All inspections: Cleeve Hill Nursing Home

This inspection took place on 7 and 8 October 2015 and was unannounced. Cleeve Hill Nursing Home provides accommodation for up to 50 people. At the time of our inspection there were 39 people living there. Up to six people can be cared for in the Winchcombe Unit which provides intermediate beds for people needing end of life support or rehabilitation. The staff employed in this unit were recruited, supervised and trained by a local hospital.

There were four people in the home living with dementia and 10 people with short term memory loss. All bedrooms, apart from three, had en suite facilities. People had access to shared bathrooms and shower rooms as well as living and dining areas. People staying at the Winchcombe Unit had single rooms with en suite facilities.

Cleeve Hill Nursing Home is currently registered to provide the regulated activity, Transport services, triage and medical advice provided remotely. This regulated activity was no longer being provided from this location and was not inspected as part of this comprehensive inspection. The provider is in the process of removing this regulated activity from Cleeve Hill Nursing Home and registering this regulated activity at another location.

There was not a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. A manager had been appointed and they were in the process of applying to become registered with CQC.

People living at Cleeve Hill Nursing Home received personalised and individualised care which reflected their wishes, likes, dislikes and preferences. They had accommodation which was maintained to a high standard and which was due for further refurbishment. People enjoyed a range of activities both inside and outside of the home seven days a week. Activities co-ordinators were employed to deliver these alongside external providers who delivered Zumba and Tai-Chi. Individual activities were provided for people who preferred to remain in their rooms. People had meals provided to a restaurant quality and with a wide range of choice. People who had specific dietary needs were catered for.

People staying for a short period of time at the Winchcombe Unit had care records which clearly identified their treatment and any changes in the health or well-being. Upgrades to the environment had been made by Cleeve Hill Health Care in response to infection control issues. They enjoyed catering supplied by the care home.

People’s health and well-being was monitored and when changes occurred referrals were made to health care professionals. Relatives said they were kept informed of any changes and involved in decisions about their loved one’s care. People had personal profiles in their rooms reflecting those important to them, their wishes for care and support as well as end of life care. When people needed help to make decisions, their legal representatives were involved and any decisions taken were made in their best interests. People said they felt safe living in the home and relatives were reassured that they were well looked after.

People were supported by sufficient numbers of staff to meet their needs. Staffing levels were flexible and monitored closely to make sure they responded to people’s changing needs. Staff had access to a range of training to equip them with the skills and knowledge to support and care for people. They said they were well supported to develop in their role and spoke positively about working together as a team.

People were involved in quality assurance processes to give feedback about their experience of their care. This feedback along with feedback from their relatives, staff and community professionals was used to make improvements to the service. Relatives and staff spoke highly of the manager and recognised the need for consistent management to embed improvements.

Our inspection of 26 July 2013 found that the provider had failed to operate effective recruitment procedures. They had failed to ensure that staff were of good character and had the skills, experience and qualifications for that work.

We did not speak with people who used the service as part of this responsive inspection.

At this inspection we found that additional checks had been put in place to make sure that all information was obtained prior to appointment. Where there were gaps in employment history these were explored and a full employment history provided. Where staff had previously worked with adults and children the reasons for leaving this employment were verified.

We found that the provider was operating effective recruitment and selection procedures.

We spoke with 15 people receiving care and support in their own homes. We sent questionnaires to 61 other people and 22 were returned. We visited six people receiving personal care in their own homes. We also spoke with four people living in the nursing home and two visitors. Overall people and their relatives were satisfied with the service received and although some issues were raised positive comments were also received.

We found that people gave their consent to the care, support and treatment they received. One person told us they were fully involved in making decisions about their care.

Each person had care plans and risk assessments in place describing the way they wished to be supported and how their needs were to be met.

People living in the nursing home had access to accommodation of a high standard which was well maintained. Where they needed equipment to promote their safety and comfort this was provided. People receiving personal care in their own home also had sufficient equipment to ensure their safety and well-being.

The recruitment processes were not robust. The provider was not obtaining the necessary information about applicants before they were appointed. Some people raised concerns about staff unable to speak English well but generally people were happy with the skills of staff.

