Clover House

At our last inspection we rated the home good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the home has not changed since our last inspection.

At this inspection we found the home remained Good.

The home had procedures to minimise the potential risk of abuse or unsafe care. Staff had received safeguarding training and were able to describe good practice about protecting people from potential abuse or poor practice. We did find some incidents had not been reported to CQC as per the regulations. We discussed this with the registered manager who was able to show us the incidents had been safeguarded and reported to the local authority as appropriate. We have made a recommendation about this.

During this inspection we found the principles of the MCA were not consistently embedded in practice. We found people’s capacity to consent to care had not always been assessed and information was, at times, conflicting. 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. We have made a recommendation around this.

At the last inspection we found the provider did not have a response-planning document. This would show how the provider planned to operate in emergency situations, such as the outbreak of fire. During this inspection we checked to see the improvements made in this area. We found the home has implemented a full contingency business plan to ensure the home could continue to be provided in the event of an emergency.

Everyone we spoke with told us they felt safe with staff who supported them. We found people were protected from risks associated with their care because the registered provider had completed risk assessments. These provided updated guidance for staff to keep people safe. Staff we spoke with demonstrated they were aware of the different risks people were vulnerable to.

We found recruitment of staff was safe at the home. We reviewed the staffing levels and found the home was adequately staffed.

Systems were in place that showed people's medicines were managed consistently and safely by staff. Staff were aware of their responsibilities in relation to infection control and they told us they were provided with personal protective equipment.

The staff training is ongoing and evidence has been seen of staff completing training. We asked the registered provider how they obtained and implemented information on best practice guidance and legislation. They told us they attended all relevant conferences and provider forums. They commented involvement helped gather and share good practice.

Peoples needs for nutrition and fluids had been considered. Files contained likes and dislikes with regards to food and drink. The people we spoke with said they were given choices on what meals they wanted making and choices of drinks. One person told us, “The food is goods.” Another said, “The staff can cook.”

We received consistent positive feedback about care provided at Clover House from people who lived at the home and their relatives. We observed staff as they went about their duties and provided care and support. We saw staff speaking with people who lived at the home in a respectful and dignified manner.

The registered manager and staff told us they fully involved people and their families in their care planning. People's beliefs, likes and wishes were recorded within care records and guidance in these records reflected what staff and people told us about their preferences.

People told us they were encouraged to give their views and raise concerns or complaints. None of the people spoken with had had cause to raise concerns and were happy with the service they received.

We observed people being offered opportunities to go out for the day or to take part in activities as they wished.

Staff understood the importance of supporting people to have a good end of life as well as living life to full whilst they were fit and able to do so. We saw evidence that plans had been discussed with people living at Clover House.

The management team and staff were able to demonstrate a shared responsibility for promoting people's wellbeing, safety and security. There was a clear vision and credible strategy to deliver high quality care and support at the hone. Staff were aware and involved in this vision and the values shared. There was a positive staff culture at the home.

The management and staff team were open and transparent in providing information and worked well with the inspection team.

Further information is in the detailed findings below.

Clover House is registered to provide accommodation and personal care for up to six adults who have mental health conditions and/or learning disabilities. The home is an adapted building in Heysham with two small lounges, a dining area and a small garden.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

At the last inspection on 24 April 2014, we found the provider was meeting the requirements of the regulations that were inspected.

During this inspection, we found the registered manager had met the requirements of the regulations. People were happy with the variety and choice of meals available. Regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration. The staff had information about people’s dietary needs, wishes and preferences, and these were being met. Mealtimes were relaxed, provided at varied times, unhurried and sociable.

We have made a recommendation the service write a response-planning document to ensure the home returned to ‘business as normal’ following an incident.

The registered manager had systems to record safeguarding concerns, accidents and incidents and took necessary actions as required. Staff had received safeguarding training and showed they understood their responsibilities to report any unsafe care or abusive practices.

Recruitment and selection was carried out safely with appropriate checks made before new staff could start working at Clover House. This was confirmed from discussions with staff.

The environment was clean and hygienic when we visited.

We found staffing levels were good with an appropriate skill mix to meet the needs of people who lived at the home. Staffing levels were determined by the number of people being supported and their individual needs.

We found medication procedures were safe. Staff responsible for the administration of medicines had received regular training to ensure they maintained their competency and skills. Medicines were safely kept and stored appropriately.

Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

People told us they were involved in their care and had discussed and consented to their care. We found staff had an understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

Interactions we observed showed people were happy with the service they received. There was a rapport and familiarity between people and staff members. The registered manager and staff were clear about their roles and responsibilities. They were committed to providing a good standard of care and support to people in their care.

The registered manager used a variety of methods to assess and monitor the quality of the service.

Relatives we spoke with during our inspection told us they were happy with the service.

Quality audits had been completed and reviewed at the time of our inspection. The registered manager had oversight of the service provided.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We saw that people were treated with respect and dignity by staff. Care plans had been developed based upon people`s individual needs. A range of risk assessments were in place and reviewed periodically. The home worked in partnership with the local health care team to support people with their health conditions. People we spoke with told us they were very happy living in the home. One person told us, 'It is quite nice actually. The people are OK and they are helpful. Food wise I have separate food from the others. They are good at helping me with that.'

Staff we spoke with explained how they would take action to identify and prevent abuse from happening in the service. This involved responding appropriately and sensitively when abuse was suspected or was at risk of occurring.

Is the service effective?

People's health and care needs were assessed, monitored and reviewed. People and their relatives were supported to be involved in their plans of care. The service worked with other agencies and services to make sure people received their care in a joined up way. There was regular contact with the local community mental health care team.

Is the service caring?

We observed people were supported by kind and caring staff. Staff we spoke with told us they enjoyed working at the home and felt well supported with their personal development. This meant people were supported by trained and experienced staff.

Is the service responsive?

We saw evidence to show us that the home was responsive when meeting people`s health care needs. Care plan records contained detailed information. This meant they were able to monitor for any changes taking place. This showed us the home had systems in place to protect people from the risks posed to people.

Is the service well-led?

Clover House is a family business. On the day of the inspection the home was managed by the manager, who worked on a daily basis at the home. We were told the registered manager attended resident review meetings and staff meetings. The manager completed a range of quality audits to monitor and review the quality of the services they provided within the home. This helped to ensure that people received a good quality service at all times.

We found that the provider had made many improvements. Medication was now administered more safely because staff had received training, and the systems for dispensing had been tightened up. New storage facilities had been installed so that drugs could be stored safely and conveniently for dispensing.

We found all staff had now received training about how to safeguard vulnerable adults. Information about who to contact for advice or to report problems was now clearly displayed.

We found that the management had put systems into place to communicate with staff on a more consistent basis. Training and supervision were now better planned. An appraisal system had been put into place. However there had been a turnover at managerial level in the home, and some slippage had occurred. Some training was not up to date with the provider's plans.

We spoke with two residents in the home, who told us they were well looked after and the culture was 'interactive', meaning they were consulted about their plans and staff would work with them to achieve tasks. On the day of our inspection the atmosphere was calm and staff were managing well.