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Inspection carried out on 25 October 2017

During a routine inspection

This unannounced comprehensive inspection took place on 25 and 26 October 2017.

Clifton Lodge is registered to provide accommodation, care and support for up to 14 older people. At the time of the inspection there were 13 people living at the home. There was a registered manager employed at the service. 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.’

Our previous inspection of the home, completed in August 2016 identified some areas where improvements were required. These included the providers recruitment processes, staff knowledge of safeguarding processes, correct application of The Mental Capacity Act 2005, staff training and quality assurance systems. At this inspection we found the provider had implemented a range of systems to ensure the shortfalls previously identified were addressed.

People told us they were well cared for and said they felt safe living at the home. Staff were aware of what constituted abuse and the actions they should take if they suspected abuse. Relevant checks were undertaken before new staff started working at the service which ensured they were safe to work with vulnerable adults.

Staff had the right skills and training to support people appropriately. Staff had completed or were in the process of completing The Care Certificate, which is a nationally recognised set of standards for health and social care workers.

People told us they felt there were enough staff available on each shift to care for them well. Staff felt well supported by the management team and received regular supervision sessions.

Pre-admission assessments were completed prior to people moving into the home. People’s risks were assessed and plans developed to ensure care was provided safely. Accidents and incidents were monitored to ensure any trends were identified to enable action to be taken to safeguard people.

Medicines were handled appropriately and stored securely. Medicine Administration Records (MAR) were signed to indicate people’s prescribed medicine had been given.

People were referred to health care professionals as required. If people needed additional equipment to help them mobilise and keep them safe and comfortable this was readily available.

The manager was aware of their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS). These safeguards aim to protect people living in care homes and hospitals from being inappropriately deprived of their liberty. These safeguards can only be used when there is no other way of supporting a person safely. Staff had an understanding of the Mental Capacity Act 2005 (2005) and how it applied to their work.

Staff ensured people’s privacy and dignity was protected. People received personalised care from staff who were responsive to their needs and knew them well. Staff created a relaxed, friendly atmosphere which resulted in a calm and cheerful culture in the home.

People knew how to make a complaint and felt confident they would be listened to if they needed to raise concerns or queries. The provider sought feedback from people and changes were made if required.

People told us they felt the service was well led, with a clear management structure in place. Relatives told us they were always made to feel welcome at any time and felt fully involved and consulted in the care of their relative.

There were systems in place to drive the improvement of the safety and quality of the service.

Inspection carried out on 3 August 2016

During a routine inspection

This inspection took place on 3 August 2016. It was carried out by one inspector.

Clifton Lodge provides accommodation and personal care for up to 14 older people. There were 13 people living in the home at the time of our visit.

There was a 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.

People had their risks assessed and plans were developed to ensure care was provided for people safely. When people’s risks changed their risk assessment was reviewed however the documentation was not always clearly updated so that the most up to date care plan reflected the current risk assessment. This meant people were at risk of not receiving safe care and support.

The provider had recruited five new staff. One new member of staff did not have all the appropriate pre-employment checks carried out to ensure they were suitable to work with vulnerable adults. The registered manager told us they had taken precautionary measures to ensure the member of staff did not work with people unsupervised. However they had not completed a risk assessment and could not evidence the actions they had taken during our inspection.

The registered manager told us that there had been challenges earlier on in the year when they had staff vacancies. The implications of this were they had to provide hands on care and had fallen behind with maintaining and updating records. They told us they had since appointed a senior care worker who supported them with day to day management of the home; they told us they were in the process of working through a back log and were confident all records would be updated as needed.

The registered manager had not always followed correct processes when making a decision in a person’s best interests. This meant that the person’s rights had not been fully protected to ensure that care was provided in the least restrictive way. The registered manager had made appropriate applications to the local authority for Deprivation of Liberty Safeguards (DoLs).

Staff had received training in safeguarding adults however two staff we spoke with had difficulty explaining to us how they would recognise abuse and what actions they would take. The registered manager told us they would take action immediately and would provide refresher training for staff. When we asked the registered manager for a list of the staff training records they were unable to provide it to us during our inspection. They agreed to compile a list and send it to us following our inspection. We received this as agreed. This confirmed staff had received training which supported them to carry out their job roles.

Medicines were stored and administered appropriately, the registered manager had put measures in place to identify gaps in recording of administration of medicines which meant errors could be identified promptly and rectified.

People told us they enjoyed the food and were offered a choice of where they would like to sit and that they could request alternatives if they did not like what was on the menu.

People were positive about staff and told us they were kind and caring. We saw staff were unhurried and worked well as a team. We saw staff being reassuring to one person who was anxious and one other person told us staff were encouraging and promoted their independence. The person told us since living in the home they were able to do more for themselves.

Inspection carried out on 7 May 2014

During a routine inspection

At the time of our inspection there were 12 people living at the home. We spoke with seven of these people about their experience of living at the Clifton Lodge. The manager assisted us throughout this inspection and we spoke with the head of shift, a care worker, the cleaner and the chef. We also spoke with two health professionals from the Royal Bournemouth Hospital who were visiting people living at the home.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

This is a summary of what we found-

Is the service safe?

The home had systems in place to monitor the quality of service provided to people. Accidents and incidents were monitored and remedial action taken to prevent further accidents.

Is the service effective?

People’s care and support achieved good outcomes. People we spoke with were happy with the way they were looked after and reported no concerns. We also had positive feedback from the visiting health professionals about the outcomes for people placed for interim care.

Is the service caring?

We spoke with people living at the home and they told us that there was a kind, caring team of staff. One person told us, “I like living here; the staff are very kind and do everything for me”. Results from the last survey carried out with people who lived at the home also found that people were happy with the service being provided.

Is the service responsive?

Services provided to people were organised so that they met people’s needs. We found people had up to date care plans in place so that staff could provide consistent care and support to people. The visiting health professionals we spoke with said that the staff knew the needs of people placed for interim care, (people discharged from hospital to the care home for additional care until they were ready to return home), and that any actions raised would be put into practice.

Is the service well-led?

The registered manager has been in post for many years and has years of experience of running a home. We found there were well developed systems for monitoring the quality of service provided to people. Accident and incident monitoring were taking place and living at the home being surveyed about their views of the service they received.

Inspection carried out on 30 May 2013

During a routine inspection

People received support to meet their needs according to their wishes. Any risks to a person's wellbeing had been identified and plans put into place to minimise these.

Activities were available for people who wished to participate in them. We saw people engaged in various activities on our visit.

People were assisted to eat and drink and were able to choose what they ate and where. Staff supported people to ensure they received sufficient nutrition and fluids.

Equipment used by people was in good condition and adequately maintained.

Staff were appropriately trained and supervised.

The provider had systems in place that ensured the quality of the service was monitored; procedures were followed properly and identified where improvements could be made.

Inspection carried out on 12 December 2012

During a routine inspection

People who lived at the service, and relatives we spoke with told us they were happy with the home. One person told us “This is a lovely place, it's my home, I live here”. A relative told us they could share any worries with the manager. Another person told us “I feel safe here and the staff are very kind to me which is important”.

For each person living in the home there was a detailed plan of care in place that included people's individual needs and wishes. The plans also detailed physical and emotional healthcare needs.

People were protected from risk of abuse or harm by there being safeguarding policies and procedures in place and by staff knowing how and when to use them.

Evidence we saw showed us that people were supported by a caring, experienced staff team. The staff team were well supported and trained.

There was a regular cycle of quality audits undertaken to ensure that the home was kept under review. Records showed us that people using the service, families and professionals involved in people's care were consulted.

Reports under our old system of regulation (including those from before CQC was created)