11 January 2024
During an inspection looking at part of the service
Clare Mount is a residential care home providing personal and nursing care for up to 29 people in one adapted building. At the time of the inspection there were 27 people using the service.
People’s experience of using this service and what we found
Health and safety actions relating to fire safety, the electrical installation and the passenger lift required completion. Infection control checklists required further development and some areas of the home required refurbishment to promote infection control. Safeguarding systems were in place. Staff understood their responsibilities in relation to safeguarding and felt comfortable to raise concerns. There were sufficient numbers of staff to provide care and support to people promptly. Medicines were well managed.
Audits were carried out by the nominated individual and the operations manager to monitor the quality and safety of the service. However, there had been delay in starting some works assessed as high risk. The provider was asked to provide an initial action plan following the inspection to inform us about when and how they would make the required improvements. Relatives were complimentary about the staff and management team and said communication had improved.
Staff had received appropriate training. People were 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.
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 28 July 2022). The service remains rated requires improvement. This service has been rated requires improvement or inadequate for the last three consecutive inspections.
At our last inspection we made a recommendation about the audit and management of some medicines. At this inspection we found the provider had made improvements.
Why we inspected
We received concerns in relation to staffing, communication, safety and person-centred care. 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 remained the same based on the findings of this inspection.
We have found evidence that the provider still needs to make improvements. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘All inspection reports and timeline’ link for Clare Mount on our website at www.cqc.org.uk.
Enforcement and Recommendations
We have identified breaches in relation to safety 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 request a further 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.