This was an unannounced inspection that took place on 15 October 2018.

Claremont Care Home is registered to provide accommodation and care for up to 24 older people, some of whom were living with dementia. The home is situated in a residential area of Sale, Manchester and is close to public transport and the motorway network. At the time of this inspection, there were 24 people living at the service. Claremont Care Home is a 'care home', people in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

We last inspected Claremont Care Home in March 2018. At that inspection, we found multiple breaches of regulations, the service was rated inadequate in the well-led domain and rated requires improvement overall. We also issued a warning notice with regards to the lack of evidence to demonstrate ‘Good Governance’. At this inspection, we found no regulatory breaches and improvements had been made in each of the five key questions of safe, effective, caring, responsive and well-led.

A manager was in place at Claremont Care Home; they had previously been the deputy manager at the home. The manager was in the process of registration with CQC. 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.

During our last inspection in March 2018 we found aspects of the home was not safe. For example, we found a cupboard on the ground floor bathroom was unlocked which stored hazardous substances, such as cleaning products. At this inspection we found cleaning materials and other substances hazardous to health were now appropriately stored in a locked cupboard to minimise the risk of people being harmed.

At the last inspection, we found other issues affecting the safety of the environment. The provider did not have a risk assessment in relation to Legionella. Legionella is a type of bacteria that can develop in water systems and cause Legionnaire's disease that can be dangerous, particularly to more vulnerable people such as older adults. At this inspection we found the provider ensured the service undertook an external comprehensive legionella risk assessment in April 2018, which indicated the risk posed to people living in the home of contracting legionnaires disease was low.

Through our observations of staff interacting with people and from conversations with the staff, it was clear that they knew the people they provided care for well. They understood people's preferences, likes and dislikes. They also had a good understanding of people's past lives, which enabled them to participate in meaningful conversations with people.

People's needs were assessed before they moved to the home and care plans were in place to inform staff of their needs and how they should be met. Staff worked with other health care professionals to maintain people's health and wellbeing.

People’s care plans had improved and were person-centred and comprehensive yet easy to navigate and information was readily accessible. Each care plan also contained a one-page profile that provided key information about the person.

There were effective and established systems in place to safeguard people from abuse and individual risk was fully assessed and reviewed. Accidents and incidents were recorded and appropriate actions taken.

Medicines management and administration processes were reviewed during the inspection and found to be safe.

We observed the mealtime experience and found this to be relaxed and well organised. People received any help, support and encouragement they required to eat and drink prom

We inspected Claremont Care Home on 6 and 7 March 2018. The inspection was unannounced, so this meant they did not know we were coming.

At the last inspection on 6 and 8 February 2017, the service was rated as requires improvement. We found three breaches of the regulations, as improvements were needed in the management of medicines, appropriate checks of Legionella had not been carried out, staff were not trained in key subject areas and the registered provider had not ensured good governance in the home. We conducted this inspection to review whether sufficient improvements had been made since the last inspection. We found that some improvements had been made, but further improvements were required.

Claremont Care Home is a privately owned residential home that provides care and support for older people some of whom are living with dementia. The home accommodates up to 24 residents in 22 single and 1 shared rooms. It is situated on a main road and has small car parks to the front and rear of the premises. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our inspection there were 17 people living in the home.

At the time of our inspection the registered manager had resigned four days before our inspection. 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. The deputy manager was available to take over managerial responsibilities until a decision had been made by the provider who was going to become the homes permanent manager.

During our tour of the home we noted a potential safety hazard. We found a cupboard in the ground floor bathroom was unlocked which stored hazardous substances, such as cleaning products. The premises had not been made secure to minimise the risk of people unintentionally touching or drinking the hazardous substances with the potential of causing themselves harm.

During this inspection, we found other issues affecting the safety of the environment. The provider did not have a risk assessment in relation to Legionella. However, we found the provider had completed routine sampling to help control the risks of legionella. Legionella is a type of bacteria that can develop in water systems and cause Legionnaire's disease that can be dangerous, particularly to more vulnerable people such as older adults.

We noted some areas of the home that would benefit with being refurbished, for example carpets in the communal areas were stained and the curtains in some people's bedrooms were in need of cleaning or being replaced and some communal chairs needed replacing due to rips in the cushions. We noticed areas around the home would also benefit from re decoration. The décor around the home appeared tired; the paintwork was scuffed and the carpets in high traffic areas of the lounge and downstairs corridor were showing signs of wear and discoloration. We discussed this with the provider who acknowledged our observations, but did not provide assurances that the home would be refurbished going forward.

