Claremont Care Home

Claremont care home is a care home providing personal care to up to 63 people. The home provides support to older adults and people living with dementia. At the time of our inspection there were 34 people living at the home.

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

Risks were not always managed safely to ensure people were kept safe. Potential infection risks were not always managed safely. Not all care plans and risk assessments had been completed when people required measures in place to keep them safe. We found care records were not always completed or accurate. Medicines were mostly managed safely, and audits were carried. However, we found some recording issues. We could not be assured environmental checks of the home were robust. The environment was worn and areas of the home unclean.

There were a variety of audits being carried out in the home however these had not always been effective in managing the necessary improvements required from our last inspection.

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.

Systems were in place to safeguard people from the risk of abuse. Incidents and accidents were reported, investigated and measures taken to mitigate future occurrences. Staffing levels were sufficient to meet people’s needs and staff were recruited safely. Relatives and friends were encouraged to visit the home and spend time with their loved ones.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 15 November 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We carried out an unannounced focused inspection of this service on 13 and 18 July 2023.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We have identified a breach in relation to the governance of the service.

Please see what action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Claremont Care Home is a care home that can accommodate up to 63 people who require support with nursing or personal care needs, some of whom are living with dementia.

At the time of our first visit, 33 people were living at the service. On our second visit, there were 32 people living at the home.

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

At this inspection, we found improvements had been made in relation to the quality of person-centred care received by people, safety and hygiene of the environment, staffing deployment and training and the culture at the service. However, further improvements were still required in relation to the safe management of medication, care records and quality assurance processes in place; the provider continued to be in breach of regulations.

We found medicines were not always managed safely across the service. Some of the concerns found during this inspection had also been identified at our previous inspection, such as gaps in medication administration records (MARs) and medication not being available to people. The provider’s internal medication audits had not been effective in identifying the issues and in driving the necessary improvements.

Risks to people's care had been considered and plans were in place to manage these. However, we found examples when equipment needed to prevent or manage risks to people’s skin integrity had not been managed safety; this was actioned immediately when raised with management.

We continued to find inconsistencies in the application of the principles of the Mental Capacity Act. People told us staff asked their consent before supporting with care tasks. People were supported to have maximum choice and control of their lives and we did not find evidence of care not being delivered in people's best interests. However, for people who were not able to consent to their care, mental capacity assessments and best interest decisions were not always decision specific or being completed in line with regulations and best practice.

Staff told us they felt well supported in their roles. Training was being completed and further training planned. Supervisions had been completed, including targeted supervisions to address areas identified by management where staff required further support and guidance.

Most people and relatives told us staff's attitude was caring. Comments were made in relation to the change and improvements in the culture at the service, since our last inspection.

We received mixed feedback about activities happening at the home. Some people told us they enjoyed the activity provision; other people told us there weren't many activities happening. Records confirmed activities were happening during the week, delivered in groups or on a one to one basis for people who chose to stay in their bedrooms.

The registered manager collaborated with this inspection, acted on the issues found or told us the actions they would take to address the issues identified.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 23 March 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made in some areas, but not in others and the provider remained in breach of regulations.

This service has been in Special Measures since 23 March 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safety of medication and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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

Claremont Care Home that can accommodate up to 63 people who require support with nursing or personal care needs, some of whom were living with dementia. The provider was also caring for people with learning disabilities and autism, but this was not included in their registration.

At the time of our first visit, 51 people were living at the service. On our second visit, there were 52 people living at the home.

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

During this inspection, we found widespread shortfalls in the way the service was managed and we were not assured the service provided safe care. We found signs of a closed culture developing at the service.

People did not always receive safe care. During this inspection, we identified and reported several safeguarding concerns. Some people and relatives told us the service did not provide safe care.

People were not always safe because systems in place were not effective to monitor risks to their health and incidents that had happened. This included individual risks, environmental risk and fire safety risks. Several people living at the home had lost weight and appropriate action had not always been taken in a timely way.

People's medicines were not always administered safely.

Good infection prevention and control procedures and relevant guidance regarding testing, visiting and vaccination as condition of deployment were not always being followed. Systems to learn lessons were not always effective.

