Our inspection of Clover House took place on 26 November 2018 and was unannounced.

At our last inspection in March 2018 we rated the service as ‘Inadequate’ and the service was placed in ‘Special Measures’. We identified eight breaches of regulation. These were in relation to staffing, person centred care, safe care and treatment, meeting nutritional and hydration needs, dignity and respect, need for consent, safeguarding service users from abuse and improper treatment and good governance.

Clover House is a ‘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. The care home can accommodate up to 39 older people who may be living with dementia or other mental health problems. Accommodation at the home is provided over four floors, which can be accessed using a passenger lift. At the time of our inspection there were 18 people living at the service.

The service had a registered manager. 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 registered manager at Clover House is also the provider.

There were enough staff to safely meet the needs of people living at the home. Some people told us they felt this varied particularly at weekends but we did not see evidence of this from staff rotas.

Recruitment processes were followed to make sure new staff were safe and suitable to work in the care sector. Staff followed a thorough induction process. Staff had received training including specialist training. However, this was not always evidenced clearly on the training matrix. Staff received support from the registered manager through supervision.

Risks to people’s health and wellbeing were managed appropriately, although, the level of observation for a person at risk of leaving the home had not been updated on all related documentation.

Systems for managing medicines were safe. Some improvements were needed for recording the application of topical medicines.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. However, one person told us staff did not always respect their preferred times of getting up and going to bed.

People enjoyed the mealtime experience although better observation of people taking their meals outside the dining room was needed. Staff supported people to choose and enjoy a nutritious diet but improvements were needed in relation to the provision of special diets. We made a recommendation in regard. People had access to a range of snacks and drinks.

People were supported to access healthcare as the need arose. A district nurse praised the service for the care they provided.

People were treated with kindness, respect, compassion and emotional support. We observed carers interact with people during the day of our visit and they did so in a way that showed they knew people well and cared about their welfare.

We observed some examples of staff not always considering people’s dignity. For example, we found underclothing belonging to other people in people’s bedrooms and we saw people were routinely given crockery and cutlery suitable for people living with dementia when they didn’t need it.

Care records were person centred and there was evidence of people, or where appropriate, their representative, being involved in the development and review of their care plans.

Visitors told us they were happy with the care their relatives received and felt the home provided a good atmosphere.

An activities programme was in place and items such as books, games and rummage boxes we

This inspection took place over two days on 12 and 13 March 2018. The inspection was conducted because we received concerns in relation to provision of food, staffing and care practice. The last inspection of this service was completed in December 2016 and was given a rating of Good.

Clover House is a residential care home situated near to the centre of Halifax. The home provides accommodation, personal care and support for up to 39 older people who may be living with dementia or other mental health problems. Accommodation at the home is provided over four floors, which can be accessed using a passenger lift. At the time of our inspection there were 29 people living at the service.

The service had a registered manager. 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 registered manager at Clover House is also the provider.

There were not enough staff to safely meet the needs of people living at the home

Recruitment processes were followed to make sure new staff were safe and suitable to work in the care sector. Staff had received training but this was not evidenced in their practice. For example, although staff had received moving and handling training, we witnessed unsafe and inappropriate moving and handling manoeuvres.

Risks to people’s health and wellbeing were not managed effectively. For example people who were nutritionally at risk were not receiving nutrition to meet their needs and alarm systems were not being used properly to alert staff to falls in people’s bedrooms.

Medicines were administered as prescribed but systems for managing medicines required improvement. We made a recommendation in relation to this.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice.

Mealtimes were chaotic and people did not receive the nutrition and hydration they needed to maintain their health. People were not routinely offered choice of food and drinks.

We saw district nurses were involved in some people’s care. However staff had not referred people’s weight loss to the appropriate health care professional.

We observed some caring approaches from staff but people's privacy and dignity needs were not met.

Care records were not person centred and not always up to date.

Visitors told us they were satisfied with the care their relatives received.

An activities programme was in place but we saw little evidence of people engaging in meaningful activities during our inspection.

Complaints were managed in line with the complaints procedure.

