Clifden House Dementia Care Centre

Clifden House Dementia Care Centre is a residential care home providing care and accommodation for up to 59 older people living with dementia or dementia type illness. Clifden House is an adapted building in a residential area of Seaford. The home had a lift to assist people in accessing upper areas of the home. There was access to an outside area with seating. At the time of the inspection there were 49 people living at the service one of whom was in hospital.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

IPC systems and processes were in place. The home looked clean and tidy and there were designated housekeeping staff. We identified an improvement was needed to the documentation of cleaning completed. This was rectified immediately by the registered manager.

Systems and processes had improved. A new electronic care system had been introduced. This was currently being used day to day alongside the previous system until all information had been reviewed and moved over.

They provider and registered manger had oversight of care documentation on this system and this enabled them to review and check how it was being used. The registered manager told us, “We are still finding new things we can add to the system and things that we could change to make it more user friendly, but I prefer it to the old system and so do the staff.”

Care documentation had been improved. As information was being moved to the new system it was being checked to ensure it was current and included all relevant information to support staff to be able to provide safe, effective care.

Improvements had been implemented to ensure that peoples consent and capacity were considered. Staff offered people choice and involved them in all day to day decisions. 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.

Peoples nutritional needs were met. Staff were able to tell us about peoples likes and dislikes and those who had specific dietary needs. Information was shared with the chef to ensure they were aware of any individual requirements.

The provider had robust recruitment processes in place. All new staff completed a period of induction overseen by the registered manager. Staff received training and told us they felt supported by the registered manager.

People received their medicines in a safe manner. Staff received training and medicine competencies were completed to ensure staff followed safe guidance at all times.

People told us they were happy living at Clifden House.

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 16 March 2020) and there were breaches of regulation. 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 and the provider was no longer in breach of regulations.

Why we inspected

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 carried out an unannounced comprehensive inspection of this service on 4 and 5 February 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve systems to assess and review mental capacity, staff induction and quality assurance. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers findings in relation to the key questions safe, effective and well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

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

Follow up

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

We found the following examples of good practice.

At the time of our inspection people were no longer required to isolate in their rooms as people’s isolation periods had been completed. Staff were supporting people to remain safe. Due to people’s dementia and memory loss, staff were working to remind people why they needed to socially distance, to support this the registered manager had made some environmental changes to the communal areas. Seating in the communal lounge and dining areas had been rearranged. This prevented people sitting closer than two metres or in groups.

People and staff working at Clifden House had individual COVID-19 risk assessments completed. This considered each person’s associated risks, including long term and underlying health conditions, ethnicity and pregnancy related issues.

The registered manager had followed current guidance in relation to infection prevention and control. This included implementing COVID-19 cleaning schedules and personal protective equipment (PPE) stations. The home was currently closed to admissions and non-essential visitors. Measures had been implemented to ensure people and staff entering the home did so following current guidance regarding PPE and social distancing. This included temperatures being taken on arrival and PPE being used. Further measures had been implemented to protect staff. For example, alternative visors had been purchased which were more comfortable for staff to wear throughout their shift. Guidance was displayed and available for all staff, this included correct procedures for putting on and taking off PPE.

During the outbreak staff monitored people’s physical health and recorded this on a monitoring form, this included people’s temperatures and general symptoms. The home had experienced a high number of positive COVID-19 people and staff. The registered manager told us staff had been amazing and all pulled together to ensure people were cared for. The registered manager had worked closely with the local authority and market support team to ensure that staffing levels were maintained whilst high numbers of staff were unwell or isolating.

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

We have made recommendations about the monitoring of infection control and dementia support at the service.

We found concerns relating to care documentation and quality assurance, management of risk, Mental Capacity Act 2005 (MCA) and staffing. There was an over reliance on verbal information being shared between staff. Staff were aware of people’s care needs, however, people's care needs, and associated risks were not consistently recorded to include all relevant information about people's needs.

Care planning and documentation relating to people's care, support and associated risks needed to be improved to ensure people received the appropriate care to meet their needs. Care documentation was contradictory or had not been updated when changes had occurred. Nutritional needs were not always clearly documented. Some specific health care needs did not have appropriate guidance in place for staff to ensure that care was provided safely and consistently.

Decisions made on people’s behalf were not accurately recorded to demonstrate the rationale for decisions made in a person’s ‘best interest’ or who had been involved in the decision. No follow up reviews were taking place to ensure decisions were still safe and appropriate.

Staff completed mandatory training, however, there was no structured induction programme for new staff to ensure they received support during a probationary period prior to being assessed as competent to work unsupervised. Staff were not completing the Care Certificate. The Care Certificate ensures that staff new to care receive an introduction to the information, skills, knowledge and values to provide high quality, safe and appropriate care for people.

There was a quality assurance system in place, however, this had not identified the areas of concern we found during the inspection.

At this inspection, we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 regarding Need for Consent, Good Governance and Staffing.

