This inspection took place on 6 January 2017 and was unannounced. We last inspected this service on 14 and 15 July 2016 and found that improvements were required to ensure people were safe and that their care was effective and caring. Improvements were also required in the way the service was managed.

Claremont House is a residential home in Leighton Buzzard, providing care and accommodation for up to sixteen older people who require personal care. There were fourteen people living at the home at the time of our inspection, some of whom lived with dementia.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People who lived at the home were safe because improvements had been made in the management of their medicines and in the way infection control was managed. Improvements had also been made in the staffing levels and there were now enough staff to meet people’s needs. Staff were trained in safeguarding and they knew how to keep people safe from avoidable harm. There were risk assessments in place to manage risk posed to people and the provider had robust policies and procedures for the safe recruitment of staff.

There were also improvements in the support that staff received in that there were now regular supervision meetings and appraisals of staff’s performance. Improvements had also been made in the management and understanding of the Mental Capacity Act 2005 and the associated Deprivation of Liberty. We found that staff were trained, skilled and understood their roles. They received an induction into the service at the start of their employment and supported people to eat a healthy and balanced diet.

People’s care needs had been identified prior to them living at the home, and appropriate care plans were in place to ensure that their needs were met in a consistent way. People’s care plans were reviewed as appropriate and they were supported in a personalised way by staff that were caring and friendly. Staff respected people’s privacy and dignity.

We found that improvements had been made in the way the service was managed, and in the quality of the service. There was a new registered manager in post, and they and the staff team were knowledgeable in their roles and responsibilities. There was also an improved quality assurance system in place to monitor and manage the quality of the service provided and in addition, the provider had an effective system in place for handling complaints. However, improvements were still required around the management of records particularly risk assessments. People’s personal risk assessments did not conform to current health and safety guidance on risk assessments. The environmental risk assessments were also not robust because they did not contain sufficient detail to guide staff on managing risk.

This inspection took place on 14 and 15 July 2016 and was unannounced. When we last inspected the service in September 2015 we found that improvements were required for the safety of the people who used the service, the effectiveness of the care and support they received, and in the way the service was managed. The service therefore had an overall rating of ‘requires improvement.’

Claremont House is a residential home in Leighton Buzzard, providing care and accommodation for up to sixteen older people who require nursing or personal care. There were fifteen people living at the home at the time of our inspection some of whom lived with dementia.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People who lived at the home were not always safe because their medicines were not managed appropriately, and the staffing levels were not always sufficient to meet their needs. They were exposed to risks of cross-contamination because of some poor practices around the management of infection control. Some parts of the home also appeared dated and needed to be refurbished. The provider however had safe recruitment processes in place and the staff were trained in safeguarding people from abuse. There were risk assessments in place to manage risked posed to people by aspects of their care and the home environment.

The service was not always effective because appraisals of staffs’ performance were not completed. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The requirement of the Mental Capacity Act 2005 and the associated Deprivation of Liberty were also not met. The staff were however trained, skilled and understood their roles. They received an induction into the service at the start of their employment and supported people to eat a healthy and balanced diet.

Staff were caring and friendly in their interactions with people and they respected people’s privacy and dignity. However, people were exposed to avoidable hazards around the home which was not reflective of a service that was caring.

The service was responsive to people’s needs. People’s care needs had been identified prior to them living at the home, and the appropriate care plans put into place. Their care plans were reviewed as appropriate and they were supported in a personalised way. The provider had an effective system in place for handling complaints.

The service was not always well-led. Some of the failings we raised during our last inspection had not been fully addressed. There were further failings noted within this and improvements were required in the quality assurance system in place.

When we visited Claremont House on 8 January 2014 we spoke with five people who used the service and one health care professional. We also spoke with four staff members including the deputy manager.

We observed good interactions between people and staff. People looked relaxed and comfortable in the company of staff. A health care professional said, “This home provides very good care. If I had a mother or father who needed care, I won’t have any hesitation to place them here.”

We found that the home had adequate arrangements in place for obtaining consent from people in relation to their care, support and treatment.

People were provided with a choice of suitable and nutritious food and drink in sufficient quantities to meet their needs. The home had systems in place to reduce the risk and spread of infection. Appropriate personal protective equipment was readily available for staff use. A staff member said, “We are never short of gloves and aprons. There is always an adequate amount available for us to use.”

We found that the premises were safe and adequately maintained. However, the garden was unkempt, which meant that people’s well-being may not be promoted. The equipment used in the home was safe and fit for its purpose. This meant that people were not at risk of unsafe equipment.

We found that the home had processes in place to ensure that complaints were appropriately addressed. Some amendments to the complaints policy were needed to ensure that information was current.

We spoke with six out of the fifteen people currently living at the home.

People told us they were well looked after by staff, who were very nice.

We were informed by people using the service that they were very happy with the care and support they received from staff.

People told us they felt safe living at Claremont House.

During our visit on 17 November 2011 we found the majority of staff treated people with respect and encouraged them to make choices about their day to day life. People told us, and we heard, staff speak with them in a kind and respectful manner.

The people we spoke with were all happy with the care provided at Claremont House. One person told us, “I can’t find fault. The attention, the food, the carers, I’d score them ten out of ten”

People said the staff knew how to support them and understood their needs. They said that call bells were answered quickly and staff didn’t mind if they kept calling for help.

We were told there was always a choice of menu, that the food was of good quality and is hot when served.

People who use the service made positive comments about the staff who care for them at Claremont House. People told us they felt that any concerns they raised with the manager or deputy would be addressed, that staff listened to them and that they trusted the staff who work at the home.

This inspection took place on 17 and 18 September 2015 and it was unannounced. When we inspected the service in January 2014 we found that the provider was meeting all their legal requirements in the areas that we looked at.

The service provides accommodation and care for up to 16 people with needs relating to old age. At the time of our inspection there were 14 people living at the home.

The home has a registered manager, who is also the provider. 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. At the time of our inspection the registered manager was on annual leave. The deputy manager was overseeing the home during the registered manager’s absence.

People felt safe in the home and staff understood their responsibilities with regards to safeguarding people.

People were supported by staff who knew them well and positive relationships had been formed. People had detailed care plans which reflected their preferences and included personalised risk assessments.

People were offered a range of activities and were encouraged to maintain their hobbies and interests.

People had been involved in planning their care and deciding in which way their care was provided. People were supported to make choices in relation to their food and drink and a balanced, nutritious menu was offered.

Staff were kind and caring. They treated people with respect and promoted maintaining people’s dignity.

Senior staff were approachable. People, their relatives and staff knew who to raise concerns with and there was an open culture.

During this inspection we found that there were two breaches of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was concerning the staffing level at the home and the appraisals of staff.

We also found there was a breach of Regulation 18 of The Care Quality Commission (Registration) Regulations 2009. This was concerning notifying the Commission of incidents that occur within a service.

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