CQC report explained · a residential care home
What the CQC found at Clock Tower Mews
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People were protected from avoidable harm, with improved risk assessments, staffing, safeguarding and medicines systems. Inspectors still found an occasion when emergency medicines were not taken out with a person and one medicine administration was not recorded.
- Effective?
- Good
- People's needs were assessed and staff were trained to support them. However, not all staff prepared specialist food and drinks to the required consistency or dietary requirement.
- Caring?
- Good
- People were treated with compassion, dignity and respect. Staff knew people's communication methods, preferences and life histories, and relatives were involved in care reviews.
- Responsive?
- Good
- Care had become more person centred, with more activities, trips and opportunities for community involvement. The complaints process worked, although the complaints policy was not in an accessible format.
- Well-led?
- Requires improvement
- Management and quality monitoring had improved, but care records were still sometimes inaccurate, incomplete, out of date or hard to navigate. The report says some staff did not read the care plans because they were difficult to use.
What inspectors found, March 2019
Rated Good and no longer in special measures; inspectors found safer, kinder care, but records and management still required improvement.
This was an unannounced comprehensive inspection. Inspectors visited on 23 January 2019 and spoke with health professionals on 29 January. They spoke with one person, relatives, staff and health professionals, observed care and reviewed care and management records.
The home supported eight people with learning disabilities and autism. Inspectors found improvements since the previous inspection. People were safer, medicines were generally managed properly, staffing had improved, and people received kind and personalised support. Activities and involvement of relatives had also improved.
The overall rating was Good. Safe, Effective, Caring and Responsive were all rated Good. Well-led was rated Requires Improvement because some care records were inaccurate, out of date or difficult to use. The previous Inadequate rating and special measures had ended, and the earlier breaches were no longer present at this inspection.
Safer care
Risk assessments, safeguarding practice, fire plans and staffing had improved since the last inspection. Staff understood how to identify and report concerns.
“People were kept safe from harm because assessments identified the risks to their health and well-being.” from the report
Kind and respectful staff
Staff treated people with compassion and dignity. They recognised distress and used people's individual preferences and communication methods to support them.
“People were treated in a compassionate manner by staff who were caring and respectful to them.” from the report
More activities and choice
People had more opportunities for sensory activities, music, trips, day centres, college and community involvement. Staff supported people to make choices and develop independence.
“People were now provided the opportunity to engage with activities.” from the report
Improved leadership
The report found that leadership had become more visible and that staff, relatives and health professionals were positive about the improvements.
“The registered manager had made most of the required improvements.” from the report
Care records were not reliable enough
needs fixingSome records contained conflicting or incorrect information, including a care plan referring to another person and missing or incomplete risk guidance. The records were also cumbersome, and some staff said they did not read them.
“People's care records, although vastly improved since the last inspection in March 2018 continued to require further development.” from the report
Special diets were not always prepared correctly
needs fixingNot all staff prepared food and drinks to the required consistency or dietary requirement, although staff who did so were aware of people's needs and had training.
“Not all staff prepared people's food to the required consistency or dietary requirement.” from the report
Medicine recording error
needs fixingOne person's medicine was given but was not recorded afterwards. Inspectors also found that emergency medicines were not taken when one person left the building.
“One person was administered their medicine which was not subsequently recorded in the record.” from the report
Some staff checks were incomplete
minorThe registered manager had not yet completed observations of staff practice. They said this would be done and reviewed regularly.
“However, the registered manager had not completed observations of staff practise which was an area they told us they would complete and regularly review.” from the report
- 01How have you made sure every care plan is accurate, person centred, easy to use and available in an accessible format?
- 02How do you check that all staff follow each person's specialist food and drink requirements?
- 03What changes make sure medicines are recorded immediately after they are given?
- 04How do you make sure emergency medicines travel with people when they leave the home?
- 05Have observations of staff practice now been completed, and what did they show?
This was an unannounced comprehensive inspection covering all five key questions and following up concerns found at the previous inspection. This explanation was written from the published report of 22 March 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, June 2018
Rated Inadequate and placed in special measures; inspectors found unsafe systems, weak leadership and gaps in person-centred care.
