About the service:

Clyde House is a residential care home which provides accommodation and personal care for up to 17 people with a mental health need. There were eight people living at the home when we completed the inspection, but one person was in hospital at the time of us undertaking our visit.

At the time of the inspection, the home was undergoing extensive renovation and there were plans in place to change the model of care. It is intended that in the near future, the current provider will apply to register Clyde House with the Care Quality Commission (CQC) as a supported living service for up to 11 people.

People’s experience of using this service:

• Despite the renovation noise, there was a calm and relaxed atmosphere in the home and people spoke with excitement about the changes being made to the environment.

• People told us they were settled at the home and happy with the care and support provided.

• Staff were responsive to people’s changing needs, but support plans hadn’t always been updated when changes had been made. This meant determining the current clinical picture and control measures in place to manage risks was difficult to determine from the information recorded.

• 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 saw people leaving the home independently and accessing the community throughout the inspection.

• There were issues identified during the inspection, which included the storage of confidential records and the security of the building. We found the main door unlocked and left on the catch which would enable unauthorised people to enter the home undetected which could pose a risk to people living there.

• All safety certificates and required risk assessments were in place. Medicines were managed safely, and staff were responsive to people’s needs to support them to remain compliant with their treatment.

• The staff were quick to identify changes in people’s presentation and worked closely with other health professionals, so people’s health and well-being was maintained.

• The home had consistent management and oversight by a registered manager who was an integral part of the care provided and whom people and their relatives spoke fondly of.

• Opportunities were provided for people who used the service, their relatives and staff to feedback their views and experiences through surveys and meetings.

• People and their relatives told us they had no cause to complain, but indicated they would have no hesitation in raising a concern with the registered manager and felt it would be sorted promptly.

• People living at the home conversed with the registered manager throughout the inspection and people’s relatives told us the registered manager was well known to them and their family member and they had confidence in their leadership.

• Relatives told us they would recommend the home to others looking for this type of care setting.

Rating at last inspection: The home was rated Requires Improvement when we last visited the home in September 2017. The report was published 05 December 2017. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Following the last inspection, we received an action plan dated 15 December 2017 detailing what action had been taken following our inspection to meet the regulatory requirements. We also met with the provider in December 2018 to receive a further update regarding the actions they had put in place. At this inspection we found a breach of regulation 12 so the service continues to be rated as Requires Improvement.

Why we inspected: This was a planned inspection based on the previous rating for the home.

Follow up: We will return to re-inspect the home in line with our inspection timescales for Requires Improvement. However, if the home re-registers as

This was an unannounced inspection which took place on 26 and 28 September 2017, it was brought forward following the inspection of another of the registered provider’s services in the area. Heaton Lodge.

We had previously inspected the service in October 2015 when we identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because medicines were not being safely managed, the premises were not always maintained securely, people were not protected against the risks associated with unsafe or unsuitable premises, there was poor infection control and lack of effective systems to regularly assess and monitor the quality of service people received.

During this inspection we checked if the required improvements had been made. We found the provider was still in breach of one of those regulations. We also found a further breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to the provider failing to provide information requested by the Care Quality Commission. You can see what action we told the provider to take at the back of the full report.

Clyde House is registered to provide personal care and accommodation for up to 17 adults with mental health conditions. There is a lounge, dining room and kitchen on the first floor and there are bedrooms and bathrooms on all three floors of the property. At the time of our inspection 10 people were living at the service.

Medicines were managed safely and people told us they received their medicines as prescribed.

To minimise the risk of people smoking in their bedrooms, a new smoking shelter had been purchased and placed at the front of the premises for easy access by people who used the service.

Staff we spoke with demonstrated a good understanding of the need for safeguarding procedures and their role in protecting vulnerable people.

People living in Clyde House told us they were happy with the care and support they received.

Staff had received the training they needed to carry out their job roles effectively.

People living in Clyde House told us they had been involved in making decisions about their care needs and had consented to the care and support that was being provided.

People who used the service were complimentary about the support staff provided them with.

The service promoted people’s independence and encouraged people to maintain contact with the local community, their relatives and friends.

People who used the service told us they were involved in reviewing their care plans and risk assessments.

Staff used daily logs in which they recorded the care and support that had been provided to the people who used the service. We found some of these logs lacked detail and reviews of care plans did not clearly indicate that people who used the service had been involved in those reviews. We recommend the service improves the way information is recorded in daily logs and that reviews of care plans indicate if the person had been involved.

