Archived: St Clare's Care Home

People’s experience of using this service: The rating for the service has improved to Good.

People were not always receiving personalised care that was responsive to their needs. People’s care plans were not always updated to reflect the care provided. The requirements of the Accessible Information Standards were not consistently met. Activities were organised but some people were at risk of social isolation. Not everyone had enough to do to keep them occupied and socially stimulated. We recommended that the provider finds out more about providing meaningful occupation, based upon current best practice in relation to the specialist needs of people living with dementia.

Improvements had been made in safeguarding people from abuse and improper treatment. Staff understood their responsibilities to keep people safe and to report any concerns. Notifications had been made to the appropriate authorities. People and their relatives told us that they felt safe.

Risks to people were assessed and managed. There were enough suitable staff to care for people safely and the provider had robust recruitment procedures. People’s medicines were administered safely and infection control procedures were robust. Incidents were recorded and monitored and lessons were learned when things went wrong.

Staff received the training and support they needed. Staff understanding of their responsibilities regarding the Mental Capacity Act 2005 had improved. 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. Communication was effective within the team and people’s needs were assessed in a holistic way taking account of people’s diverse needs and their preferences. People were supported to have enough to eat and drink and to access health care support when needed.

People and their relatives told us that staff were kind. One person said, “I find the staff caring, respectful and considerate.” People were supported to express their views and to make choices about their care and support. People’s independence was encouraged as much as possible. Staff understood the importance of maintaining confidentiality and protected people’s dignity. Staff were knowledgeable about end of life care. People and their relatives were supported to plan for end of life. Staff respected people’s wishes and their needs were anticipated to plan for a comfortable and dignified death.

People and their relatives knew how to complain and felt confident that any concerns would be dealt with appropriately. Complaints and their resolutions were recorded and this information had been used to make improvements at the home.

Improvements had been made in how the home was managed. Systems for ensuring quality and monitoring practice had improved. Governance arrangements were robust and provided the registered manager and the provider with clear oversight of practice. The registered manager was aware of areas of practice that needed to improve and when we brought issues to their attention they could demonstrate that work was already in progress to make improvements. People, their relatives and staff described visible leadership in the home and said they were included and involved in developments. Staff had developed positive relationships with other agencies and worked effectively in partnership to achieve good outcomes for people.

Rating at last inspection: Requires Improvement, the last inspection report was published on 30 March 2018.

Why we inspected: This was a scheduled inspection based on the previous rating. Following the last inspection, the provider had submitted an improvement plan on 23 April 2018.

Follow up: ongoing monitoring.

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

At the last inspection in June 2015 the home was rated Good.

St Clare’s Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

St Clare’s Care Home provides nursing or personal care for up to 60 adults over 65 years of age, some of who are living with dementia. At the time of our inspection there were 59 people living at the home. Accommodation is provided in a purpose built, two story building set in large grounds in a rural area of East Sussex.

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.

People told us they felt safe, staff knew how to recognise and report abuse. However, staff told us at times they were using unplanned restraint. We found when allegations against staff had been made, the Care Quality Commission and local authority had not always been notified.

Where risks to people were identified, some of the risk assessments lacked information and guidance for staff to follow to reduce the risks.

Medicines were stored and administered safely, where people required staff to support them to apply topical creams, consistent application records were not always kept.

People’s rights were not fully protected because consent to care and treatment was not always sought in line with current legislation.

People’s care records were not consistently accurate. There was a system in place for people and their relatives to be involved in reviewing the care people received.

The systems and processes in place to monitor and drive improvement were not fully effective at identifying shortfalls in the service.

There were enough staff available to meet people’s needs, the service was using agency staff to cover vacant shifts and they endeavoured to use the same staff where possible to aid consistency. The provider followed safe recruitment procedures.

People were protected from the risk of infection and the provider ensured people lived in a safe environment because regular checks on the environment were carried out.

Staff felt they received enough training to meet people’s needs, they commented positively about the training and support they received.

People received adequate nutrition and hydration and they commented positively about the dining experience. Consistent records were not always kept where people had their fluid intake monitored.

People were supported to see health professionals when required and staff acted upon their guidance.

The provider had plans in place to improve the environment to meet the needs of people who were living with dementia.

People and their relatives spoke positively about the staff supporting them. Our observation of staff interactions were positive. Staff described how they supported people in a way that promoted their privacy and dignity. Staff spoke positively about the people they supported.

There were a range of activities on offer for people to take part in. Our observation of people’s engagement in activities was mixed.

People, their relatives and staff had the opportunity to provide feedback on the service and where feedback was given, the provider had acted upon it.

People and their relatives knew who the registered manager was, and they felt able to approach them with any concerns. People, their relatives and the staff spoke positively about the registered manager.

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

The manager had listened to comments people and their relatives had made and used these to implement changes to improve the quality of care provided in the home.

We spoke with eight people about their experiences of living in the home. One person told us "in the whole of the UK there couldn't be a better care home than this" and another person said "it's absolutely excellent. I'm looked after really well". We spoke with two relatives who told us they thought the home was very good.

We spoke with six members of staff who told us they felt well supported by the manager. One member of staff told us "the care here is very good" and another said they had worked and visited several homes in the area and specifically chose to work at St Clare's.

We spoke with twenty people and one visitor. Everyone told us they were satisfied with the care they or their relative received. We saw records that showed people were involved in developing their care plans. People said they understood their care plans and that staff had explained things to them and what they could expect whilst staying at St Clare's. We saw how staff worked with people, at their own pace, to make sure they knew what support was needed and how best they could meet that need.

We found that all of the records we reviewed were accurate, up to date and had been regularly reviewed and evaluated.

People were protected against the risks associated with medicines because appropriate arrangements were in place to manage medicines.

We looked at staff records and found staff were recruited using a robust system and saw there were good systems in place to ensure staff were well supported in their work. Staff said they made every effort to provide a person centred service.

People said they were treated very well and their experiences in the home were positive and that they felt valued. People told us that if they had a complaint they would talk to the manager and they were confident any issues would be dealt with properly.

People told us that the nurses gave their medicines to them regularly when they were due. One person said that although they looked after their own medicines when they were in their own home, they were happy for the nurses to look after their medicines and liked 'being waited on'. Another person said that the staff trusted them and left medicines for them to take in their own time. This meant that people were given their medicines to them in their preferred way.

We found gaps in the way the home was recording information about medicines which meant that the home had not taken the appropriate steps to ensure that people received the right medication at the right time.