People had been asked for feedback as part of the quality assurance process. Comments included, "I'm over the moon" and "I am looked after very well".

At this inspection we looked at the regulated activity personal care provided by Cleeve Link. In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time of this inspection.

Four people contacted us to share their experiences of the agency and to let us know about concerns they had about the attitude of staff, the service provided and issues around moving and handling training. We haven't been able to speak with other people using the service directly. We gathered evidence of people's experiences of the service by using information provided to us from other social and health care professionals, by reviewing responses to the provider's annual survey and looking at the complaints log. We found that the provider was responding to people's concerns or complaints. For instance providing English and cooking classes for international staff.

We found that people were involved in the review of their care. Audits were in place to monitor the quality of care records and the quality of care provided. Concerns had been raised about how people with dementia and moving and handling needs were supported. We found staff had access to training in both areas and observations of their practice identified any shortfalls or the need for further training.

We spoke with 12 people using the service and three visitors. We talked with people about how they consented to the care, treatment and support they received. Some people were unsure about whether they had care plans but we noted that they had personal profiles in their rooms which included a copy of their care records. Some people told us staff talked to them about the care and support they received. One person told us, "the staff are very happy to give me care as I need it". We found that people's needs were being assessed and their care records kept up to date to reflect their changing needs. People and their relatives were being consulted about their care needs.

We talked with people about their meals and access to drinks. They were provided with hot drink machines around the home and we observed people helping themselves. Cold drinks were also provided in communal lounges and their rooms. One person told us "the food is fantastic and they can't do enough for you. You pick from a three course menu for lunch and dinner, but if you don't fancy it when it comes, they'll always sort you out'. Where people were at risk of dehydration and malnutrition systems were in place to monitor this and provide them with a nutritional and well balanced diet.

People told us they felt safe and were treated with dignity. One person said, "staff treat people respectfully. Staff are gorgeous to people".

This inspection was to look at improvements made following our inspection of November 2011. As noted in the judgement of the report we found significant improvement in the practices of the home around reviewing and updating of care plans.

We also looked at recruitment practices because of information we had received which caused us concern. Whilst we found good practice in this area we also identified a serious concern in recruitment of an individual in the home. We have taken compliance action and the provider must address this concern.

An area we looked at at our previous inspection was that of safeguarding. We have noted from this visit that the provider has reviewed and updated their policy and procedure around safeguarding. We were also provided with evidence that managers and senior staff have all now completed updated safeguarding training.

We spoke to a number of people living in the home about their care and the quality of the care they receive. All were very positive about the care telling us, " I get the care I need", "it is very good her, the staff are excellent, very kind and caring". One person told us, "I have no complaints about the care or the staff there is not one I would complain about". Another person told us, "staff respect your dignity".

We spoke with five individuals receiving a service from Cleeve Link and eight living at Cleeve Hill Nursing Home.

Individuals made a number of comments about the quality of the care they receive: "find staff charming, kind and thoughtful...never been unhappy about anything."staff always pleasant...it's a good place to live" and "staff all very kind".

We asked individuals living in the care home about the quality of the food and they told us: "it's all very good", "always a lovely choice", "it's like hotel food I enjoy what I am given".

Those receiving a service from the domiciliary agency told us: "I like getting the same carer", "excellent service...regular carer, competent staff" , "I feel safe, trust care workers implicitly...very good indeed". One person told us "the best thing is the continuity of care....we get the care we need".

Comments about the quality of care received by the home which we looked at included:

"It was always a comfort to know that she was being so well looked after and was comfortable in her final years."

"I am really grateful for the caring environment you all provided".

A GP told us that they had a "very professional relationship with lead nurses" and "they are very responsive in doing anything we ask them to do".

Archived: Cleeve Hill Nursing Home

All Inspections

7 and 8 October 2015

During a routine inspection

25 October 2013

During an inspection looking at part of the service

13, 14 August 2013

During a routine inspection

28 November 2012

During an inspection in response to concerns

29, 30 August 2012

During a routine inspection

3 April 2012

During an inspection looking at part of the service

15 November 2011

During an inspection in response to concerns