At our last inspection of the service in October 2015 there was a lack of robust systems being in place to monitor the quality of service people received. Since that inspection, a new auditing system had been put in place but, at the time of our inspection was not fully operational.

The service is required to have a registered manager in place. 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 service did not have a registered manager. The last manager had left the service in May 2017. The provider was working at the service whilst a new manager was being recruited. The registered provider had also employed a quality consultant who was advising them on im

During our inspection we spoke with the manager, care coordinator and cook. We looked at a selection of the provider’s records, including a sample of people’s care records.

We considered the evidence collected under the outcomes which were reviewed and addressed the following questions: is the service safe; is the service effective; is the service responsive; is the service well led?

Below is a summary of what we found. Please read the full report for the evidence supporting our summary.

Is the service safe?

Medication was safely administered, recorded and stored.

Improvements in staffing for the home meant that a cook had been employed since our last visit to the service. This meant staff could spend more time supporting people using the service rather than having to cook.

We found care plans to be fully completed with relevant and important information. All records were securely stored.

Is the service effective?

Care plans and risk assessments were up to date and regularly reviewed. This meant staff had information to inform them of the up to date health status of people using the service.

The new cook had developed appropriate new menus with the support of people using the service. Each person using the service had a nutritional care plan in place to support staff in making sure they received a nutritious and well balanced diet. Discussions with the cook confirmed that he was aware of people’s known medical conditions, such as insulin controlled diabetes.

Is the service responsive?

Evidence seen in records demonstrated that people using the service were supported by other healthcare professionals such as general practitioners and district nurses. Care staff also supported people to attend appointments at local community healthcare facilities such as clinics and hospitals.

Is the service well led?

A manager was in post, who confirmed they had submitted their application to become registered with the Care Quality Commission.

The service worked well with other agencies and services to make sure people received their care in a joined up way.

Systems were now in place to monitor the quality of service delivery. We saw evidence to demonstrate that care plans and risk assessments were being reviewed on a regular basis by both the key workers and care coordinator.

During our inspection we spoke with the manager, deputy manager and the care staff on duty. We also spoke with three people who lived at Clyde House. We spent some time observing the interactions between staff and the people who lived at Clyde House. We looked at a selection of the provider’s records, including a sample of people’s care records.

We considered the evidence collected under the outcomes we reviewed and addressed the following questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. Please read the full report for the evidence supporting our summary.

Is the service safe?

We saw staff support people and encourage them to do things for themselves where they were able and to make choices about what they wanted to do. People living at Clyde House told us how the care staff supported them with aspects of their care. One person told us “The staff are brilliant, that is all I can say about them. I wouldn’t consider going anywhere else”.

Improvements were needed to the way in which medication is administered, recorded and stored. We asked the provider to tell us what they are going to do to meet the requirements of the law relating to medicines management in the home.

During our visit to Clyde House we found a number of concerns around the staffing of the home. We found that only two care staff were on duty to support ten people using the service. We discussed our concerns with the deputy manager of the service at the time of our visit. We asked the provider to tell us what they are going to do to meet the requirements of the law relating to staffing in the home.

During our visit to Clyde House we found a number of concerns around the maintenance of the records for the home. We found that not all care plan records were fully completed with relevant and important information. We found some records which should have been securely stored, were not. We asked the provider to tell us what they are going to do to meet the requirements of the law relating to records.

Is the service effective?

There were advocacy services available if people needed them. This meant that when required people could access additional support.

We found that some of the documentation relating to care planning and risk assessing were not always being fully completed or being updated within the required timescales. Lack of such important information being available meant that staff did not always have proper guidance to inform them of the up to date health status of the person using the service. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to records.

At the time of our visit no cook was employed at the service and care staff had the responsibility for preparing all meals. No set menus were in place which made it difficult to assess if people were receiving a nutritious and well balanced diet. No records were kept of the food prepared each day and no record was kept of the meals people chose at each meal time. Lack of recording dietary intake could place some people using the service at risk, especially those people with known medical conditions, such as insulin controlled diabetes.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to meeting nutritional needs.

Is the service caring?

The atmosphere in the home was found to be relaxed and care staff were observed interacting with people using the service in a professional and attentive manner.

