Archived: Cliveden Manor

We previously inspected the service on the 12, 13 July and 2 August 2017. The service was rated Requires Improvement at the time. We found people were not always receiving their medicines in line with good practice. At the time of our last inspection the provider was working with the Clinical Commissioning Group (CCG) pharmacist to make improvements to the storage and administration of medicines. We have been monitoring the service to ensure improvements were made to the key questions, Safe and Well-Led. At this inspection we found improvements had been made.

Cliveden Manor is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

People living in the care home occupied either one or two bedroomed apartments. Accommodation was spread over three floors. A range of communal seating areas were available. People could choose to have a meal in a restaurant, bistro area or in their apartment. The first floor had an activities and library area. The second floor had a unit called ‘The Willows’, which provided support to people living with dementia.

The care home could provide nursing and care support up to 85 older adults, at the time of our inspection 76 people lived at the home.

The service had 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.

We received positive feedback from people, their relatives and staff on how the service was led. Comments included, “Very well run and have a great ability, endless patience,” “Splendid, seems to work very efficiently” and “Excellent, proactive, concerned about the residents in their care.”

People told us they were supported by staff who were kind and caring. People said “Sweet natured, so good, they put up with so much. Even the cleaners have time for you” and “All staff are so obliging, friendly, kind and compassionate.”

People told us staff treated them with dignity and respect and they were encouraged to be as independent as they could be. Comments from people included, “Staff are very good, very respectful and “Oh yes, we are treated very respectfully.”

The provider had processes in place to undertake pre-employment checks on staff to ensure they were suitable to work with people. People told us there were enough staff to provide them with safe care. We observed call bells were answered in a timely manner.

Staff were aware of the need to report any incidents and accidents. Trends in accidents were monitored and lessons learnt when things went wrong were shared within the home and across the provider’s locations.

People were supported by staff that had developed a good working relationship with them. Staff were aware of people’s likes and dislikes.

People were supported to engage in meaningful activities and keep in contact with family and friends. People were provided with lots of opportunities to visit places of interest in the local area and further away, for example, trips to the seaside, Hyde Park and National Trust properties.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Cliveden Manor provides 24 hour care and nursing for up to 85 people. There are 63 studio suites and one bedroom apartments for people with assisted living needs and the Willows unit which includes 16 studio suites for people with dementia care needs. At the time of our inspection there were 77 people living at the service.

At our last inspection on 22 and 26 September 2016 we found the provider was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because we found people’s medicines were not being consistently recorded and the risks associated with self-medicating were not always being managed. The provider submitted an action plan dated 15 November 2016 which set out the actions they planned to make to address the breach. The current inspection provided an opportunity to assess whether the action plan had been successfully completed. We found risk assessments for people’s medicine were mainly in place and records had improved. However, further improvements were required.

Since our previous inspection in September 2016 the service has a new registered manager. They have also changed the way in which medication is administered to people who receive a service under the residential care option. We found at this inspection that there had been a number of medication errors, which the registered manager and their team were managing, but we also found further improvements were required as some practices needed improving and minor errors in recording were still found at this 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.

There were sufficient staff to meet people's needs. Staff rotas confirmed planned staffing levels were maintained. Staff told us they felt well-supported. One commented, “I am well-supported, definitely” and “Staff are the best thing here. They all smile and it cheers you up”.

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The service had safe recruitment procedures and conducted background checks to ensure staff were suitable to undertake their care role.

People and their families told us they felt safe at Cliveden Manor. Comments included, “I have never seen anything of concern”. One visiting professional said, “Everyone seems quite happy and I have not heard of any concerns”.

Staff understood their responsibilities in relation to safeguarding people. Staff received regular training to make sure they stayed up to date with recognising and reporting safety concerns. The service had systems in place to notify the authorities where concerns were identified. The provider had reported safeguarding concerns where appropriate and in particular with regard to the number of medicines errors which had occurred in May and June 2017. The local authority safeguarding team were investigating one of these concerns at the time of the inspection and we were awaiting an outcome.

