The inspection was carried out on 23 November 2015 and was unannounced. At the time of our inspection there were 23 people living at Clare Lodge.
Clare Lodge is care home for up to 24 older people or people living with a dementia. There were two people who were on end of life care pathways at the time of our inspection.
There was a manager in post who had registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.
The Mental Capacity Act (2005) provides a legal framework for making particular decisions on behalf of people who may lack mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. Where they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.
People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes are called the Deprivation of Liberty Safeguards (DoLS).
We checked whether the service was working in line with the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. At the time of the inspection we found that people’s freedoms had been restricted by the service to keep them safe and some applications were completed and awaiting authorisations while others were in progress. Staff had received training in Mental Capacity Act 2005 (MCA) and were aware of how to protect people’s rights. People were asked for their consent before staff carried out any care or support.
People told us that they felt safe and well cared for by the service, relatives confirmed their relatives were kept safe. Staff had received training in how to safeguard people from abuse and knew how to report and elevate concerns, both internally and externally.
There were safe and effective recruitment practices in place to ensure that staff were suitable to work with vulnerable people. There were sufficient numbers of staff on duty to meet people’s care and support needs. However people told us staff at the weekend had less of a ‘presence’, so it felt like there were less of them, although rotas confirmed that the numbers were the same. The manager told us they did not work at the weekend and also there was no admin staff or laundry staff so there were fewer staff around.
Staff were appropriately trained in how to administer medicines safely and we saw that they supported people to take their medicines regularly and at the right times. Potential risks to people’s health and well-being had been identified and were reviewed and managed effectively.
People were supported to participate in a range of activities, some provided by staff and some provided by outside entertainers who visited the home.
Staff were respectful of people’s privacy and dignity. We saw that interactions between staff and people were positive, caring and respectful. Staff were observed to be patient, when assisting people and demonstrated a good knowledge of people’s needs and wishes.
People and their relatives told us that they were listened to and complaints were investigated, recorded and responded to appropriately. There was a clear complaints procedure which was also in pictorial form. We saw many letters and cards of gratitude and saw that compliments and comments were also recorded.
People were offered a choice of food and drinks and people told us the food was good. There were arrangements in place for people who required additional dietary support. Staff supported people to maintain their health and wellbeing.
There were effective systems in place to monitor the quality of the service and there were on-going plans in place to demonstrate the manager and staff worked hard to achieve continuous improvement. The manager had undertaken a survey which was sent to all stakeholders about the quality of the service including people who used the service, their family and friends and professionals. The results had been evaluated and actions were in place where required.