There was little evidence of effective leadership. Staffing was not appropriately organised and systems for auditing the quality and safety of the home were not effective. Records relating to people who lived at the home were not well maintained or kept securely.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this time frame.

If not enough improvement is made within this time frame so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varyi

Our inspection of Clover House took place on 5 December 2016 in response to a number of concerns raised about the standard of care and was unannounced.

Clover House is a residential care home situated near to the centre of Halifax. The home provides accommodation, personal care and support for up to 39 older people who may be living with dementia or other mental health problems. Accommodation at the home is provided over four floors, which can be accessed using a passenger lift. At the time of our inspection there were 25 people living at the service.

There was a registered manager in post at the service who had been in this position for a number of years and was also the registered 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.

People felt safe in the home. Staff were trained to recognise abuse, appropriate safeguarding mechanisms were in place and referrals had been made to the local authority where required.

The home was well maintained and adapted to the needs of people living with dementia.

Accidents and injuries were documented, analysed and action plans put in place as a result. Risk assessments covered the environment and risks relating to the care and support of people living in the home.

Adequate staffing levels were in place which were assessed according to people's needs. Staff were knowledgeable about people and were appropriately trained. Robust recruitment procedures ensured staff employed were suitable to work with vulnerable people.

Medicines were generally safely managed with appropriate protocols in place.

People's care needs were assessed and appropriate plans of care put in place. These were person specific and reviewed regularly. However, although the service was mostly acting within the legal framework of the Mental Capacity Act 2005 (MCA), some people's Deprivation of Liberty Safeguards (DoLS) conditions were not reflected in their plans of care. Consent forms for care and support were in people's care records but these were not always signed. Some people or their relatives were involved in the planning and reviewing of their care.

Health care needs were met and communication was good with the multi-disciplinary team.

People were supported to consume a balanced diet and told us the food was good. Where people were at nutritional risk, referrals were made to the dietician.

The atmosphere in the service was relaxed and staff showed a caring attitude. The registered manager showed a passion for dementia care and staff told us they led by example and felt able to speak to the registered manager with any concerns.

Complaints were seen to be documented and actioned appropriately.

Activities took place although not always on a planned basis and the provider had purchased dementia friendly materials for these.

A range of checks and audits were in place with analysis and actions taken.

Staff morale was good and there was a positive culture apparent. Regular staff meetings were held and people's opinions of the service were sought through annual surveys.

This inspection took place on 8 April 2015 and was unannounced. At the last inspection on 8 May 2014 we found the service was meeting the regulations we inspected.

Clover House provides personal care for up to 39 older people who may be living with dementia or have other mental health needs. On the day of the inspection there were 24 people living in the home. Accommodation is provided over four floors, which can be accessed using a passenger lift.

The home has a registered manager who is also the owner of 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.

People told us they felt safe and staff were confident in how to identify and report any safeguarding concerns.

A refurbishment plan was underway to improve the environment but better systems were needed to ensure one job was fully finished before another was started. Certificates showed the premises and equipment were safe however improvements were needed in identifying and addressing maintenance works in a timely way. During our visit we noted some areas of the home felt noticeably cooler than others and the registered manager was arranging for contractors to be brought in to investigate the cause.

People received their medicines when they needed them. One recording anomaly had not been identified by staff but was dealt with swiftly by the registered manager when we brought it to their attention. People had access to health care services.

Staff were safely recruited and the Care Certificate standards were being used for induction. Staff training was up-to-date and systems were in place to ensure all staff received regular supervision and appraisal.

Staff understood and had implemented the legal requirements relating to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS).

People praised the staff for their kindness. We saw staff had a good rapport with people whilst treating them with dignity and respect. Staff had a good knowledge and understanding of people’s needs and worked together as a team. There were sufficient staff to deliver the care people required and care plans provided information about people’s individual needs and preferences.

People enjoyed the different activities available and we saw people smiling, singing and laughing as they joined in the afternoon tea dance. People told us the meals were good and we saw a choice of food and drink was offered throughout the day.

Complaints had been investigated and responded to appropriately.

The registered manager was visible working with the team monitoring and supporting the staff to ensure people received the care and support they needed. We saw quality assurance systems were used effectively to make improvements to the service.

