harm or abuse and had received training in safeguarding. Staff knew what action to take if they were concerned about the safety or welfare of an individual. They told us they would be confident reporting any concerns to a senior person in the home or the provider and they knew whom to contact externally. The registered manager understood when they were responsible for informing the local authority and CQC about safeguarding.

Most of the medication procedures in the home were safe but sometimes additional checks were not completed and there were missing signatures in the records. People who needed medicines as required and hidden had the correct procedures followed. Storage of medicines was done safely and in line with regulations.

Staff and the registered manager had some understanding about people who lacked capacity to make decisions for themselves. However, people were at risk of having their human rights breached when they lacked capacity because the Mental Capacity Act Code of Practice was not followed. Staff understood about Deprivation of Liberty Safeguards (DoLS) and the process to follow. One person had an authorised DoLS with no conditions and others had applications submitted correctly.

People were supported to see a wide range of health and social care professionals to help with their care needs. Staff supported and respected the choices made by people. People’s differences were respected. People had a choice of meals, snacks and drinks, which they told us they enjoyed. When a special diet was required by a person it was provided. People and their relatives thought the staff were kind and caring and we observed positive interactions. The privacy and dignity of people was respected.

Staff had good knowledge about people’s needs and their care plans were being revised to a new format. The needs of the people were reflected in their care plans.

There were quality assurance procedures in place to keep people safe. When shortfalls had been identified they rectified the issue. However, people were at risk of not being informed when changes occurred because they had not updated their statement of purpose or ensured their CQC ratings were available on their website; following the inspection these were rectified. There were good systems in place to manage the complaints and the registered manager demonstrated a good understanding of how to respond.

We made a recommendation the provider refers to national guidance about notifications which need to be made to CQC.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found:

Is the service caring?

We found from our observations and talking with people the service was caring. We observed staff treated each individual with dignity and respect. People told us how friendly staff were and how they felt staff listened to what they wanted. One person told us "staff always ask me what I want to do". We observed staff supporting people with care tasks such as assisting with meals. They did so in a dignified and caring manner. Interactions observed between people and care staff were supportive and respectful. Staff respected people's privacy and did not enter people's rooms without knocking and asking their permission to enter.

One person told us their relative was always made to feel welcome when they visited the home. A relative we spoke with told us "the staff are always friendly and I feel informed about the care my relative is receiving".

Is the service responsive?

We found the service responsive to people's wishes and choices and responded to the health and social care needs of individuals. People we spoke with told us their choices about how they spent their day were respected. People's preferences were actively sought and recorded as part of personal care planning. We were told currently people were being consulted about how breakfast was arranged as part of giving more choice to people. However we have noted how people were not able to have a bath if this was their preferred choice and the continued failure of the provider to resolve the lack of this facility.

Staff told us there was good communication and there were daily handovers so they felt informed about people's care needs. Staff told us if they had any concerns they would speak to the nurse in charge or the care manager.

The service was responsive to people's needs. Care plans we looked at contained assessments of need and outlined how needs would be met. The assessments were regularly reviewed to ensure they reflected people's up to date needs and preferences. We found where people had complex needs relating to their physical health, such as nutrition, professional advice and guidance was sought to ensure people's needs were met.

Is the service safe?

We found from what people told us and how the service responded to risks the service was safe. People who lived in the home told us they felt safe. One person told us "if I am unhappy about anything I will tell one of the carers they would do something about it". Another person told us "I know I can always make a compliant if I am really not happy about something. I am sure they would listen to me and do something about it".

The service identified, assessed and managed risks to the health, safety and welfare of people. People's care plans contained individual risk assessments to minimise these risks. Where people had moving and handling needs these were clearly specified so people were assisted in a safe manner.

We found there were improved arrangements to help ensure people were, as far as possible, safe from the risks to their health as a result of infections.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The manager said they had not needed to submit any Deprivation of Liberty Safeguards applications but they knew about the procedures to follow if an application was ever needed.

Is the service effective?

We found the service to be effective because people's care treatment and support achieved good outcomes. There was evidence of improved health for example where an individual had a pressure wound. The condition of the wound had significantly improved as a result of the care the person received. Another person's condition had improved to the extent they were now independent in having their meals and able to eat normally.

One person told us how coming to the home had been the best decisions she had made and how much their health had improved since living in the home. Another person went to their own home at night yet still retained their accommodation in the home and received care during the day.

We saw evidence of where people's health had improved in relation to treatment and care. In one instance this was the care of an individual who had a pressure wound. We saw where the service had referred individuals to specialists such as dietician and the mental health team. This enabled the service to support people with complex health and care needs so they could effectively meet those specific needs.

Is the service well led?

Currently this service has a manager who is not registered with the Care Quality Commission. There is also a care manager in place to support the manager in the provision of care. We found inconsistent practice in how the service was led in that there were failures to make the improvements we had previously identified. The provider and manager had clearly through its audits, improved guidance and communication with staff made real efforts to address failures in the quality of care. However shortfalls in record keeping continued from the previous inspection. The system put in place namely checking of food and fluid charts by nursing staff was not identified by managers as failing. Where people needed creams applied for skin conditions records of this care did not demonstrate this care was being consistently provided. This meant whilst managers reacted to the areas of non-compliance they had not ensured improvements had taken place and were sustained.

We found improvements had been made in the providing of individual supervision this ensured staff received this element of support. There were regular staff meetings and staff told us they found managers approachable and supportive.

There were comprehensive systems in place to monitor and audit the quality of the service. People views were sought about how they felt about the service they received. There were actions put in place and some improvements made as a result of external and internal audits. However there was a failure to identify through the audits undertaken shortfalls in practice around completion of records evidencing the consistency of care being provided. This showed these quality assurance systems were not effective or robust in identifying areas for improvement.

During our inspection we spoke with 15 people who used the service, four people's relatives, six care staff, four ancillary workers. All of the people we spoke with gave mostly positive feedback but were concerned there were not enough staff available. One person told us ''I can't grumble about anything. They make me comfortable.' Care staff we spoke with told us they provided good care but there was a problem with staffing levels.

We saw the home assessed people's needs and care plans were developed to meet these needs. These plans had not always been completed with sufficient detail to ensure care delivery to meet needs. People told us they felt safe living at the home and confident staff would respond to any concerns they raised.

We found people were not protected from the risk of infection because appropriate guidance had not been followed. For example, we saw open used commodes and urinals in people's rooms. We saw the housekeeper's mops and buckets were dirty and did not follow national guidance for the prevention and spread of infection.

We found staffing levels were not always appropriate to meet the needs of people who lived in the home. We saw medication being administered later than prescribed and people told us they had to wait for their care needs to be met when they requested help.

We saw care records and other required records were incomplete and did not include appropriate information to protect people from unsafe treatment.

Everyone we spoke with said they were happy overall with the care provided. We were told 'We are all looked after properly' and 'Staff come quickly when I need them'.

People told us they were able to express their views and get involved in making decisions about their care and daily living.

People told us that the deputy and area manager was very visible and continually checked that people were receiving an appropriate standard of service. We were told,' The deputy manager is always around and into everything.'

We observed that the care plans detailed the care needs of the people at the home. We saw that an assessment about people's mental capacity had not been completed

We saw that people who were nursed in bed had appropriate care. We saw that charts were not always completed to show a regular change of position. We saw that the records were up to date and showed staff supported people to eat and drink properly. The charts did not show the amounts of fluid taken on a daily basis.

Staff told us that they had received all necessary training.

It should be noted that the older part of the building was not in use at the time of the inspection. We did not view this part of the home. The provider had recently recruited a new manager. This manager was due to commence employment the week after our inspection .