Archived: Cliff House Care Home

The service did not have a registered manager and are required to do so. 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.

There was not enough sufficient trained staff to meet people’s needs and wishes. People were left unattended in communal areas for periods throughout the day. They had no means of calling for assistance.

During our inspection visit we observed that staff were friendly and approachable. When staff delivered care it was done in a respectful and appropriate way. Staff were caring and communicated well with people when they had the opportunity. However, they focused on tasks they were performing rather than on the people they were caring for.

Staff did speak in a positive manner about the people they cared for and they said they wished they had more time to spend with people. Staff had a good understanding of people’s health care needs however no account was taken of emotional or personal needs. People were offered healthy food and drinks though they did not have free access to drinks. Staff were not always available to assist people to eat their meals in a timely manner.

Mostly people were left un-stimulated and had nothing to occupy them other than a TV which most people could not see or hear properly.

There were no effective training and processes in place for staff to follow to keep people safe. People’s physical health was promoted. However, staff were unaware of how to ensure people’s rights under the Mental Capacity Act were promoted. Medicines were stored appropriately but were not always administered and recorded as prescribed.

Most people were escorted or taken to the communal sitting area when they were dressed. They stayed there for the duration of the inspection visits. Meals were served as a task and no effort was made to make lunch a social occasion. Most people were given their lunch where they had been sitting all morning and were not given the opportunity to socialise and use lunch time as a social activity.

People were supported to maintain relationships with family and friends. Visitors were welcomed at any time.

Records we looked at were not personalised and did not include decisions people had made about their care including their likes, dislikes and personal preferences. However, there was a good hand over sheet in use that was personalised. There was little or no activity to stimulate and occupy people. There was one person dedicated to activities. However, due to lack of care staff they were called upon to assist people with everyday living tasks.

The service was not managed in an inclusive manner. People were not facilitated to have their wishes made known, therefore they were not recorded as part of care planning. There was no system in place to capture staffs’ knowledge of people’s needs and wishes.

The provider did not have a quality assurance process in place. There they had no means of identifying and addressing the failings in the service.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at this inspection visit. You can see what action we told the provider to take at the back of the full version of the report.

Is the service safe?

We spoke to two people on the day of the inspection that lived at Cliff House Care Home. They told us that they felt safe living there and that they would find it easy to talk to the manager if they had any worries. We found records that staff had checked with two other people when they first arrived if they felt safe living at the service and that people had confirmed they did feel safe. This helped to ensure that people were protected from abuse and neglect at Cliff House Care Home.

At Cliff House Care Home appropriate checks were undertaken before staff began work to ensure that they were safe to work with vulnerable people. This meant that the provider was checking to ensure people employed were of good character and had the qualifications, skills and experience necessary.

We also found staff received induction training on the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards and that most staff had received additional training on this legislation within the last two years. The Mental Capacity Act 2005 is an act introduced to protect people who lack capacity to make certain decisions because of illness or disability. Deprivation of Liberty Safeguards' (or DOLS) have been introduced to protect individuals from the unlawful deprivation of their liberty. We found that the manager had also planned for staff training in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards to be renewed within the next week. This meant that staff had the skills and knowledge needed to identify the possibility of abuse and prevent abuse from happening.

Is the service effective?

We saw that people using Cliff House Care Home received effective care. This was because care was planned based on the needs of individuals, staff were trained, advice was sought from health professionals and appropriate equipment was available. For example care plans to assist people with their mobility were well documented and included any equipment that was required such as a hoist. We looked at the training records for staff and found that all staff had received training within the last year on how to assist people to move safely and comfortably. We observed one technique used to assist a person to move that did not follow best practice. We discussed this with the manager who agreed to complete observational supervision of staff to ensure standards of assisting people to move were consistent and safe.

Is the service caring?

We saw staff interacting with people with kindness and compassion. Staff we spoke to knew people well and responded to their individual needs. People's diversity, values and human rights were respected. Time and energy had been invested in supporting people with communication difficulties. Some people living at Cliff House Care Home had difficulty communicating verbally. Staff told us that they used a variety of communication methods including, writing, picture cards and a computer to make sure people could be asked for their choices and express their preferences. We spoke with two families who were visiting their relatives on the day of the inspection. One family member told us, 'Staff have developed a way of communicating with my relative; they are so kind and have such a good and pleasant rapport.' This meant that people were receiving personalised care and their diversity, values and human rights were being respected.

Is the service responsive?

Questionnaires had been used to ask staff about their working environment, colleagues, training, management and equipment available. This provided staff with the opportunity to raise issues and make comments. We saw that the manager had raised a concern on behalf of staff with the provider in response to a specific concern. Questionnaires had also been sent to people living at Cliff House Care Home. This meant that systems were in place to obtain the views of staff and people using the service.

Is the service well-led?

The service had a registered manager who was providing clear leadership. Staff and relatives told us they were confident to raise any issues or concerns with the registered manager.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others. Examples included an audit of medication which identified actions to improve recording of medicine administration and an audit on laundry highlighted the need to order more bed linen. Other audits were completed on infection control, kitchen and domestic equipment, general environment and care plan records. We saw actions had been taken to ensure the standard of service was maintained or improved. These actions reduce risks to people and help the service to run effectively.

At this inspection visit we found that information about people's medicines in their care plan files ensured they would receive individualised care that met their needs.

We found that people's medicines administration record (MAR) charts were usually properly completed by staff. We saw that written protocols were kept with each MAR to guide staff in their decision making for any medicines with varied instructions about when and how much to give.

We saw that the manager regularly checked the medicines systems in the home. This included MAR charts to ensure their completion. We also found that people's medicines were safely stored and saw staff safely administering people's medicines.

We spoke with two people who said that staff retained and administered their medicines to them on their behalf, which they had agreed to. One person said, 'it's safer that way, as I easily forget what I am taking.'

Overall, people told us they were happy or satisfied with their nursing care and support and mostly enjoyed the meals provided and said they were regularly consulted about these. We found people were properly supported to enable them eat and drink sufficient amounts to meet their needs.

Two people told us, that activities were regularly organised and one person told us about residents' meetings, which they attended. One person said, 'There's plenty of opportunity to say what you think about life here and you can always make suggestions about how things are organised.' Another said, 'The meals suit me fine, cook asks us what we want each day and whether we have enjoyed our meal.'

We were not able to hold discussions with some people because of their conditions, such as dementia. We observed staff interacting and supporting people and found staff were supported to deliver care and treatment that was safe and appropriate to people's needs and rights. However, we found that people were not fully protected against the risks associated with unsafe medicines practices. This was because the provider did not have appropriate arrangements in place to consistently manage the recording of these.

We found that the home was clean and accessible, including for people using wheelchairs, and that people's rooms were personalised and comfortable.

We saw that people's needs were assessed and their care was well planned. This included assessing risks that could affect people and providing information for staff about their health conditions.

We found that staff were aware of how to protect people from abuse and also that people felt safe at Cliff House. One person told us, "I feel completely safe here." We also found that recruitment procedures helped to ensure that suitable staff were employed to work at the home.

We found that although consent was sometimes sought for people's care, where people were unable to consent for themselves, for example due to dementia, the correct procedures were not always being used.