Cliftonville Care Home

Cliftonville Care Home is a residential care home providing personal and nursing care for up to 106 people. The service provides support to older or younger adults with a diagnosis of dementia or physical disability. At the time of our inspection there were 59 people using the service.

Cliftonville Care Home provides accommodation across three floors with communal lounge and dining rooms on each floor. One of the floors specialises in providing care to people living with dementia. The upper floors can be accessed via two lifts. All bedrooms have private en-suite facilities.

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

The providers systems and processes to monitor oversight of the safety and quality of the service had not always been effective in identifying some concerns we found during inspection, including, some areas of safety in the environment. The provider was responsive to the concerns raised and made the required changes.

People were mostly protected from the risk of infection and we found the home was clean and odour free. However, the manager had not ensured COVID-19 testing for visiting professionals had been adhered to as per government guidance. Government guidance has changed since our inspection and testing is no longer required.

Individualised risk assessments were in place and strategies to reduce risk were planned into care and recorded for staff guidance. There was a system in place to review accidents and incidents and prevent reoccurrence. Positive risk was supported and people were encouraged to be as independent as possible.

Systems and processes protected people from the risk of abuse, staff knew how to raise concerns to safeguard people. People told us they felt safe.

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.

There was a robust system in place to ensure staff were recruited safely. Although there were enough staff to meet people’s needs, people found the high use of agency staffing at times unsettling. The provider had listened to people’s concerns and was actively recruiting permanent staff.

Medicines were administered, stored and disposed of safely. Staff were trained and competency checked and ensured people received their medicine when they needed it.

The provider and manager understood the duty of candour and were open and honest when things went wrong. There was evidence of feedback sought from people and staff, both felt listened to and improvements were made.

The provider worked in partnership with healthcare professionals to ensure people’s needs could be met.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 22 December 2021) and there were breaches of regulation. The service remains rated requires improvement. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We received concerns in relation to the safety and managerial oversight of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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 and well-led sections of this full report.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Cliftonville Care Home is a nursing home providing personal and nursing care for up to 106 older or younger adults with a diagnosis of dementia or physical disability. At the time of inspection 80 people were being supported in one adapted building.

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

Staff did not always have the information required to support people safely. Not all risk assessments and care plans contained sufficient or up to date information.

Records were not consistently completed to evidence care and support was delivered. Repositioning, oral care and food and fluids tasks were not always documented.

Unexplained injuries to people had not always been investigated to identify a cause and mitigate any potential risks.

Audits did not always identify when records were not completed or when information was missing or incorrect. The service had a new manager who was in the process of implementing change and improvements, however these had not been embedded into practice.

People were supported by staff who were safely recruited and who engaged with people well. People told us they felt safe at Cliftonville and staff were kind.

Medicines were administered as prescribed and documentation evidenced policies and procedures were followed.

People were protected from COVID-19. Staff wore appropriate personal protective equipment (PPE) and regular cleaning of the service was in place.

People, relatives and staff had not always been asked to feedback on the service. The manager had an action plan in place in make improvements and engage people better.

Complaints had been addressed and responses had been sent to involved parties. The manager was aware and understood their responsibility regarding the duty of candour.

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 11 October 2019)

Why we inspected

We received concerns in relation to risk management, record keeping, staffing and oversight. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those

key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

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.

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

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

Enforcement

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.

We have identified breaches in relation to safe care and oversight of the service at this inspection.

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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Cliftonville Care Home is a residential care home providing personal and nursing care to 106 people aged 65 and over at the time of the inspection.

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

People and relatives were happy with the care and support they received and spoke positively about staff and the registered manager. People's care and support needs were met by staff who knew them well and enjoyed working with them.

Appropriate recruitment checks took place before staff started work and there were enough staff available to meet people's needs. Staff received comprehensive training to enable them to carry out their roles effectively. Staff were happy working for the service and felt supported by the registered manager and colleagues.

Care records contained extensive, clear information covering all aspects of people's individualised care and support. Risk assessments were comprehensive and information about people was written in a respectful and personalised way.

People and their relatives were involved in the planning and delivery of their care, and regularly asked for feedback which was acted upon when appropriate. Staff were encouraged to be actively involved in service development.

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.

There was a range of activities available for people and these were well attended and received. People's spiritual and emotional needs were met by staff.

The service had established links in the local community and worked in partnership with key organisations including local authorities and other agencies to improve the service for people. Staff at the service worked with health and social care professionals to ensure good outcomes for people.

There were systems in place to monitor and improve the quality of the service. When there were problems, the registered manager dealt with them appropriately and worked to reduce the likelihood of recurrence.

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 1 February 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.

There was a registered manager in post. 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 were supported by a team of staff that had the managerial guidance and support they needed to do their job. The quality of the service was monitored by the audits regularly carried out by the manager and by the provider.

People were safeguarded from harm as the provider had systems in place to prevent, recognise and report any suspected signs of abuse. Staff knew their responsibilities as defined by the Mental Capacity Act 2005 (MCA 2005) and Deprivation of Liberty Safeguards (DoLS) and had applied that knowledge appropriately.

Staff understood the importance of obtaining people’s consent when supporting them with their daily living needs. People experienced caring relationships with the staff that provided good interaction by taking the time to listen and understand what people needed.

People’s needs were met in line with their individual care plans and assessed needs. Staff took time to get to know people and ensured that people’s care was tailored to their individual needs. People’s care and support needs were continually monitored and reviewed to ensure that care wasprovided in the way that they needed.

There were sufficient numbers of experienced staff that were supported to carry out their roles to meet the assessed needs of people living at the home. Recruitment procedures protected people from receiving unsafe care from care staff unsuited to working with vulnerable people. Staff received training in areas that enabled them to understand and meet the care needs of each person.

People were supported to have sufficient to eat and drink to maintain a balanced diet. Staff monitored people’s health and well-being and ensured people had access to healthcare professionals when required. Medicines were managed safely.

At the last inspection the service was rated as Good.

People told us they were well cared for at Cliftonville and the staff knew the care they needed and how they wished to be supported. One person said 'I am very well looked after here' and another person said 'the staff are kind and I feel safe living here'.

People told us they thought there were enough staff who had the right skills to care for them safely and that the staff were kind and patient. 'One person said the staff are very very good here'.

The people also told us they were able to make decisions about their lives, such as their choice of food, clothing and personal routines. They also told us that there were activities going on in the home that they could join in with if they wanted to. One person told us that they particularly enjoyed the carpet bowls game and another person told us that they enjoyed the cinema evenings that were regularly held at the service. The visiting relative we spoke with told us that the staff kept them informed about their relative's progress and they were also involved in making decisions about their care.

We looked at the way that the service provided care to people with dementia and saw that staff provided them with kind and sensitive support that met their individual needs. We saw that staff supported people to make informed and meaningful choices about their food preferences and other decisions such as where to spend their time and what activities they wished to participate in.