Updated 2 April 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This included checking the provider was meeting COVID-19 vaccination requirements. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection team consisted of two inspectors, one nurse advisor and two Experts 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. One Expert by Experience supported the inspection team on site by speaking with people and visitors. A second Expert by Experience contacted families by phone for feedback after the inspection visit.
Service and service type
Clovelly House Residential Home LTD is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Clovelly House Residential Home LTD is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service had two managers registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. A new manager commenced employment at Clovelly House in September 2021 and they registered with CQC in December 2021. One of the current registered managers is also the Nominated Individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. For the purposes of this inspection report, we will refer to that registered manager as the Nominated Individual.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed the information we held about the service. We contacted the local authority safeguarding and commissioning teams for feedback and looked at information sent to us since the last inspection. This included information the provider is required to send about incidents at the service. We reviewed information the provider submitted as part of the enforcement action issued following the last inspection. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke with ten people who used the service and one relative. We spoke with 13 members of staff, including the nominated individual, registered manager, deputy manager, senior care staff, care staff, activities co-ordinator, kitchen and domestic staff. We spoke with one visiting healthcare professional.
We looked around the home to review the facilities available for people and the cleanliness of the service. We also looked at a range of documentation including six people's care files and medication administration records for seven people. We looked at six staff files and reviewed documentation relating to the management and running of the service, such as audits and complaints.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We spoke to an additional seven relatives by phone. We reviewed additional documentation sent to the inspection