Clare House Care Home is a nursing home for up to 40 older people. At the time of our inspection 31 people were living at the service. The home was divided into two units and people were cared for by qualified nurses and care assistants. Some people had complex nursing needs. The home is managed by Bupa Care Homes (BNH) Limited (BUPA), a national provider of care and nursing homes.

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 and associated Regulations about how the service is run.

At the last inspection on 2 June 2015, the service was rated Good.

This inspection took place on 2 May 2017 and we found the service remained Good.

People were happy with the care they received. They liked the staff and found them kind, caring and polite. We observed that the staff cared for people in a sensitive and compassionate way. Visitors and relatives of people who lived at the service were satisfied with the care people received.

The staff felt supported and enjoyed working at the service. They worked as a team.

People were administered medicines in a safe way, they lived in a safe and well-maintained environment and the risks they were exposed to had been assessed. There were enough staff to keep people safe and meet their needs. Staff recruitment procedures included checks on their suitability to work with vulnerable people.

People were able to make choices about their care and treatment and there was evidence they had consented to this. The staff had the training and support they needed to care for people in a suitable and safe way. People were able to make choices about the food they ate and were offered a varied and balanced diet. People's health needs were being met and they were able to access other healthcare professionals as needed.

People were supported to take part in a range of different activities which reflected their needs and interests. Their care was planned with them to make sure their wishes were identified and followed. People knew how to make complaints and most people were satisfied that any concerns they had were addressed.

There were systems for auditing the quality of the service and for listening to the views of the people who lived there and other stakeholders. Records were appropriately maintained. The provider's senior managers regularly visited the service and provided guidance and support.

The inspection took place on 2 June 2015 and was unannounced. The last inspection of the service was on 22 September 2014 and there were no breaches of Regulation identified.

Clare House Nursing Home (Uxbridge) is a nursing home registered to provide accommodation, personal and nursing care for up to 43 older people. At the time of our inspection there were 35 people living at the home. The home was divided into two units and people were cared for by qualified nurses and care assistants. Some people had complex nursing needs. The home is managed by Bupa Care Homes (BNH) Limited (BUPA), a national provider of care and nursing homes.

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 and associated Regulations about how the service is run.

The provider had systems to make sure people were involved in planning and consenting to their own care.

Medicines were appropriately managed although we noted some areas where improvements were necessary. The provider responded to these and put in place the necessary arrangements to ensure safe management of medicines.

There were enough staff employed at the service and the recruitment of these staff included checks on their suitability.

The staff assessed the risks for each person and took action to minimise these.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLs). DoLS provides a process to make sure that providers only deprive people of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them. The provider was aware of their responsibilities and had acted in accordance with the legal requirements.

The staff were appropriately supported and trained so that they could meet people’s needs safely.

People’s nutritional needs were met and they were offered a variety of freshly prepared food. They were able to make choices about the food they ate.

The staff worked with other healthcare professionals to assess, plan for, monitor and meet people’s individual healthcare needs.

People had positive relationships with the staff. They felt the staff were kind, caring and attentive. They were supported to make choices and felt well informed.

People’s privacy and dignity was respected.

People’s individual needs were assessed, planned for and met in a personalised way. The staff were aware of people’s individual preferences, likes and dislikes.

People’s recreational and social needs were met. There was a programme of planned activities and people were supported to pursue individual hobbies and interests.

There was an appropriate complaints procedure and complaints were investigated and acted upon.

People living at the home and the staff felt there was a positive and open culture. They were able to approach the manager and felt listened to and supported.

The manager was experienced and worked alongside the staff.

There were comprehensive systems for monitoring the quality of the service. Concerns and risks were identified and acted upon.

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

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

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

Is the service safe?

People were being cared for in an environment that was safe, clean and hygienic. The records we read showed that the home was cleaned daily. We found the environment neat and tidy with no unpleasant odours. The people we spoke with told us that they felt safe in the home. One of the people we spoke with said, “The place is clean and tidy.” We saw that the service had effective infection control procedures. Equipment in the home included hoist and evacuation ski pad, which had been well maintained and serviced on an annual basis under maintenance agreements.

There were enough staff on duty to meet the needs of the people living at the home and keep them safe. The staff records we read showed that the staff had received appropriate training to keep people safe. Training included health and safety and manual handing. Staff were able to explain how this training kept the people who used the service safe. We observed staff interaction with people who used the service. We saw they followed the infection control procedures and wore gloves and aprons when appropriate.