People were given time to make choice and decisions about the care they wished to received. Care staff were seen to support people sensitively and with patience.

One person using the service told us, “The staff are brilliant, that is all I can say about them. I wouldn’t consider going anywhere else”.

Is the service responsive?

Evidence was available in records to demonstrate that people using the service were supported by other healthcare professionals such as general practitioners and district nurses. Care staff also supported people to attend appointments at local community healthcare facilities such as clinics and hospitals.

Is the service well led?

Since our last visit to the service in December 2013 the service had been without a manager for a number of months. This meant that the deputy manager had responsibility for overviewing the management of this service as well as another service operated by the same provider.

The service worked well with other agencies and services to make sure people received their care in a joined up way.

Although there had been systems in place to audit and monitor the quality of service and care being provided in Clyde House these systems had ‘slipped’ in recent months and no evidence was available to demonstrate that such audits had taken place. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing and monitoring the quality of service provision.

We had inspected Clyde House Limited in May 2013. We had a number of concerns and asked the provider to send us an action plan outlining how they intended to become compliant with the relevant regulations. We also undertook a responsive inspection in August 2013 because we had received some information of concern and found further areas in which the provider did not conform to the necessary regulations. The provider sent us a further action plan outlining how they intended to become compliant with the regulations.

We undertook this inspection in order to check that both these action plans had been implemented. There were ten people living at Clyde House Limited. We talked to some of the people who used the service as well as the staff who were working there. We looked around the building and checked records of care as well as other records relating to the provision of the service. We looked at arrangements for safeguarding people who lived there and for supporting staff. We found that Clyde House was now compliant with the relevant regulations.

We visited Clyde House Limited because we had previously issued warning notices requiring the provider to become compliant with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We had also received some information of concern.

During our inspection we spent time talking to people who used the service as well as to staff. People told us that they liked living at Clyde House and appreciated the recent improvements which had been made.

We inspected the building and checked the state of repair and cleanliness as well as the routines which were in place to ensure this. We also talked to the manager who divides their time between Clyde House Limited and another location a few yards further down the same road.

As well as this scheduled inspection, we inspected Clyde House to check if an Action Plan by the provider had been implemented. This had been supplied to us following a previous inspection. We also inspected Clyde House because we had received information of concern.

When we inspected Clyde House on this occasion we spent time looking around the home and talking to the people who used the service as well as the staff who worked there. Some of the people we spoke to had lived in the home for a number of years. They told us “it’s all right here” and “you can get up and make yourself a drink when you like”. Some people spent most of their time in their rooms whilst others spent time in the communal areas. We saw that some people enjoyed going out and that one person was planning a trip away with their family.

We were told that the previous registered manager had left the employment of the provider the previous Friday. We met the new manager who had just completed a period of induction and for whom this was the first day in the role. Clyde House shared a number of joint administrative and management arrangements with another home which is part of the same company. We saw that there was quite a lot of interaction between the two homes including people from the other home who visited people at Clyde House.

We spoke with three people who were living at Clyde House who were all happy with the service they received. We heard comments such as “The staff are sound (good)”; "I would not change anything about this place” and “I like going out to the pictures.”

We found that people were involved in their care and that staff asked for permission before undertaking care tasks. Records were not always updated when required but it had been noted that this was an issue and there were plans in place to rectify this.

We found that there unsuitable hand washing facilities in the three bathrooms that we looked at. Liquid soap was not available in all bathrooms and there were no dispensers for paper towels. This meant people were not able to wash their hands effectively.

The home was in need of some maintenance but the provider had plans to deal with the issues that had been highlighted by the manager.

We found that there were suitable numbers of appropriately qualified staff to meet the needs of people. However there were references missing in the three staff files that we looked at. This meant that there was insufficient evidence to show that effective recruitment procedures had been followed.

The people living at the home told us they had no complaints and were aware that they could raise a complaint with a staff member or the manager. People told us that the manager and deputy manager were approachable and they would not have any difficulties in discussing their concerns.

People using this service told us that they got on well with staff and that their care and support was provided in a dignified, safe and private manner. One person commented “I feel safe living here and the staff help me to do the things I enjoy and help me out when I’m not feeling so confident.”

People confirmed that they received the right amount of support to make decisions and choices about things that were important to them. Advocacy services were available if people needed independent support.

