We carried out a review of the data available to us about Clifton House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Clifton House, you can give feedback on this service.
Clifton House is a care home providing personal care to up to 16 people. The service provides support to people with mental health conditions and some people also had a learning disability. At the time of our inspection there were 11 people using the service. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
People’s experience of using this service and what we found
Right Support: Model of Care and setting that maximises people’s choice, control and independence
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. Staff were trained in safeguarding to keep their knowledge of their responsibilities up to date. The registered manager reported any allegations to the local authority safeguarding team and reviewed safeguarding investigations, accidents and incidents and feedback on the service to improve. Health and safety checks were carried out of the premises and equipment to make sure they were safe. The premises were clean, tidy and hygienic and staff followed current infection control and hygiene practice to reduce the risk of infections.
Right Care: Care is person-centred and promotes people’s dignity, privacy and human rights
People received the right support in relation to risks, such as those relating to mental health conditions and learning disabilities. There were enough staff to support people safely and staff knew people well. The provider checked staff were suitable to work with people through recruitment checks. Staff received training in infection control practices, including the safe use of personal protective equipment (PPE). People received the right support in relation to their medicines and the provider had good oversight of this through electronic systems and audits.
Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.
The service was managed well and the registered manager was experienced and understood their role, as did all staff we spoke with. The registered manager oversaw the service with regular checks and reviews to ensure people received good quality care. Communication with people, relatives and staff was good and their feedback was used as part of improving the service. Staff felt well supported. Care was provided in a person-centred way. The provider worked with local health and social care services to ensure people received the care they needed.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
At the last inspection the service was rated good (report published October 2018).
Why we inspected
This inspection was prompted by a review of the information we held about this service.
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.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
At our last inspection in November 2017 we identified breaches of regulations relating to safe care and treatment, good governance, meeting people’s nutritional needs, premises and equipment, person-centred care and submitting notifications of significant incidents to CQC. We rated the service ‘Requires Improvement’ overall and in each key question and we served the provider with requirement notices and warning notices. At this inspection we found the provider had taken the necessary action and was now meeting the legal requirements.
Clifton House 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. Clifton House accommodates up to 16 older people in one adapted building.
The provider was a partnership. One of the partners was also the 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. For the purposes of this report where we have referred to the provider we are referring to the person that is also the registered manager.
The provider undertook a range of risk assessments to keep people safe. These included reviewing risks related to people’s specific needs and the care home environment. The registered manager reviewed risk assessments and risk management plans to ensure they reflected changes and continued to be relevant. Staff understood the provider’s safeguarding procedures and the actions they should take to keep people safe. Safe recruiting procedures were in place to ensure they were suitable to deliver care. Staff followed appropriate infection prevention and control practices when delivering care, cleaning the environment and managing food.
People were supported with an assessment of their needs prior to admission and their needs were reassessed on an ongoing basis or when their needs changed. Staff received induction and ongoing training and were supported by the registered manager with supervision and appraisal. People’s nutritional needs were assessed by healthcare professionals and staff following guidelines to meet people’s eating and drinking requirements. Staff supported people with timely access to healthcare professionals and monitored people’s health needs.
People received their care and support from staff they described as kind. Staff encouraged people to be independent and promoted their dignity. Staff ensured that visitors were made to feel welcome and people received the support they required around their spirituality.
People’s care plans were personalised and reflected their preferences for care and support. The service provided activities for people to participate in at home and in the community and people were protected from social isolation. People had access to the provider’s complaints procedure.
The registered manager and leadership team took decisive action to address the shortfalls we found at our last inspection. Good governance was in evidence in the provider’s quality assurance processes and staff felt supported. The views of people, relatives, staff and visiting health and social care professionals were gathered and used to shape service delivery. The provider worked in partnership with other services to secure positive outcomes for people.
Clifton House 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. Clifton House accommodates up to 16 older people in one adapted building.
The provider was a partnership. One of the partners was also the 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. For the purposes of this report where we have referred to the provider we are referring to the person that is also the registered manager.
At this inspection we found new risks to the health, safety and wellbeing of people at Clifton House. The provider’s arrangements for assessing and managing risks to people posed by their healthcare conditions and by the environment were ineffective. They had not considered the impact of changes in people’s health and how these posed new risks to people’s safety. Environmental risks were not appropriately managed. Aspects of the environment posed a risk of injury or harm to people from trip and slip hazards, missing or inappropriate restrictors on windows, potential exposure to sharp items and poor cleanliness and hygiene around the premises. The provider had not considered risks posed to people from furniture and items they had stored inappropriately around the environment and from the use of free standing oil filled radiators brought in to provide additional heating. Notwithstanding these issues we found the provider continued to maintain a servicing programme of the premises and equipment used by staff so had taken action to ensure those areas of the service covered by these checks should not pose unnecessary risks to people.
People’s care records and associated risk assessments were out of date and/or inaccurate so staff did not have access to current information about how to keep people safe. Staff did not fully understand how to support people with their healthcare needs and conditions and the provider did not use best available evidence to ensure people experienced good health outcomes. Staff did not always respond quickly when people's health changed to seek appropriate medical support and assistance. People were not involved in planning their care and support needs and their records showed limited information about their preferences and likes and dislikes. This meant people may have experienced support that did not reflect their diverse needs, wishes and choices for how this was provided.
There were enough staff deployed during our inspection to keep people safe. But staff did not always have time to spend with people in a meaningful way and support them to communicate their needs and wishes. There was not enough for people to do to meet their social and physical needs and people who chose to spend time alone were at risk of becoming socially isolated. The provider did not routinely assess and review staffing levels as the level of dependency at the service changed. This meant they could not be assured that there were enough staff to meet people’s needs at all times.
