Claremont Court is a purpose built nursing home providing care to people across three floors. The home accommodates up to 57 people with nursing needs and specialises in providing care to people living with dementia. At the time of our inspection there were 54 people living at the home and all people were living with dementia.

This inspection took place on 04 May 2018 and was unannounced.

At our last inspection we rated the service Good with a rating of Requires Improvement in Responsive due to shortfalls in care planning, we made a recommendation in this area. At this inspection we found improvements had been made to care planning and the rating in Responsive had improved to Good. Evidence continued to support the overall rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

Why the service is rated Good.

People received safe care in which risks were managed and incidents were responded to appropriately. Medicines were managed and administered safely by trained nurses. People lived in a clean and safe home environment and plans were in place to keep people safe in the event of an emergency. There were sufficient numbers of staff at the home to keep people safe and checks were undertaken to ensure staff were suitable for their roles.

People were prepared food that matched their preferences and dietary needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. We made a recommendation about record keeping in relation to the Mental Capacity Act 2005. Staff had the training and support to carry out their roles effectively. People’s needs had been assessed and appropriate support was in place to ensure people’s healthcare needs were met.

People were supported by kind and compassionate staff that knew them well. The provider had systems in place to involve people in decisions and we found an inclusive atmosphere at the home. Staff encouraged people to retain skills and independence and care planning supported this. People’s privacy and dignity was respected by staff when receiving care.

People were very happy with the activities on offer at the home and we noted these matched people’s needs and interests. Care was planned in a person-centred way and we noted particularly positive outcomes were being achieved for people living with dementia. People’s care was regularly reviewed and records documented people’s wishes with regards to end of life care. Complaints were documented and responded to appropriately.

There was strong leadership at the home and people spoke highly of the management team. The provider had strong links with the local community that people benefitted from. Regular checks and audits were carried out and people’s feedback was gathered through surveys. Regular meetings were held which were used to involve people, relatives and staff in the running of the home.

Further information is in the detailed findings below.

This was an unannounced inspection which took place on 04 February 2016.

Claremont Court provides nursing care and accommodation for a maximum of 57 older people who may be living with dementia. They also provide respite care. (Respite care is a service giving carers a break by providing short term care for a person with care needs). Accommodation is provided over three floors. At the time of this inspection there were 53 people living at the home, all apart from one person was living with dementia. The age range of people was from 63 to 101. There was no one receiving respite care at the time of our inspection.

During our inspection the registered manager was present. 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.

Claremont Court was last inspected on 07 April 2015 when it was given an overall rating of ‘Requires Improvement’. Six breaches of Regulations were identified and requirement notices were issued. These related to medicines, consent to care, infection control, dignity and respect, staff levels and support and quality assurance systems. At this inspection we found that the requirement notices were met.

Everyone that we spoke with said that the manager was a good role model. Quality monitoring systems were in place that included seeking the views of people in order to drive improvements at the home.

People said that they felt safe and we observed that they appeared happy and at ease in the presence of staff. Potential risks to people were assessed and information was available for staff which helped keep people safe.

People told us that there were, on the whole, enough staff on duty to support them at the times they wanted or needed and we observed this to be the case during our inspection. Robust recruitment checks were completed to ensure permanent staff were safe to support people.

People said that they were happy with the medical care and attention they received and we found that people’s health needs and medicines were managed effectively. People’s needs were assessed and care and treatment was planned and delivered to reflect their individual care plan.

Staff were skilled and experienced to care and support people to have a good quality of life. New staff completed an induction programme and were provided with training and supervision after this. We did note that on some occasions staff did not respond appropriately to people who were living with dementia. We were given assurances that staff would receive further guidance about this.

People said that they consented to the care they received. Mental capacity assessments were completed for people and their capacity to make decisions had been assumed by staff unless there was a professional assessment to show otherwise.

People said that the food at the home was good and that their dietary needs were met. There were a variety of choices available to people at all mealtimes.