Staff deployment and the management of the shift was not effective to ensure people’s needs were met in a timely way. We received mixed feedback regarding staffing levels at the service. On review of all information gathered during this inspection, we have made a recommendation for the provider to review their staff deployment practices.

Staff had not been supported to have the appropriate knowledge and skills to deliver safe and effective care. We found training was not kept up to date and staff were not offered regular supervision or appraisal meetings.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The model of care was not consistent with current best practice. The management of behaviour considered challenging to others did not follow a positive behaviour support approach. People were not supported to take part in activities that were meaningful to them and that promoted their independence.

We found there were coded key pads in the building that could be an unnecessary restriction for some people, as these prevented people from moving through the home freely. We found inconsistency in the application of the principles of the Mental Capacity Act. We made a recommendation for the provider to review this practice. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. There were policies and systems in place, but these weren’t always being followed in practice.

People did not always receive person centred and dignified care. We observed staff not being responsive to people’s needs. There were a lack of meaningful activities and interaction being offered to people. We observed people’s dignity not always being protected. We made a recommendation in relation to promoting people’s dignity and privacy.

The provider failed to implement processes to effectively monitor the quality of the service and to identify the issues found during our inspection. Records were not always complete or contemporaneous.

We found widespread shortfalls in the way the service was managed, in particular a lack of management oversight and accountability. There was a risk of people receiving inappropriate care. Although some checks were being conducted on behalf of the nominated individual, these did not ensure that all issues were identified or that issues identified were timely acted upon.

The management team collaborated with the inspection process and told us about the plans they would put in place to address the issues found during this inspection.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 13 May 2021)

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations.

Why we inspected

We undertook a focused inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about moving and handling, pressure care, unexplained bruises, weight loss, fire safety, staff’s training, staffing levels, medicines management, management of the home, hygiene and infection control. A decision was made for us to inspect and examine those risks.

We inspected and found there were further concerns with people not receiving person centred and dignified care, so we widened the scope of the inspection to become a comprehensive inspection which included the five key questions.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Responsive and Well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, person centred care and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Claremont Care Home can accommodate up to 63 people who require support with nursing or personal care needs. At the time of our visit, 55 people were living at the service. Claremont Care Home is situated in Farsley, between Leeds and Bradford.

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

The registered provider did not have effective governance systems in place to maintain and improve the quality and safety of the service. Analysis of accidents and incidents were brief in detail and did not show clear evidence patterns or trends were being identified. We found quality assurance audits did not cover all areas relating to the quality and safety of service provided and there were no clear lines of accountability for progressing actions arising from audit findings.

Care plans were inconsistent, and we found some care plans were not accurate. People were not being weighed as frequently as directed by their care plan. One relative said, “Well [name of person] is very thin now. I don’t know if they weigh her or not because they haven’t said.” We found records of food and fluid and re positioning charts were inconsistently recorded as well as what pressure relief was required. We fed this back to the registered manager and nominated individual.

The home was clean, however, we found cleaning documentation was not been being completed by staff in full. We spoke to the registered manager about this. They told us they were working with the infection control prevention team in addressing this. We observed staff on the first day of inspection touching their masks or having masks under their chin. We spoke to these staff on inspection as well as the management team. On day two of the inspection we saw improvements in this, and all staff were wearing their PPE appropriately.

We saw maintenance of the building was underway and an action plan was in place to support this. Most actions had been completed.

On the whole people received their medicines as prescribed. We found some areas of improvement were needed which was fed back to the nurse and registered manager on the day of inspection. For example, not all protocols had been updated for prescribed medication. The nurse was in the process of completing these at the time of our inspection. People, relatives and staff felt there was enough staff. Staff told us it was hard when other staff called in sick or were on annual leave. We observed people’s needs were met in a timely manner during the inspection.

People we spoke with told us they felt safe and staff had a good understanding of how to safeguard adults from abuse. One staff member said, “I would contact my manager straight away. I know this would be dealt with.” Safe systems of recruitment were followed to ensure staff were safe to work with vulnerable people.