People received the medicines that had been prescribed to them. However we saw some elements of current working practices increased the risks of administration errors being made due to a lack of detailed information about people’s preferences for when they took their medicines and the way some medicines were administered and stored.
The provider maintained adequate recruitment procedures to check the suitability and fitness of any staff employed to work at the service. However they did not routinely undertake criminal records checks on existing permanent staff so they could not be fully assured of their continuing suitability to work at the service. Support for staff to help them to meet people’s needs was variable. Staff had received training in topics and subjects relevant to their work. However staff told us supervision (one to one meetings) were not always effective in helping them to continuously improve their work based practice.
People did not always experience support that was kind and respectful. Staff were not always attentive to people’s needs and mealtimes did not always provide for a comfortable and dignified experience for people.
The provider had limited oversight of the service. Their quality assurance systems were ineffective and did not identify numerous shortfalls we found at the service. The provider did not always promote an open, inclusive culture in which people and staff had effective means to communicate their views and experiences. They had not met their legal obligation to submit notifications to CQC of events or incidents involving people at the service so we could not check they had taken appropriate action to ensure people's safety and welfare in these instances. At this inspection we also found the provider had not taken action to improve to ensure they met the breach in legal requirement we found in October 2015.
The provider demonstrated they could be responsive in making some improvements when needed. During our inspection they made improvements that immediately reduced some of the risks we found to people’s safety and wellbeing. They had also reintroduced a programme of activities after our inspection to improve the quality of opportunities for people to have their social and physical needs met. However it was too early to judge whether these improvements could be sustained and maintained. There was some evidence that the provider sought people’s views about the quality of the service and took action to make improvements when these were suggested. They maintained arrangements for dealing with people's complaints or concerns if these should arise.
The provider continued to support staff to keep people safe from abuse. Staff had been trained in safeguarding adults at risk. The provider sought assurances that temporary agency staff had completed appropriate training in this area. Staff understood their duty to observe and report any concerns they had about people if they thought they were at risk of abuse.
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. People were supported to be as independent as they could be. Staff encouraged people to eat and drink enough to meet their needs and people were happy with the meals they ate. The design and set up of the environment provided people with a degree of flexibility in terms of how they wished to spend their time when at home. People were given space and privacy to meet with their visitors if they wanted this. Around the environment there was signage to help people orientate.
At this inspection we found the provider in breach of legal requirements with regard to person centred care, safe care and treatment, meeting nutritional and hydration needs, premises and equipment, good governance and notification of other incidents. We are taking enforcement action in relation to the breaches of legal requirements with regard to safe care and treatment and governance and we will report on this when our action is complete. You can see what action we told the provider to take with regard to the other breaches at the back of the full version of the report.
We inspected Clifton House on 5 October 2015. The inspection was unannounced. At the previous inspection of 9 December 2013 the home had met all the required standards.
Clifton House provides accommodation and personal care for up to 16 older people, including people living with dementia. At the time of the inspection there were seven people living in the home.
The home was managed by 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.
The service provided safe care for people. People we spoke to told us they felt safe and well cared for. Records showed that people who lived in the home had been involved in risk assessments and in planning the support they needed as far as they were able. Safeguarding issues had been appropriately raised with the local authority. However, the provider did not have robust systems in place to demonstrate the audit trail of each safeguarding event. It was not always possible to identify a clear pathway between the time a safeguarding alert was raised and how this had been concluded. This meant that the provider could not ensure that the people using the service had had the most appropriate individual response suitable for them.
You can see what action we told the provider to take at the back of the full version of the report.
We saw that people’s health and nutrition were regularly monitored. People were supported at mealtimes and had choice regarding their preferred meal. Food was nutritious and hot. There were established links with GP services, hospitals and local authority.
Care records were individual to each person and contained information about people’s life history, their likes and dislikes, and information which would be helpful to hospitals or other health support services.
There were sufficient numbers of trained staff working in the home at all times and staff were supported by the manager and deputy manager. Staff had completed mandatory training and there were clear details as to when this training should be refreshed.
Where people lacked the capacity to make decisions for themselves staff had followed the requirements of the Mental Capacity Act 2005. Staff had received relevant training. The manager understood their responsibilities in relation to the Deprivation of Liberty Safeguards (DoLS) and knew how to apply it to people in their care.
There was an open and inclusive atmosphere in the service. People who used the service and staff told us they found the manager to be approachable and supportive. Staff were able to challenge when they felt there could be improvements.
The provider had a clear set of values that included the aims and objectives, principles, values of care and the expected outcomes for people who used the service. The service had quality assurance systems in place. These ensured people continued to receive the care, treatment and support they needed. There were also meetings between the home and people who lived there as well as meetings with relatives.
During our follow up review we found that the provider had taken appropriate action to address the aforementioned issues which were identified in the services previous inspection report. We spoke with two people who used the service. They both told us they felt the staff who worked at Clifton House treated them well. One person said 'the staff are all very good here'. Another person told us 'I think the staff are really good at their jobs'.
We also talked to the proprietor, the registered manager and two other members of staff. We found managers and staff were able to access information we had requested quickly and had the right mix of up to date knowledge and skills to meet the needs of the people who lived at Clifton House.
However, although people receiving services in the home told us they were happy and we saw that they were well supported by staff; we found that failures to maintain certain records and ensure staff had access to all the information they required meant the needs of the people who used the service might not be fully met. We also found that people's needs may not always be met because staff had not continually refreshed their training in some key aspects of their role.