Equipment was available in sufficient quantities and used where needed to ensure that people were moved safely and staff were able to describe safe moving and handling techniques. Effort had been made to ensure the design and decoration of the home was suitable for people who lived with dementia.

Information of what to do in the event of needing to make a complaint was displayed in the home. During our visit we observed staff assessing if people were happy as part of everyday routines that were taking place.

People said that they were treated with kindness and respect. We observed interactions by staff to people that were warm, positive, respectful and friendly whilst remaining professional. We observed that staff routinely checked that people were happy with the support being offered.

This inspection was carried out on the 7 April 2015. Claremont Court is a service that is registered to provide accommodation and nursing care for 57 older people some of whom are living with dementia. Respite care is also provided. This provides temporary relief to those who are caring for family members, who might otherwise require permanent placement in a service outside the home. The registered provider is Carebase (Claremont) Limited. Accommodation is provided over three floors. The top floor is primarily for people who are more independent where some people are living with dementia, the middle floor is for people who are all living with dementia and the ground floor is for people who mostly have advanced dementia and have more physical needs. On the day of our visit 52 people lived at the service.

On the day of our visit there was a registered manager in day to day charge. 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 2014 and associated regulations about how the service is run.

There was not always guidance for staff in relation to the safe administration of people’s medicines. Where people needed an ‘As required’ medicine there was no information for staff on when this should be given. There was no guidance from the pharmacy on the best way to give covert medicines where people were receiving them. This is a breach of regulation 12 of the The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Medicines were stored appropriately and audits of all medicines took place.

Staff did not always have the most up to date guidance in relation to their role. The service’s mandatory training had not been completed by all of the staff and nurses were not up to date with their clinical knowledge which included wound and catheter care.

One to one meetings were not regularly undertaken with staff and their manager and appraisals had taken place for all staff. This is a breach of regulation 18 of the The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There were not sufficient numbers of staff deployed to meet people’s needs. People were left on their own in the lounge for periods of time which was a risk to their safety. These are a breach of regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People and relatives said they felt their family members were safe from abuse. However two relatives said that they were concerned that their family member was left on their own for too long.

The service was not always clean. There was a risk of infections spreading where soiled laundry had not been kept separate from un-soiled laundry. This is a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Risk assessments for people were up to date and detailed. Each risk assessment gave staff information on how to reduce the risk. These included risks of poor nutrition, choking and falls. Staff had a good understanding of each person’s risks.

There were complete pre-employment checks for all staff. This included full employment history and reasons why they had left their previous employment. This meant as far as possible only staff with the mix of skills and competencies were employed.

Staff had knowledge of safeguarding people and what to do if they suspected abuse.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes . Staff had knowledge of their responsibilities under the Mental Capacity Act 2005 (MCA), and the Deprivation of Liberty Safeguards (DoLS). However the registered manager had not submitted DoLS applications to the local authority for people in the service who’s liberty may need to be deprived. Where people lacked capacity and had bed rails, applications had not been to the local authority in relation to their liberty being deprived. These are breaches of regulation 11 and 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Staff gave examples of where they would ask people for consent in relation to providing personal care. We saw several instances of this happening during the day.

People were not offered a choice of meals. Menus were not available in a format big enough for people to see. Those people who needed support to eat did not always receive this in a timely way. This is a breach of regulation 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People and their relatives said that the food was good. We saw that there was a wide variety of fresh food and drinks available for people throughout the day.

People had access to external health care professionals as and when they required it.

There were times when staff were not considerate of people living at the service. One person’s radio had not been tuned in properly to a radio station for most of the morning which meant that they had not been able to listen to anything. This is a breach of regulation 9 of the Health and Social Care Act 2008 (Regulated Activities)

People and relatives felt that staff were kind. People were treated with kindness and compassion by staff throughout the inspection. Staff acknowledged people warmly and sat talking with people. Where people were anxious staff responded in a caring and reassuring way.

We saw that staff knew and understood people’s needs in relation to the care that they received.