There were arrangements in place to deal with foreseeable emergencies. This included 24 hours staffing and first aid training. Each room had a call alarm that people could use in an emergency.

The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom. The staff we spoke with had received DoLS training and understood their responsibilities in relation to this legislation.

Is the service effective?

People told us that they were happy with the care they received and felt their identified needs were being met. One of the people we spoke with said, “ The staff are attentive to my needs.” We observed staff’s interaction with people. The staff were polite, offered people choices and made sure they were happy with the care they provided.

Is the service caring?

People were supported by kind and attentive staff. The staff we saw were caring when supporting people. The people we spoke with said, “ The staff are nice” and said that staff were, “Good” to them. We saw staff treated people in a pleasant manner and took time to re-assure people and understand what they wanted.

Is the service responsive?

People’s needs had been assessed before they moved into the home. The records we read showed that staff had asked them about their likes and dislikes prior to them moving into the home. We saw records of social activities that showed people had access to the things that were important to them. People had been supported to pursue social activities that they enjoyed. We saw the care plans were regularly updated and people were given the opportunity to change their mind about what they wanted to do.

Is the service well-led?

The staff we spoke with were aware of the aims and objectives of the home and had a good understanding of the quality assurance processes that were in place. We saw that people were regularly asked what they thought about the service and the manager took action to resolve any issues. We read the most recent annual customer feedback questionnaire and found that the majority of people using the service were positive about the service. People told us that the manager had consulted with them before implementing changes to service. For example, when there had been a change to the schedule of planned social activities.

During our visit on 19 December 2012 we found that the service was not meeting standards in relation to consent to care and treatment, the service was failing to plan people's care appropriately and treat people with dignity and respect. They were also failing to ensure that staff were appropriately trained and supervised. We requested following our visit the provider send us an action plan detailing how improvements would be made.

We carried out our recent visit to ensure improvements had been made and we also checked that other standards were being met.

People told us since our last visit that improvements had been made. One person told us “we had a meeting with the new manager she seemed to listen to what we had to say, she seems very good".

A person who had recently been admitted to the home said "it’s very nice here, it’s not like my own home but the staff are good, they make sure I am safe."

Another person who had been using the service for many years told us "its not like how it used to be, I don't really have many people to talk to anymore, I would like to have a few more things to do, as I like chatting to people and being in good company."

Following our recent visit we found that improvements had been made to the running of the service, we also found standards were being met in additional areas that had not been previously inspected.

We looked at the care records of nine people and spoke with seven service users, one person's relatives and six members of staff. People who use the service told us they enjoyed living at the home and felt well cared for. One person who had recently been admitted to the home told us, "the staff are good they respect my wishes and I asked for only female staff to help me and they had accommodated that request". Another person told us "I have been here a while now and it is good, the staff work hard but sometimes there are not enough of them".

One person told us "they have resident meetings and it's a waste of time people don't turn up". The same person also told us they were frequently not offered what was on the menu for dinner and told us "you never see a strawberry in here even when the supermarkets are giving them away".

Decisions regarding end of life care were not always appropriately documented and records did not contain sufficient information about the person's wishes.

Care assessments and care plans were up to date and regularly reviewed. However, they were not always detailed enough to make sure the staff could deliver care effectively in line with people's assessed needs. We observed that people were not always treated with dignity and respect and they were ignored or spoken to inappropriately. We looked at staff training and found that there were gaps in staff knowledge and skills.

People using the service told us there were opportunities for them to express their views about the home. They said they could talk to staff or contribute to the resident’s forum/meetings.

People confirmed they made decisions about their daily lives and staff respected their choices. People told us “I felt like having a day in bed today” another said “I’ve never been so well looked after – nothing is too much trouble”.

People said they were able to raise concerns with staff working in the home and they were happy living there.

People were usually in safe, accessible surroundings that promoted their wellbeing. We noted the carpeting on the first floor posed a trip hazard to anyone walking in the corridor. The carpet was due to be replaced but no immediate action had been taken to minimise the potential hazard.

People told us staff were usually very responsive to call bells, they did say at busy times they sometimes had to wait longer than normal but said 'we don't wait hours'.