Clifton House

Clifton House is a residential care home providing personal care to up to 39 people. At the time of our inspection there were 30 people using the service, the majority of whom were living with dementia.

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

Improvements had been made to the governance systems but further embedding was needed. The provider's systems had not always been effective at either identifying where improvements were needed, or acting on their own findings in a timely way.

Where risks to people were known due to their diagnosed health conditions, risk assessments and care plans were not always detailed to guide staff on how to support people safely. Some parts of the environment were not always kept clean, and this placed people at an increased risk of harm.

Improvements had been made to recruitment practice so staff were safely recruited. There were some vacant posts and the provider was actively recruiting to these. Staff received support and training to carry out their role although some more specialised training was due for completion so staff continued to be effective in their role. People received the support they need to eat and drink safely.

The provider had made improvements to the environment so it was a nicer place to live, and further work was taking place so it was more welcoming to people living with dementia.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice although some improvements were needed to records in relation to this.

Staff were respectful of people and took time to offer support and reassurance when this was needed. There was ongoing work to improve the detail of care records to ensure these were accurate, detailed and person centred. We observed kind and caring interactions and people's dignity was respected.

People and relatives told us they were involved in their care although records did not always reflect this. Communication and involvement of people using the service had improved although further work was needed.

Complaints were handled appropriately. Staff we spoke with felt supported by the registered manager. Relatives spoke positively about the registered manager and the staff team.

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

Rating at the last inspection and update

The last rating for this service was inadequate (published 04 October 2022) there were 5 breaches of the regulations. We issued a warning notice and the provider completed an action plan. At this inspection we found improvements had been made and 3 breaches were met. However, we found the provider remained in breach of 2 regulations.

This service has been in Special Measures since 04 October 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

This service is now rated as requires improvement.

Why we inspected

This inspection was carried out to follow up on actions we told the provider to take at the last inspection.

Enforcement

We have identified breaches in relation to the management of risk and systems for the oversight of the service.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Clifton House is a residential care home providing personal care to up to 39 people. At the time of our inspection there were 38 people using the service, the majority of whom were living with dementia.

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

We were not assured people were kept safe. Risks to people’s health and safety had not always assessed and mitigated. People’s medications were not always managed safely. We were not assured people’s health needs were effectively monitored or health concerns were consistently escalated to the relevant professionals. People were not protected people from the risk of abuse. We were not assured people were encouraged and supported to make choices about their eating and drinking. We were not assured staff followed advice of healthcare professionals in relation to people’s health and treatment needs. The environment did not take into consideration the needs of people living with dementia.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Not all people had person-centred care plans to ensure they received personalised care. Staff did not have clear written guidance on how to meet people’s needs. Not all people’s communication needs had been explored to encourage effective communication. People’s end of life wishes had not been explored. The provider had failed to implement effective systems to assess, monitor and improve the service. We were not assured the registered manager understood their regulatory requirements. People’s care records did not always contain relevant and accurate information. The provider had tried to gather feedback from staff and relatives, this had not been effective, and they had not explored alternative methods. We were not assured staff and the registered manager were carrying out their duties in line with the duty of candour.

Complaints were handled appropriately. Staff we spoke with felt supported by the registered manager. Most relatives knew who the registered manager was.

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

Why we inspected

This inspection was prompted by a whistle-blowing concern we received about the service, the quality of care, infection control practices, and staff recruitment. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to person centred care, dignity and respect, safe care and treatment, good governance and fit and proper persons employed, at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the 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.

Clifton House provides accommodation and Nursing or personal care for up to 39 people. On the day of our inspection, 39 people were living there, some of whom were living with dementia.

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

People did not always receive safe and consistent support with their prescribed medicines.

People’s individual risk assessments were not always updated to account for changes in circumstance. However, staff members were knowledgeable about risks and knew what to do to minimise the potential for harm to people.

People received safe care and support as the staff team had been trained to recognise potential signs of abuse and understood what to do to safely support people.

Staff members followed effective infection prevention and control procedures when supporting people. Staff members had access to, and used, appropriate personal protection equipment.

The provider supported staff in providing effective care for people through person-centred care planning, training and one-to-one supervision.

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

People had access to additional healthcare services when required. Staff members knew people’s individual health outcomes and supported them appropriately.

People were supported to maintain a healthy diet by a staff team which knew their individual preferences.

People received help and support from a kind and compassionate staff team with whom they had developed positive relationships.

People were supported by staff members who were aware of their individual protected characteristics like religion, age, gender and disability.

People were provided with information in a way they could understand.

The provider had systems in place to encourage and respond to any complaints or compliments from people or those close to them.

The provider, and management team, had good links with the local communities within which people lived.

The management team and provider had systems in place to identify improvements and drive good care.

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 rating for this service was ‘Good’ (published 19 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Clifton House is a registered care home providing accommodation for up to 39 people who require support with personal care. At the time of our inspection there were 38 people living at the home.

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’s rights to privacy and confidentiality were not always respected by the staff that supported them.

People were kept safe and secure, and relatives believed their family members were safe from risk of harm. Potential risks to people had been assessed and managed appropriately by the provider.

Staff had been recruited appropriately and had received relevant training so that they were able to support people with their individual care and support needs. People received their medicines safely as prescribed to them.

Staff sought people’s consent before providing care and support. Staff understood when the legal requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) should be followed.

People had a variety of food, drinks and snacks available throughout the day. They were able to choose the meals that they preferred to eat.

People were supported to stay healthy and had access to health care professionals as required. They were treated with kindness and compassion and there were positive interactions between staff and the people living at the location.