Inspectors visited without notice on 22 and 27 March 2018. They spoke with relatives, staff, managers, health professionals and commissioners. They reviewed three people's care records and management records. They also observed care because people could not speak with them directly.
The home was not consistently safe. Risk assessments were incomplete or out of date. Staff were not clear about fire evacuation arrangements, some training was overdue, and one person's tablets were crushed against medical advice. Care plans did not always reflect people's changing needs or preferences.
There were kind and respectful interactions, enough staff, clean surroundings and prompt access to health professionals. However, people and relatives were not consistently involved in care planning, activities were limited, and quality checks had failed to identify serious problems. The overall rating was Inadequate, so the home was placed in special measures.
Enough staff
Inspectors found there were enough staff to support people's needs in a timely way.
“People were supported by sufficient numbers of staff to meet their needs.” from the report
Kind and respectful care
Staff were observed treating people with kindness, respect and dignity. They maintained privacy during personal care.
“People were addressed by staff with respect and kindness, and who treated them in a dignified manner, ensuring their privacy was maintained.” from the report
Access to health professionals
Staff referred people to health professionals when their needs changed. Inspectors saw a pressure area being reported and treated promptly.
“People had access to a range of health professionals as their needs changed.” from the report
Fire safety and risk assessments
seriousStaff could not explain how they would evacuate people in a fire. Personal evacuation plans were poorly completed and had not been read by staff. Risk assessments did not consistently reflect people's needs.
“Staff were not able to tell us the method of evacuation they would use.” from the report
Medicines
seriousOne person's tablets continued to be crushed even though a pharmacist had advised that this should not happen. The report says this could make the medicine ineffective or unsafe.
“Staff had not sought a prescription for this liquid from the GP, and continued to crush the person's tablets against medical advice.” from the report
Staff training and support
seriousSeveral training areas were overdue or had not been provided. Staff had also lacked regular supervision, appraisals and professional development.
“Due to the lack of supervisions, professional development and overdue training in many areas, this was a breach of Regulation 18 of the Health and Social Care Act (Regulated Activities) Regulations 2014.” from the report
Care planning
seriousCare records were not consistently updated when people's needs changed. People and relatives were not always involved in developing or reviewing care.
“People's care needs were not consistently met. One person had seen the dentist in the previous January and had been asked to make a follow up appointment for May 2018.” from the report
Limited activities
needs fixingActivities did not consistently match people's ages, interests or preferences. Some people spent much of their time watching television without tailored stimulation.
“Activity in the home during the inspection was sterile and lacked interaction or innovation by staff.” from the report
Weak management checks
seriousThe provider's audits had not identified or corrected important problems. Records and risk assessments remained inaccurate despite previous findings and internal reviews.
“The governance systems in Clock Tower Mews were ineffective at identifying, rectifying and monitoring required improvements at all levels of management.” from the report
- 01What has been done to make every person's risk assessment and personal evacuation plan accurate and up to date?
- 02How are staff trained and checked on fire evacuation, safeguarding, medicines, infection control and people's specific care needs?
- 03How do you make sure medicines are given exactly as prescribed, including medicines that are difficult to swallow?
- 04How are people and their relatives now involved in writing and reviewing care plans when needs or preferences change?
- 05What individual activities and community opportunities are now available for each person?
This was an unannounced inspection of all five key questions, but inspectors could not speak directly with people and reviewed care information for three people. This explanation was written from the published report of 1 June 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Clock Tower Mews
4 rated inspections over 2 years: the service has held its Good rating throughout.
- March 2019Goodcurrent ratingup from InadequateSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- June 2018Inadequatedown from Requires improvementSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- April 2017Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- March 2017GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- December 2013
Report published without a new overall rating.
- September 2013
Report published without a new overall rating.
- March 2013
Report published without a new overall rating.
- August 2012
Report published without a new overall rating.
- November 2010
Registered with the Care Quality Commission on 25 November 2010.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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Most charge £980 to £1,300 a week. 82 can care for a couple. 12 years' experience on average.
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