People told us they were happy living at Clifden House Dementia Care Centre. People’s health was monitored, and referrals made to other agencies if any issues were noted. The service worked collaboratively with other health care teams to provide consistent care for people.

A new electronic medication system had been introduced. Staff told us this had led to improvements with medication. Medicine procedures were in place to ensure people received their medicines as prescribed and medicines were given safely.

Staff knew people well and understood their needs and preferences. Staff were caring and engaging with people. People told us they found staff to be very kind and supportive. There was a weekly activity schedule which people told us they enjoyed. People were encouraged to participate in activities and supported to maintain relationships with friends and family.

There was an open culture which was inclusive and valued people and their individuality. Staff were aware of their roles and responsibilities and told us they enjoyed working at Clifden House Dementia Care Centre and felt supported by management. People had access to a complaints policy and told us they would be happy to raise a concern if they needed to.

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 11/07/2017)

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified three breaches of regulation.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We carried out an unannounced inspection 16 and 17 June 2016 where we identified a breach in relation to Regulation 12 because people’s support needs in relation to fire safety had not been assessed. Following the inspection, we received an action plan that told us people’s individual needs had been assessed. At this unannounced inspection on 05 and 09 May 2017 we confirmed this and that people’s needs had been reviewed and updated as and when their needs had changed. The provider had therefore met this Regulation.

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.

Record keeping in some areas of care planning was not accurate or up to date. Before our inspection the registered manager had identified some areas where this was the case, for example in relation to Deprivation of Liberty care plans. However, we recommended the registered provider continued to monitor that care plan documentation was continually reviewed and updated to ensure accuracy.

Each person had a personal emergency evacuation plan to be followed in the event of a fire or emergency. The home’s policy had been updated based on this and a detailed fire risk assessment had been carried out to ensure people’s safety.

A wide range of activities were available for people to participate in if they wished and people enjoyed spending time with staff. External entertainers were provided on both days of our inspection with music to suit a range of tastes and interests. Throughout our inspection we observed people being offered a variety of activities, actively participating and showing that they enjoyed them. For those who liked a quieter life the gardens offered a secure and safe environment to take a stroll. The home kept hens and those who chose to, could assist in their upkeep.

There were safe procedures for the management of medicines. People had access to healthcare professionals when they needed it. This included GP’s, dentists, community nurses and opticians.

Staff had a good understanding of the Deprivation of Liberty Safeguards (DoLS) and knew that people either had or that applications had been made to have a DoLS. (A DoLS is used when it is assessed as necessary to deprive a person of their liberty in their best interests and the methods used should be as least restrictive as possible).

Staff had the skills and knowledge necessary to provide people with safe and effective care. Appropriate checks had taken place before staff were employed to ensure they were able to work safely with people at the home. Staff received regular support from management which made them feel supported and valued. They were encouraged to develop their skills and take on additional responsibilities. For example, to be a ‘Champion’ in a particular area such as infection control, or the management of medicines.

Staff were kind and caring, they had developed good relationships with people. They treated them with kindness, compassion and understanding. They supported people to enable them to remain as independent as possible. Staff showed that they understood how to assist people living with dementia through the use of good moving and handling techniques when they supported people to move about the home. They communicated clearly with people in a caring and supportive manner.

Clifden House Dementia Care Centre provides care and support for up to 59 older people living with dementia. The care needs of people varied, some people had complex dementia care needs that included behaviours that challenged. Other people’s needs were less complex and required care and support associated with mild dementia and memory loss. Most people were fully mobile and able to walk around the home unaided. The care home provides some day and respite care for people living locally. On occasions staff can meet more complex care needs with community health care support including end of life care when required. At the time of this inspection 52 people were living at the home.

We carried out an unannounced inspection on 14 and 16 January 2015 where we found improvements were required in relation to the management of medicines, the documentation of complaints and in relation to the supervision and appraisal of staff. The provider sent us an action plan that told us how they would address these issues. We carried out this unannounced inspection 16 and 17 June 2016 to check the provider had made improvements and to confirm that legal requirements had been met. We found that the provider had addressed the breaches found at the last inspection. However, we identified a breach in terms of fire safety.

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.

There was no advice in care plans about how to evacuate people in an emergency or in the event of a fire. Fire drills were not recorded and whilst alarms were sounded regularly, and staff had regular fire safety training, the provider had not tested that staff knew what to do in an emergency situation.

There were mixed views about the culture of the home. Some staff, visitors and professionals said that there was an open culture and that they could raise any issues of concern. Others said communication with some of the management staff could be difficult. Most of the staff told us they were supported well and had regular opportunities to share their views on the running of the home. All complaints were documented and actions had been taken to address them.

There were safe procedures in place for the management of medicines. There were enough staff employed to ensure that people's needs were met. Staff received ongoing training and support, which included a mixture of online training and attendance at external training courses. They had access to health qualification training and specific training on caring for people living with dementia. There were safe recruitment systems to ensure that new staff were checked before starting to work in the home.

