Clifton View Care Home

Clifton View Care Home is a purpose-built care home providing accommodation for up to 76 people requiring nursing or personal care. At the time of our inspection, 75 people were living at the service. The accommodation was established over three floors. The ground and second floor were for people with longer term care needs. On the first floor was a short stay assessment and rehabilitation unit.

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

Staff did not always have sufficient guidance in care plans. However, staff had received training on how to complete their roles. Medicines were mostly safely managed, but staff did not always record why ‘as needed’ medicines were given and did not always have a second staff member sign when instructions for medicine administration were hand-written. People felt safe at the service, and the registered manager had investigated any concerns. People were safe from the spread of infection.

People were referred for a deprivation of liberty assessment if the staff were concerned about restrictions on their liberty. However, staff did not always complete mental capacity assessments into what decisions a person may not be able to make. This meant it was not always clear how people were supported in the least restrictive way possible.

There was a caring culture at the service. Staff were seen to be kind and people spoke highly of staff’s compassion and kindness. People were provided with a variety of activities and we saw people engaging positively with staff. People were treated with dignity and respect.

Audits were not always effective at creating improvements at the home. There was a positive ethos at the service and people spoke highly of the care provided. Visiting professionals attended the home and reported good communication with the staff team.

Rating at last inspection:

The last rating for this service was good (published 22 March 2019)

Why we inspected

The inspection was prompted due to concerns received about neglectful care. The provider had also alerted us to some concerning incidents that had occurred at the service. As a result, we undertook a focused inspection to review the key questions of safe, caring and well led.

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

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Clifton View on our website at www.cqc.org.uk.

Enforcement

We have identified 2 breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and good governance. Please see the action we have told the provider to take at the end of this report.

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

People’s experience of using this service:

People felt safe and staff ensured that risks to their health and safety were reduced. We found that sufficient staff were deployed to safely meet people’s needs. Staff had received training to ensure they had the knowledge to protect people from the risk of avoidable harm or abuse, whilst providing care.

People were protected from the risk of an acquired health infection, as the service employed dedicated cleaning staff to ensure the environment was clean and had appropriate policies and procedures to monitor and reduce the risk.

Systems were in place to support people to take their medicines safely. Staff received relevant training and felt well supported. People were asked for their consent to their care and appropriate steps were taken to support people who lacked capacity to make decisions.

People were supported to eat and drink enough to maintain good health.

There were positive and caring relationships between people using the service and the staff who cared for them. Staff promoted people's right to make their own decisions about their care where possible and respected the choices they made. People were 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 supported this practice.

People were treated with dignity and respect by staff who understood the importance of this.

People received person-centred and responsive care from staff who had a clear understanding of their current support needs. Care plans were in place, which provided information about the care people required.

People knew how to make a complaint and there was a clear complaints procedure in place.

When people were at the end of their life the service had effective measures in place to support them and ensure their wishes and needs were met.

An open and transparent culture enabled people and staff to speak up if they wished to. The management team provided strong leadership and a clear direction to staff.

There were robust quality monitoring procedures in place. The management structure of the service was clear.

People's safety had been considered and risks had been reduced by the introduction of equipment or guidance. Staff had received training in relation to safeguarding and knew how to protect people from harm.

Information was provided in a range of formats to support understanding. People were able to access spiritual support to meet their religious beliefs.

There was a registered manager at the home and the rating from their previous inspection was displayed at the home and on their website. When required notifications were usually completed to inform us of events and incidents, this helped us the monitor the action the provider had taken.

Rating at last inspection: Requires Improvement (Published July 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection. At this inspection we found the service had improved to Good.

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

We carried out an unannounced inspection of the service on 7 and 11 July 2017. Clifton View Care home provides accommodation for persons who require personal care or nursing, for up to a maximum of 76 people. On the day of our inspection 71 people were using the service. Care was provided on residential and nursing floors as well as a rehabilitation unit, with the aim of supporting people to return to their own homes.

There was a registered manager in place. 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 medicines were not always managed safely. Medicines were not always securely monitored to ensure people could not gain access to medicines which could cause them harm. There were gaps in people’s medicine administration records and also examples where medicines had not been given with no record of the reason why.

