Clovelly House

Clovelly House is a residential care home providing personal care to 17 people aged 65 and over at the time of the inspection. The care home can accommodate up to 21 people, some of whom live with dementia.

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

Systems to monitor how well the service was running were updated and made more effective during our inspection. The registered manager needs to continue to review the systems they have in place to ensure they are effective.

The provider had some systems in place to manage risks and keep people safe from avoidable harm. We have made a recommendation that the provider keep updated with risk management requirements.

Staff followed good practice guidance to prevent the spread of infection.

People liked the staff that cared for them. Staff were kind and caring and made sure people’s privacy and dignity was respected. People were involved in making decisions on the care they wanted.

Staff received training, supervision and support so that they could do their job well. Staff enjoyed working at Clovelly House. Staff were given incentives to do their job well and keep their training requirements up to date.

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.

Complaints and concerns were followed up to make sure action was taken to rectify the issue.

The manager was passionate about giving people a high-quality person-centred service. They ensured that people were afforded opportunities to have a presence in their local community and experience new and different activities.

The registered manager was receptive to areas of concern we found during the first two days of our inspection. They acted immediately to rectify these issues.

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. We considered this guidance as there were people using the service who have a learning disability.

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

Why we inspected

The inspection was prompted in part due to concerns received about the safety of people living at the service. A decision was made for us to inspect and examine this risk.

Rating at last inspection and update

The last rating for this service was requires improvement (published 28 January 2021).

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

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

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

Recommendations

We have made a recommendation that the provider consider the different guidance available regarding risk management in their service.

Follow up

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

Clovelly House is a residential care home providing personal care to 14 people aged 65 and over at the time of the inspection. The care home can accommodate up to 21 people, some of whom live with dementia.

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

People and their relatives were happy with the service provided by the staff team at Clovelly House. Relatives told us there had been improvements in the management of the home and they praised the registered manager, the provider and the staff. We found that the home was well-managed. The management team monitored all aspects of the service, actioned improvements and shared learning with the staff team.

Relatives felt their family members were safe at Clovelly, looked after by caring staff who worked well as a team. One relative said, “I’d recommend Clovelly House to anyone.” Staff had received training in a range of topics and had used their knowledge to improve the care they provided to people. People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible and in their best interests.

Infection prevention and control practices mostly ensured that people were protected as far as possible although some staff did not always wear their masks properly. Risk assessments were carried out so that risks could be minimised and medicines were given safely. Staff supported people to eat and drink well and worked with other healthcare professionals to ensure people received any treatment they needed.

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 (report published 3 February 2020), there were multiple breaches of regulation and the service was in Special Measures. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

This service has been in Special Measures since February 2020. 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. The provider was no longer in breach of the regulations relating to these three key questions.

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 a focused inspection of the key questions of safe, effective and well-led.

We did not inspect the other key questions. 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 inadequate to requires improvement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Clovelly House on our website at www.cqc.org.uk.

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 coronavirus and other infection outbreaks effectively.

Enforcement

Following our last inspection we took urgent enforcement action to restrict any further admissions to the home. We also required the provider to send us information weekly so we could monitor whether there were improvements in the quality of the service being provided to people. The condition to restrict admissions has now been removed from the provider’s registration as improvements had been made.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Clovelly House is a residential care home providing personal care to 17 people aged 65 and over at the time of the inspection. The care home accommodates up to 21 people in one adapted building.

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

People’s health, welfare and safety were placed at risk because the provider did not have effective systems in place to assess, monitor and improve the safety and quality of the service. There was a lack of management oversight of the service and the management team failed to understand the importance of this aspect of their role.

Comprehensive risk assessments were not in place to ensure staff knew how to keep people as safe as possible. Staff did not have the competence or skills to respond appropriately in emergency situations, which put people at risk. There was not an effective system in place to learn lessons from incidents or accidents. Staff numbers and deployment meant that people were not always fully supported in the way they wanted to be and there was a risk that both people and staff were not safe. Medicines were not managed safely.

The provider did not have a satisfactory system in place to ensure that people were protected from abuse and harm. Staff did not have the training or support to carry out their role in line with current good practice guidance and did not always support people to eat and drink enough.

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; the policies and procedures in the service did not support this practice.

Staff did not always show respect for people or treat them as adults. People were not always given opportunities to make decisions about their care and did not have many choices about the way they led their lives. Staff did not always encourage and support people to maintain their independence.

Care plans had not all been updated or reviewed so staff did not have sufficient guidance to provide each person with the care they wanted. Staff were not always following care plans and records of care were incomplete. The provider had failed to ensure that people would receive the best possible care, in line with their preferences, at the end of their lives as no end of life care planning had been done.

At the start of the inspection there was a serious risk in the event of fire as fire safety arrangements were not robust enough. The provider addressed some of the issues so fire safety had improved by the third day of the inspection.

People told us they felt safe and were happy living at Clovelly House. Relatives were satisfied with the care people received. Activities were organised and people told us they had enough to do. New staff were recruited in line with the regulations and staff were aware of their responsibilities to protect people from the spread of infection.

People spoke highly of the staff and liked the food. People and their relatives knew how to complain but had never needed to. Staff involved other healthcare professionals to support people to maintain their health.

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 (report published 23 May 2018).

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding including the number of falls and serious injuries; care planning; and a number of other concerns about the safety and effectiveness of the care being provided to people living at the home. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, 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.

