We carried out a review of the data available to us about Clarence House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Clarence House, you can give feedback on this service.
Clarence House provides accommodation and personal care for up to 11 people who have a learning disability and complex behavioural or mental health related support needs. At the time of this inspection, there were 9 people living at the service.
People’s experience of using this service and what we found
Right Support:
People were positive about the support they received and told us staff listened to them. People were engaged in varied activities of their interest, including activities to enhance their skills and learning.
Risks to people’s care were assessed and managed well. Medication was managed safely. The service followed safe recruitment practices and we found enough staff were available to support people. At the time of our inspection, there was an outbreak of COVID – 19 at the service. We found the provider was following current guidelines in relation to infection prevention and control and visiting, although some staff had to be reminded at times by the registered manager to wear their personal protective equipment appropriately.
Right Care:
People had to request staff’s support to access some areas at the home. We discussed with the registered manager if people’s movements were being restricted and what measures were in place to prevent this happening unnecessarily. We were reassured by the evidence reviewed and feedback gathered from people, relatives and staff this was not an issue and appropriate measures were in place. 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.
The provider completed person-centred assessments and care plans were updated when required. We found some areas of people’s care plans were not always written from people’s point of view. We discussed this with the registered manager and saw evidence of this being immediately reviewed.
Right Culture:
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 able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. There was a person-centred culture at the service. Support provided promoted people’s choice and control. Communication plans had been developed to ensure staff communicated well with people. We observed positive interactions between people and staff. People told us they were able to lead fulfilling lives and develop their interests.
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 7 June 2018).
Why we inspected
The inspection was prompted in part due to concerns received about how risks to people’s care were managed. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
We found no evidence during this inspection that people were at risk of harm from this concern. Please see safe and well-led sections of this full report.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Clarence House provides accommodation and personal care for up to 11 people who have a learning disability and complex behavioural or mental health related support needs. It is divided into two units for men and woman. At the time of this inspection there were nine people living there.
The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.
A registered manager was not in place as they had recently left the service, and applied to de-register as 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. The regional operations manager was currently managing the service.
People who used the service told us they felt safe at Clarence House. Building maintenance and cleaning had improved, with some minor issues still apparent, which were dealt with straight away.
Staff had a good understanding of how to safeguard adults from abuse and who to contact if they suspected any abuse and safe recruitment and selection processes were in place.
Emergency procedures were in place and people knew what to do in the event of a fire. Risk assessments were individual to people’s needs and minimised risk whilst promoting people’s independence.
Detailed individual behaviour support plans gave staff the direction they needed to provide safe care. Incidents and accidents were analysed to prevent future risks to people.
We saw medicines were administered in a safe way for people. Staff had training in safe administration of medicines although not all staff competency checks on the administration of medicines had been refreshed in the last year. The regional operations manager said these were a priority for completion.
The required number of staff was provided to meet people’s assessed needs.
Staff told us they felt supported. Staff had received an induction and role specific training, which ensured they had the knowledge and skills to support the people who lived at the home. The overview of staff training needs was not up to date, although we saw training certificates to show staff had received the relevant training. A new training matrix was forwarded to us following our inspection.
People were supported to eat a balanced diet, and meals were planned around their tastes and preferences.
People were supported to maintain good health and had access to healthcare professionals and services. They were supported and encouraged to have regular health checks and were accompanied by staff to health appointments. The area operations manager promoted partnership working with community professionals and responded positively to their intervention and advice.
The service was adapted to meet people’s individual needs, with specialist furniture and fittings.
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.
Positive relationships between staff and people who lived at Clarence House were evident. Staff were caring and supported people in a way that maintained their dignity, privacy and diverse needs.
People were involved in arranging their support and staff facilitated this on a daily basis, and they were supported to be as independent as possible throughout their daily lives.
The management team promoted an open and inclusive culture whereby people were encouraged to express their diverse needs and preferences.
Care records contained detailed information about how to support people and included measures to protect them from social isolation. People engaged in social and leisure activities which were person-centred.
Systems were in place to ensure complaints were encouraged, explored and responded to in good time and people told us staff were approachable.
The absence of the registered manager had left some recent gaps in governance, which the regional operations manager and senior staff at the service were in the process of addressing, such as medicine’s competence assessments and an up to date overview of training.
Improvements had been made to the system of governance and audits within the service and the necessary improvements had been made since our last inspection to meet the regulations.
Feedback from staff was positive about the regional operations manager. The management team were visible in the service and knew people’s needs. People who used the service and their representatives were asked for their views about the service and they were acted on.
Clarence House provides accommodation and personal care for up to 11 people who have a Learning Disability. The service is divided into two units for men and women.
The service is required to have 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. The service had a registered manager.
Since our last inspection the registered provider has made a number of improvements to the cleanliness and maintenance of the home. However, during our inspection we saw evidence the registered provider had not ensured the safety and dignity of all people who used the service and building maintenance was still required. This was a continuing breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations.
People who used the service told us they felt safe at Clarence House. Staff had a good understanding of how to safeguard adults from abuse and who to contact if they suspected any abuse. Risk assessments were individual to people’s needs and minimised risk whilst promoting people’s independence.
Effective recruitment and selection processes were in place and medicines were managed in a safe way for people.
There were enough staff to provide a good level of interaction, although some staff told us they worked long hours to cover for absence..
Staff had received an induction, supervision, appraisal and role specific training. This ensured they had the knowledge and skills to support the people who used the service.
