Archived: Cloisters E M I Residential Care Home

Cloisters EMI is a ‘care home’ and is registered to provide care and support for up to 20 older people and people living with dementia. People in care homes receive accommodation and nursing or 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.

At the time of the inspection there were 20 people living at the home. Accommodation is provided across three floors and facilities included one dining room, two large TV rooms, a garden area to the rear of the building as well as a small car park at the front.

At the time of the inspection there was 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 previous comprehensive inspection which took place in October 2016, the home was rated as ‘Requires Improvement’. We found the registered provider was not meeting legal requirements in relation to ‘good governance’.

Following the previous comprehensive inspection the registered provider submitted an action plan which outlined how they were improving the standards of care and quality of service. We then conducted a ‘focused’ inspection in February 2017 to check the provider had made enough improvements to meet their legal requirements.

During the focused inspection we found that a number of improvements had been made and the registered provider had met the breach in regulation.

During this inspection we found the registered provider was delivering a ‘good’ service although we have made a number of suggestions to the registered provider in relation to the on-going assessment and monitoring of people living at the home and quality assurance systems.

We reviewed a number of care records and risk assessments which were in place for the people who lived at Cloisters. Care plans and risk assessments were being regularly reviewed and staff were familiar with people's support needs. However, audits and checks were not identifying some areas of concern we raised during the inspection.

We have recommended that the registered provider reviews their quality assurance processes

Accidents and incidents were being recorded and monthly audits were conducted. However, we found evidence to suggest that accidents/incidents were not being thoroughly investigated. This meant that some of the records were not up to date and important information was not being recorded.

We have recommended that the registered provider reviews their processes in relation to accident and incidents.

During this inspection we found the home was operating in line with the principles of the Mental Capacity Act, 2005 (MCA). People were appropriately assessed, mental capacity assessments were decision specific and there was best interest processes in place for people who lacked capacity.

We found the environment to be clean, well maintained and free from any odour. There was an effective cleaning rota in place and infection control policies were being adhered to.

Health and Safety audit tools were in place to monitor, assess and improve the quality and standards of the home. This meant that people were living in a safe environment.

Supervisions and appraisals were taking place. Staff were receiving the necessary training to support them in their roles and staff expressed that they felt supported on a daily basis.

During this inspection we found that care records contained person centred information and staff were able to provide person centred care. The environment itself had been adapted to support people living with dementia although we did discuss some further improvements which could be made with the registered manager.

We reviewed the recruitment processes and found these were safely managed. This meant that staff who were working at the home had suitable and sufficient references and the appropriate criminal record checks had been carried out.

Medication processes and systems were safely managed. During the inspection we found that routine monthly medications audits were being conducted, medication administration records (MARs) were being appropriately completed and only staff who had received the appropriate training were administering medication. This meant that people were receiving a safe level of care in relation to the medications which they were being prescribed.

The day to day support needs of people living in the home was being met. We reviewed a number of files which demonstrated that the appropriate referrals were taking place and the relevant guidance and advice which was provided by professionals was being followed accordingly.

Privacy and dignity was preserved and respected. Staff were observed providing dignified care and there was evidence to show how people were provided with ‘choice’ and supported to remain as independent as possible.

There wasn’t an activities co-ordinator at the time of the inspection. We were informed that each staff member was responsible for arranging activities as part of a scheduled rota. The feedback we received about activities was positive. People we spoke with said they enjoyed the activities which were organised and people were observed taking part in the activities. .

People told us they were happy with the quality and standard of food they received. We observed good quality, nutritious food being offered during the inspection. People were offered a variety of choices and preferences, likes and dislikes were also recorded in people’s care records.

We reviewed the complaints policy and processes which were in place. People and relatives we spoke with were familiar with the complaints process. At the time of the inspection there were no formal complaints being investigated.

Staff morale was positive. Staff expressed how there was an open and supportive culture within the home and expressed that it was a ‘lovely’ home to work in.