Care records were inconsistently completed and lacked detail about people's care and support. Care plans had not been effectively reviewed to ensure their current needs and preferences were known. The monitoring of people's care and support was inconsistent. For example, records relating to a person’s late stage kidney disease had not been recorded to guide staff how they needed to be supported with this long term condition. Furthermore, we found one person who had received end of life care did not have a detailed end of life plan in

We inspected Claremont Care Home on 6 and 8 February 2017. The first day of the inspection was unannounced. This meant the home did not know we were coming. Our last inspection took place on 18 and 22 December 2015. At that time we rated the service as requires improvement overall.

Claremont Care Home is a privately owned residential home for older people. The home accommodates up to 24 residents in 22 single and 1 shared rooms. It is situated on a main road and has small car parks to the front and rear of the premises.

At the time of our inspection there was a registered manager employed by the service. 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.

Feedback received from people using the service we spoke with was generally complimentary about the standard of care provided. People living at Claremont Care Home told us the manager was approachable and supportive.

People's healthcare needs were being met, however, we found medicines were not always being managed safely. Staff were not always signing medicine administration records (MAR) to confirm they had administered people’s medicines. We also noted one person’s medicines had been left with the person to take, however this was not safe practice because the senior on duty could not be assured the person had taken their medicines.

Potential safety hazards were identified as we walked around the home. The owner of the home acknowledged our concerns and was keen to address these issues.

Appropriate plans were in place to guide staff in how to minimise risks to keep people safe. Staff knew what action to take to ensure people were protected if they suspected they were at risk of harm. They were encouraged to raise and report any concerns they had about people through safeguarding and whistleblowing procedures.

We found that risks assessments were updated when risks had been identified, however, care plans did not always capture people’s assessed needs.

Three of the four care plans we looked at did not have information about people’s particular preferences at the end of their life and whether they had been given the opportunity to discuss this. We have made a recommendation that the service takes advice from a reputable source, about end of life training for care staff and on supporting people to express their views and decisions about their care, treatment and support at the end of life.

We observed staff interacting with people in a positive, respectful and friendly manner. People told us staff were kind and caring. Staff were able to describe how they would support people to retain their independence and we observed aspects of this during the first day of inspection, particularly during the lunch time meal.

The requirements of the Mental Capacity Act 2005 (MCA) were not being fully met as staff lacked knowledge of the Act. The registered manager had submitted Deprivation of Liberty Safeguards applications where appropriate.

People's nutritional needs were met and people had a varied diet, and opinions about the quality of the food were positive. Staff ensured that people had enough to eat and drink. Staff ensured people were supported to maintain their health and wellbeing and people received support from specialist healthcare professionals when required.

We found staff received regular supervision; however there were gaps in the provision of training. We noted gaps in health & safety, first aid, dementia awareness, and food hygiene training. The provider told us they had booked additional training shortly after our inspection. However, we found the registered manager’s training audit had failed to identify these shortfalls prior to our inspection.

We noted that the environment

Claremont Care Home was last inspected in June 2014 when it was found to be meeting the regulatory requirements which applied to a home of this kind.

The current inspection took place on 18 December 2015 and was unannounced. The inspector returned to complete the inspection on 22 December 2015.

Claremont Care Home is a privately owned residential home for older people. The home accommodates up to 24 residents in 22 single and 1 shared rooms. It is situated on a main road and has small car parks to the front and rear of the premises.

There is a registered manager at the home. 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.

We found that the people who lived in the home and their relatives were pleased with the service provided by the staff. They felt safe and said that there were sufficient staff who knew about them and so provided personal care which met their needs. People were able to exercise choice whilst living at the home and staff had a good idea of people’s preferences and how to provide care in a way that met these and took them into account.

The home had a key worker system which meant that each person was allocated to a named member of staff who would look after certain requirements and make sure that personal care needs were addressed. Most people told us that they thought the food was good. Medicines were administered safely for those who wished to have help with this.

Communal areas of the home were clean but we had some concerns about other aspects of infection control. Record-keeping did not always confirm that personal care had been provided or other requirements had been met. Some attention was required to fire precaution arrangements and policies and procedures needed revision. We have included some recommendations in respect of these areas of concern.

One inspector carried out the inspection. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found-

Is the service safe?

We saw evidence to demonstrate people who lived at the home or their relatives were involved in decisions relating to their care. Care plans were in the process of being updated. We saw the new format was easy to read and contained detailed information for staff on how they should provide care and support which kept people safe.