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

Rating at last inspection

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

Why we inspected

This inspection was prompted in part due to concerns received about staffing levels, environment, record keeping, and overall management of the service. A decision was made for us to inspect and examine those risks. We found evidence during this inspection that people were at risk of harm from some of these concerns, however, we did not find evidence that harm had occurred.

This report only covers our findings in relation to the key questions of safe and well-led which contain those requirements and concerns. We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance the service can respond to coronavirus and other infection outbreaks effectively.

Prior to the inspection 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.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We found evidence the provider needs to make improvement. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to people’s safety, infection control and governance at this inspection.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and the local authority and clinical commissioning group to monitor their progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

• Visitors were asked questions about their COVID-19 status upon entering the building, and on entry were provided with PPE (Personal Protective Equipment) and had their temperature taken.

This comprehensive inspection took place over two days on 13 and 29 June 2017. At the last inspection in June 2016, the service required improvement to become Safe, Effective and Responsive. At this inspection we found the required improvements had been made.

There was a registered manager in place. 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 told us they felt safe at the service. Staff were confident about how to protect people from harm and what they would do if they had any safeguarding concerns. There were appropriate systems in place to make sure that people were supported to take medicines safely and as prescribed. Risks to people had been assessed and plans put in place to keep risks to a minimum.

There were a sufficient number of staff on duty to make sure people’s needs were met. Recruitment procedures made sure that staff had the required skills and were of suitable character and background.

Staff were supported by a comprehensive training programme to help them carry out their roles effectively. Staff were led by an open and accessible management team. There were opportunities for staff to participate in service developments through supervision and team meetings.

The manager and staff were aware of the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). DoLS are put in place to protect people where their freedom of movement is restricted. 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.

People were provided with sufficient amounts of food and drink. Where people required support with eating or drinking, this was appropriately provided and took into account people’s likes, dislikes and preferences.

People told us staff were caring and that their privacy and dignity were respected. Care plans showed that people and their relatives were involved in decisions and individual preferences were taken into account. Care plans gave clear directions to staff about the support people required to have their needs met. People were supported to maintain their health and had access to health services if needed.

People received good care at the end of their lives. Staff were well trained in this area and sensitive to the needs of people, their friends and relatives.

People’s needs were regularly reviewed and appropriate changes were made to the support they received. People had opportunities to make comments about the service and how it could be improved upon.

The manager had good oversight of the service and was well known tom people who used the service. They had made improvements at the service since they started in post. There were systems in place to look at the quality of the service provided and action was taken where shortfalls were identified.

Claremont Care Home is situated in Farsley, Leeds and is easily accessible by car and public transport. The home sits within extensive grounds consisting of lawned areas and a car park to the front. The home can accommodate up to 63 people. Some people were living with dementia.

At the time of our inspection the home did have a registered manager; however, they were no longer in day to day control. The regional manager was managing the home, who was in the process to be become the 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.

We found some areas of the premises did not comply with current Health and Safety guidance and were therefore, a safety risk to people who used the service. However, a risk assessment had been completed. Staff received training but did not always receive appropriate ongoing or periodic supervision to make sure competence was maintained. The care plans we looked at did not contain appropriate mental capacity assessments. People’s care plans were reviewed on a regular basis but the care plans were not always updated and it was difficult to locate information.

We found people were cared for, or supported by, sufficient numbers of suitably qualified and experienced staff. Appropriate recruitment procedures were in place to make sure suitable staff worked with people who used the service and staff completed an induction when they started work.

People told us they felt safe in the home and we saw there were systems and processes in place to protect people from the risk of harm. Staff had a good understanding of safeguarding vulnerable adults and knew what to do to keep people safe. People were protected against the risks associated with medicines because medicines were well managed but some slight amendments were required.

At the time of our inspection Deprivation of Liberty Safeguards were completed appropriately. There was opportunity for people to be involved in a range of activities within the home. People mealtimes experience was generally good. People received good support which ensured their health care needs were met. Most staff were aware and knew how to respect people’s privacy and dignity.

People had opportunity to comment on the quality of service provided and influence service delivery. Effective systems were in place which ensured people received safe, quality care. Complaints were welcomed and were investigated and responded to appropriately.

