What life is like for people using this service:

Everybody we spoke with told us that they were happy with living at Clarendon House. They said that staff were caring, that they received their medicines on time, that the food was tasty, and that staff treated them with respect.

People told us that they were able to make their own decisions and could choose what they want to eat, when they want to get up or what time they wanted to go to bed. Relatives and friends were able to visit people who used the service and people maintained good links with the community.

The service had close links with various health care professionals to ensure that people’s health and wellbeing was managed appropriately.

We observed that staff had good relationships with people who used the service and care was delivered in a person-centred way.

If people required equipment, the manger ensured that he liaised with the relevant professionals. The environment was homely and generally well maintained.

Staff had access to a variety of training to ensure they had the right knowledge and skill to meet people’s needs.

Staffing levels were appropriate to meet people’s needs and everyone told us that there were sufficient staff deployed.

The provider had appropriate systems in place to ensure people who used the service were safe from avoidable harm. Risk assessments provided sufficient detail to ensure that staff knew how to manage risk.

The manager undertook regular checks which ensured that quality of care provided was monitored and any improvements were made if required. People who used the service, relatives and staff spoke very positively about the manager and told us that the team worked very well together, which ensured people who used the service received a good service.

More information is in the detailed findings below.

Rating at last inspection: Requires Improvement (date last report published) 10 January 2018.

About the service: Clarendon House Residential Dementia Care Home is a residential care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. Clarendon House Residential Dementia Care Home is a care home that provides personal care and accommodation for up to six older people who live with dementia.

Clarendon House Residential Dementia Care Home is a family business. The service is owned by Mr and Mrs Kritikos. The registered manager is Mrs Kritikos, who does not work at Clarendon House Residential Dementia Care Home. The service is managed by Mr Kritikos. However, the registered manager does not work within the service. The service is managed by Mr Kritikos.

Why we inspected: This was a planned inspection based on the rating at the last inspection. During our last inspection we rated the service requires improvement. During this inspection we found the service had made the required improvements and was no longer in breach with regulations.

Follow up: We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

This inspection was carried out on 16 November 2017 and was unannounced.

During our last inspection in October 2015 we rated the provider overall Good.

Clarendon House Residential Dementia Care Home is a residential care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

Clarendon House Residential Dementia Care Home is a care home that provides personal care and accommodation for up to six older people who live with dementia.

There was a manager registered with the Care Quality Commission (CQC). The registered manager covered two services and the provider employed a designated manager at Clarendon House to provide consistency and a constant presence. 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.

Medicines, in particular controlled drugs, were not always managed safely. Storage, recording and administration of controlled drugs did not comply with the relevant legislation.

Risks to people who used the service in relation to the treatment or care were assessed and management plans were put into place to mitigate such risks. However, the lack of servicing the stair lift on a regular basis might have put people under unnecessary risk.

The service did not have a formal quality assurance monitoring system, which resulted in shortfalls in relation to medicines management and the operation of equipment used to lift people.

People were protected from abuse and staff had the appropriate skills and knowledge to understand the different forms of abuse and knew how to report them appropriately.

The home was clean and free of unpleasant smells and staff followed appropriate infection control procedures.

Accidents and incidences were discussed with staff and looked at to see if similar incidents and accidents could be avoided in the future.

People were assessed to ensure treatment or care provided was suitable to their needs.

Staff received the appropriate support, supervision and training to ensure that they had the right skill set to support people who used the service.

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.

People who used the service were provided with wholesome, nutritious and home cooked meals, which were prepared according to their likes and dislikes.

The home worked well with external health and social care professionals to ensure people’s differing health care needs were met.

Overall people lived in a well maintained and homely environment, which was suitable to their needs.

Staff were observed to support people with kindness and respect, people were consulted prior to care or treatment was provided and they were encouraged to maintain their independence.

People’s privacy and dignity was respected and staff understood that people were allowed and able to make their own decisions.

Care was person centred. Reviews of people’s care records ensured that people’s changing needs could be responded to and be met.

Complaints made by people who used the service were taken seriously and were investigated to ensure lessons were learned.

While the service did not provide specific end of life care, people were supported to be as comfortable as possible if they fell ill or if their health deteriorated.

The management at the home was visible, approachable and supportive. People who used the service, relatives and staff spoke positive about the care and support provided by the manager.