There were procedures in place to help staff identify and therefore prevent abuse from occurring. Staff were aware who they should contact, both internally and externally, should they suspect someone had been the victim of abuse.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We saw policies and procedures were in place and the manager was able to explain the procedure for submitting an application if one were needed.

We looked at a sample of staff recruitment files and saw they contained the appropriate safety checks such as: a Disclosure and Barring Service check. Application forms, references and training records showed staff had the skills and experience required to support people who lived at the home.

We spoke with three people’s relatives who told us, “I have absolutely no concerns about the care.” “I know (My relative) is safe here.”

Is the service effective?

We spoke with staff who demonstrated a good understanding of the needs of the people they cared for.

We saw documentary evidence to show staff supervision was taking place on a regular basis to assess staff performance and identify training needs.

We spoke with staff who told us they felt well supported by the manager and providers. They told us they had access to training relevant to their role.

We spoke with three relatives who told us: “The staff here are all lovely, I would recommend the home to anyone.” We spoke with a visiting general practitioner (GP) who told us they visited the home regularly and had no concerns about the care provided at the home. They told us they thought the manager and staff responded well to any advice or instructions relating to people’s health care. The GP told us where people were receiving care at the end of their life this was provided with sensitivity and compassion.

Is the service caring?

We saw staff approached people in a sensitive, friendly and compassionate manner. We spent time observing staff interacting with the people they cared for. We saw staff encouraging and supporting people in a calm and relaxed way.

We saw staff were spending time sitting with people chatting whilst writing up daily records. An activities coordinator arrived after lunch and people were able to decide if they wanted to take part in the beauty treatments.

We spoke with six people who lived at the home who told us: “They (staff) treat me with respect and they explain things to me.” “They are all very kind to me.” “We have a laugh with them (staff).” “They (staff) help me if I need help; they work hard; they always have a smile for you and are caring.”

Is the service responsive?

We saw evidence to show people’s care needs had been assessed before they moved into the home. This was to ensure the home was the most appropriate place to meet the person’s needs. Care plans recorded people’s care needs and the action required from staff to meet needs.

Care plans contained information about people’s interests and preferences so care and support was provided in the way the person wanted. Our observations showed staff had a good understanding of people’s care needs. The people we spoke with told us: “They know me and what I like.” “I can’t praise them enough.”

A visiting GP told us requests for visits were appropriate and they were not called out unnecessarily. We were told communication between the home and the surgery was good and if they were unsure of something the manager would ring for advice.

We saw the most recently completed relative survey forms in people’s care plans. Within the survey forms relatives had indicated the provider listened to and acted upon comments and were; “Very accommodating.”

Is the service well-led?

The manager had been in post for six months and had not yet made application to register with the Care Quality Commission (CQC). We discussed this with the manager who told us they would submit an application as soon as they had all the necessary documents in place.

The manager told us they were introducing a different care plan format and a number of systems to monitor the quality of service provided for people. These included care plan reviews, daily environmental checks and observations. They told us a resident and relative survey was carried out to obtain people’s views and opinions on the service they received. The manager told us results of the survey were used to improve the service.

Staff and relatives of people who used the service spoke positively about the manager. The staff we spoke with told us, “The manager is approachable.” “You can speak to the manager.” “They have made some changes but it is good.” Relatives told us, “The communication is good if anything happens we are informed straight away.”

We visited Claremont Care Home on 26 September 2013 and there were 22 people resident at that time. There was an acting manager, who was not on the premises on the day of our visit, but no registered manager in place. Interviews were due to commence to appoint a new manager.

Appropriate policies and procedures were in place and up to date and staff members were aware of how to access them and the correct procedures to follow.

We saw five care records which contained relevant health, medical information, monitoring charts, risk assessments and personal profiles. Wishes and preferences were recorded and people who used the service and their relatives were included in discussions about their care.

We spoke with two visitors and four people who used the service. One visitor said, “I visited a large number of homes and chose this one because the level of care impressed me”. One person who used the service told us, “I have never regretted coming here. I’m well looked after, well fed and we have a happy time together”.

We spoke with four members of staff who demonstrated an awareness of both safeguarding and capacity issues. Staff felt they were well supported and said that seniors and the provider were approachable. Staff meetings were held regularly, however some training needed to be brought up to date.

Complaints were taken seriously and followed up appropriately and regular audits were carried out. The results were analysed and improvements made as appropriate.