This unannounced inspection took place on Wednesday 22 March 2017.

Claremont Lodge is registered to provide personal care and accommodation for 18 people. The home is situated in a residential area of Salford, close to local amenities and a park. Accommodation is in mainly single rooms with shared lounges and dining room.

Our last full comprehensive inspection of Claremont Lodge was in August 2015 where the home was given an overall rating of ‘Good’. Since that inspection, we received concerns in relation to falls management and therefore conducted a focussed inspection in April 2016, looking specifically at this area. At this inspection the home was rated ‘Requires Improvement’ overall. The key question for Well-led was also rated as ‘Requires Improvement’, whilst the key question for Safe was rated ‘Inadequate. This inspection looked at any improvements made since our previous visit to the home.

At the time of this inspection there were 16 people living at Claremont Lodge.

People living at the home told us they felt safe. The staff we spoke with had a good understanding of safeguarding, whistleblowing and how to report any concerns.

We found medication was ordered, stored and administered to people safely. There were also audits of medicines to ensure there were no shortfalls in practice.

Staff were recruited safely with references from previous employers sought and DBS (Disclosure Barring Service) checks undertaken. This would ensure that staff were suitable to work with vulnerable adults.

There were sufficient staff working at the home to meet people’s needs. Feedback from people living at the home, visitors and staff was that staffing levels were sufficient.

Staff received an induction when they started working at the home, as well as receiving appropriate training and supervision to support them in their role.

The home worked within the requirements of the MCA (Mental Capacity Act) and DoLS (Deprivation of Liberty Safeguards). We saw appropriate assessments had been completed if there were concerns about a person’s capacity. DoLS referrals had been made as necessary to the local authority. Staff spoken with displayed a good knowledge about MCA/DoLS and what action they would take if they had concerns about a persons capacity.

We saw people received enough to eat and drink, with people also making positive comments about the food provided at the home. The staff we spoke with knew about people whose were at risk with regards to their nutrition such as if they had lost weight or were at risk of choking. Where people had suffered weight loss, the home followed guidance from other professionals such as dieticians.

All of the people we spoke with during the inspection, including people living at the home and visiting relatives made positive comments about the care provided.

People told us they felt staff treated them with dignity and respect and promoted their independence where possible. We saw people being offered choices about how they wanted their care to be delivered.

People felt the home was responsive to their needs and we saw examples of staff doing this during the inspection when assisting people to walk around the home, administering medication and helping people to transfer in and out of their seat.

Each person living at the home had their own care plan, which was person centred and captured information about peoples life history. This would help ensure staff had appropriate information available to them in order to provide person centered care.

There was a complaints procedure in place which allowed people to voice their concerns if they were unhappy with the service they received. We looked at any complaints that had been made and saw an appropriate response had been provided to the complainant.

All of the people we spoke with told us they felt the service was well-led and that they felt listened to and could approach management with concerns.

There were systems in place to monitor the qua

In response to concerns about a specific incident, we carried out an unannounced focused inspection of Claremont Lodge on 19 April 2016. Focused inspections do not look at all five key questions of safe, responsive, caring, effective and well-led, they focus on the areas indicated by the information that triggered the concerns. During this inspection we looked at the key questions of ‘safe’ and ‘well-led'.

We last inspected Claremont Lodge on 11 and 12 August 2015. At that time the service was rated as ‘Good’. Claremont Lodge is a care home registered with the Care Quality Commission (CQC) to provide personal care and accommodation for up to 18 people. At the time of our inspection the service had full occupancy.

Claremont Lodge is situated in a residential area of Salford, Greater Manchester and is close to local amenities and a park. Accommodation is mainly provided in single rooms with shared lounges and a dining area. Claremont Lodge is an older building with some of the décor worn and traditional in presentation.

During this inspection we found two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 in regard to safe care and treatment and good governance. We are currently considering our enforcement options.

At the time of our inspection there was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We looked at care plans and associated documentation and found a variety of issues. These included a lack of pre-admission assessments, baseline assessments that did not provide sufficient information to demonstrate how identified risks were mitigated and existing risk assessments that were contradictory and not easy to understand. We also found newly emerging risks were not always recognised and responded to effectively.

We found the service did not always complete their own pre-admission assessment to ensure they could meet peoples' individual needs before they were admitted into Claremont Lodge. This meant the risks to the health and safety of people who used the service were not always fully assessed which exposed people to a risk of avoidable harm.

The service had failed to recognise and respond to changes in a persons physical health, and failed to update relevant care plans and associated risk assessments for a condition that was likely to deteriorate.

We found confidential personal identifiable records relating to people who used the service were not stored securely.

We found the way in which accidents and incidents were recorded across two separate systems was inconsistent and fragmented.

Systems for audit, quality assurance and questioning of practice were ineffective. In particular for falls, medication and care plans.

