Claremont Nursing Home

Updated 22 February 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

One specialist nurse advisor and 2 inspectors (one who specialised in medicines) carried out this inspection. An Expert by Experience spoke with people who used the service. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Claremont nursing home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Claremont nursing home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. A new manager had started in post in November 2022 but was not yet registered.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 10 people who lived at the home to hear their views about the care they received. We also observed staff providing support to people. We spoke with the manager, regional manager, service development and regulation director, a health care practitioner, the deputy manager, and a visiting paramedic linked with the GP practice who visited the home weekly. We reviewed 6 care plans, 21 medicines records, and documents relating to maintenance of the service. We requested further records such as audits, staff meeting minutes, and supervision records sent to us electronically.

After the inspection we spoke with 2 care assistants, and 7 relatives. We also received feedback from the local authority quality monitoring officer, a tissue viability nurse and a safeguarding practice consultant/social worker.

Updated 22 February 2023

About the service

Claremont Nursing home is a purpose-built care home providing personal and nursing care. The home is split into two separate ground floor units, Claremont House and the Lodge. Nursing care is provided to people living in Claremont House whilst specialist dementia care is provided to people living in the Lodge. At the time of our inspection 42 people were living at the service. The service can support up to 52 people.

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

Improvement was needed to ensure people always received good quality, compassionate, individualised and safe care as a minimum standard.

Actions to detect, investigate and report allegations of abuse or neglect were not sufficient. Adults at risk were not always effectively safeguarded in a timely manner. The local authority had received a high number of safeguarding referrals from relatives and external professionals raising concerns about people’s care. Due to the poor record keeping within the service, some concerns had been difficult for the local authority to investigate.

People did not always receive personalised care that met their needs. Some care records were poorly completed and did not reflect that people were receiving care in accordance with their assessed needs.

Staff had not ensured that risks relating to the development of pressure ulcers were fully mitigated, and that pressure relieving equipment in place was suitable and in line with best practice guidance.

Where people were at risk of falls, or had sustained falls, systems were not sufficiently robust to mitigate risk as far as possible; individual data was not being reviewed to identify themes or trends to reduce risk.

Staff had not always received regular supervision that ensured good practice within the service. Clinical training had not always been completed by all registered nurses, and training relating to falls prevention and pressure area care was not set as mandatory for staff to complete to ensure they were sufficiently skilled. Staff told us, and we observed, they were very rushed when supporting people, and felt they could not spend quality time with people. Some people told us that they had to wait for staff to respond to their request for support. Staff were recruited safely.

Auditing processes had not been effective. Analysis of accidents and incidents were not robust. Some areas we identified as requiring improvement at the last inspection continued to be unmet. This included completion of documentation to ensure people’s assessed needs were being met, and the management of risk.

People were mostly 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.

Improvements were found in the management of people’s medicines with some minor improvements still required. Where the supply of people’s medicines had been an issue, staff had not always followed incident procedures, so that the issues could be promptly resolved.

Infection control procedures across the home were improved. However, some further improvements were required to ensure complete cleanliness within the home.

Systems and processes designed to identify shortfalls, and to improve the quality of care were not always effective. While some improvements were noted since the last inspection in February 2022, on-going concerns were raised on this inspection.

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 24 February 2022).

We issued the provider with a Warning Notice, notifying them that they were failing to comply with the relevant requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and a timescale by which they were required to become compliant. We undertook a remote review of the Warning Notice in November 2022, and found not all areas had been met.

At this inspection we found the provider remained in breach of regulations.

Why we inspected

We received concerns in relation to people’s nursing care needs and safeguarding procedures. 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 changed from requires improvement to inadequate based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, staffing, safeguarding 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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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.