This inspection took place on 11 and 13 April 2018. It was unannounced on day one of the inspection.

Clarence House provides accommodation for up to 33 people who require personal care, some of whom may be living with dementia. It is situated in Brigg with access to local amenities and shops. At the time of the inspection 18 people lived at the service.

Clarence House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

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

People told us they felt safe living at the service. Staff understood how to report safeguarding concerns. Safeguarding issues raised were investigated and action was taken to address any shortfalls. Safeguarding recommendations made by the local authority were implemented to help staff monitor people’s health and wellbeing.

Risks to people’s wellbeing were monitored. General maintenance was undertaken. Accidents and incidents were monitored and emergency plans were in place to help to protect people’s health and safety. Environments risks were monitored and emergency planning was in place.

Minor issues with infection control found on day one of the inspection were quickly addressed. Medicines management was safe.

Staffing levels were determined by and monitored in line with people’s dependencies. People’s needs were met in a timely way by staff. Staff undertook training in a variety of subjects, they had regular supervision and a yearly appraisal to maintain and develop their skills. Further training had been undertaken following the recommendations gained from safeguarding issues that were investigated, to enhance the staff’s skills. Staff recruitment procedures were robust.

People told us staff who looked after them were caring and kind.

Staff treated people with dignity and respect. People’s preferences for their care and support were recorded and were known by staff. Staff encouraged people to maintain their independence, even if there were risks present. People’s health was monitored by relevant health care professionals to help to maintain their wellbeing. People’s nutritional needs were met.

Care and support was provided in line with the Mental Capacity Act 2005. Staff encouraged people to make choices about how they wished to live their life, where this was possible. Care and support was provided in people’s best interests where people lacked the capacity to make decisions for themselves.

There was a complaints policy in place and issues raised were investigated and resolved. Local advocates were available to people to help raise their views.

Activities were provided that people could join in with, if they wished. Visiting was unrestricted and visitors were made welcome.

Meetings, spot checks and audits took place to help the management team monitor the quality of service provided. Issues found were acted upon to maintain or improve the service.

This inspection was carried out by a social care inspector over one day. We considered all the evidence we gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found-

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic. Equipment in the home was maintained and checked regularly. CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. There was evidence that assessments concerning people’s capacity to make informed decisions had been carried out under the Mental Capacity Act 2005, to ensure their rights were protected.

There were enough staff available to meet the needs of the people who used the service. The new acting manager told us that staffing levels had been increased in response to the recent admission of a group of people from another service, in order to ensure their care and welfare was appropriately met. There was evidence recruitment checks were carried out of new staff to ensure they were safe to work with people who used the service.

Is the service effective?

People told us they were happy with the support they received and had no complaints. Staff told us they enjoyed their work and we observed they interacted with people in a positive manner.

Is the service caring?

People were supported by kind and attentive staff. A group of people who moved into the home earlier on in the week, told us they were very comfortable in their new surroundings and that staff had provided reassurance and support to help them settle in to the home. We observed that care staff demonstrated care and compassion with meeting people’s needs.

Is the service responsive?

People’s needs had been assessed before they moved into the home. Care records confirmed people’s preferences, interests and individual needs had been recorded and care and support had been provided that overall met their wishes.

Is the service well-led?

There was a quality assurance system in place to enable the service to be monitored.

We saw evidence of regular consultation with people who used the service and their relatives to enable their feedback about the home to be provided. We saw this included regular meetings and events that were planned, to enable people to participate and be involved in the life of the home.

What people who used the service and those that matter to them said about the care and support they received:

We spoke to a person who had moved in to the home when it first reopened. They told us they were very happy with the service and had no complaints. They told us, "It is absolutely gorgeous.” People who moved into the home earlier on in the week told us they were very comfortable in their new surroundings. One person told us, “I can’t pick any problems. Everything is like a family…I just press the bell…..it is perfect.”

We undertook this unannounced inspection over two days, on 19 and 20 November 2015. The service was last inspected on 11 September 2014 when the service was found to be compliant with the regulations inspected.

Clarence House is registered to provide personal care and accommodation for up to 33 people, some of whom may be living with dementia. The service is situated close to the centre of Brigg.

At the time of our inspection visits there were 21 people who were using the service.

There was 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.

We saw that staff had been safely recruited to ensure they did not pose a risk to people who used the service and that they had received training to ensure they could recognise and report potential abuse. Staffing levels had been evaluated to ensure there were enough staff available for meeting people’s needs. People had been assessed to enable staff to manage known risks and keep them safe from harm. Medicines were administered to people safely and checks of the building were regularly carried out to ensure it was well maintained.

A range of training was provided to enable staff to effectively carry out their roles. We saw staff engaged with people throughout our inspection in a courteous way and kind way to ensure they were in agreement with decisions made about their support. Best interest meetings were held when people lacked the capacity to make important decisions for themselves. People were provided with a range of healthy and nutritious meals and their intake was monitored with the involvement of relevant community health care professionals where required.

People who used the service were supported by staff who demonstrated courtesy and kindness and showed consideration for the importance of maintaining people’s dignity and wishes for privacy. People’s private records and information was maintained in a confidential manner.

People or their relatives were involved in the planning of their support which was reviewed on a regular and ongoing basis. People were provided with a range of activities to enable them to have opportunities for social stimulation and interaction. A complaints policy was in place to ensure people could raise any concerns about the service when required.

The registered manager had a range of experience to run the service and understood the requirement to report accidents, incidents and other notifiable incidents to the Care Quality Commission. A range of audits were regularly carried out to enable the quality of the service to be monitored and enable the service to learn. People who used the service, their relatives and other stakeholders were consulted and feedback from them was used to help the service to develop.