You are here

Clifton Court Nursing Home Requires improvement

Reports


Inspection carried out on 21 August 2019

During a routine inspection

Clifton Court Nursing Home is a care home providing accommodation with personal and nursing care for up to 40 people. Some admissions to the home are part of the ‘Discharge to assess’ (D2A) scheme (funded by the Clinical Commissioning Groups). The D2A scheme aims to ensure people are moved out of hospital (when medically stable) to receive a period of rehabilitation/reablement in a residential setting, prior to assessment of their long-term care needs. At the time of our inspection visit there were 34 people living at the home, three of whom were on the D2A scheme.

People’s experience of using this service and what we found

At our last inspection in June 2018, we rated the service as good. At this inspection we found the registered manager and provider needed to improve risk management procedures, and demonstrate they were consistently monitoring and mitigating risks to people’s safety. Oversight of staffing levels also required improvement.

Systems designed to check on and improve the quality of the service provided were not always effective, as they had not picked up some of the issues we identified.

The service was led by a provider, a part time registered manager and management team which included a part time deputy manager, a nursing team and a care manager. People and staff gave us mixed feedback about whether the management team were approachable and responsive to their concerns and feedback.

We received mixed feedback from people, relatives and staff about whether there were enough staff to keep people safe and respond to their preferences and health needs. Following our feedback, the provider acted straight away to increase care staff on each shift. They also planned to increase management support.

People were not always supported to have choice and control of their care decisions. Improvements were required in how people's consent to their care and treatment was sought and recorded.

People's nutritional needs were being met. However, some records of how staff supported people to eat and drink enough to maintain their health required improvement.

People received kind and compassionate care from care and nursing. The staff team worked hard to promote people’s dignity and prevent people from becoming unwell. Staff understood how to keep people safe from the risk of abuse, and embraced team working to reduce potential risks to people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection

The last focussed inspection report for Clifton Court was published in June 2018 and we gave an overall rating of good. At this inspection we found the service had not sustained this rating and have rated the service as requires improvement in all areas.

Why we inspected

This was a responsive comprehensive inspection prompted in part due to concerns received about staffing levels and the leadership of the home. A decision was made for us to inspect and examine those risks. The inspection was also prompted in part by a notification of a specific incident, following which a person using the service died. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident. The information CQC received about the incident indicated concerns around safety of people at the home. This inspection examined those risks.

Enforcement

We have identified two breaches in relation to safe care and treatment of people and good governance at this inspection.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 1 May 2018

During an inspection looking at part of the service

Clifton Court Nursing Home provides accommodation, nursing and personal care for up to 41 older people, who may live with dementia. Thirty nine people were living at the home at the time of our inspection visit on 1 May 2018. Clifton Court Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At the last inspection, the service was rated ‘Good’ in all areas. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for ‘Clifton Court Nursing Home' on our website at www.cqc.org.uk.

At this inspection we visited the service following some concerning intelligence which related to moving and handling practices at the home and the safe support of people. We conducted a focussed inspection in the areas of Safe and Well-led, to look at the concerns and how people’s safety was maintained. At this focussed inspection we found the service remained ‘Good’ in Safe and Well-led, and the service continues to be rated ‘Good’ in all areas.

There was a registered manager in post. 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 were protected from the risks of harm, because staff understood their responsibilities to protect people from harm and to share any concerns with the registered manager or the provider. The registered manager checked staff’s suitability for their role before they started working at the home and made sure there were enough suitably skilled staff to support people safely and effectively.

Risks to people’s individual health and wellbeing were identified and care was planned to minimise the risks. Medicines were stored safely, and improvements were being made to medicines management to ensure people always received their medicines when they needed them.

The provider and registered manager regularly checked the premises and equipment were safe for people to use. Staff were guided and supported in their practice by a registered manager they liked and respected.

Care was planned to meet people’s individual needs, abilities and preferences. Care plans were regularly reviewed and updated when people’s needs changed.

People and their relatives were encouraged to share their opinions about the quality of the service, through surveys and meetings.

The provider’s quality monitoring system included regular reviews of people’s care plans and checks on medicines management and staff’s practice. Accidents, incidents, falls and complaints were investigated and actions taken to minimise the risks of a re-occurrence.

Further information is in the detailed findings below.

Inspection carried out on 4 October 2017

During a routine inspection

Clifton Court Nursing Home provides accommodation, nursing and personal care for up to 41 older people, who may live with dementia. Forty-one people were living at the home at the time of our inspection visit on 4 and 5 October 2017. At the last inspection, the service was rated Good. At this inspection we found the service remained Good in all five questions and Good overall.