People benefitted from caring relationships with the staff. People and their relatives were involved in their care and people's independence was actively promoted. Relatives and staff told us people's dignity was promoted.

Where risks to people had been identified, risk assessments were in place and action had been taken to manage these risks. Staff sought people's consent and involved them in their care where possible.

People and their families told us people had enough to eat and drink. People were given a choice of meals and their preferences were respected. Where people had specific nutritional needs, staff were aware of, and ensured these needs were met.

Relatives mostly told us they were confident they would be listened to and action would be taken if they raised a concern.

The service had systems to assess the quality of the service provided, but these were not always effective. However we found the registered manager and clinical team were attempting to manage errors identified. Systems were in place that ensured people were protected against the risks of unsafe or inappropriate care.

We had mixed feedback from staff about the support they received from the registered manager and all of the team at the service. Staff supervision and other meetings were scheduled as were annual appraisals.

People, their relatives and staff told us all of the management team were approachable and overall there was a good level of communication within the service.

Relatives told us the team at Cliveden Manor were very friendly, responsive and overall well-managed. The service sought people's views and opinions and acted on them.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Cliveden Manor provides 24 hour care and nursing for up to 85 people. There are 63 studio suites and one bedroom apartments for people with assisted living needs and the Willows unit which includes 16 studio suites for people with dementia care needs. During our inspection there were 74 people living at the service.

In the most recent inspection of Cliveden Manor in March 2015 we found breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. This was because we found people’s medicines were not being consistently recorded and there was also inconsistency in how effectively people were protected against the risks of dehydration.

The provider submitted an action plan dated 17 August 2015 which set out the action already taken or to be taken to address this. The current inspection provided an opportunity to assess whether the action plan had been successfully completed.

The service had 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.

We found progress had been made to address previously identified areas of concern. For example, there had been improvement in medicines management and fluids monitoring. Some concerns with aspects of medicines management remained however which has been reflected in this report.

We received mostly positive feedback on the quality of the service from people who lived in Cliveden Manor and their relatives. In a few cases, people’s experience of the service had not been positive. At the time of the inspection their concerns were being addressed through the provider’s complaints procedure. Healthcare professionals we contacted were very positive about the standard of care they observed and the communication and co-ordination that existed between Cliveden Manor and themselves. They told us they were able to work well with staff and that the service responded to and took part in projects being carried out within the health and social care sector locally.

There were safeguarding procedures in place and staff received training on safeguarding vulnerable people. This meant staff had the skills and knowledge to recognise and respond to any safeguarding concerns. The registered manager and staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) 2005. They understood that where people lacked capacity a mental capacity assessment needed to be completed and best interest decisions made in line with the MCA. Staff had a good understanding about giving people choice on a day to day basis and this was supported by our observations during this inspection.

Risks to people were identified and managed well at the service so that people could be as independent as possible. A range of detailed risk assessments were in place to reduce the likelihood of injury or harm to people during the provision of their care.

We found staffing levels were adequate to meet people’s needs effectively. The staff team worked well together and were committed to ensure people were kept safe and their needs were met appropriately. Where agency staff were used, the service tried to use staff who were familiar with Cliveden Manor, its routines and the people who lived there.

Staff had been subject to a robust recruitment process. This made sure people were supported by staff that were suitable to work with them.

Staff received appropriate support through induction and supervision. All the staff we spoke with said they felt able to speak with the registered manager or care service manager when they needed to. There were staff meetings held to discuss issues and to support staff.

We looked at summary records of training for all staff. We found there was an on-going training programme to ensure staff gained and maintained the skills they required to ensure safe ways of working.

Care plans were in place to document people's needs and their preferences for how they wished to be supported. These were subject to review to take account of changes in people's needs over time. We found the use of both paper and system based care records led to some lack of consistency. The system based records, including the hand-held ones used by care staff, were very comprehensive and up to date.

The service was managed effectively. The quality of care was regularly checked through audits and by giving people the opportunity to comment on the service they received and observed.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to the management and monitoring of medicines.