The inspection took place on 21 October 2015 and was unannounced. There were 25 people living at the home at the time of the inspection.
Cliffe Vale is located close to the centre of Shipley. The home provides personal care to a maximum of 27 people and caters predominantly for older people and people living with dementia. The home is a detached property and provides accommodation on three floors, the home does not have a passenger lift, there are a number of stair lifts which provide access to the upper floors.
The home has 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.
The last inspection took place on 29 October 2014. At that time we found the provider was not meeting two regulations. These were the regulations relating to the Mental Capacity Act 2005 and monitoring and assessing the quality of the services provided. The provider sent us an action plan with details of how they were going to make the required improvements. They told us they would have completed the action plan by February 2015. New regulations came into effect on 01 April 2015 and we cross referenced the old regulations to the new regulations so that we could check the provider had taken appropriate action. We found the provider had not taken appropriate action and there were breaches of the new regulations.
We looked at how the service was working to meet the requirements of the Mental Capacity Act 2005 and found people were at risk of being deprived of their liberty unlawfully. This was a breach of the regulations because people must not be deprived of their liberty without lawful authority.
People living in the home and their relatives told us they felt safe. However, we found safeguarding incidents were not always recognised or reported to the right agencies, such as the Local Authority safeguarding team and the Commission. This was a breach of the regulations because it meant the provider did not have proper systems in place to make sure people were protected from abuse.
The provider did not always make sure the required checks were completed before new staff started work. This was a breach of the regulations because it meant people could be at risk of receiving care and treatment from staff who were not fit and proper persons to work in a care setting.
There were no housekeeping or laundry staff employed at the time of the inspection. The cook finished work after lunch and the activities coordinator only worked two hours a week. The care assistants were responsible for housekeeping, laundry and kitchen duties and were also responsible for providing social activities in addition to their caring roles and responsibilities. The home did not have enough staff and the staff that were employed were not properly supported by means of training, supervision and appraisals. This was a breach of the regulations because provider of care services must make sure there are enough staff deployed to deliver the service and that staff are trained and supported to carry out their duties.
People were at risk because medicines were not always managed properly. This was a breach of the regulations.
The standards of cleanliness were poor and this was a breach of regulation because it meant people were living in a home which was not clean.
The hot water temperatures were not maintained within safe limits and there were no bath thermometers to check the temperature of the water before people got into the bath which meant people could be at risk of scalding. This was a breach of regulation because it put people who used the service at risk.
People told us they were satisfied with the food. However, we found the choice of food was limited and people’s dietary needs and preferences were not always catered for. This was a breach of the regulations because the way people’s dietary needs were catered for did not demonstrate regard to their well-being.
We were concerned at how people’s weight and nutritional intake was monitored. This was a breach of regulation because it put people at risk of receiving unsafe care and treatment.
People who used the service and their relatives told us the staff were very caring and compassionate. During the inspection our observations supported this view. However, we found some working practices did not promote people’s privacy and dignity. For example, people were limited in their choice of bathroom. This was because the home had a “bath person” who worked two days a week to support people with bathing and always used the same bathroom. This was a breach of the regulations because the provider’s processes for monitoring the quality of the services provided had not identified this practice compromised people’s privacy and dignity.
People’s needs were not always assessed properly. People’s care plans were not person centred and did not have enough information to guide staff on how to meet their individual needs and preferences. This was a breach of regulation because there was a risk people would not receive care which was appropriate, met their needs and reflected their preferences.
People told us they knew the manager and were able to make a complaint if they needed to. They said they didn’t have any complaints. However, we found the complaints policy was not up to date and complaints were not always recorded and people were not always given feedback on the actions taken in response to their complaints. This was a breach of the regulations because the provider did not have proper systems for receiving and dealing with complaints.
Accurate and complete records were not maintained in respect of each person who used the service. For example, this was evident in people’s care plans, risk assessments and the food and fluid charts.
The systems for monitoring, assessing and improving the quality of the services provided and for identifying and managing risks were not effective. This was a breach of the regulations because of the lack of good governance.
We found the provider was in breach of eight regulations in relation to safe care and treatment, person centred care, safeguarding, staffing, recruitment, premises, complaints and good governance. You can see the actions we have asked the provider to take at the back of the full version of the report.
The overall rating for this service is ‘Inadequate’ and the service is in ‘Special measures’.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.