We found the following examples of good practice.
• Visitors were checked to reduce the risk of them catching and spreading infections.
• People were safely admitted to the service.
• Personal protective equipment (PPE) was in place and staff were supported to use this correctly.
• The premises were clean and tidy, with regular cleaning taking place.
• People and staff were regularly tested for COVID-19.
We found the following examples of good practice.
Measures had been implemented to ensure people entering the home did so following current guidance regarding PPE and social distancing. Cleveland View had a visitor coordinator whose responsibilities were to make sure anyone entering the home, entered safely.
The provider had robust systems to ensure safe admissions.
An additional cleaning schedule had been introduced to ensure robust measures to reduce infection risks, including additional tasks such as cleaning of any regular touch point surfaces. Some items that could not be effectively cleaned needed removing. The registered manager confirmed these had been removed after the inspection.
The service had plenty of PPE available. PPE stations were in place round the service, however, these were placed over the handrails. The registered manager immediately sourced some drawers to store the PPE in.
The provider participated in the COVID-19 regular testing programme for both people and staff.
People were encouraged to stay in regular contact with friends and relatives. Staff supported people to make regular telephone and video calls and a visiting pod had been set up. In preparation for allowing visitors back into the home a testing cabin had been built near the entrance to the home. Therefore visitors could be tested and have somewhere to sit whilst waiting for the result.
Staff ensured activities still took place. Such as learning to cook with a slow cooker and watching virtual walks around local areas.
The management team made sure staff received enough support during the pandemic and when additional staff were needed.
Staff participated in various training sessions around infection control, COVID-19 and using PPE. Although there was a designated area for staff to change when arriving at and leaving work, this was not always being used effectively. The register manager acted on this immediately and put a more robust system in place.
There were COVID-19 specific policies and plans, which meant staff were guided to take appropriate actions to reduce the risk of transmission.
Further information is in the detailed findings below.
People’s experience of using this service: People told us they were happy and spoke positively about the support they received. People’s independence was promoted and they felt their voice was heard.
Risks to people were assessed and addressed. Emergency plans were in place. Medicines were managed safely, however, we have made a recommendation about the management of some medicines.
Staff were supported with training, supervision and appraisal. 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 received personalised support based on their assessed preferences and needs. A wide range of activities took place, which people enjoyed.
The management of the service was committed to monitoring and improving standards. Feedback was sought and acted on. The service worked in close partnership with external professionals to develop and share best practice.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk.
Rating at last inspection: Requires improvement (report published April 2018)
Why we inspected: This was a planned inspection. It was scheduled based on the previous rating.
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.
The service was last inspected in July 2017 and was rated Good.
Cleveland View is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Cleveland View accommodates up to 60 people across three separate units, each of which have separate adapted facilities. Two of the units specialise in providing care to people living with a dementia. At the time of our inspection 52 people were using the service.
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. The registered manager was also one of the owners and registered providers of the service. The registered manager joined the service in September 2017.
Risks to people using the service were not consistently assessed or addressed. Emergency plans were in place to support people in emergency situations but fire drills had not been carried out in line with the provider’s own policies. Medicines were not always managed safely. Staff received training but the provider did not have systems that effectively planned and recorded this. For people who displayed fluctuating mental capacity mental capacity assessments and best interest decisions had not been completed for their care and treatment. People did not always receive support to safely manage their food and nutrition or to monitor their nutritional health. Care plans did not always contain personalised detail on the type of support the person wanted or needed. The provider and registered manager carried out a number of quality assurance audits to monitor and improve standards at the service but where issues were identified there was no record of remedial action being taken or completed. The provider’s quality assurance processes had not identified the issues we found during this inspection.
Risks to people arising from the building were regularly reviewed and required test and maintenance certificates were in place. The provider and registered manager monitored staffing levels. The provider’s recruitment policies minimised the risk of unsuitable staff being employed. Policies and procedures were in place to safeguard people from abuse and to promote infection control.
Staff were supported through regular supervisions and appraisals. People were supported to access external professionals to maintain and promote their health. The premises had been adapted to make them suitable for the people living there.
People and their relatives spoke positively about the support they received from staff at the service, describing it as kind and caring. People told us staff treated them with dignity and respect. Throughout the inspection we saw numerous examples of kind and caring support being delivered. People were supported to access advocacy services where needed.
There was limited support for people to access activities. Policies and procedures were in place to investigate and respond to complaints. At the time of our inspection nobody was receiving end of life care, but policies and procedures were in place to arrange this should it be needed. End of life care plans were in place for people, which meant information was available to ensure their final wishes were respected.
Staff spoke positively about the leadership provided by the registered manager. Feedback was sought from people and staff in meetings and in feedback questionnaires. The registered manager and deputy managers were making efforts to forge links with organisations and agencies in the local community. The registered manager had informed CQC of significant events in a timely way by submitting the required notifications. This meant we could check that appropriate action had been taken.
We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we took at the back of the full version of this report.
This is the first time the service has been rated Requires Improvement.
Cleveland View Care is a 60 bedded purpose built care home providing personal care for older people and older people with dementia. The home has three units. The ground floor unit accommodates a maximum number of 30 people who require personal care. There are two units on the first floor of the home and within these units there are eight 'time to think' beds, which give people the option of looking at whether they need more permanent support in a care home. At the time of the inspection there were 48 people using the service.
At the last inspection in January 2015 we rated the service as ‘Outstanding’ in one domain, namely 'effective' and overall ‘Good’.
There was a registered manager in post but at the time of our inspection this person had been on extended leave from the service since September 2016. 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.