People’s capacity was considered when decisions needed to be made. This helped ensure people’s rights were protected in line with legislation and guidance.
People were supported to eat a balanced diet and meals were planned alongside people.
Staff were caring and supported people in a way that maintained their dignity and privacy.
People were supported to be as independent as possible throughout their daily lives.
The service was led by each individual’s goals and aspirations. Individual needs were assessed and met through the development of detailed personalised care plans and risk assessments, although one file we sampled contained contradictory information about medicines.
People and their representatives were involved in care planning and reviews. People’s needs were reviewed as soon as their situation changed.
People engaged in social activities which were person centred. Care plans illustrated consideration of people’s social life which included measures to protect them from social isolation.
Systems were in place to ensure complaints were encouraged, explored and responded to in good time and people told us staff were always approachable.
The culture of the organisation was open and transparent. The manager was visible in the service and knew the needs of the people who used the service.
People who used the service, their representatives and staff were asked for their views about the service and they were acted on.
The registered provider did not provide formal supervision to enhance the professional development of the manager and support them in their role; however they completed regular monitoring visits and were available to provide advice on the telephone.
The registered provider had an overview of the service. They audited and monitored the service to ensure the needs of the people were met and that the service provided was to a high standard.
You can see what action we told the provider to take at the back of the full version of the report.
The service had 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
Since our last inspection the registered provider has made a significant number of improvements to the cleanliness and maintenance of the home. However, during our inspection we saw evidence that the registered provider had not ensured the safety and dignity of one person who lived at the home.
Staff had all received training in safeguarding adults and were confident to report any concerns to their manager. The registered manager kept a log of all incidents which resulted in a safeguarding referral being made. On the day of our inspection we observed staff de-escalating a number of situations in a calm and appropriate manner.
Pre-employment checks were completed to ensure people were safe and suitable to work with vulnerable adults. There were enough staff on duty to support people in a timely manner.
People’s medicines were managed and administered safely. Medicines were kept securely and the medicines room and trolley’s were kept locked when not in use.
Although staff we spoke with told us they had received regular training we were unable to clearly evidence from the registered providers training matrix that this training was up to date. We saw evidence that new staff were supported and that all staff received regular supervision with their manager.
The registered manager and the staff we spoke with were aware of how their role in complying with the Deprivation of Liberty Safeguards (DoLS). The registered manager understood the procedure for requesting an authorisation and under what circumstances a referral may be required.
We saw people were offered a choice of food and drink and were supported by staff to purchase and cook meals.
Staff treated people with kindness and compassion and responded to people in a timely manner. During our inspection we saw staff resolve situations that had the potential to escalate into more challenging exchanges Staff approached these situations in a manner which enabled the situation to be resolved without causing conflict. Staff were able to verbalise how they maintained people’s dignity and privacy.
Peoples care and support records were person centred and were reviewed regularly. People took part in a range of activities and were supported by staff to take personal responsibility for aspects of their daily lives including planning the activities they wanted to participate in.
The service had a policy for ‘management and prevention, restrictive physical interventions’ which was evidence based and easy to follow. Following any episodes of physical intervention, staff told us they had a de-brief session to evaluate the incident.
The registered manager completed a number of audits each month which assisted them to monitor and assess the quality of the service provision.
The registered manager supported people who lived at the home to be involved in making decisions about their care, support and the environment in which they lived. This was achieved with resident meetings and quality surveys.
You can see what action we told the provider to take at the back of the full version of the report.
The inspector and specialist adviser, also through observation and looking at records used the information they were given to answer the five questions we always ask;
• Is the service safe?
• Is the service effective?
• Is the service caring?
• Is the service responsive?
• Is the service well led?
Below is a summary of what we found.
If you want to see the evidence supporting our summary please read the full report.
Is the service safe?
People were not cared for in an environment that was clean and hygienic.
The premises were not adequately maintained.
Is the service effective?
The service had an induction programme in place to support new members of staff.
Three staff we spoke with said they felt supported.
We saw from the training matrix that annual training was generally not up to date.
Is the service caring?
Five service users we spoke with said they liked living at Clarence House. One service user said, “This is the best house that I’ve lived in”. Another service user said, “Staff treat me well”.
Is the service responsive?
We spoke with a visiting professional from the Community Assessment Team. They described staff as ‘accommodating and willing to listen’. They said they had access to peoples support plans and incident reports.
One service user we spoke with told us, “I see Dr X every few months”.
Is the service well led?
Three staff we spoke with told us they had received regular supervision.
There was not an effective system in place to regularly assess and monitor the quality of service that people receive.
There was no evidence that learning from incidents / investigations took place and appropriate changes were implemented.
'Yes, get to do lots of activities.'
'They [registered manager] are very clear in relation to advocacy. Very on the ball and empower clients.'
We found that the staff we spoke with understood the needs of the people they cared for.
We observed staff to be caring and supportive towards the people in their care.
We saw that the provider had effective processes in place to monitor quality and these included audits and analysis of incidents and complaints.
People said they were supported to make choices, and that staff treated them with respect and understanding.
Each person said they were happy with their care. One person told us that they liked their keyworker because she listened to them and tried to help sort out their problems.
People we spoke with told us that staff were good at helping them and arranging things that they enjoy doing.
Two of the people we spoke with knew about safeguarding procedures and their right to be kept safe from abuse. They knew who to report any concerns to and said they were comfortable talking to staff about the subject.