Clare Mount

Clare Mount is a residential care home providing personal and nursing care for up to 29 people in one adapted building. At the time of the inspection there were 27 people using the service.

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

Health and safety actions relating to fire safety, the electrical installation and the passenger lift required completion. Infection control checklists required further development and some areas of the home required refurbishment to promote infection control. Safeguarding systems were in place. Staff understood their responsibilities in relation to safeguarding and felt comfortable to raise concerns. There were sufficient numbers of staff to provide care and support to people promptly. Medicines were well managed.

Audits were carried out by the nominated individual and the operations manager to monitor the quality and safety of the service. However, there had been delay in starting some works assessed as high risk. The provider was asked to provide an initial action plan following the inspection to inform us about when and how they would make the required improvements. Relatives were complimentary about the staff and management team and said communication had improved.

Staff had received appropriate training. 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.

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 28 July 2022). The service remains rated requires improvement. This service has been rated requires improvement or inadequate for the last three consecutive inspections.

At our last inspection we made a recommendation about the audit and management of some medicines. At this inspection we found the provider had made improvements.

Why we inspected

We received concerns in relation to staffing, communication, safety and person-centred care. 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.

The overall rating for the service has remained the same based on the findings of this inspection.

We have found evidence that the provider still needs to make improvements. 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.

You can read the report from our last comprehensive inspection, by selecting the ‘All inspection reports and timeline’ link for Clare Mount on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safety and governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request a further 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.

Clare Mount is a residential care home providing personal and nursing care for up to 29 people in one adapted building. At the time of the inspection there were 20 people using the service.

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

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.

People received their medicines as prescribed but some records relating to the management and administration of medicines needed further auditing and updating.

Safe systems of staff recruitment were in place. Staff knew people well and there were sufficient numbers of staff to meet people’s needs. Staff had received training in safeguarding and were aware of their responsibilities. Risks to individuals and staff were identified and well managed. All the required health and safety checks were taking place. The provider was managing the risks related to COVID-19.

Assessments of people’s needs were person centred and gave staff the information they needed about what was important to and for the person. Staff received the induction, training and support they needed to carry out their roles effectively. Staff were very positive about recent in depth training they had received. People’s nutritional needs were met, and most people were very positive about the food. The home was clean, improvements had been made to the decor and furnishings of the home. Some repairs and improvements were still needed. People’s health needs were met.

Throughout the inspection, staff were observed to be kind and caring. Staff were friendly, happy and attentive. They knew people well and people knew the staff who were supporting them. People, and where appropriate their families, were involved in decisions about their care.

Detailed person-centred support plans and risk assessments were in place to guide staff. There was a range of activities on offer. Relatives told us they felt involved and were made to feel very welcome. There was an appropriate system in place to manage complaints. The service was following the Accessible Information Standard (AIS). People's wishes for end of life care and support were identified and recorded.

Systems for auditing, quality monitoring and oversight had been improved. The systems and improvements we saw during our inspection needed to be embedded further and required a longer-term track record of sustained improvement and good practice. Everyone spoke positively about the registered manager, the changes and the way the home was now run. People told us the atmosphere and support provided had improved. A relative said, “Nothing is ever too much trouble for the team. They do everything they can to accommodate [person] and myself.” People told us the registered manager and staff were approachable and helpful.

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 8 December 2021, republished 11 June 2022 with additional actions) 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. The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

At our last inspection we recommended that the provider ensured all staff understood the principles of MCA and DoLS. At this inspection we found the provider had acted on the recommendation and improvements had been made.

This service has been in Special Measures since 8 December 2021. 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 inspection was carried out to follow up on action we told the provider to take at the last 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.

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

Recommendation:

We have made a recommendation about the audit and management of some medicines.

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.

Follow up

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

Clare Mount is a residential care home providing personal and nursing care for up to 29 in one adapted building. At the time of the inspection there were 26 people using the service.

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

Medicines were not managed safely which placed people at risk of harm. Risks to people’s health, safety and wellbeing were not managed safely and there was a lack of guidance in place to support and manage people’s behaviours. People’s health needs had not always been escalated and there was a delay in people receiving timely healthcare.

