Claremont Care Home is situated in Farsley, between Leeds and Bradford. The service is registered to provide nursing care and accommodation to up to 63 older people. The service also provides care and support to people who are approaching the end of their lives. At the time of the inspection, there were 52 people at the service, with two people in hospital. The majority of people who used the service were living with dementia.

This comprehensive inspection took place over two days on 13 and 29 June 2017. At the last inspection in June 2016, the service required improvement to become Safe, Effective and Responsive. At this inspection we found the required improvements had been made.

There was 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.

People told us they felt safe at the service. Staff were confident about how to protect people from harm and what they would do if they had any safeguarding concerns. There were appropriate systems in place to make sure that people were supported to take medicines safely and as prescribed. Risks to people had been assessed and plans put in place to keep risks to a minimum.

There were a sufficient number of staff on duty to make sure people’s needs were met. Recruitment procedures made sure that staff had the required skills and were of suitable character and background.

Staff were supported by a comprehensive training programme to help them carry out their roles effectively. Staff were led by an open and accessible management team. There were opportunities for staff to participate in service developments through supervision and team meetings.

The manager and staff were aware of the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). DoLS are put in place to protect people where their freedom of movement is restricted. 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 were provided with sufficient amounts of food and drink. Where people required support with eating or drinking, this was appropriately provided and took into account people’s likes, dislikes and preferences.

People told us staff were caring and that their privacy and dignity were respected. Care plans showed that people and their relatives were involved in decisions and individual preferences were taken into account. Care plans gave clear directions to staff about the support people required to have their needs met. People were supported to maintain their health and had access to health services if needed.

People received good care at the end of their lives. Staff were well trained in this area and sensitive to the needs of people, their friends and relatives.

People’s needs were regularly reviewed and appropriate changes were made to the support they received. People had opportunities to make comments about the service and how it could be improved upon.

The manager had good oversight of the service and was well known tom people who used the service. They had made improvements at the service since they started in post. There were systems in place to look at the quality of the service provided and action was taken where shortfalls were identified.

The inspection took place on 10 May 2016 and was unannounced. We carried out a comprehensive inspection in April 2015 and rated the service as requires improvement. We found the provider had breached two regulations associated with the Health and Social Care Act 2008. We concluded that records relating to people’s consent and Deprivation of Liberty Safeguards were not always accurate. We told the provider they needed to take action; we received an action plan. At this inspection we found the home was still breaching one of these regulations. However, some improvements had been noted.

Claremont Care Home is situated in Farsley, Leeds and is easily accessible by car and public transport. The home sits within extensive grounds consisting of lawned areas and a car park to the front. The home can accommodate up to 63 people. Some people were living with dementia.

At the time of our inspection the home did have a registered manager; however, they were no longer in day to day control. The regional manager was managing the home, who was in the process to be become the 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.

We found some areas of the premises did not comply with current Health and Safety guidance and were therefore, a safety risk to people who used the service. However, a risk assessment had been completed. Staff received training but did not always receive appropriate ongoing or periodic supervision to make sure competence was maintained. The care plans we looked at did not contain appropriate mental capacity assessments. People’s care plans were reviewed on a regular basis but the care plans were not always updated and it was difficult to locate information.

We found people were cared for, or supported by, sufficient numbers of suitably qualified and experienced staff. Appropriate recruitment procedures were in place to make sure suitable staff worked with people who used the service and staff completed an induction when they started work.

People told us they felt safe in the home and we saw there were systems and processes in place to protect people from the risk of harm. Staff had a good understanding of safeguarding vulnerable adults and knew what to do to keep people safe. People were protected against the risks associated with medicines because medicines were well managed but some slight amendments were required.

At the time of our inspection Deprivation of Liberty Safeguards were completed appropriately. There was opportunity for people to be involved in a range of activities within the home. People mealtimes experience was generally good. People received good support which ensured their health care needs were met. Most staff were aware and knew how to respect people’s privacy and dignity.

People had opportunity to comment on the quality of service provided and influence service delivery. Effective systems were in place which ensured people received safe, quality care. Complaints were welcomed and were investigated and responded to appropriately.

We found breaches in regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the provider to take at the end of this report.

This was an unannounced inspection carried out on the 24 April 2015.

Claremont Care Home is situated in Farsley, Leeds and is easily accessible by car and public transport. The home sits within extensive grounds consisting of lawned areas and a car park to the front. The home can accommodation up to 63 people. Some people were living with dementia.

