Clifton Court Nursing Home

Clifton Court Nursing Home is a care home providing accommodation with personal and nursing care for up to 41 people. There are 40 bedrooms across two floors. One of these bedrooms can be shared. The service provides support to older people, some of whom are living with dementia, a sensory impairment and/or a physical disability. At the time of our inspection there were 38 people living at the home.

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

Significant improvements had been made since our last inspection. Risks to people’s health and wellbeing had been identified, assessed and managed well. Records guided staff on what to do to minimise identified risks and help keep people safe. Medicines were ordered, stored, administered and disposed of safely. People had access to healthcare services when they needed it.

There were enough staff to keep people safe. People told us staff were kind and considerate. People looked clean and well kempt. Staff demonstrated great patience in difficult situations, and we saw some lovely, relaxed interactions between staff and people. People were encouraged to express their views and be involved in their care. 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 understood the importance of a positive mealtime experience to encourage people to eat and drink well. Overall, we receive positive feedback about the food provided. People had a choice of what they ate and drank. People were encouraged to have a healthy and balanced diet.

A thorough assessment was carried out before people moved into the home. The registered manager recognised people’s care needs may change in a new environment and ensured people’s care was continually reviewed in line with best practice.

People and where appropriate, their families, were involved with people’s care. Staff understood the importance of knowing people and their lifetime experiences so they could provide care that met people’s preferences and routines. There was a programme of activities and entertainments to provide people with opportunities for social engagement.

Staff received training and had regular opportunities to talk about their role and encouraged to undertake further training and gain qualifications. Staff were compassionate and knew how best to support someone nearing the end of their life and understood the importance of making sure people’s final days were lived as they wanted them to be.

People and relatives consistently told us the home was well-led. The home worked in partnership with others to improve outcomes for people. The provider regularly communicated with people and their relatives to share information and gather their views about the quality of the service. People and relatives knew how to complain and were confident these would be dealt with appropriately. Systems and processes were in place to monitor and improve the quality of care provided and regular checks were completed to ensure people received high quality care.

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 10 December 2019) and there were breaches of regulation. 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

This inspection was prompted by a review of the information we held about this service and to follow up on breaches identified at the last 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.

Follow up

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

Clifton Court Nursing Home is a care home providing accommodation with personal and nursing care for up to 41 people. There are 40 bedrooms across two floors. One of these bedrooms can be shared. The service provides support to older people, some of whom are living with dementia, a sensory impairment and/or a physical disability. At the time of our inspection there were 37 people living at the home.

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

A new electronic care management system had been implemented which improved the accuracy and efficiency of data recording and monitoring. Records showed staff were recording sufficient information about accidents and incidents. These were reviewed to check for accuracy and action taken to improve quality of life.

Changes in people’s physical and emotional health were identified quickly and closely monitored. Timely referrals were made to specialised external healthcare professionals where necessary.

Records were updated regularly and staff could easily access important information about people.

The registered manager understood their safeguarding and regulatory responsibilities. Appropriate referrals had been made to the local authority, and us, CQC where necessary.

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 requires improvement (published 10 December 2019)

Why we inspected

This inspection was prompted by a Regulation 28 The Coroners (Investigations) Regulations 2013 report which was issued to prevent further deaths after a person living at Clifton Court Nursing Home died.

We undertook this inspection to check the provider had taken sufficient action to prevent further deaths from occurring. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

Follow up

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 and what we found

At our last inspection in June 2018, we rated the service as good. At this inspection we found the registered manager and provider needed to improve risk management procedures, and demonstrate they were consistently monitoring and mitigating risks to people’s safety. Oversight of staffing levels also required improvement.

Systems designed to check on and improve the quality of the service provided were not always effective, as they had not picked up some of the issues we identified.

The service was led by a provider, a part time registered manager and management team which included a part time deputy manager, a nursing team and a care manager. People and staff gave us mixed feedback about whether the management team were approachable and responsive to their concerns and feedback.

We received mixed feedback from people, relatives and staff about whether there were enough staff to keep people safe and respond to their preferences and health needs. Following our feedback, the provider acted straight away to increase care staff on each shift. They also planned to increase management support.

People were not always supported to have choice and control of their care decisions. Improvements were required in how people's consent to their care and treatment was sought and recorded.

People's nutritional needs were being met. However, some records of how staff supported people to eat and drink enough to maintain their health required improvement.

People received kind and compassionate care from care and nursing. The staff team worked hard to promote people’s dignity and prevent people from becoming unwell. Staff understood how to keep people safe from the risk of abuse, and embraced team working to reduce potential risks to people.