In December 2016 the registered provider had identified that the lack of leadership and oversight had impacted the service and improvements needed to be made to the operation of the service. Subsequently they asked the previous registered manager for the service to provide oversight of Cleveland View Care Centre as well as their own care home. Since then they had been splitting their time between the two homes. They had critically reviewed the service and had started to introduce measure to ensure the service improved. During our inspection the registered provider noted the manager needed to spend more time at the service to ensure the improvements were prioritised and readily embedded into staff practice.
People and their relatives told us staff at the service provided personalised care. Care plans were person centred but over recent months had not been regularly reviewed, to ensure they reflected people’s current needs and preferences. The manager had identified this slippage of staff practice and by 10 April 2017 had ensured that staff had reviewed all of the people’s care records.
People were supported to access activities they enjoyed. However, on the 22 March 2017 we noted that activities were localised downstairs and people living on the dementia care unit were not benefiting from access to activities. We discussed this with the regional manager and manager, who immediately addressed this matter, and on the 10 April 2017 we found the activity coordinator had reverted to their previous practice of involving both floors in activities inside and outside of the home.
People and their relatives spoke positively about the staff at the service, describing them as kind and caring. Staff treated people with dignity and respect. Staff knew the people they were supporting well, and throughout our inspection we saw staff having friendly and meaningful conversations with people. People were supported to be as independent as possible and had access to advocacy services where needed. Procedures were in place to investigate and respond to complaints.
People and relatives we spoke with told us they felt the service was safe. Risks to people using the service were assessed and plans put in place to reduce the chances of them occurring.
Safeguarding and whistleblowing procedures were in place to protect people from the types of abuse that can occur in care settings. People’s medicines were managed safely. There were enough staff deployed to keep people safe. The registered provider’s recruitment processes minimised the risk of unsuitable staff being employed.
Staff received mandatory training in a number of areas, which assisted them to support people effectively, and were supported with regular supervisions and appraisals. People’s rights under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) were protected.
People were supported to maintain a healthy diet and to access external professionals to monitor and promote their health.
People and staff spoke positively about the manager who was overseeing the service, saying she supported them and included them in the running of the service. The manager and registered provider carried out a number of quality assurance checks to monitor and improve standards at the service. The manager had informed CQC of significant events in a timely way by submitting the required notifications. This meant we could check that appropriate action had been taken.
We carried out this unannounced inspection on the 20th and 22nd January 2015. We last inspected this service in January 2014.
Cleveland View is a 60 bedded purpose built care home providing personal care for older people and older people living with dementia. The home has three units. The ground floor unit accommodates a maximum number of 30 people who require personal care. There are two units on the first floor of the home. Both units provide care and accommodation to people with dementia (15 beds on each), however one is for males and the other is for females.
The home had a registered manager in place and they have been in post as manager since 2012. 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 living at the service received good, kind care and support that was tailored to meet their individual needs. Staff ensured they were kept safe from abuse and avoidable harm. People we spoke with were positive about the care they received and said that they felt safe.
Assessments were undertaken to identify people’s health and support needs and any risks to people who used the service and others. Plans were in place to reduce the risks identified. Care plans were developed with people who used the service to identify how they wished to be supported and decide upon goals they wanted to achieve whilst at the service.
Staff were trained and understood the principles and processes of safeguarding, as well as how to raise a safeguarding alert with the local authority. Staff said they would be confident to whistle blow (raise concerns about the home, staff practices or provider) if the need ever arose.
Accidents and incidents were monitored each month to see if any trends were identified. At the time of our inspection the accidents and incidents were so few that they were unable to identify any trends.
We found people were cared for by sufficient numbers of suitably qualified, skilled and experienced staff. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers and we saw evidence that a Disclosure and Barring Service (DBS) check had been completed before they started work in the home. The Disclosure and Barring Service carry out a criminal record and barring check on individuals who intend to work with children and vulnerable adults, to help employers make safer recruiting decisions and also to prevent unsuitable people from working with children and vulnerable adults.
We found that medicines were stored and administered appropriately.
We observed a lunchtime and a tea time meal, these meals were flexible to suit the needs of the people who used the service. The lunch time was quiet as a few people had gone out to a local pub, tea time was busier with lots of friendly chatter and banter.
We saw that the service was clean and tidy and there was plenty of personal protection equipment (PPE) available. Two members of staff were infection control leads and they explained the training they had received and the meetings they attended.
The registered manager had been trained and had a good knowledge of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager understood when an application should be made, and how to submit one. Staff did have a small understanding but were booked in for MCA and DoLS training on the 26th January 2015.
People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. The care plans contained a good level of information setting out exactly how each person should be supported to ensure their needs were met. Care plans provided evidence of access to healthcare professionals and services.
Staff received training to enable them to perform their roles and the service looked at ways to increase knowledge to ensure people’s individual needs were met. Staff had regular supervisions and appraisals to monitor their performance and told us they felt supported by the registered manager.
Staff were supported by their manager and were able to raise any concerns with them. Lessons were learnt from incidents that occurred at the service and improvements were made if and when required. The service had a system in place for the management of complaints. The manager reviewed processes and practices to ensure people received a high quality service.
We saw safety checks and certificates that were all within the last twelve months for items that had been serviced such as fire equipment and water temperature checks.
We were able to observe the experiences of people who used the service. We saw that staff treated people with dignity and respect. We saw that people had their needs assessed and that care plans were in place.
People were supported to eat and drink sufficient amounts to meet their needs.
We saw that the service had appropriate equipment. We saw that regular checks and servicing of equipment was undertaken to ensure that it was safe.
People told us that they felt comfortable in raising a concern or complaint with the manager or staff.