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 care plans we looked at did not contain appropriate and decision specific mental capacity assessments. The applications for the Deprivation of Liberty Safeguards had been carried out; however, people had their liberty deprived illegally.

There were enough staff to keep people safe and staff training and support provided equipped staff with the knowledge and skills to support people safely. Robust recruitment and selection procedures were in place to make sure suitable staff worked with people who used the service and staff completed an induction when they started work.

People were happy living at the home and felt well cared for. People’s care plans contained sufficient and relevant information to provide consistent, person centred care and support. People enjoyed a range of social activities and had good experiences at mealtimes. People received good support that ensured their health care needs were met. Staff were aware and knew how to respect people’s privacy and dignity.

People told us they felt safe. Staff had a good understanding of safeguarding vulnerable adults and knew what to do to keep people safe. People were generally protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines safely. People’s physical health was monitored and appropriate referrals to health professionals were made.

The service had good management and leadership. People got opportunity to comment on the quality of service and influence service delivery. Effective systems were in place that ensured people received safe quality care. Complaints were investigated and responded to appropriately.

You can see what action we told the provider to take at the back of the full version of the report.

We carried out this inspection to check that the provider had taken action since our last inspection in September 2014. Following our inspection we identified concerns because we could find no evidence staff had been offered individual supervisions and had not had an appraisal for over a year.

During our inspection in January 2015, we found improvements had taken place to the way staff had been supported to develop their skills. In the files we looked at we saw evidence staff had been offered monthly supervision sessions in line with the policy of the service. Additionally, the service had carried out appraisals on all staff. From the appraisal, a training plan had been developed.

Two inspectors 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 is based on our observations during the inspection, speaking with people, their relatives and the staff supporting them and from looking at records.

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

Is the service safe?

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents. This reduced the risks to people and helped the service to continuously improve.

When people were identified as being at risk, their care plans showed the actions that would be required to manage these risks. These included the referring to specialist services such as speech and language therapy and the dietician.

The service had policies and procedures in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). Staff received safeguarding and Mental Capacity Act training. This meant people would be safeguarded as required.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in developing their plans of care, wherever possible. From speaking with staff they were able to demonstrate a good understanding of people’s care and support needs.

Suitable arrangements were in place for staff to receive updated training to ensure they had the skills, knowledge and experience to meet the needs of people who used the service. However, the service did not offer supervision in accordance with the policy of the service. This meant people who used the service were at risk of being cared for by staff who had not been supported by the service in line with their policy.

Is the service caring?

We saw staff were attentive and respectful when speaking with or supporting people. The home had a relaxed and comfortable atmosphere. We saw that there was some good humoured banter between several people living at the home and staff. One person said “The care staff are good.” People looked well cared for and we observed staff knocking on people’s door before they entered.

Relatives we spoke with told us, “On the whole the home is ok: I have had some issues with aspects of care but have managed to address these with the manager.” They felt staff understood the needs of their relative; they told us “The care staff know them well and know what they wants and needs.”

Is the service responsive?

People’s needs were assessed and records we looked at showed they received specialist support or equipment that they needed.

People’s preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

People we spoke with knew how to make a complaint if they were unhappy.

We saw the staff team acted in a professional manner and responded appropriately to people’s care needs. We saw them explain to people what they were going to do and asked permission before they carried out any support or care.

The service could show us no evidence they had sought the views of people who used the service. They carried out surveys of people’s relatives and the results of these had been mixed.

Is the service well-led?

The service had a quality assurance system, and records showed that identified problems and opportunities to change things for the better had been addressed promptly. As a result we could see the quality of the service was continuously improving.

Staff we spoke with were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and the quality assurance systems in place. This helped to ensure that people received a good quality service. They told us the manager was supportive and responsive.

Effective management systems were in place to promote and safeguard people's safety and welfare. For example, health and safety records and peoples care records were up to date and had been reviewed regularly.

Relatives we spoke with told us they thought management of the home was very good. They told us, “The home had got better since the new manager came into place.”

We found that the necessary improvements had been made to ensure peoples' needs were consistently met and we observed positive interactions between staff and people who used the service. The registered manager spoke positively about the changes that had been implemented since our last visit particulary in relation to increased staffing levels and the overall way in which the home was being run.

One person we spoke with liked it at the home and their relatives said the provider communicated well with them, the home was clean and their mum always looked comfortable when they visited. A second person we spoke with who lived at the home said staff were friendly and the food was okay. A third person said they were comfortable and “pleased with things.” We overheard one person speaking with a member of staff as they were passing in their wheel-chair after having been supported to go to the bathroom and they said “Your girls are absolutely marvellous.”

