Clare Court Care Home

Updated 3 February 2024

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

The inspection was carried out by 2 Inspectors, a Specialist Nurse Advisor and an Expert by Experience. 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

Clare Court Care 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. Clare Court Care 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 been in post for 2 months and had submitted an application to register. We are currently assessing this application.

Notice of inspection

This inspection was unannounced. Inspection activity started on 19 September 2023 and ended on 12 October 2023. We visited the location on 19 and 20 September 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. 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 sought feedback from the local authority and professionals who work with the service. We used all this information to plan our inspection.

During the inspection

We spoke with 10 people using the service and 11 of their relatives. We spoke with 13 staff, including the manager, regional managers, carers, senior carers, nurses, and housekeeping staff. We sought information from external professionals working with the staff team. We reviewed a range of documents including 12 care plans and other records of care monitoring. We looked at multiple medication administration records. We reviewed policies and procedures and quality assurance checks and documentation. We reviewed three staff files. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

Updated 3 February 2024

About the service

Clare Court Care Home is a nursing home providing accommodation, personal and nursing care to up to 80 people. The service provides support to older adults and people living with dementia. At the time of our inspection there were 61 people using the service. The home is split into three floors. The ground floor accommodates people who require residential care, the middle floor provides support to people living with dementia and the top floor accommodates people with nursing care needs. However, there were people on all floors living with dementia. Everyone had en-suite facilities in their rooms. People shared lounges and a separate dining area on each floor. There was also a communal garden area.

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

The management team had not always investigated how serious injuries had occurred at the time of the injury. Risk assessments did not always provide enough guidance to robustly manage risks. Relatives of people receiving care and staff felt staffing levels were not always adequate. We found evidence of the inappropriate use of low-level restraint without assessment and guidance for staff. We saw significant improvements in medicines management.

People’s care was not always person centred and did not always reflect their wishes. Monitoring and recording of food and fluid consumption for people at risk of losing weight was not adequate. People enjoyed the food served to them. We saw improvements in staff induction training and support.

We saw and heard evidence about examples of both poor and good practice with regard to promoting dignity respect and independence. We saw examples of staff not respecting people’s privacy and not treating them in a dignified way. Some people and relatives told us staff were respectful of their privacy and dignity.

People and their relatives told us they felt there was not enough for them to do. This particularly impacted people who were mainly cared for in their rooms.

Systems to monitor the care people received and ensure they were safe and well, were not effective. Opportunities to learn when things had gone wrong had been missed.

People were not always supported to have maximum choice and control of their lives and staff did not always 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.

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 08 September 2022) 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 the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part by notification of an incident involving a person who was using the service . The information shared with CQC about the incident indicated potential concerns about the management of risk of falls. This inspection examined those risks.

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

The provider has put together an action plan based on the concerns found at this inspection and has stated they are working to address all areas of concern. The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

Enforcement

We have identified continued breaches in relation to lack of personalisation of people’s care, management of people’s safety, staffing levels and deployment and systems and processes to monitor overall quality of care. We identified a new breach in relation to protecting people from the risk of abuse. We found the service was no longer in breach with regard to how it was supporting people in line with the Mental Capacity Act (MCA) 2005.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an 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.

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.