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

Enforcement

We have identified breaches in relation to safe care and treatment; good governance; person-centred care; consent to care; staffing; and safeguarding people from abuse and avoidable harm.

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

Following the first two days of the inspection we had serious concerns around the safety of people using the service. We wrote to the provider asking them to tell us about the actions they had taken to reduce the risks. We returned to the service on 9 December 2020 to check that the provider had taken the actions and we found they had not done everything they told us they had done.

Therefore, we stopped the provider from admitting any more people to the service without our permission. We required the provider to ensure the service is audited by a competent person to provide an accurate oversight of the service and to send us a weekly summary of the audits. This summary must include actions taken to ensure people receive safe and effective care.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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 of 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.

The home accommodates up to 21 people in a two storey building which is served by a main lift and some stair lifts up to the upper floor. Nursing care is not provided.

At our previous comprehensive inspection in April 2017. We found two breaches of the regulations. The home was rated as requires improvement. We undertook a focussed inspection in September 2017 and found improvements had been made. We did not review the rating of the service at this time. This unannounced inspection took place on 10 April 2018. The service is now rated as good.

A registered manager is not a condition of the services registration.

People felt safe living at the home, with the staff, and with the care and support the staff gave them. Assessments of all potential risks to people were carried out and guidance put in place to minimise the risks.

There was an effective recruitment process in place to reduce the risk of unsuitable staff being employed. There was a sufficient number of staff with the right experience, skills and knowledge deployed to make sure that people were kept as safe as possible. Staff followed the correct procedures to prevent the spread of infection.

Assessments of people’s support needs were carried out before the person was offered a place at the home. This was to ensure that the home could provide the care and support that the person needed and in the way they preferred. Technology and equipment, such as hoists, were used to enhance the support being provided.

Staff received induction, training and support to enable them to do their job well. People's nutritional needs were being met and people were supported to have enough to eat and drink. A range of external health and social care professionals worked with the staff team to support people to maintain their health and well-being.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People and their relatives were involved in planning their care. Information about advocacy services was available if anyone wanted an independent person to assist them with any decisions they wanted to make. Staff respected people’s privacy and dignity and encouraged people to remain as independent as possible.

Care plans were personalised and gave staff guidance on the care each person needed. People were encouraged to participate in activities and interests of their choice.

The service had received a number of compliments from people and their relatives. Staff were happy to be working at the home.

People and their relatives were given opportunities, such as written questionnaires and meetings, to give their views about the service and how it could be improved.

The provider was aware of their responsibility to uphold legal requirements, including notifying the CQC of various matters. The management team worked in partnership with other professionals to ensure that joined-up care was provided to people.

After the comprehensive inspection, the provider wrote and told us what they would do to meet legal requirements in relation to the breaches. We undertook a focused inspection on 14 September 2017 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this breach. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Clovelly House’ on our website at

www.cqc.org.uk.

Clovelly House is registered to provide accommodation for up to 21 older people some of whom may be living with dementia. There were 21 people living at the service at the time of our inspection.

The registered provider manages the service which means there is no requirement to have a separate registered manager. A registered provider has legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

At this focused inspection on 14 September 2017 we found that the provider had followed their action plan and the legal requirements had been met.

We found that provider was sending in the required notifications to CQC and that all the required information had been obtained following the recruitment of new employees.

This unannounced inspection took place on 19 April 2017.

The registered provider manages the service which means that there is no requirement to have a separate registered manager. A registered provider has legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The registered provider did not have a robust recruitment process in place to ensure that only staff of good character were employed within the service. People were looked after by enough staff to support them with their individual needs and who trained to carry out their roles.

Not all care plans contained up to date information about how people should be cared for. Whilst some risks to people had been identified there were not risk assessments in place for all risks. Staff were trained, supported and supervised to do their job. Staff treated people with dignity and respect. Various activities were offered based on peoples choices.

People received their prescribed medicines in a timely manner and medicines were stored and disposed of in a safe way.

People were provided with a good choice of meals. Staff referred people appropriately to healthcare professionals.

The provider was acting in accordance with the requirements of the Mental Capacity Act (MCA) 2005 including the Deprivation of Liberty Safeguards (DoLS). The provider was able to demonstrate how they supported people to make decisions about their care. Where people were unable to do so, there were records showing that decisions were being taken in their best interests. DoLS applications had been submitted to the appropriate authority. This meant that people did not have restrictions placed on them without the correct procedures being followed.

A range of audits were in place. However, these were not always as effective as they should have been. This was because they did not identify and fully detail the action to be taken. The registered provider had not always notified the CQC about important events that, by law, they are required to do so.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Health and Social Care (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

All of the people that we spoke with had positive comments to make about their experiences of living at Clovelly House. They told us that they were treated well and said that they felt safe and were comfortable. They also told us that they had enough to do each day. People were supported to access a range of health care services.

People's food likes and dislikes were catered for. People told us that they liked the food and that they always had enough to eat and drink.

There were maintenance and checking systems in place to ensure that people were safe when using different types of equipment for their support and care needs.

People said that they liked the staff and that there was always enough staff on duty to safely meet their individual support and care needs. Staff said that they enjoyed working at the home because the team of staff worked well together. They also said that they had the experience and training to safely do their job.

People's views and suggestions were taken into account to improve the quality and standard of the service, if needed. The majority of records were kept up-to-date, so that people were protected from unsafe and inappropriate support and care.