We found people's needs, and any associated risks, were assessed appropriately. The information provided within people's care records enabled staff to provide the necessary care and support for people that used the service. We found that staffing levels were adequate to meet people's needs. However, the level of qualified nurse input was restricted during late mornings because of the medication round. This was being addressed by the provider at the time of the inspection. We found the care records contained suitable and accurate information and the records were also stored securely.

We spoke with three people that used the service and two relatives. One person that used the service said that "they couldn't grumble about anything" and they were "happy at the home". Another person said "they had no complaints" and commented that staff came to help when necessary.

One of the relatives we spoke with commented they were happy with the support being provided for their mother and they had settled in to the home well. Another relative said they were happy with the care and support being provided for their mother and they were fully informed about aspects of her care.

We used a number of different methods to help us understand the experiences of people who used the service because some people had complex needs and they were not able to tell us their experiences. Other people were able to tell us about their experiences. The people we spoke with told us they were satisfied with the care and support they received. They made the following comments:

“I can do my own bits like tidying around in my room but they will always help if I need anything.”

“Everything is fine; I get what I need.”

“All the staff are very nice.”

“The carers are very kind and always come and check I’m ok.”

“The manager always pops up to see me and sits with me. The owners also come and always ask if I’m ok and if I’ve any concerns. If I ask for anything they will always do it. They are very thorough.”

We spoke with two relatives who said choices and preferences of people who used the service were respected and accommodated. They said they were contacted when it was appropriate and overall communication with the service was good.

We spoke with seven staff who told us appropriate systems were in place to make sure people were respected and involved in making decisions about their care. All staff we spoke with said the care provider and manager monitored the service well.

We used a number of different methods to help us understand the experiences of people who used the service because some people had complex needs and they were not able to tell us their experiences. Other people were able to tell us about their experiences. The people we spoke with told us they were satisfied with the care and support they received. They made the following comments:

“Staff listen and things are usually explained.”

“I just say when I’m going to bed. I prefer a shower on a morning and that’s never a problem.”

“I like to stay in bed watching television.”

“I chose my meal at lunchtime.”

“Staff understand my needs and I’m well looked after.”

“It’s very nice here. I don’t use the call bell but staff come and check on me.”

“I waited a long time to go to the toilet this morning but it is only occasionally when I have to wait.”

“Staff understand the care I need. They move me around very well.”

“The staff are very good.”

“I am happy with the staff.”

We spoke with four visitors who told us they were close relatives of people who used the service and had visited on a frequent basis. They all said people were well looked after. They made the following comments:

“They go through the care plan about every six months; they explain it all and check everything is ok.”

“We can basically ask for anything. The staff are brilliant and look after everybody well.”

“It’s very good, there are no problems. My mum is always clean, personal care is good and she always wears her own clothes.”

“It had been better since the manager had arrived.”

“We have been concerned about my mother’s health; they have tried absolutely everything possible to make sure she was getting all she needed.”

“The management team often come around and chat. They don’t sit in the office all the time. I’m very comfortable going to them, they’re very approachable.”

“I’ve never had any problems but if I did I’d be happy to talk to the manager or one of the others about it.”

At previous inspections we have set compliance actions and issued a warning notice because the care provider was not meeting some of the essential standards. At this inspection, some staff told us the service had improved and the management team had introduced positive changes. One member of staff said, “Staff are communicating better. It’s getting back on track.” Another member of staff said, “There has been a big change. Staff are realising it’s not ok to have attitude and there are now stiff measures in place.” Other staff said there had been very little change and nothing much had changed.

Some staff said there were still occassions when some staff did not communicate well with people who used the service. Three members of staff said the service still had to improve in this area. One member of staff said they were aware that staff who interacted well were being paired up with staff who didn’t interact as well. Another member of staff said, “They are trying hard but it still has to improve.” We observed occassions when staff did not interact appropriately when they were supporting people who used the service. For example, two staff members helped people to eat their lunch but they did not speak to them during this.

We received feedback from a healthcare professional who said, “The nursing staff and carers have good working relationships with the (name of healthcare service) and respond promptly to treatment advice given following an assessment. They refer appropriate clients in a timely manner and will contact the service via telephone with any concerns.”

Another agency told us they had noted improvements. They said, “During the review it was evident that a great deal of effort has been made to achieve compliance with the infection control standards.” They also said it was very important this was maintained.