The inspection visit was carried out by one inspector. During the inspection, they spoke with the home manager, who was also the provider, the deputy manager, the relief manager, a support worker, the cook, four people who lived at the home and one relative, who was a regular visitor. After the visit they spoke with another relative. The inspector also looked around the premises, observed staff interactions with people who lived at the home, and looked at records. There were 19 people living at the home on the day of the visit.

The majority of the people who lived at the home were unable to talk to us about their experiences, due to their advanced dementia and difficulty with verbal communication.

We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five key 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. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

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

Is the service safe?

We found the premises and grounds were being adequately maintained and the building was clean. The manager told us the home had cleaning staff who worked every day for six hours.

People who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises. Environmental audits at the home were regularly carried out and actions identified followed up in a timely manner.

Outside the building there was a suitable secure area, with a table, parasol and chairs, for people to enjoy if the weather was suitable. The relative we spoke with pointed out of a lounge window and told us, “They’ve improved the outside areas recently – it needed it though.”

Equipment was checked on a regular basis. For example slings were checked each time they were used, and the hoists had last been serviced in January 2014. Two people who lived at the home needed hoisting, hoists were kept in their bedrooms.

There were sufficient numbers of suitably qualified staff at the home. They manager said they were looking into using a dependency tool for working out staffing levels for all shifts. Two people who lived at the home needed hoisting by two staff, other people were independently mobile.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

Is the service effective?

We looked at two people’s care records and saw their individual needs were thoroughly assessed and care and support was developed from an assessment of their needs.

One person’s care record showed they had lost a significant amount of weight during a recent hospital stay. Records showed that this person had been putting on weight since they had returned to the home. When we spoke with the manager about this they told us the hospital had “almost given up on them.” They told us they had been complimented by the district nurses who visited the home for “bringing people back from the brink.” The inspector had also heard positive feedback from district nurses about the high quality of people’s care at the home when they had attended a multidisciplinary meeting.

People were provided with a healthy nutritionally balanced diet to support their health, this protected people from the risks of inadequate nutrition and dehydration.

The manager told us the senior care workers at the home had recently attended training relating to pressure area care. A support worker told us they were taking a degree in Health and Social Care. This showed the manager ensured staff had the required skills and knowledge for their job role.

Is the service caring?

We observed staff interactions with people who lived at the home were kind, caring and unrushed. Staff bent down to talk to people on their level, giving people enough time to understand and respond. When staff were delivering care or assistance we heard them talking to people and explaining what they were doing.

One member of staff we spoke with told us, “The care’s absolutely brilliant here towards the residents. I worked at another home up until recently and it’s a lot nicer here.”

The two relatives we spoke to were both happy with the care provided at the home. One said, “It’s okay, no major problems. There’s not a lot in the way of activities.” The other relative we spoke with said, “They always let me know if anything’s happened.”

When we looked around the home we saw people’s bedrooms had been personalised and contained personal items such as family photographs. We saw care records documented how to encourage people to maintain contact with their family and friends.

When we looked at care records we saw that people’s likes and dislikes were recorded. For example what they liked to eat and drink and what activities they enjoyed doing. Peoples’ care records also included life history information. This helped care staff to get to know people and to know how to engage with them.

Is the service responsive?

We saw from the care records that people’s needs had been assessed before they moved into the home. We saw and heard that the care, treatment and support provided to people who lived at the home met their individual requirements. Care plans and risk assessments were regularly reviewed and updated, taking account of peoples’ changing care needs.

The provider took account of complaints and comments to improve the service. Both relatives we spoke with told us they had never needed to make a complaint and had no concerns.

When we asked one relative whether there was anything that could be improved they told us they had raised concerns with the care staff because their mother’s hair often looked unkempt. They said, “She always liked her hair to look nice”. They told us the hairdresser did their mother’s hair every two weeks. When we asked them they said they had not raised this with the manager they said, “It’s not worth complaining about. She is very happy there.”

This relative also commented that people who lived at the home often had “food down their fronts.” We had also observed this during the afternoon on the day of the inspection; two people had spilled food on their clothes at lunchtime and care staff had not changed them.