People were not always treated with dignity and respect. People were being alternately supported to eat during meal times and staff were seen to stand over people to put food into their mouths. This is a breach of regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Staff knocked on people’s doors and waited for a response before entering and personal care was given in the privacy of people’s own rooms or bathrooms.

We were not provided with any evidence of how complaints had been addressed however there was a complaints policy which people and relatives had knowledge of.

People’s personal history, individual preferences, interests and aspirations were all considered in their care planning. Care plans provided staff with information so they could respond positively, and provide the person with the support they needed in the way they preferred.

Care plans were reviewed every month to help ensure they were kept up to date and reflected each individual’s current needs. We found instances where a change had occurred and care was changed to reflect this. Staff responded to people’s needs as and when they needed it.

There was a programme of activities in place and an activities coordinator who worked part time at the service. People were also supported to access the outside community.

Audits of systems and practices carried out were not always effective. Where concerns had been identified these were not always addressed. This is a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Staff said they felt supported and were listened to by the registered manager. Regular staff meetings took place and staff contributed to how the service ran. Meetings were minuted and made available to all staff.

Annual surveys were sent to the relatives who were very complimentary of the service.

You can see what action we told the provider to take at the back of the full version of the report.

When we inspected this service on 8 February 2013 we found the provider was not compliant with the Essential standards of quality and safety with regards to, cleanliness and infection control and maintaining accurate records. This inspection was carried out to check whether compliance had been achieved. We also inspected the staffing standard as concerns had been raised and we inspected further outcomes as part of our planned schedule of inspection.

The majority of people who used this service had dementia, therefore, in order to gain some understanding of their experiences we spent time observing the interactions between the staff and people who lived in this home. We did speak with three people who used the service and a relative who was visiting their family member.

People told us the staff looked after them well. One person said "They look after me well and treat us with respect". A relative said "The staff discussed my relative's needs before they moved here". This relative also told us "Care is brilliant, my relative is so much better, calmer and they have gained weight". We found the staff cared for people and met their assessed needs.

People we spoke with and a relative told us the home appeared clean. We found that since the previous inspection action had been taken to improve the cleanliness of the home.

A relative told us there were enough staff to meet their family member's needs. We found the staff numbers had increased since the last inspection.

We spoke with two people who used the service, three members of staff, the acting manager and the business manager.

People we spoke with said " My room is clean I see the cleaners here most days" and " I feel the home is clean". However, other evidence did not support these views for all areas of the service.

We looked at a sample of areas in the home because concerns had been raised with us that the cleanliness of the environment had not always been adequately maintained. Our observations confirmed that cleaning standards in four of the five bedrooms we saw and their en suite bathrooms and one communal toilet were inadequate.

The staff we spoke with had not had practical training in cleaning or infection control but had completed an e-learning course. The staff told us that they did not know there were any policies relating to infection control, despite these being kept in the service.

This meant that people using the service were at risk of infection and areas of the home would have been unpleasant for people to use.

We reviewed a sample of the records to demonstrate that people using the service had received the care they required. These were inconsistent and had not always been completed.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

We spoke to three residents in passing and held discussion with four others. We were told that it was a ‘happy home’ and that it was ‘comfortable.’

One person said that she had no regrets at coming to the home and that she was “Very happy. There are people to talk to and I have a nice room.” Staff were said to be respectful and treated people with dignity and kindness.

We were told by one resident that she liked to be surprised about the day’s entertainment or social activities taking place. Another said that she would like to go swimming and was hoping that this could be arranged.

People told us they felt safe and that their needs were met where required but their independence was also encouraged. Staff were described as helpful and we were told that if anything was required, staff could be approached.

In addition to the comments made directly to us we saw a number of testimonies in the comments book at reception. For example, ‘I am very happy with the staff, so kind. My mother is very happy.’ Another written comment said, ‘Lovely relaxed family atmosphere. It’s a joy to visit and excellent standards of care.’