We found three breaches during this in

We carried out an unannounced comprehensive inspection of this service on 15 October 2015. A breach of Regulation 13 HSCA 2008 (Regulated Activities) Regulations 2014 Safeguarding services users from abuse and improper treatment was found. We found that that applications to deprive people from the liberty had not been made and care workers did not receive training on the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). After the comprehensive inspection, the provider wrote to us on 15 December 2015 to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection on 4 February 2016 to check the provider had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Clarendon House Residential Dementia Care Home on our website at www.cqc.org.uk.

Clarendon House Residential Dementia Care Home is a care home that provides personal care and accommodation for up to six older people who have dementia care needs. On the day of the inspection there were six people residing at the home.

During our focused inspection on 4 February 2016 we found that the provider had taken the necessary steps to ensure that people were not deprived of their liberty and care worker received the appropriate training in MCA 2005 and DoLS.

We carried out this unannounced comprehensive inspection of this service on 15 October 2015. During our last inspection on 28 August 2014, we found the provider met the regulations we inspected.

Clarendon House Residential Dementia Care Home is a care home that provides personal care and accommodation for up to six older people who have dementia care needs. On the day of the inspection there were six people residing at the home.

There was a registered manager in post. 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.

People told us they felt safe at the home and safe with the staff that supported them. They told us that staff were attentive, kind and respectful. They said they were satisfied with the numbers of staff and that they didn’t have to wait too long for assistance.

The registered manager and staff at the home had identified and highlighted potential risks to people’s safety and had thought about and recorded how these risks could be reduced.

Not all staff demonstrated understanding of the principles of the Mental Capacity Act 2005 (MCA); however, we observed practices which demonstrated that people were asked to make their own decisions. We found that the provider did not make appropriate applications to the supervisory body under Deprivation of Liberty Safeguards (DoLS). For example, people were under continuous supervision and were not able to access the community without staff supervision.

People told us they were happy with the food provided and staff were aware of any special diets people required either as a result of a clinical need or a cultural preference.

There were systems in place to ensure medicines were handled and stored securely and administered to people safely and appropriately.

Staff were able to demonstrate that they had the knowledge and skills necessary to support people properly. People told us that the service was responsive to their needs and preferences.

People had good access to healthcare professionals such as doctors, dentists, chiropodists and opticians, and any changes to people’s needs were responded to appropriately and quickly.

People told us staff listened to them and respected their choices and decisions.

People using the service and staff were positive about the registered manager. They confirmed that they were asked about the quality of the service and had made comments about this that were acted on.

We found one breach of regulations. You can see what action we told the provider to take at the back of the full version of this report.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, is the service effective, is the service caring, is the service responsive, is the service well led?

During the inspection, we spoke with one person who used the service and two relatives. We spent time observing and also spoke with two care workers, the registered manager and their deputy.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Staff understood their role in safeguarding the people whom they supported. They knew how to report any concerns they had to the manager and document any concerns promptly.

The home had systems in place to identify assess and manage risks relating to the health, welfare and safety of people who used the service. People's health, safety and welfare were protected and equipment to meet their care needs was provided if they required it.

The Care Quality Commission monitors the operation of the Deprivation of Liberty

Safeguards (DoLS), which applies to care homes. The registered manager knew when an application for deprivation of liberty would need to be submitted for authorisation.

There was a robust system in place to ensure the home was kept clean and people were not put at unnecessary risk of infection

Is the service effective?

Relatives of people using the service told us they were happy with the way their relatives were treated and staff were ‘very nice and welcoming’. People's care needs had been assessed and care and treatment were planned and delivered in a way that promoted people's safety and welfare. Risk assessments had been carried out where necessary. Care plans had been regularly reviewed with involvement from people and those who were important to them.

Staff told us there was good communication amongst staff about the service and people's needs, which enabled them to carry out their roles effectively in providing the care and support people needed. They told us regular team meetings helped them keep informed.

Is the service caring?

We saw staff interact with people who used the service in a respectful manner supported and encouraged people to participate in activities. The relatives of the people using the service told us they were confident people were safe. Staff were seen using a variety of techniques to communicate with people and offering reassurance if they became distressed.

Is the service responsive?

People received individualised care that was responsive to their interests and preferences. Staff made sure people were supported to take part in activities they had enjoyed for many years including gardening and watching sport on television.

The manager conducted audits to ensure the standards of care given were met and monitored and did respond to issues as they arose. People's care and health were monitored closely. Written notes about people's health and care were completed by staff.