There was a registered manager in post. 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 were protected from the risks of harm, because staff understood their responsibilities to protect people from harm and to share any concerns with the registered manager. The registered manager checked staff’s suitability for their role before they started working at the home and made sure there were enough suitably skilled staff to support people safely and effectively.

Risks to people’s individual health and wellbeing were identified and care was planned to minimise the risks. Medicines were stored, administered and managed safely and the registered manager regularly checked the premises and equipment were safe for people to use.

The registered manager and staff understood their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People continued to have freedom of choice.

People were supported to eat and drink enough to maintain a balanced diet that met their preferences. People were referred to other healthcare professionals when their health needs changed.

People were cared for by kind and thoughtful staff who knew their individual preferences for care and their likes and dislikes. Staff respected people’s right to privacy and supported them to maintain their dignity and independence.

Care was planned to meet people’s individual needs, abilities and preferences. Care plans were regularly reviewed and updated when people’s needs changed. People were supported and encouraged to maintain their interests and to socialise in the home and in the local community.

People and their relatives were encouraged to share their opinions about the quality of the service, through surveys and meetings. Staff were guided and supported in their practice by a registered manager they liked and respected.

The provider’s quality monitoring system included regular reviews of people’s care plans and checks on medicines management and staff’s practice. Accidents, incidents, falls and complaints were investigated and actions taken to minimise the risks of a re-occurrence.

Further information is in the detailed findings below.

Inspection carried out on 17 November 2015

During a routine inspection

We inspected this service on 17 and 20 November 2015. The inspection was unannounced.

The service provides accommodation and personal care for up to 40 older people, some of whom lived with dementia. There were 40 people were living at the home on the day of our inspection.

There was a registered manager in post. 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 provider’s policies and procedures minimised risks to people’s safety. Staff understood their responsibilities to protect people from harm and were encouraged and supported to raise any concerns. The registered manager assessed risks to people’s health and welfare and wrote care plans that minimised the identified risks.

There were enough staff on duty to meet people’s health care and social needs. The registered manager checked staff’s suitability to work in social care during the recruitment process. The registered manager regularly checked the premises and equipment were suitable and maintained to ensure risks to people’s safety were minimised. People’s medicines were managed, stored and administered safely.

Staff understood people’s needs and abilities because they read the care plans and shadowed experienced staff until they knew people well. People’s needs were met effectively because staff received appropriate training and support. Staff were encouraged to reflect on their practice and to develop their skills and knowledge, which improved people’s experience of care.

The manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and ensured people or an appropriate representative consented to care and treatment. No one was subject to a DoLS at the time of our inspection.

People were offered meals that were suitable for their individual dietary needs and met their preferences, which minimised risks to their nutrition. People were supported to eat and drink according to their needs and staff understood the importance of helping people to maintain a balanced diet.

People were cared for by kind and compassionate staff who understood them. Staff knew about people’s individual preferences for care and their likes and dislikes. Staff ensured people obtained advice and support from other health professionals to maintain and improve their health or when their needs changed.

People and their representatives were involved in planning and agreeing how they were cared for and supported. Care was planned to meet people’s individual needs, abilities and preferences and care plans were regularly reviewed.

The provider’s vision and values were understood and shared by all staff. The management team demonstrated the skills and quality of leadership to inspire and support staff effectively.

The provider’s quality monitoring system included consulting with people, their relatives and other health professionals to ensure planned improvements were focussed on people’s experience.

The registered manager made regular quality checks of people’s care and health, medicines management, meals and suitability and management of the premises. Accidents, incidents, falls and complaints were investigated and actions taken to minimise the risks of a re-occurrence.

Inspection carried out on 20 November 2014

During a routine inspection

We inspected Clifton Court on 20 November 2014 as an unannounced inspection. At the last inspection on 27 January 2014 we found there were no breaches in the legal requirements and regulations associated with the Health and Social Care Act 2008.

Clifton Court is registered to accommodate a maximum of 40 people. It provides nursing care to older people and people living with dementia. On the day of our inspection there were 33 people living at the home.

A requirement of the service’s registration is that they have 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. At the time of our inspection there was not a registered manager working at the service. This was because the previous registered manager had left in July 2014. The provider had recruited a new manager who told us they would register with us.

People who lived at the home told us they felt safe and were happy living there. People were protected against the risk of abuse, as the manager and staff understood their responsibilities to protect people from harm.