We found breaches in regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the provider to take at the end of this report.

During our inspection in January 2015, we found improvements had taken place to the way staff had been supported to develop their skills. In the files we looked at we saw evidence staff had been offered monthly supervision sessions in line with the policy of the service. Additionally, the service had carried out appraisals on all staff. From the appraisal, a training plan had been developed.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people, their relatives and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents. This reduced the risks to people and helped the service to continuously improve.

When people were identified as being at risk, their care plans showed the actions that would be required to manage these risks. These included the referring to specialist services such as speech and language therapy and the dietician.

The service had policies and procedures in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). Staff received safeguarding and Mental Capacity Act training. This meant people would be safeguarded as required.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in developing their plans of care, wherever possible. From speaking with staff they were able to demonstrate a good understanding of people's care and support needs.

Suitable arrangements were in place for staff to receive updated training to ensure they had the skills, knowledge and experience to meet the needs of people who used the service. However, the service did not offer supervision in accordance with the policy of the service. This meant people who used the service were at risk of being cared for by staff who had not been supported by the service in line with their policy.

Is the service caring?

We saw staff were attentive and respectful when speaking with or supporting people. The home had a relaxed and comfortable atmosphere. We saw that there was some good humoured banter between several people living at the home and staff. One person said 'The care staff are good.' People looked well cared for and we observed staff knocking on people's door before they entered.

Relatives we spoke with told us, 'On the whole the home is ok: I have had some issues with aspects of care but have managed to address these with the manager.' They felt staff understood the needs of their relative; they told us 'The care staff know them well and know what they wants and needs.'

Is the service responsive?

People's needs were assessed and records we looked at showed they received specialist support or equipment that they needed.

People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

People we spoke with knew how to make a complaint if they were unhappy.

We saw the staff team acted in a professional manner and responded appropriately to people's care needs. We saw them explain to people what they were going to do and asked permission before they carried out any support or care.

The service could show us no evidence they had sought the views of people who used the service. They carried out surveys of people's relatives and the results of these had been mixed.

Is the service well-led?

The service had a quality assurance system, and records showed that identified problems and opportunities to change things for the better had been addressed promptly. As a result we could see the quality of the service was continuously improving.

Staff we spoke with were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and the quality assurance systems in place. This helped to ensure that people received a good quality service. They told us the manager was supportive and responsive.

Effective management systems were in place to promote and safeguard people's safety and welfare. For example, health and safety records and peoples care records were up to date and had been reviewed regularly.

Relatives we spoke with told us they thought management of the home was very good. They told us, 'The home had got better since the new manager came into place.'

One person we spoke with liked it at the home and their relatives said the provider communicated well with them, the home was clean and their mum always looked comfortable when they visited. A second person we spoke with who lived at the home said staff were friendly and the food was okay. A third person said they were comfortable and 'pleased with things.' We overheard one person speaking with a member of staff as they were passing in their wheel-chair after having been supported to go to the bathroom and they said 'Your girls are absolutely marvellous.'

We observed the care provided by staff. We found staff spoke with people who used the service in a kind, considerate and respectful way. We found lunchtime in the dining room a lively environment which did not provide the optimum circumstances for staff to prioritise their attention and time effectively. We found the provider had the necessary safeguarding processes in place and staff were able to describe the different signs of abuse and how to report concerns. We also found there was a complaints process in place which was brought to the attention of people who used the service.

We spoke with two people who were visiting during our inspection. One person said the care provided was 'satisfactory' and the "necessities of life were adequately covered". The second person we spoke with said they had no concerns about the care being provided.

We found staffing levels in the home were adequate but the skill mix was not always consistent enough to ensure appropriate continuity of care.

We spoke with three people that used the service and two relatives. One person that used the service said that "they couldn't grumble about anything" and they were "happy at the home". Another person said "they had no complaints" and commented that staff came to help when necessary.

One of the relatives we spoke with commented they were happy with the support being provided for their mother and they had settled in to the home well. Another relative said they were happy with the care and support being provided for their mother and they were fully informed about aspects of her care.