People’s choices and independence were respected and promoted. Staff responded appropriately to people’s support needs. People received care from staff that knew them well and benefitted from opportunities to take part in activities that they enjoyed.

The provider had management systems in place to audit, assess and monitor the quality of the service provided, to ensure that people were benefitting from a service that was continually developing.

Clifton House provides care and accommodation for to up to 39 people. Some people live in the home on a temporary basis following discharge from hospital whilst plans for their future are made. Some people living in the home are living with dementia. At the time of our inspection there were 39 people living in the home.

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.

Staff actions did not always show that people were valued and treated with care and dignity. People did not feel staff were always responsive to their needs.

People enjoyed their meals but actions were not always taken to ensure their choices were facilitated. Referrals were not always made in a timely manner to ensure that people that had lost small amounts of weight regularly over a period of time received advice and support as needed.

The systems for quality monitoring and sharing the findings with people needed to be improved so that systems were robust and was easier to understand for people.

People were protected from harm because staff understood their responsibility to take action to protect people and the provider had systems in place to minimise the risk of abuse.

People were involved in planning their care and management of any risks identified in relation to the care they received. People received care and support from staff that were trained and supported to carry out their roles.

There were sufficient staff available to meet people’s needs and recruitment process ensured that suitable staff were employed.

People were supported to receive their medicines as prescribed.

Staff worked in line with the Mental Capacity Act and Deprivation of Liberty Safeguards to ensure people’s human rights were protected.

People received support from healthcare professionals to monitor their ongoing health conditions and emergency treatment as needed.

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

Is the service safe?

We saw that people's individual needs had been assessed and that there were enough suitably trained staff to care for people.

We saw that people generally received good and safe care and all the relatives spoken with told us that they were happy with the care provided. The relatives of one person who was moving on told us, 'It has been brilliant, staff are caring. Mum's been safe.'

CQC monitors the operation of the Deprivation of Liberty Safeguards (DOLS) which applies to care homes and hospitals. No applications to restrict anyone's liberty had been made. The manager understood how this legislation applied to people and protected their rights.

The premises were well maintained and equipment used by staff to provide care and support was maintained to ensure people were kept safe.

Staff were alert to the signs of or potential for, abuse of vulnerable adults and procedures were in place, which were reviewed regularly to prevent abuse.

We saw that the provider regularly monitored the quality of service provision.

Staff were supported to meet the needs of people through the provision of regular training, supervision and staff meetings that enabled good practice to be developed.

Recruitment procedures ensured that only appropriate people were employed in the home. This meant that people were safe from harm.

Is the service effective?

People's care and health needs were assessed, planned and delivered in a personalised way. We saw that people's changing needs were monitored and care and support appropriately adjusted. This meant that people's care was planned and delivered in line with their individual needs.

The environment was safe and clean and met the needs of the people living there because the appropriate adaptations were in place to support people to move around freely and for their needs to be met appropriately.

Staff training was sufficient to meet all the needs of people using the service. People living in the home were supported to meet goals and improve their skills.

Is the service caring?

Staff responded to people's needs in a caring and appropriate way. Staff spoke with people in a tone that expressed friendship and support and offered people choices throughout the day. Conversations with staff showed that they considered them to be individuals and expressed concern and respect for them and their relatives.

We saw that people were supported to be involved in activities that ensured that their emotional and social needs were met. People were supported to dress and have hair styles that reflected their individual personalities. People were supported to maintain relationships that were important to them. They were supported so that their preferences, interests and diverse needs were met.

People living in the home told us they were happy and the carers were nice and kind. One person told us that they were able to have a shower when they wanted and were able to go out when they wanted.

Is the service responsive?

We saw that people's care plans and risk assessments were reviewed on a regular basis to ensure that their changing needs were planned for.

We saw that actions were taken to protect people's health as needed. We saw that staff had identified that one person's health was deteriorating and were liaising with the doctor ensuring that the appropriate investigations were undertaken. One relative told us, 'Any concerns they (staff) are on the ball.' Another relative told us, 'Communications are good.' This showed that the service was responsive and kept relatives informed about people's health.

We saw that there were systems in place to raise concerns and that these were responded to in a timely manner. One relative told us that when they had raised any issues they had been listened to and taken on board. This meant that the service responded to concerns and addressed them appropriately.

Is the service well led?

The registered manager had been in post since the home had opened. The manager was experienced and caring and provided good leadership based on how best to meet the needs of people in an individualised way.

There was a robust system in place to monitor the quality of the service they provided. This included regular audits of all aspects of the care and support given to people and the views of relatives and professionals who visited the home. Action plans were produced and implemented when necessary.

Everyone we spoke with told us they were happy with the care provided. One relative said, 'People get good food, are washed and bathed regularly and we are kept in informed about how mum is. Management plans were detailed so that staff were able to care for people safely. This meant that people received the care and support they needed and were happy with the care provided.

We saw that food choices were available at mealtimes and special dietary needs were met.. This showed people were eating enough to remain healthy.

We saw that people received their medicines at the times prescribed. Two people living in the home and their relatives told us that people were able to see the doctor when needed. Records showed people were supported to access a variety of health professionals. This meant their health was monitored and treatment provided if needed.

All staff spoken with told us they felt supported by the manager and staff team. Systems were in place to ensure that staff received the appropriate training and support they needed to carry out their roles safely.

There were systems in place to monitor the service and make adjustments as needed. The views of people using the service were listened to and acted on when appropriate.