Registered managers are required by law to notify CQC of certain events in the service such as serious injuries, deaths or events that stop the service from operating. Records we looked at confirmed the registered manager had failed to notify CQC of an event that stopped the service from operating.

Following our inspection on the 20 May 2014, a compliance action was made as we had concerns that people were at risk because accurate and appropriate records were not always maintained by the service. The provider then wrote to us detailing what action had been taken to address our concerns. We undertook this inspection to see what improvements had been made.

Documentation was arranged in chronological order and was up to date and accurate reflecting peoples’ current needs.

We found files contained a number of assessments including mobility, communication, moving and handling, skin integrity, nutrition and a falls risk assessment.

We saw evidence of regular reviews of risk assessments and care plans.

Criminal Record Bureau (CRB) checks, now known as Disclosure and Barring Service (DBS) checks had been undertaken to ensure staff were suitable with vulnerable people.

We found people were now protected against the risks of unsafe or inappropriate care arising from poor and inadequate record keeping.

We found care was planned and delivered in a way that was intended to ensure people’s safety and welfare during their stay.

We spoke to two visiting health professionals one of whom told us; “No concerns, staff are very friendly and helpful. I have witnessed them using equipment and staff really try their best. Hand on heart the staff are very good”.

One visiting relative said “I feel my X are very safe here. There could be more activities and motivation but they are cared for well enough. The place is in need of modernisation but the staff are definitely caring and supportive”.

We spoke to staff who were able to demonstrate a good awareness of safeguarding issues and explain how they would raise any concerns.

We looked at staff training records which demonstrated training in Infection Prevention and Control had been undertaken.

We found there was a range of training that staff had undertaken, which was appropriate to their job role and responsibilities.

Staff we spoke with told us: "I feel very supported by the manager and seniors. They are helping me do my level 3 NVQ at the moment” (National Vocational Qualification).

We found that incidents and accidents were fully recorded with action taken to avoid repeat incidents. Clear instructions were displayed on the staff notice board informing staff what action to take in the event of an incident.

We looked at the care files of six people who used the service and found that people living in the home were having their care and support needs met in a safe way and according to their personal preferences.

One person who used the service told us; “I find it excellent here, the food is good. My bedroom is very clean and comfortable. I have no worries at all”.

A relative of a person who used the service told us; “My X is always clean and well looked after. I’ve been around a few homes and the level of staff care here has been brilliant”. Another relative said “I’m happy with the standard of care here, it is homely and not at all clinical if you know what I mean”.

One member of staff told us; “I get loads of support from the manager, recently I’ve done mental health training, infection control, first aid and moving and handling. I get regular supervision where we cover all sorts of things like training, holidays or any problems".

We found that effective systems were place to monitor the quality of the service provided.

One relative told us; “I’m aware of the complaints policy here, but if there was anything I wasn’t happy with I would speak to the staff or the manager”. Another relative said; “If I had any complaints I would have spoken to the management, but the girls have been fantastic, I can’t thank them enough”.

There was a relaxed and friendly atmosphere in the home. People looked well cared for in a homely environment.

We spoke with visiting relatives, they told us that they were very satisfied with the care that their relatives received. One relative said; “I come at different times, I have no worries with anything, we like the atmosphere here and I have no concern, she always looks cared for”.

When we spoke with two people who used the service, comments included: “I am very well looked after here and I don’t tell lies”, “I have no complaints at all”, “The food is very good, we don’t have a lot to do, but I enjoy a good sing song and the staff treat me very well, I can't complain”.

The environment was clean and organised but in areas, in need of remedial decoration work. We noted that cleaning regimes were in place and daily check lists were completed for all areas of the home. Individual bedrooms and communal areas were clean, tidy and free from malodours.

We found that medicines were safely administered.

We sampled six staff personal files. We found that they were well maintained and contained the required information to demonstrate that staff had been safely and effectively recruited.

Care files did not demonstrate that suitable arrangements were in place, to ensure that the provider was acting in accordance with the consent of people who used the service.

People living in the home told us they were cared for very well. Staff were helpful and kind. All the staff knew what they wanted and treated them well. They were supported to access other health and social care services they needed. Comments such as, “nothing is too much trouble”, and “I am well cared for” were made.

We found staff were very caring and professional when dealing with people. They responded sensitively to people’s needs, particularly when people could not communicate their needs effectively. They were polite and well mannered.

People told us there were no rigid routines they were expected to follow such as the time they went to bed. They usually pleased themselves what they wanted to do. Staff took into account their views and respected their right to privacy and independence. They always knocked on their door and waited to be invited in. They could have visitors when they wanted and staff made them very welcome.

People said staff were respectful when they spoke to them. They responded to all requests for assistance in a timely manner. They said they got the help they needed and described staff as "very good” and "very nice".