People, relatives and staff raised concerns about the number of staff working at the home. During busy periods people’s needs were not always responded to in a timely manner. Equipment was not always stored safely.

We have made a recommendation about the numbers of staff working at the service and the safe storage of equipment.

Safe recruitment procedures were in place to ensure only appropriate staff worked with vulnerable people. Staff could identify the potential signs of abuse people could face. Risks to people’s safety were assessed and reviewed.

The principles of the Mental Capacity Act (2005) had not always been followed when decisions were made about people’s care. The process for ensuring decisions were made on behalf of people by relatives who were legally entitled to do so was not always followed. However, staff were observed offering people choices. Some care records contradicted the information provided by external professionals in relation to the decision of whether a person wished to be resuscitated or not.

People were supported by staff who completed an induction prior to commencing their role. The majority of staff training was up to date; however, a small number of refresher training was required. Staff received supervision of their role, although the frequency, in which staff received this, was inconsistent. Staff felt supported by the registered manager.

People were supported to maintain good health in relation to their food and drink. People’s day to day health needs were met by staff.

People and relatives spoke positively about the staff and felt they were kind and caring and supported them or their family member in a respectful and dignified way. Staff understood people’s needs and listened to and acted upon their views.

People felt able to contribute to decisions about their care, although people’s care records did not always reflect this. People were provided with information about how they could access independent advocates.

People’s privacy was maintained and respected. People’s friends and relatives were able to visit whenever they wanted to.

An activities coordinator was in place; however the hours provided was not sufficient to enable them to support people effectively with their hobbies or interests.

Before people came to live at the home assessments had been carried out to determine whether their needs could be met. This led to detailed care plans being put in place. However, some care plans needed to be implemented more quickly and be more person centred. People felt their preferences were not always taken into account when staff supported them.

People were provided with the information they needed if they wished to make a complaint and they felt their complaint would be acted on.

The registered manager required additional support to ensure effective care and support was provided for all people living at the home. Quality assurance processes were in place; however, these had not identified all of the concerns raised during this inspection. People’s records were not always reviewed to ensure they reflected people’s current care and treatment. The registered manager was well-liked by staff. People were encouraged to provide feedback about the quality of the service.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the provider to take at the back of this report.

.Accommodation is located over three floors. The first floor provides intermediate care (where people require assessment and support to return to their own home following hospital admission) which is managed Monday to Friday by City Care Services which is part of the NHS.

We carried out this unannounced inspection of the home on 2 August 2016.

At the time of our inspection there was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 told us that they felt safe living in the home and they were cared for by staff in a respectful and dignified manner. Their rights to privacy and to be able to express their views and opinions were respected and supported by staff.

The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 and to report on what we find. These safeguards protect people when they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. The registered manager had submitted five applications for a DoLS to the supervisory body (local authority) and they were awaiting the outcome.

Staff received regular training, in order for them to provide care to people in a way which ensured that their needs were met. Staff knew how to manage any identified risks to people and they provided the care needed as described in each person's care record. People were supported to access a range of health and social care professionals and their health needs when people required both routine and more specialist help. Clear arrangements were in place for ordering, storing, administering and disposing of people's unused medicines and people received their medicines as prescribed.

People were provided with a varied choice of meals. When necessary, people were given any extra assistance they needed to eat or be provided with fortified snacks and drinks to make sure that they had enough to eat and drink to keep them healthy.

There was a warm and welcoming atmosphere in the home and staff worked closely with people and their families to ensure each person was supported to maintain their individual interests and to have a meaningful and enjoyable life. In addition staff provided a varied programme of communal activities for those who wished to participate in them.

The registered manager ran the home in an open and inclusive way and encouraged people, their relatives and staff to speak out if they had any concerns. The provider and registered manager listened and took action to resolve any issues or concerns identified. Formal systems were also in place for handling and resolving formal complaints.

The provider and registered manager worked together as a team in order to regularly assess and monitor the quality of all the services provided. This approach ensured that any shortfalls in quality would be quickly identified and actions take to improve and develop the services people received.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.