We asked people if they thought the service they received could be improved in any way. Most people were satisfied with the service they received and told us that they wouldn’t change anything. One person suggested that it would be good if staff arranged activities in the evening. This person said, “I sometimes get bored watching TV. It would be nice if staff could get us together in an evening, but I’m not sure others would want to join in. We do have board games though.” Another person told us that their bedroom needed decorating because one of the walls had been damaged by water from a leaking gutter the previous winter. This person also told us that the flooring in one of the bathrooms was unsafe because it was slippery when wet. When asked about the décor in the dining room a person living in the home commented, “It could do with a lick of paint.”

A person told us that they had chosen a member of staff to be their key worker. He added, “We are well looked after here. I help out in the house and garden and go out when I want to with my key worker.” Another person said, “It’s great here. Nothing could be better”.

The people we spoke to told us that their care and support was provided in accordance with their preferences. They confirmed that staff listened to their views and suggestions and were confident that any request they made for a change in their support would be accommodated wherever possible. A person using the service said “The support I receive helps me to become more confident.”

People said that they enjoyed the meals and that they had access to drinks and snacks at all times. One person said, “Jugs of hot water are left out for us to make tea and coffee when the cook is busy in the kitchen. At other times we make our drinks in the kitchen.”

This inspection was carried out over two days on 27 and 29 October 2015. Our visit on the 27 was unannounced.

We last inspected Clyde House Limited on 10 September 2014. At that inspection we found that the service was meeting the regulations we assessed.

Clyde House is registered to provide personal care and accommodation for up to 17 adults with mental health conditions. There is a lounge, dining room and kitchen on the first floor and there are bedrooms and bathrooms on all three floors of the property.

The home had a manager registered with the Care Quality Commission (CQC) who was present on both days of the inspection. 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.

We identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

People who used the service, who we asked, said they felt safe living in the home.

Staff who we asked demonstrated a good understanding of the need for safeguarding procedures and their role in them.

Although people who used the service told us they felt safe we found some areas in the home where people’s safety was being compromised.

We looked at the way in which medicines were managed. The records of the administration of medication did not give us confidence that medicines were always being managed safely.

We found that systems in place to check and respond to environmental risks, such as the fitting of window restrictors and carrying out risk assessments of individual bedrooms were not always effective which meant potential health and safety issues were not always detected or addressed.

Although all rooms had been portable appliance tested (PAT) many of the items brought into the home after PAT had been carried out, had not. This could place both people using the service and staff at risk of potential damage to their health.

The head housekeeper told us that due to the nature of the service, people did not always allow the housekeeper’s into their rooms, making it difficult to maintain a good level of cleanliness. In two bedrooms we entered we could see that the bedding was extremely dirty and in need of laundering. Other bedrooms looked in need of deep cleaning and in need of re-decoration and re-painting.

On checking the laundry facilities in the home we found that staff did not have access to a soap and paper towel dispenser following after dealing with soiled linen. Lack of maintaining appropriate levels of cleanliness throughout the whole home and lack of appropriate equipment to help maintain hand hygiene could place both people using the service and staff at risk of potential infection and cross infections.

People spoke positively about the staff who they felt were kind and caring and we observed good interactions between the staff and people who used the service.

Staff had access to a range of appropriate training and received supervision on a regular basis and felt management to be approachable and supportive.

People’s care plans contained sufficient information to guide staff on the care and support people required. Where able, people had been involved and consulted about the development of their care plans. This helped to make sure people’s wishes were considered and planned for.

Care records seen indicated that people using the service had access to other health and social care professionals, such as social workers, doctors and mental health specialist.

We saw that appropriate arrangements were in place to assess and monitor if people were able to consent to their care and treatment and staff we spoke with had a good understanding of the care and support people required.

Records were kept of the food served and, when necessary, we saw action had been taken, for example a referral to other health care professionals such as a dietician or speech and language therapist, if a concern had been identified.

People who used the service had access to a complaints procedure and knew who to speak with should they have any concerns, worries or complaints.

The registered manager told us that they monitored and reviewed the quality of service on a monthly basis by carrying out audits (checks) on all aspects of the management of the service for example, care plans, infection control, medication and the environment. During our examination of these completed audits, we noted that none of the concerns we raised during this visit about medication, the environment and infection control had been ‘picked up’ during the monthly audit process.