The registered manager was aware of their responsibilities and had notified the CQC of events and incidents that occurred in the home in accordance with the CQC’s statutory notifications procedures. The registered provider ensured that the ratings from the previous inspection were on display within the home.

We reviewed the range of policies and procedures which were in place. Policies and procedures were available to all staff and staff were able to discuss specific procedures and processes with us during the inspection.

After the comprehensive inspection, the provider wrote to us to tell us what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on 16 February 2017 to check that they had they now met legal requirements.

This report only covers our findings in relation to the specific area / breach of regulation. This covered two questions we normally asked of services; whether they are 'effective' and ‘well led.’ The question 'was the service safe’, ‘was the service responsive' and ‘was the service caring' were not assessed at this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Cloisters EMI Residential Care Home on our website at www.cqc.org.uk.

There was a registered manager in post at the time of our inspection. 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.

Cloisters EMI Residential Care Home is registered in the category of dementia care for twenty elderly people. It is a detached Victorian house with parking facilities, front and rear gardens which are well maintained. The home has a passenger lift to all levels. There are two lounge areas and a dining room which are also used for activities.

At the previous inspection in October 2016 we found mental capacity assessments were not decision specific and best interest decisions were not recorded in people’s plan of care. At this inspection we found improvements had been made. Mental capacity assessments were completed and were decision specific to help support people living with a dementia and who lacked capacity to be involved in the care planning process. Where people had lacked capacity to make decisions we saw that decisions had been made in their ‘best interest’. We saw this followed good practice in line with the MCA (Mental Capacity Act) Code of Practice. A plan of care was in place to support this practice which was subject to regular review. This breach had been met.

At the previous inspection we found a lack of quality monitoring within the service. At this inspection we found the service’s overall governance arrangements were robust to assure a safe, effective service and to drive continuous improvement. This included a number of internal audits and also the home’s response to external audits. We saw the provider had a thorough auditing system which looked at different aspects of the service. For example, care, medicines, cleanliness of the premises, health and safety, maintenance/decorating schedule and safety checks on equipment and services such as fire safety, gas and Legionella compliance. This breach had been met.

The home had 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.

Cloisters EMI Residential Care home provides care an accommodation for up to 20 older people who are living with a dementia. It is a detached Victorian house with parking facilities and front and rear gardens which are well maintained. The home has a passenger lift to all levels. The service is close to pubs, shops, supermarkets and cafés. At the time of the inspection there were a total of 17 people who used the service.

We looked at the arrangements in place for quality assurance and governance. Quality assurance and governance processes are systems that help providers to assess the safety and quality of their services, ensuring they provide people with a good service and meet appropriate quality standards and legal obligations. The registered manager told us they carried out regular checks on the service; however auditing tools were not completed to confirm this.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty were being met. People subject to DoLS had this recorded in their care records. However, mental capacity assessments were not decision specific. Best interest decisions were not recorded in care plans.

People were protected by the services approach to safeguarding and whistle blowing. People who used the service told us they felt safe and could tell staff if they were unhappy. People who used the service told us that staff treated them well and they were happy with the care and service received. Staff were aware of safeguarding procedures, could describe what they would do if they thought somebody was being mistreated and said that management acted appropriately to any concerns brought to their attention.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety.

Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. Risk assessments contained general information on how to keep people safe; however some risk assessments required further detail to make sure staff had the written guidance on how to keep people safe.

There were sufficient staff on duty to meet the needs of people who used the service. We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Appropriate systems were in place for the management of medicines so that people received their medicines safely. Written guidance was not available for those people prescribed medicines on an ‘as required’ basis.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. Staff had received supervision and an annual appraisal.

We saw that people were provided with a choice of healthy food and drinks, which helped to ensure that their nutritional needs were met. At the time of the inspection nutritional screening was not in place, however the registered manager had met with a health professional to discuss and implement this.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments

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There were positive interactions between people and staff. In general we saw that staff treated people with dignity and respect. However, the dining experience at lunchtime compromised the dignity of people. People were not always provided with choice or their food cut up into manageable portions.