People told us they liked the food served and they could have an alternative if they did not want what was offered. Nutritional assessments were carried out to ensure that no one was at risk of malnutrition or dehydration. People were supported to attend health care appointments as needed. All visiting professionals told us the home was in touch with them if there was a concern about people’s needs. One professional told us, “We have regular contact with the home, and they contact us about residents who they are concerned about and the staff have been caring.”

Staff understood the principles of consent and the Mental Capacity Act (2005). Mental capacity assessments were in place and Deprivation of Liberty Safeguards (DoLS) had been submitted when required. Best interests meetings had been held if there was a concern that someone did not have capacity to make a decision. Staff had a good understanding of safeguarding; they were able to recognise different types of abuse and told us what actions they would take if they believed someone was at risk.

People were supported by staff who knew them well, staff were kind and caring and enjoyed looking after people. People told us they were happy with the activities provided. A new minibus had been purchased and they were awaiting delivery by the end of the month. A number of outings had already been planned.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we have taken at the back of the full version of the report.

At the time of our inspection the service provided care and support to 49 people.

We spoke with a number of people who used the service. Many were not able to express verbally their experiences of living in the home, but we observed people for interaction and signs of wellbeing.

We spoke with three visiting relatives and six staff members, this included the registered manager and activities co-ordinator. We also spoke with a health care professional who visited the home on a regular basis.

Below is a summary of what we found. The summary describes what people who used the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

People had been cared for in an environment that was clean and well maintained. We saw that services had the necessary checks carried out. Risk assessments were in place to provide information to staff to help minimise the risk of any harm to people. However, we noted that some of the care documentation was not accurate or up to date.

Staff told us that there was enough staff and they felt well trained in the work they undertook.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff were able to describe when a DoLS had been put in place in the past and why this had been used. Staff had been trained to understand when an application should be made, and the manager knew how to submit and review one.

Is the service effective?

We saw individual plans of care were in place. There was evidence to confirm that each person had their care plans reviewed on a monthly basis.

People and their relatives told us that the care provided was appropriate and met people's needs. Discussion with staff confirmed that staff knew and understood people's individual care and social support needs.

Training records seen confirmed staff had received appropriate training to meet the needs of people living at the home.

Is the service caring?

People were supported by kind and caring staff. We saw that staff were very kind and polite and gave people time when supporting them.

Our observations confirmed that people were encouraged to be independent, but were helped when they needed any support.

Is the service responsive?

Individual care plans were developed for each person following admission. People were given choices. People had access to activities and had been supported to maintain relationships with their friends and relatives.

Is the service well-led?

We saw that a number of quality assurance processes were in place. However, this did not include feedback from people who used the service and their representatives.

The home had a registered manager who had been in post a number of years. There were allocated team leaders to manage each of the three zones in the home. The team leader was supported by senior carers. Staff told us they were clear about their roles and responsibilities. Senior care staff worked in the home alongside more junior staff to lead and guide them. Staff said they were kept up to date with any changes as required and felt the home had a supporting team.

The improvements required to comply with the regulations in relation to records have been made.

We looked at a range of records within Clifden House and found they were kept securely and could be located promptly when needed. We saw people's personal records including medical records, were generally accurate and fit for purpose. One relative of a resident said, 'Their care plan is written down and I have been consulted about it. It looks at every aspect of their care.'

Care workers had a good understanding of the care needs of the people living in the home. We observed they attended to people's needs in a timely manner and showed patience and understanding when supporting people.

The improvements required to comply with the regulations in relation to the storage and administration of medicines had been made.

People were aware of how to raise concerns and make comments on the services provided. Complaints made had been responded to and investigated appropriately.

There were sufficient numbers of staff on duty to meet the needs of the people living in the home. However, the care workers were not allocated time to complete care records and the manager had no administrative support. The shortfalls in relation to records identified at the last inspection had not been addressed. We noted that not all the records maintained by the home were accurate, complete or fit for purpose. This meant that there was a risk that people had not been protected from the risk of unsafe or inappropriate care and treatment. Not all records containing personal information had been stored securely or kept confidential.

We spoke to 11 people using the service, five relatives, and one professional health worker. Some people had complex needs and were not always able to verbalise their experiences, so we observed the interaction between staff and other people closely.

Feedback from relatives and the visiting health professional was positive about the care and support provided at Clifden House. People who used the service made some positive comments about the care and staff working in the home. One person said, 'I am happy here they look after you really well. 'One visitor said, 'The care here is very good and the food is exceptional.'

We looked at the systems and processes in place for the safe management of medicines. We found that people were happy with how their medicines were given to them. We saw that care plans had information on the use of medicines. We found that there were some procedures in the service which did not follow safe practices with regard to medicine management.

We looked at records held in the home and how these were stored. Not all care records were up to date or reflected all the current needs of people using the service. We found that records were not always stored securely, or able to be located promptly.