The inspection took place on 13 and 15 June 2018. The first day of the inspection was unannounced. This meant that the provider and staff did not know we were coming. We last inspected the service in June 2016 and at that time identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breach was related to safeguarding.We took action by requesting the provider send us an action plan stating how and when they would achieve compliance. During this inspection we found that the service was no longer in breach of this regulation. Some action had been taken to ensure that safeguarding referrals were reported appropriately. However, we found a further breach relating to records and good governance. You can see what action we told the provider to take at the back of the full version of the report.
Clarendon Court 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.
Clarendon Court accommodates up to 55 people across three separate units, each of which have separate adapted facilities. One of the units specialises in providing care to people living with dementia. At the time of the inspection there were 54 people receiving a service.
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.
Overall, people and relatives were complimentary about the care and support provided at the home. The home was very clean and well maintained.
In the main, any safeguarding concerns had been identified and reported appropriately to the local authority and CQC. However, we found two examples where local safeguarding procedures had not been followed. Staff needed to follow reporting procedures when the registered manager was not at the service.
Whilst in most cases action had been taken to mitigate any risks, records were not always complete and up to date. Staff spoken with could explain action taken to manage any identified risks more safely. However, care plans and risk assessments did not always provide staff with clear information and guidance about potential risks and how these should be managed.
Staffing levels were calculated using a tool based on the dependency of people living at the service. We reviewed the dependency tool which indicated that there were sufficient numbers of staff to meet people’s needs. Staff were recruited using safe practices. People received their medicines safely, we noted that staff needed to ensure they were aware when people needed regular monitoring, when taking certain medications.
People received sufficient to eat and drink and staff acted to address any concerns. However, we found in some cases that care plans were not always updated with the latest information. People were positive about the food available.
Where possible staff enabled people to make their own decisions and we observed staff obtaining verbal consent from people. Staff understood and complied with The Mental Capacity Act 2005 (MCA)and where people lacked capacity to consent we saw that mental capacity assessments and best interest decisions were recorded.
People were supported by suitably skilled and knowledgeable staff. Staff were up to date with training and received regular supervision and appraisals.
Staff were kind and caring in the way they approached people. People told us that were treated with dignity and respect. People received care that was centred around their individual needs and staff were aware of people's individual preferences. People and their relatives were included in decisions about their care.
Care plans were in place for each person. Those for wound care showed good evidence that specialist opinion was sought from the tissue viability team. Most parts of the care records were recorded well, however some care plans had not been consistently updated and records were not always signed or dated.
People could take part in person-centred activities and were encouraged to maintain hobbies and interests. The activities coordinator was very motivated. There were a range of activities available which people could choose to take part if they wished.
People and relatives were positive about the management of the service. They told us they were in regular contact with the staff and the registered manager, who was very approachable and were always kept up to date. Staff were positive about the support they received from the management team.
There were some quality assurance processes in place and audits were carried out on a regular basis. Despite the quality assurance and audit systems in place, these were not effective as care plans did not always record the needs of people adequately and safeguarding procedures had not always been followed.