People’s independence was encouraged. Activities, outings and social occasions were organised for people who used the service. People’s needs were assessed and their care plans were in place.

The registered provider had a system in place for responding to people’s concerns and complaints. Relatives told us they knew how to complain and felt confident that staff would respond and take action to support them. People we spoke with did not raise any complaints or concerns about the service.

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

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found-

Is the service safe?

We saw from the staff training matrix that staff had undergone appropriate training related to the safeguarding of vulnerable people. Staff we spoke with were able to explain procedures to us which helped ensure the safety of people who used the service.

Accidents and incidents were all recorded and were monitored which helped identify and possible trends. These incidents were then used during training sessions which helped minimise the risk of similar incidents happening again.

Deprivation of Liberty Safeguards (DoLS) become important when a person is judged to lack the capacity to make an informed decision related to their care and treatment. The provider told us an application for DoLS had been made in January 2014. The required procedure had been followed and managed appropriately.

Is the service effective?

We saw care plans and consent forms for the provision of care had been signed by the person who used the service or a family member. This showed the person had their care needs assessed with them and had been involved in writing their care plans.

People`s mobility had been assessed by the provider which helped ensure the person could move around the care home freely and safely. On a monthly basis, people had risk assessments completed related to nutritional requirements and risk of falls which helped ensure their health and welfare.

Is the service caring?

We spent time in communal areas during our inspection and we saw staff members interacted positively with people who used the service. We saw people were assisted with their personal care and, at lunch time, staff offered people support in a patient, unhurried manner.

We saw that people`s wishes and choices had been recorded in their care plans which reflected a person-centred approach to providing care. Person-centred planning is a way of helping people to plan their support, focusing on what is important to the person. People`s care needs and support were provided in accordance with their identified needs. One person who used the service told us, "It`s a lovely little home. They`re all very good here."

Is the service responsive?

We saw people had attended a range of social activities within the local community, which included being supported to meet their spiritual and religious needs. During our inspection, we also observed different activities took place during the day.

We spoke with two people who used the service and they both knew how to make a complaint. One told us, "I would just talk to one of the staff. I know they would listen and see to it for me."

Is the service well-led?

We saw that the provider had a quality assurance system in place which included a range of internal and external checks. Those we observed had addressed any shortfalls that had been identified. Consequently, the quality of service continued to improve.

The provider worked well with a range of agencies, which included the local authority and health and social care professionals. This helped ensure people who used the service received their care and support as and when they needed it.

We checked nine medication administration charts and found they provided a detailed record of the medication people had taken. They showed people had received their medication at the right time.

There were recruitment procedures in place and an external 'human resources' company provided support with regard to staff management. We looked at three personnel files and found job descriptions, contracts and evidence of references, identification and qualification checks to ensure the safe recruitment of staff.

People who lived at the home told us they were well looked after, there were always staff on duty to help them and they didn't have to wait long for assistance. Records showed the staff assessed each person's care needs monthly and considered this information at monthly meetings to review the level of staffing required to meet people's needs.

There were systems in place to record and securely retain, information regarding the care delivered to people who lived at the home. This included records of incidents and accidents such as falls. These were monitored each month using a central log to identify any trends and record actions taken.

We spoke to a family member of a person living at the home. They told us their relative had 'Never been so well'. They told us that they felt their relative was well looked after and that the staff at the home were welcoming to all family members and kept them fully informed of any changes or concerns. They told us that when their family member had been unwell, the home had worked hard supporting their mobility which had assisted their relative's recovery and wellbeing.

Throughout our visit we observed staff being attentive to the needs of the people in the home and their tone and manner was respectful and caring.

Staff told us they always had a handover period and that the daily record system was informative particularly when new staff came on duty. Staff said they had regular meetings and they felt they were knowledgeable about the people who lived at the home and were aware of their preferences. One staff member told us that they spent time talking with the people who live at the home to personalise their care, for example meal choices and getting to know theirs likes or dislikes.