Clare Hall Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The provider had systems and processes to manage and follow up on accidents and incidents. Staffing levels enabled staff to carry out people's planned care. However, some staff raised concerns they didn’t always have enough staff to meet people’s needs promptly. Staff told us they knew how to raise concerns and would do so if they were worried about safety or the quality of care. Care records showed risks to people's health were assessed and managed by staff. Staff supported people safely in line with their risk assessments and management plans. Medicines were being safely managed during a change in the process of medicine management at the home. The provider had effective systems to prevent and control infections and maintain the safety of equipment and the environment. Information was shared and lessons learned when things went wrong. The service worked within the principles of the Mental Capacity Act (MCA) and if needed, appropriate legal authorisations were in place to deprive a person of their liberty (DoLS).

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives were confident accidents and incidents involving their family member would be shared with them and they were kept informed.

Staff told us they would report any accidents and incidents, and that learning was taken from these events and actions taken to reduce future risks. The management team were aware of their responsibility to be open and honest when things went wrong, to apologise when necessary and keep people and their relatives informed of actions taken following any incidents.

The management team monitored accidents and incidents, to identify possible learning and ensure action had been taken to mitigate individual and service level risks. Learning from accidents and incidents was shared with staff through handovers and regular staff meetings. We saw minutes of these meetings which showed that staff were kept informed about changes and improvements and that lessons learned were shared.

People told us the staff knew and understood what support they required, and they regularly saw professionals such as chiropodists and doctors in order to support them.

Staff were aware of people who were staying at the home for a period of respite, or on a short-term basis. They confirmed care plans were in place to advise them of people’s needs.

External healthcare professionals told us the provider promoted safe systems, pathways and transitions. One healthcare professional told us about a person they supported, “I feel that staff at Clare Hall are largely able to meet the needs of the service user…communication has been effective with Clare Hall staff since admission.” Another healthcare professional told us, “They (staff) needed additional support as the service user had needs that were a bit above what would be normal. They learned a new method of transfers and appear to have picked up the required skills quickly.”

Systems were in place to support people on admission with risk assessments undertaken to ensure people were safe. Care records showed people’s needs and risks were assessed prior to and on admission to the home. People’s health needs were detailed in their care plans and guidance was in place to guide staff. Staff ensured people did not miss important medical appointments and that healthcare professionals had the information they needed to provide effective care.

People said they felt safe at Clare Hall Nursing Home. Comments included, “It is generally good here.”

Staff told us they knew how to raise concerns and would do so if they were worried about safety or the quality of care. They understood their safeguarding responsibilities to keep people safe, challenge discrimination and report any concerns. The management team explained that people’s capacity was assessed in accordance with the Mental Capacity Act (MCA) and assessments were stored within people’s records.

We did not observe any safeguarding concerns during our site visit. Staff were observed speaking to people in a kind and considerate way. People appeared relaxed and comfortable around staff. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA). We observed some people had restrictions placed on their movement. For instance, bed rails and lap belts on wheelchairs. This was to promote their safety and prevent harm and these restrictions were lawful.

When safeguarding concerns were reported to the provider, they worked with the local authority safeguarding team to investigate and take any actions needed. Training records showed that staff had received safeguarding adults training. The service worked within the principles of the Mental Capacity Act (MCA) and if needed, appropriate legal authorisations were in place to deprive a person of their liberty (DoLS). Records reflected MCA assessments had been undertaken to consider people’s capacity to make decisions about their care. Care plans contained information about where decisions were being made in people’s best interests, and the reasons for this. DoLS applications and authorisations were in place for people around any restrictions within their lives that they did not have capacity to consent to. Systems to review these were also in place. Improvements were made during our site visit to the handover sheet to accurately reflect who had a DoLS in place to ensure staff were informed.

People and/or their relatives felt they were involved in assessing and managing risks. One person told us, “I do feel safe. Staff are definitely respectful.”

Staff told us they understood peoples risk assessments and care plans and how to support people safely. They also told us they were made aware of any changes to people’s plans when changes were required. The deputy manager told us about people's individual emergency evacuation plans which were in place to support people in an emergency.

Staff supported people safely in line with their risk assessments and management plans. Observations showed staff understood how to support people to manage risks to their safety. For example, people were observed having support with their mobility, transfers and meals in line with the guidance contained in care plans and risk assessments. People who required pressure relieving equipment to prevent the risk of pressure damage to their skin had these in place.

There were systems in place to assess people’s individual risks and guidance was accessible to staff to enable them to support people safely. Care plans were reviewed regularly, as well as when people’s needs changed, which enabled staff to provide care that met people’s current needs. The provider had 2 clinical support staff who reviewed people’s care records to ensure they accurately reflected people’s needs. Monitoring systems were in place which staff completed to confirm people had received their planned care, such as repositioning. We saw improvements since the last inspection regarding mattress checks, weight loss management and the appropriate use of crash mats. Some staff were living onsite. The provider had a risk assessment in place to minimise risks that might occur.

People and their relatives raised no concerns with us about the safety of the environment.