There was a high turnover of staff at the home and communication was poor. The majority of staff did not have English as their first language and some did not always actively try to engage with people living at the home. Staff records showed that staff had received training, but could not always demonstrate this learning. There was a lack of training for staff around support for people's behaviours that challenged and most staff had no previous experience of working in care.

Care records were not detailed enough and there was conflicting information in people’s care plans. There was a lack of personalised care at the service, shared laundry and a lack of stimulation. There were limited social activities on offer for people and some people told us that their television and radio were broken. People’s spiritual and religious needs were not being met.

We received mixed feedback from people and their families about the service. Relatives told us there was a lack of communication at the service and a lack of privacy and dignity for people. Some relatives told us people's rooms were not always clean. There was a lack of oral healthcare for people and people's health needs were not always met. The culture was poor at the service and people's humans rights were not being upheld.

People generally told us that the food was good and one relative remarked how their family member’s weight had increased since being at the service. Professionals that had recently visited the service gave positive feedback about the staff, who they said were caring and helpful. Staff we spoke with told us that the registered manager was supportive and team meetings were taking place.

People were not always 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 systems in the service did not support this practice.

Staff did not always follow infection control procedures and the home was not clean in some areas.

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 13 January 2021).

Why we inspected

We received concerns in relation to staffing and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective, responsive and well-led only.

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 inadequate. This is based on the findings at this inspection.

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

The provider had taken action to mitigate the risks following inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Clare Mount nursing 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care, staffing, person centred care and good governance at this inspection. We have also made a recommendation around mental capacity and DoLS.

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

Follow up

We will request an action plan for 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 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.

Clare Mount is a residential care home providing personal and nursing care to up to 29 people in one adapted building. At the time of the inspection there were 22 people using the service.

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

People and their relatives told us they felt safe. Feedback from people and their relatives was very positive. Staffing levels were appropriate and staff had been recruited safely. Three quarters of the staff team were male. We have made a recommendation about the consideration of a more balanced gender mix of the workforce.

Staff wore appropriate Personal Protective Equipment (PPE) and infection prevention and control procedures were in place. Where maintenance issues with tiling had been identified on the first day of inspection, these had been actioned swiftly once the home had re-opened.

The environment was clean and people had access to a range of activities. Communication passports and life histories had been completed to ensure care was person-centred.

Staff told us they enjoyed their jobs and felt well supported by the registered manager, who was always there for them. There was evidence of continuous learning and good outcomes for people. The registered manager was passionate about providing a good standard of care and had good oversight of people's needs.

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 3 December 2019) and there were multiple 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 undertook this targeted 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 infection control. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with infection control, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe, responsive and well-led. 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 requires improvement to good. This is based on the findings at this inspection. Please see the safe, responsive and well-led sections of this full report.

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.

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

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 had not ensured the premises were secure or properly maintained. Risks were generally well managed however some records of care provided were contradictory or incomplete. All the required checks on staff had not been completed before staff started to work at the home. Staff understood their responsibilities to protect people from harm or abuse. Medicines were managed safely.

Staff received the induction, training and support they needed to carry out their roles. People's nutritional needs were met. Everyone told us they enjoyed the food. People’s health needs were met. Adaptations including signage had been made to help those living with dementia find their way around.

People told us they were treated with dignity and respect. Staff interactions were kind and caring. They spoke in a respectful manner and demonstrated kindness and respect. They had a good rapport with people who lived in the home and knew them well.

Records did not always identify or reflect people’s personal preferences. There was a range of activities on offer but they had not always been developed in line with peoples interests and preferences. There was a suitable complaints procedure.

The provider’s systems for the oversight and monitoring of the quality of the service were not sufficiently robust. People spoke positively about the registered manager.

The provider had notified CQC of significant events such as safeguarding concerns.

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

Rating at last inspection

This service was registered with us in October 2018 and this was the first inspection.

Why we inspected

This was a planned inspection based on our published methodology.

Enforcement

We have identified breaches in relation to the security and maintenance of the premises, records of care provided, governance systems, staff recruitment checks and identifying and meeting people’s preferences. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for 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.