People told us they were confident to raise issues of concern with the manager if ever the need arose. There were arrangements in place to safeguard people and staff had been trained in adult protection.

People said they liked their bedrooms and were able to furnish them with their own belongings and possessions. They were very pleased with all their care and support they received and were very happy living in the home.

The provider had invested significantly in upgrading the premises for peoples comfort and benefit.

An unannounced inspection took place on 11, 12 and 18 August 2015.

Claremont Lodge is a care home registered to provide personal care and accommodation for up to 18 people. The home is situated in a residential area of Salford, close to local amenities and a park. Accommodation is in mainly single rooms with shared lounges and a dining area. Claremont Lodge is an older building, some of the décor is worn and traditional in presentation. A new updated kitchen has recently been installed.

At the time of the inspection there were 15 people living at the home, one person was in hospital and the home had two vacancies. There was a registered manager at 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.

At the last inspection on 20 and 23 May 2014 we found the service was non-compliant in the way it managed the records of people who used the service. We asked the service to provide us with an action plan detailing how they would improve and on 15 September 2014 we inspected the service again and found improvements had been made to the required standard.

People using the service told us they felt safe and well cared for. Staff communicated with people appropriately, responded to their needs promptly and treated them with kindness and respect. Staff sought and obtained people’s verbal consent before they helped them.

Claremont Lodge benefited from a core of staff who had worked there for many years and there was a low turnover of staff. Staff knew each person using the service well. The service did not use a formalised method to assess dependency. However, we looked at the staffing rota covering the previous three months and found staffing levels to be sufficient. Throughout our inspection we found sufficient numbers of staff on duty to meet the needs of people who used the service. Some members of staff told us that they thought the hours they were expected to work were too long.

Staff were able to demonstrate an understanding of safeguarding issues and were aware of when to report concerns and who to report them to. A poster was displayed in the main office giving information about how to report a safeguarding concern.

Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

Accidents and incidents were recorded and monitored appropriately. Where necessary, we found preventative measures had been put in place to minimise identified risks.

A variety of individual risk assessments had been completed for people who used the service and placed within their respective care plans. The service maintained a separate grab file that contained a personal emergency evacuation plan (PEEP) for each person who used the service.

A number of quality assurance audits were being completed on a regular basis and these included audits for people’s rooms, kitchen and the general environment. We saw where issues had been identified, remedial action had been taken.

Claremont Lodge had been working with the local council to improve its approach to infection prevention and control and general cleanliness of the environment. At the time of inspection   we found the service to be visibly clean and tidy and free from any odour. The service was completing regular audits for cleanliness and taking action when issues were identified.

We found safe recruitment procedures in place and recruitment records were kept which included application forms, interview notes, verification of identity, references and disclosure and barring (DBS) checks.

All new staff completed a structured three day induction programme that was overseen by the registered manager. Mandatory training for staff was mainly delivered via short online e-learning modules. After talking to staff, it was clear this type of training did not suit everyones individual learning style and gaps in knowledge were present.

A number of staff had completed the ‘six steps to success in care homes’ training course delivered externally by the NHS. The six steps training course is a nationally recognised standard for end of life care.

Staff meetings were held on a regular basis and minutes of meetings were recorded. Regular staff supervision sessions were held and records maintained.

We spoke with staff to ascertain their understanding of the Mental Capacity Act (MCA) (2005) and Deprivation of Liberty Safeguards (DoLS) legislation. We found that staff had a working knowledge of MCA but lacked a general understanding of DoLS, in particular conditions attached to DoLS.

Since our last focused inspection on 15 September 2014, the service had made progress in improving the quality of care plans. However, in the six care plans we reviewed the service did not adequately demonstrate, to what extent, people who used the service and/or their representative wished to be involved in planning and agreeing their own care, treatment and support. The care plans we looked at were not sufficiently person centred and were too task orientated. There was insufficient information about an individual’s life history, likes, dislikes and preferred activities.

The meal time experience at Claremont Lodge was pleasant and calm. Where necessary, people who used the service were provided with an appropriate level of support. A choice of food and drink was offered and personal food preferences were catered for.

The service offered a limited choice of daily activities. However, the service did have a programme of planned social activities that occur at various intervals throughout the year, the most recent being a ‘picnic in the park’ which was held in the local community. The service actively sought the support and involvement of local businesses in its fundraising activities.

The service had a complaints policy and people who lived at the home and their relatives all said they felt able to raise any concerns at any time. We saw evidence of where a complaint had been made, it was documented and dealt with in a timely and appropriate manner. We saw some examples of compliments being given to the service in the form of ‘thank you’ cards and letters of appreciation.

The views of people who used the service and their representatives were being sought through residents meetings. The last such meeting took place in March 2015. We saw how the views expressed by people living at the home resulted in a number of positive outcomes such as iPads being purchased for two people who wanted to watch football on a more regular basis.