Staff told us they had no concerns about the quality or safety of the equipment they used. The maintenance person told us about the safety checks they carried out. They said they were provided with anything they needed to make sure the building was maintained to a safe standard.

We observed staff using equipment such as hoists and found there were no concerns related to their use. Fire equipment and signage was in place. There was very poor signage around the home to guide people to specific areas of the home. The nominated individual told us in an action plan they submitted after our site visit, ‘Appropriate and dementia friendly signage will be sourced and purchased.’

There were established systems in place which included regular checks to ensure equipment, and the environment was safe. We reviewed records of checks which showed where concerns had been noted appropriate action had been taken to rectify any issues. The management team had a maintenance book in place for staff to record any concerns they found.

People told us there were enough staff available to meet their care needs. However, some people reported that although staff were available to provide care and support, they did not always have time to talk to them. Some people reported delays when using the call bell system, although they said staff did respond, but not always in a timely way. Comments from people included, “If I ring the call bell, they are not very quick, they don’t come for 10 minutes, or even longer”; Nobody ever comes to see me for a quick chat” and “How long is a piece of string ... they could do with more staff, between 17.00 -19.00 there is not so many people (staff) around.” People were complimentary about the carers and nurse’s skills and knowledge and people told us relevant health care professionals were involved in their care. This ensured people received evidence-based care and treatment. One person told us, “It’s a good home, the staff look after me. I am hoisted with 2 carers.”

The management team showed us monthly call bell audits. These showed most call bells were responded to within 5 minutes. However, they did not show actions taken for call bells taking over 5 minutes. We were assured this would be added to the audit. The registered manager told us in the provider information return, ‘Staffing levels are not determined by budget limitations or a staffing ladder model. Staffing is based on the care needs of residents and staff are being listened to when they voice the need for additional staff or roles.’ We received mixed feedback from staff relating to there being enough staff available to promptly meet people's needs. Staff told us they completed an induction when they started to work at the service. They confirmed and records showed they undertook the providers mandatory training and completion of these was monitored by the management team. This included training in supporting people with a learning disability and autism.

We observed there were enough staff to respond to people when needed and provide planned care in line with people’s needs. Call bells were going off throughout the visit, these were answered quickly, Where we observed staff using moving and handling techniques to support people with their mobility, there were enough staff to ensure this was done safely. We observed that the registered manager was supported at the home by a deputy manager, the nominated individual, a clinical support and receptionist who were all supernumerary. The registered manager told us working on the day of our visit was a registered nurse, a nursing assistant, 7 care staff, 4 housekeeping staff, a chef, a kitchen assistant, 2 activity staff, a maintenance person and a gardener. They confirmed they had a full staff team and only used agency staff to cover staff absences.

The nominated individual showed us a staffing tool they used to ensure there were enough staff to keep people safe. This showed the staffing levels were above what had been assessed. We discussed there appeared to be a lot of staff at the home, but care staff were busy, and task orientated, they told us they would consider the deployment of staff at the home. Recruitment processes were in place and appropriate checks had been carried out on newly recruited staff to ensure they were safe to work with people. Staff had received appropriate training and support. Systems were in place that identified the numbers and skill mix of staff required to provide safe care.

People raised no concerns about the cleanliness of the home. They confirmed the staff wore personal protective equipment (PPE) appropriately when supporting them with personal care.

Staff told us they had received infection control training which included the use of Personal Protective Equipment (PPE) and minimising the risk of cross infection. The management team told us infection control training was in place for staff and guidance was provided in the event of any outbreaks of infection. Staff confirmed they had access to enough PPE to use when providing personal care to people.

The kitchen was well organised and clean. The freezers, fridges and food dry store were clean and tidy, and food was stored appropriately. The home was clean and hygienic and free from odours. We observed cleaning staff throughout our site visit. We saw PPE stations were situated throughout the home and were well used by staff. We observed staff changed gloves and aprons for personal care.

Temperature checks of refrigerators and freezers were taken daily. There was a housekeeping team who were available in the home 7 days a week to ensure cleanliness. The laundry was well organised. The provider required the management team to undertake an infection control audit every 3 months and where concerns were identified action was taken.

People received their medicines safely and as prescribed. People said they had access to pain relief medicines when they needed them. Where people needed their medicines administered at specific times they received them promptly.

Staff confirmed they had received relevant training to administer medicines and confirmed their competency had been assessed. Staff told us, the new electronic medicines system was challenging but they were getting used to it to record any medicines administered. They confirmed they felt supported and could access assistance if they had any difficulties.

The provider had started to use an electronic medicines system the week of our site visit. They had ensured staff had received the required training to use the system safely. The deputy manager was overseeing the process and had been the point of contact for any issues found. They checked daily for any discrepancies and acted upon them. The nominated individual was in the process of revising the homes medication management policy to include the new electronic process. They sent their revised policy to CQC after our site visit. Overall medicines were managed safely. There were appropriate arrangements for the ordering, storage, and disposal of medicines. There were protocols in place for medicines prescribed ‘as required.’ At the last inspection not all topical administration of creams had been consistently signed by staff to show they had been applied. At this assessment action was being taken to improve the recording of prescribed creams on the providers electronic system.