The manager assessed risks to people’s health and welfare and wrote care plans that minimised the identified risks. Care records were up to date. We saw that care was planned so that people received care and support that met their needs.

We found that there were enough staff to meet people’s health and care needs. People could not always access hobbies and interests that met their individual preferences.

Staff received induction and training that met their needs when they started work at the home. The provider had procedures in place to keep staff training up to date.

The manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (D0LS) to ensure that people who could not make decisions for themselves were protected. People had access to advocacy services when they needed to. An advocate is a designated person who works as an independent advisor in another’s best interest.

People were offered nutrition that met their individual dietary needs. People were supported to main good health and access the services of other healthcare professionals when they needed to.

People told us they liked the staff and made their own decisions about their care and support. We saw staff offered people a choice in how they spent their day and what they would like to eat.

The provider obtained feedback from people and their relatives about the service to identify where improvements were needed to the quality of service provision. People were able to make complaints or raise concerns with the provider when they needed to.

The provider conducted regular quality assurance checks to highlight where areas may need improvement, and acted to improve the service where issues had been identified. Some issues regarding the management of medicines had not been identified in audits by the provider.

Inspection carried out on 6 February 2014

During a themed inspection looking at Dementia Services

On the day of our visit 10 of the 40 people who lived at the home had a diagnosis of dementia or confusion. They were not able to tell us about their care and treatment. One person smiled and nodded to us when we asked if they were happy at the home. We spoke with three people who lived at the home, three relatives and care staff and observed how staff interacted with people.

Relatives we spoke with told us, �The manager is very friendly�, �This place is fantastic� and �X and Y (named staff) lead by example.� We invited people to share their views with us via a comments box that was left at the home, but no-one completed a comments card.

We saw that staff were compassionate and spoke reassuringly with people. They explained what was happening throughout the day. Staff encouraged people to make decisions about how they were cared for. When one person told a care worker their leg hurt, we heard the care staff ask if they would like the nurse look at it.

Staff recorded when other, external health professionals visited people. Records included the advice that was given and how the person responded to the recommended treatments. When people needed to transfer to hospital, information was readily available to make sure their physical and psychological needs were known and understood by hospital staff.

The manager checked that people were happy with the quality of the service through surveys, informal conversations with people and their relatives and observing staff.

Inspection carried out on 4 February 2013

During a routine inspection

We spoke with four people who lived at the home and two relatives. They all told us that the home was a nice place to live. They told us that staff were kind and understood them well. One person said, �It is lovely here, the people are very nice, very kind they couldn�t be more helpful.� A relative told us, �We have family meetings and give feedback and share ideas and staff always follow up.�

In the four care plans we looked at we saw that people or their relatives had signed to say they had agreed how people should be cared for and treated. The care plans were detailed and had clear instructions for staff to follow.

We found that there were policies and procedures in place to make sure that medicines were managed appropriately and safely. We saw that the clinical lead person regularly checked that staff followed the procedures.

We saw that staff recorded every time they asked for advice from other health professionals. A visiting health professional that we spoke with told us they had confidence in staff�s ability to notice when people when became unwell. They said, �Staff recognise the subtle changes in people.�

We looked at three staff files and found the manager recorded the checks they made before staff started working at the home, as well as the ongoing training and support staff were given. A member of care staff told us they had regular one to one meetings with the manager and that both the manager and deputy were very approachable and supportive.

Inspection carried out on 5 March 2012

During a routine inspection

We arrived at the home at 9.25am and were greeted by the manager and a person who lives at Clifton Court. The home were not aware that we were going to visit.

We spent a majority of our time in the large lounge. We spoke with two people who prefer to spend a majority of their time in their bedroom, two members of staff, the manager and a visitor to the home. We looked at paperwork whilst in the lounge and observed the interaction between staff and people who live at the home.

All of the people we met spoke positively about their life at Clifton Court. People said that they have a choice in everything that they do. We were told that the "dentist comes regularly, the chiropodist every six weeks and the hairdresser every week." During the morning of our visit people in the large lounge were engaged in a quiz and in the afternoon watched a DVD. Staff chatted to people and appeared to have a good relationship with them.

At the time of our visit the home was clean and no unpleasant odours were noted. People appeared to have their personal hygiene needs met and were well dressed.

Staff and people that live at the home praised the manager saying that she is friendly and helpful.

We were told that people are offered a choice of meal and we heard people being offered a choice for the evening meal. People commented that the food is good.

The atmosphere at the home was relaxed and friendly.

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