Other stakeholders who have an interest in the service said they were still concerned about the service. One agency told us that the consistency of any improvements was not sustained for any length of time. Another agency told us they had serious concerns about the service.

In the main, people we spoke with told us that they were happy with the care they received. We received the following comments from people who use the service.

“It’s very nice, the staff come straightaway. I would recommend it.”

“I’m well looked after and have everything I need.”

“The place is fine. It’s quite alright here, I like it.”

“The staff are very kind.”

One person told us that they chose when to get up in the morning and sometimes had a cup of tea in bed.

We were told by people who use the service that the staff respected their privacy.

One person we spoke with told us that they would prefer it if their wheelchair was left near the armchair as then they would be able to get about without having to wait for staff. We later saw that they waited ten minutes for support to get back in their wheelchair.

At the time of our visit work was being carried out on the lounge fire door but despite this some people were sat close to the door. One person had been given a blanket but another had not and told us, “They don’t seem to realise that I’m an old lady too, they don’t realise I’m cold.”

A visitor said, “The new manager is what Claremont needed, she’s the best thing that’s happened; the day staff are exceptional; some are so caring, it’s the weekends where it fails.”

The manager and staff told us about a new customer care training programme. All staff we spoke with had received at least one session. Staff told us the training was good and covered privacy, dignity and respect. One member of staff said, “It covers attitude and goes through how you look after everyone, and how to report bad customer care.” Another member of staff said, “It explains about customer care and how we should be trying to offer the best.”

Staff told us the service had improved and the manager had introduced positive changes. One member of staff said, “The manager has made a very big difference. She’s hands on and knows what is going on. The number of good hard working staff has increased and the number of lazy staff is less.” Another member of staff said, “The new manager has brought us up to standard which is good, she knows the residents and they like her, she’s the best one we’ve had.” Another member of staff said, “They are seriously addressing customer care, it’s better but they still have lots of work to do.”

We talked to people about their evening meal. They told us they had had enough to eat and had enjoyed their meal.

Some people waited a long time for their evening meal. The manager told us that they had recently changed the evening meal arrangements and still needed to make further improvements.

One visitor told us that the person they were visiting had put on weight since coming to Claremont. They told us that before coming to Claremont they had been losing weight.

Staff told us that there was always plenty available to eat and drink.

In the main, people who use the service said there were enough staff. One person said the staff were very busy; another person said they sometimes had to wait for support but not every day.

Most staff said they did not have any concerns about the staffing levels. We spoke to 12 staff and the manager; ten staff and the manager said there were enough staff; two staff said there were periods when it was too busy.

In the main, people told us they were satisfied with the service they received, however, we saw evidence that people were not always treated with respect and their care needs were not always met.

People told us that they are treated with dignity and respect. When we asked one person if staff closed the door when they provided personal care they said, “Oh yes, oh yes, they close the door.” We observed staff closing doors once they had entered a room.

We observed some good interaction between staff and people who use the service. For example, one staff member was courteous and caring when they visited people in their rooms to find out if they needed any support. One person told us that they can have a laugh and a joke with certain staff. However we did observe some poor interaction. For example, staff gave people drinks but did not speak to them, people were being moved using the hoist and staff often spoke between themselves and ignored the person they were assisting. We visited the service on two occasions and examples of poor practice were observed at both visits.

People generally told us they were satisfied with the care they received; several people described the care as ‘good’ and the staff as ‘nice’. One person said, “You couldn’t wish for better care.” Another person said, “This is the best I’ve been to; you just go and ask and they give you what you want.” Two people told us that, overall, they were satisfied with the care but some areas could improve. One person felt staff should respond quicker when they called for assistance, another person said the staff were nice but they often had to wait for assistance, and they would prefer to get up later on a morning.

Two people who use the service said they often had to wait too long for staff. One person said they often had to wait when they pressed their buzzer for assistance. Another person said, “I always have to wait. They’re all very nice but you can’t catch them.” On the day of our inspection the person said they had asked for assistance to go to the toilet but were still waiting. The nurse confirmed the person had requested support and staff were aware.

Staff told us that people generally received good care although, at times, there were not enough staff so they often had to rush. They said the keyworker system worked well and ensured people’s personal care needs were met. Staff said they had good systems for passing on information to each other.

People were very complimentary about the staff and told us they were treated with respect and can make choices. One person said, “I’m very happy, the staff are wonderful. If there was something wrong I would say.” Another person said, “I choose when to go to bed, staff never rush me and we usually have the same staff to help us.”