Is the service well-led?

The home had an experienced registered manager who was supported by a deputy manager. Checks to monitor the quality of the service were carried out. Staff meetings took place regularly so staff views about the service were taken into account. Staff were clear about their roles and responsibilities and felt well supported by management staff. The management team had systems in place to support workers.

We spoke with one person who used the service, two representatives of people who used the service and three care staff. One representative told us that they were ‘delighted’ with the care provided. Another representative told us that ‘staff were caring and always willing to help’. One person who used the service told us that ‘people were nice’.

Since our last inspection in May 2013, we noted that the registered provider had implemented a new care plan format from October 2013.

Care records we looked at indicated that the needs of people had been attended to and contained risk assessments where necessary.

We observed that there was good interaction between staff and people who used the service.

We looked at the staff rota for October 2013 and noted that the members of staff working on the day of the inspection was correctly recorded in the rota. However, we observed that the rota we were shown on the day of our inspection had not been changed to reflect that one member of staff had recently left the home. This was addressed by the provider after the inspection.

We observed that the home had various policies. It was however not clear when these were last reviewed.

We carried out an unannounced late night inspection following concerns raised with regards to the home. As a result, at the inspection we focused on Outcome 13 Staffing, Regulation 22 and Outcome 21 Records, Regulation 20 (HSCA 2008 Regulated Activities).

During the inspection we spoke with member of staff who was working during the night shift and we also spoke with one person living at the home. This person told us that he was “happy” at the home.

We observed that people appeared to be happy and comfortable. The atmosphere at the home appeared relaxed and people who used the service were watching TV together in the lounge.

Following a safeguarding concern received, we checked whether the doors of the bedrooms of people who used the service were locked and found that none of the doors were locked.

During the inspection we noted that there was no current staff rota and that there were no up to date records of the shifts staff worked. This meant that it was not evident that the health, safety and welfare needs of people who used the service were being met at all times. We also noted that people's care records were not always updated with necessary information regarding their care and progress.

We spoke to all the people using the service. Most people were able to tell us about the service that they received. A person with communication needs gestured, nodded or shook their head in response to the questions that we asked. People told us that they felt safe and received the care they needed and wanted. People were very positive about the staff that supported them.

People’s care plans were regularly reviewed and included detailed information about the individual support and care that people using the service needed. People were involved in decisions about their care. People’s independence and skills were promoted and supported by staff. We saw that people using the service were involved in carrying out some household tasks.

People were supported and encouraged to make decisions about their lives. During the inspection people decided what they wanted to eat and what they wanted to do.

People’s health, safety and welfare were protected as they received the advice and treatment that they needed from a range of health and social care professionals.

Staff knew about their roles and responsibilities in meeting the needs of people who use the service and they supported people in a friendly and respectful manner.

There were enough skilled and experienced staff to meet people’s needs.

Records were accurate and up to date.

During our visit to Clarendon House Residential Dementia Care Home, we spent most of the time talking to people using the service to gain their views about what it was like living in the home. Some people due to their varied health and communication needs had difficulty in speaking to us but they gestured, nodded or shook their head when answering questions.

People told us they were happy living in the home, liked their bedrooms, enjoyed the food and chose what to eat. People confirmed they had their needs met, and had the opportunity to participate in activities of their choice. During our visit people showed signs of ‘well being’. People were seen to be relaxed, they smiled and laughed and approached staff without hesitation.

People informed us they received the care and support they wanted and needed. They told us they received advice and treatment from health and social care professionals.

People including visitors and a care manager told us that staff listened to them and were approachable. People confirmed they felt safe living in the home and knew who to talk to if they had any worries or concerns.

Staff spoke of enjoying their job supporting and caring for people at Clarendon House Residential Dementia Care Home. They confirmed there was good teamwork and felt well supported by management staff.

Comments from people using the service included; “I get up when I want”, “I like the food,” “I am happy here, it’s very nice,” I can choose what I want,” “I like the staff,” “Staff help me,” “They talk to me,” “I’ll tell staff if there are issues,” “I like the garden, I sometimes sit outside,” “It’s a good home,” and “It’s a nice atmosphere,” and “I like my bedroom.”

Visitors and a care manager spoke positively about the service provided to people. Comments included; the home is “homely,” staff are “nice and friendly,” my relative is “very well cared for,” and “I am very happy with the care.”