Is the service well-led?

The manager at the home was also the registered provider. The manager also had responsibility, as the registered provider, for Bankfield Manor Care Home.

The manager told us they were due to start their maternity leave the week following our visit. They explained there were plans in place for the relief manager to increase their hours and manage the home while they were on maternity leave. They said the relief manager would work Monday to Friday at the home from 8am until 4pm; the relief manager normally worked mornings. They also told us the deputy manager was “more than capable” of stepping up into the manager role if the relief manager was off for any reason. They said the home had recently taken on three new support workers to ensure the relief manager could be freed up from providing care ‘on the floor.’

The manager told us they would be able to do some work from home while they were on maternity leave, and would be calling in at the home on a regular basis. They said, “I am confident that everything will be okay while I am off.”

People were protected against the risks of inappropriate or unsafe care because the provider had effective systems in place to assess and monitor the quality of service people received.

We carried out this inspection in response to anonymous information of concern which we had received.

On the day of our inspection we arrived at Clover House at 10am and met with the registered manager. They told us there were 25 people living at the home on that day. During our visit we looked around the home, including people’s bedrooms and bathrooms. We also observed people interacting with staff in the lounge and dining areas, and having lunch.

During the day we spoke with seven people living at the home, three regular visitors, the cook, the manager, the deputy manager and the relief manager. After the visit we contacted the home’s dietician and the local authority contracts department, in relation to the food provided for people living at the home.

Relatives and people we spoke with told us the care provided to people at the home was good. One person told us, “The staff are all lovely,” and another said, “It’s not like being at home but it’s okay,” a third person said, “They look after you alright,” and a fourth person said, “It’s not so bad really.”

When we asked people about activities one person told us “There’s not really a lot to do,” another person said, “I like the singing and dancing; we sometimes do a quiz.” We observed group activities taking place in one of the lounges during the afternoon of our visit.

All of the people we spoke with told us they were happy living at Clover House. They told us the staff were kind and caring. We observed care staff were kind, considerate, and respectful when they were talking with people and supporting them.

We looked around the home and found it was clean, odour-free and had systems in place to reduce the risk and spread of infection. We also looked at three peoples’ care records and evidence which showed people and their relatives were asked for their views about their care and treatment at the home.

During our visit we found evidence that suggested people’s nutritional needs were not always being met. We also noted that people’s complaints, comments and concerns were not always acted upon to their satisfaction. We have asked the provider to make improvements in these areas.

On the day of our visit there were 23 people living at Clover House. During our visit we observed people interacting with staff in the lounge areas and having lunch.

We also spoke with seven people living at the home, three regular visitors, seven staff, the registered manager and the deputy manager.

Staff we spoke with felt confident the care provided to people living at the home was good. They told us they felt well-supported by the manager and deputy manager.

We observed individual and group activities taking place during the day. When we asked people about activities one person told us “There’s not really enough to do. I do get bored sometimes.”

We asked people about the food and they told us it was good. One person told us “Breakfasts are best. You can have bacon and eggs as well as porridge if you want” and another said “You get a good choice. There’s always something I can eat.”

People living at the home and their relatives all told us they were happy living at Clover House and they got plenty of choices about their daily living. They all felt there were enough staff to help them and that the staff were good to them.

Comments included:

“It’s a nice place to be. All the staff are nice and I’ve got friends.”

“I’m delighted to be here. I’d give it 95 out of 100!”

“I’m absolutely happy here. I can have fun.”

“I don’t want to stop in my room because there’s some good people down here you can talk to.”

“I enjoy myself here. It’s a good place to be.”

During our visit we spoke with many of the people who live at the home, however due to complex care needs the majority of people were not able to give us their opinions on the service they receive.

Two people told us that they like the staff. One person said the home was fine but they didn't have anybody to talk to.

A person visiting their relative told us that they thought the home had improved recently and didn't have any problems.

A visiting community nurse told us that the staff at the home worked very well with them.

People who live at the home told us that the staff are kind and that they give then the help and support they need. They told us that they enjoy the meals at the home and are comfortable in their surroundings.