Some people said there were enough activities and opportunities if people want to go out; others thought they could do with some more activities.

One person who had recently moved into the home said they were very happy with the service they received. They were pleased that someone from the home had visited them before they moved in to discuss their care and ‘had sorted out what was needed’. They confirmed that assessments and plans for delivering care were completed.

We got a mixed response from people about the meals. Some people who use the service said they enjoyed the food and there was a good choice of meals. Others said the food was not good quality and they often had the same things to eat. One person who was complimentary about the food said, “You get a choice to eat and if you don’t like what’s on the menu they will cook you something different.” One person who was not satisfied with the meals said, “I’m not impressed with the food. It’s the same thing, pork pies, week in, week out.” Another person said, “The food is sometimes cold, and I think they buy cheap so it doesn’t taste very good. As part of the review we visited the service twice, on the second visit people said the choice of food had improved.

We received generally positive feedback from visitors. One visitor told us that since admission his spouse had gained weight because staff had encouraged them to eat and had monitored their weight on a regular basis. Another visitor said, “My relative tells me there is always plenty of food, if you don’t like it they get you something else.”

Visitors we spoke to said they were kept informed about the care people received and if their condition changed. One visitor said, “They asked about (name of person) past life so they knew all about her. She loved wearing jewellery so they always put her jewellery on. Her personal care is good." Another visitor said, “I find the staff are lovely they know how to care for my wife.” Another visitor said, “We visited 11 other homes before making a decision on Claremont. Everything we have asked for we have been given.”

Two visitors suggested that the service needed a good manager and were concerned that the home had been managed by several managers in the last two years.

Staff said people are well cared for and systems have generally improved to make sure people’s needs are met. One staff said, “People are treated properly. We have good carers, everything works well now, it’s a lot better.” Another staff said, “People get a good service and their needs are met; everything is in place.” One staff said people get opportunities to do different things during the day but they thought the service could improve by offering people more activities. Staff said they would benefit from more training.

People who use the service said they were generally satisfied with the care they receive. One person told us the home was "marvellous". When asked if she felt that staff knew how to look after her properly she said "some know better than others" but she felt that she and her family had "picked the right place". Another person described the home as “brilliant” and said that he felt that they “couldn’t make it better if they tried.”

In the main, people told us that the food was good and had improved over recent months. One person said 'I've had a lovely breakfast." Another person said, "They make a lovely cup of tea and you can have plenty." One person felt the meals had “too much seasoning” and there was no choice if the meal was something they did not feel they could eat. They told us that they wanted plain biscuits but had been told that there weren’t any.

People who live at the home and visitors were complimentary about the staff. One person spoke well of the care she was receiving and said, “Very good these girls, they do try to help me.” Another person said, "The staff are very nice." Another person told us the staff were “all very caring” and that the staff “seem very nice”.

During our visit we observed some good interaction from staff but we also observed poor interaction where staff did not communicate with the people they were supporting.

A new keyworker system that has been introduced. Staff said it was working well and had helped improve the care that people receive. Staff said they have clearer responsibilities and better systems are in place to make sure people’s needs are met.

Staff told us that staffing levels were generally adequate although they did have peak times when they were busy.

The senior management team told us they are confident that better systems are in place to monitor quality but they are still continuing to improve their systems.

As part of our review we contacted a number of health and social care agencies who have been involved with Claremont Care Home. We received some positive feedback that told us the service has improved and the home has worked well with agencies to improve the service. We also received some feedback that told us the home should continue developing and improving the service.

This overall inspection involved both an announced visit/meeting with the regional manager, which did not include a site visit to the home, and also an unannounced visit to the home. The unannounced visit was in response to concerns raised by a relative and local council.

We observed the care provided by staff. We found staff spoke with people who used the service in a kind, considerate and respectful way. We found lunchtime in the dining room a lively environment which did not provide the optimum circumstances for staff to prioritise their attention and time effectively. We found the provider had the necessary safeguarding processes in place and staff were able to describe the different signs of abuse and how to report concerns. We also found there was a complaints process in place which was brought to the attention of people who used the service.

We spoke with two people who were visiting during our inspection. One person said the care provided was “satisfactory” and the "necessities of life were adequately covered". The second person we spoke with said they had no concerns about the care being provided.

We found staffing levels in the home were adequate but the skill mix was not always consistent enough to ensure appropriate continuity of care.