This inspection took place on 21 and 22 November 2018 and was unannounced on the first day.

At the last inspection in October 2016, the service was rated Good. At this inspection we found some concerns with the quality of the service. Medicines were not consistently managed in a safe way and improvements were needed with aspects of the recruitment process and the care recording systems. We have rated the service Requires Improvement.

Clarendon Hall Care Home accommodates up to 52 people. The building is purpose built with lift and stair access to the first floor. Accommodation consists of single occupancy rooms over two floors. There are communal areas on the ground floor, including a dining room and a range of sitting rooms. At the time of this inspection 44 people were using the service.

Clarendon Hall 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.

The service had a registered manager in post. A registered manager is a person who has registered with the 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.

There were shortfalls in the administration and recording of some people’s medicines. People had not always received their medicines as prescribed due to stock control or administration practices.

Staff demonstrated a good awareness of safeguarding procedures and knew who to inform if they witnessed or had an allegation of abuse reported to them. The registered manager was aware of their responsibility to liaise with the local authority where safeguarding concerns were raised and such incidents were managed well.

The provider's systems to assess, monitor and improve the quality of the service provided had not been effective in identifying and addressing all the issues highlighted during our inspection, although the area director acted during the inspection to speak with senior staff, implement new supplementary recording systems and direct senior staff to complete additional audits.

People told us they enjoyed the food. A choice of food and drinks was always available. Improvements were needed with regular weight monitoring when there was increased risk identified and with the records to support the action staff had taken when people experienced poor or reduced intake. We have made a recommendation about improving the recording of people’s weights and their food and fluid intake.

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. There were some inconsistencies with consent records as it was not clear if some people had legally appointed attorneys to make decisions on their behalf. We have made a recommendation to improve consent recording and staffs understanding of this.

Overall, there were safe systems in place to manage risks to people’s health and safety. One person’s risk management plan was amended during the inspection to provide more detailed guidance for staff around their safety when eating and drinking. Accidents and incidents were reviewed to identify any actions that could be taken to prevent a reoccurrence and keep people safe.

The environment was clean and tidy and staff had access to personal protective equipment to help prevent the spread of infection. Health and safety checks were undertaken and there were appropriate procedures in place in the event of an emergency.

Staff had received training in how to safeguard people from the risk of abuse. They knew what to do if they had concerns.

Sufficient number

This unannounced inspection took place on 18 and 19 May 2016. The service was last inspected on 10 July 2013 when the service was found to be compliant with the regulations inspected.

Clarendon Hall is a purpose built home and is registered to provide accommodation for nursing and personal care for up to 52 people, some of whom may be living with dementia. Accommodation is provided on two floors with lift and stair access. All rooms are for single occupancy and some of these have en- suite facilities. The service is located on the outskirts of Grimsby, with public transport facilities close by. There is ample car parking available. At the time of our inspection there were 40 people using the service.

There was a registered manager in place. 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 told us they felt safe and trusted the staff. Training had been provided for staff about how to keep people safe from harm. Staff were employed following a robust recruitment and selection process, to ensure they were safe to work with vulnerable people and did not pose a risk to them.

Staff demonstrated a positive understanding for the promotion of people’s personal dignity and privacy, whilst involving them in making choices about their lives. Staffing levels were assessed according to the individual needs and dependencies of the people who used the service. People’s private records and information was maintained in a confidential manner.

The registered manager and staff were following the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS); they ensured people were not being deprived of their liberty in an unlawful way.

People told us they enjoyed their food and their nutritional status was monitored to ensure risks from malnourishment and dehydration were acted on with involvement of specialist health care professionals when required.

People told us that staff were caring and kind and they were happy with the support that was delivered to them. People were provided with a good variety of opportunities for social stimulation and interaction to enable their wellbeing to be promoted. People and their relatives were involved in the planning of their support which was reviewed on a regular and on-going basis. A complaints policy was in place to ensure people could raise any concerns about the service when required.

People told us the leadership at the service was approachable and supportive and they were encouraged to give their views and opinions about the service to enable it to continually improve. The registered provider promoted an open and transparent organisation and staff were supported through regular training, supervision, team meetings and annual appraisals to help them to develop their careers. The service had an effective auditing system to assess and monitor the quality of the service provided.

The registered manager was aware of their responsibilities and submitted notifications about incidents affecting the health and welfare of people who used the service to the CQC as required.

There was a positive and friendly atmosphere throughout the home and we observed staff interacting with people, providing gentle encouragement to enable their involvement in decisions about their support.

We observed staff offered choices about support that was provided to ensure people’s dignity was maintained. Relatives and people who used the service told us they were regularly consulted about their individual wishes and feelings, to ensure these were promoted.

People told us their health needs were well met and that staff took prompt action to involve external professionals when this was required. A visiting district nurse told us the service worked well with her team and followed advice that was given.

People told us they were, "Happy" with the care that was provided and that staff were, "Helpful and kind." People said they felt, “Comfortable” and "Safe." Relatives told us that concerns were taken seriously and that action was taken to address shortfalls that were required.

We found the service had an in house programme of induction and mandatory training for staff to follow, to ensure they were equipped with the skills needed to carry out their jobs.

We saw evidence that range of systems were available to enable the provider to monitor the quality of the service that was delivered. We found that regular audits and monthly reports were carried out, on key performance indicators such as accidents, complaints, medication and use of bed rails.

People who used the service told us that they were involved in making decisions about the support that was provided and that staff respected their needs and wishes.

People who used the service told us that they were “Very happy” with the care that was provided and that staff “Look after me very well.”

People living in the home told us their health needs were met and that staff took prompt action to involve external professionals when needed.

People using the service said that staff were “Helpful and kind.”

People using the services said that they felt “Safe” and that concerns were taken seriously by the manager.

Recent relative feedback included the following comments:

“Thanks for your kindly excellent caring.”

“A big thank you to all who have looked after our mother.”

“Heartfelt appreciation.”