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 focussed inspection report for Clifton Court was published in June 2018 and we gave an overall rating of good. At this inspection we found the service had not sustained this rating and have rated the service as requires improvement in all areas.

Why we inspected

This was a responsive comprehensive inspection prompted in part due to concerns received about staffing levels and the leadership of the home. A decision was made for us to inspect and examine those risks. The inspection was also prompted in part by a notification of a specific incident, following which a person using the service died. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident. The information CQC received about the incident indicated concerns around safety of people at the home. This inspection examined those risks.

Enforcement

We have identified two breaches in relation to safe care and treatment of people and good governance at this inspection.

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.

At the last inspection, the service was rated ‘Good’ in all areas. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for ‘Clifton Court Nursing Home' on our website at www.cqc.org.uk.

At this inspection we visited the service following some concerning intelligence which related to moving and handling practices at the home and the safe support of people. We conducted a focussed inspection in the areas of Safe and Well-led, to look at the concerns and how people’s safety was maintained. At this focussed inspection we found the service remained ‘Good’ in Safe and Well-led, and the service continues to be rated ‘Good’ in all areas.

There was a registered manager in post. 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 were protected from the risks of harm, because staff understood their responsibilities to protect people from harm and to share any concerns with the registered manager or the provider. The registered manager checked staff’s suitability for their role before they started working at the home and made sure there were enough suitably skilled staff to support people safely and effectively.

Risks to people’s individual health and wellbeing were identified and care was planned to minimise the risks. Medicines were stored safely, and improvements were being made to medicines management to ensure people always received their medicines when they needed them.

The provider and registered manager regularly checked the premises and equipment were safe for people to use. Staff were guided and supported in their practice by a registered manager they liked and respected.

Care was planned to meet people’s individual needs, abilities and preferences. Care plans were regularly reviewed and updated when people’s needs changed.

People and their relatives were encouraged to share their opinions about the quality of the service, through surveys and meetings.

The provider’s quality monitoring system included regular reviews of people’s care plans and checks on medicines management and staff’s practice. Accidents, incidents, falls and complaints were investigated and actions taken to minimise the risks of a re-occurrence.

Further information is in the detailed findings below.

There was a registered manager in post. 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 were protected from the risks of harm, because staff understood their responsibilities to protect people from harm and to share any concerns with the registered manager. The registered manager checked staff’s suitability for their role before they started working at the home and made sure there were enough suitably skilled staff to support people safely and effectively.

Risks to people’s individual health and wellbeing were identified and care was planned to minimise the risks. Medicines were stored, administered and managed safely and the registered manager regularly checked the premises and equipment were safe for people to use.

The registered manager and staff understood their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People continued to have freedom of choice.

People were supported to eat and drink enough to maintain a balanced diet that met their preferences. People were referred to other healthcare professionals when their health needs changed.

People were cared for by kind and thoughtful staff who knew their individual preferences for care and their likes and dislikes. Staff respected people’s right to privacy and supported them to maintain their dignity and independence.

Care was planned to meet people’s individual needs, abilities and preferences. Care plans were regularly reviewed and updated when people’s needs changed. People were supported and encouraged to maintain their interests and to socialise in the home and in the local community.

People and their relatives were encouraged to share their opinions about the quality of the service, through surveys and meetings. Staff were guided and supported in their practice by a registered manager they liked and respected.

The provider’s quality monitoring system included regular reviews of people’s care plans and checks on medicines management and staff’s practice. Accidents, incidents, falls and complaints were investigated and actions taken to minimise the risks of a re-occurrence.

Further information is in the detailed findings below.

The service provides accommodation and personal care for up to 40 older people, some of whom lived with dementia. There were 40 people were living at the home on the day of our inspection.

There was a registered manager in post. 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 provider’s policies and procedures minimised risks to people’s safety. Staff understood their responsibilities to protect people from harm and were encouraged and supported to raise any concerns. The registered manager assessed risks to people’s health and welfare and wrote care plans that minimised the identified risks.

There were enough staff on duty to meet people’s health care and social needs. The registered manager checked staff’s suitability to work in social care during the recruitment process. The registered manager regularly checked the premises and equipment were suitable and maintained to ensure risks to people’s safety were minimised. People’s medicines were managed, stored and administered safely.

Staff understood people’s needs and abilities because they read the care plans and shadowed experienced staff until they knew people well. People’s needs were met effectively because staff received appropriate training and support. Staff were encouraged to reflect on their practice and to develop their skills and knowledge, which improved people’s experience of care.

The manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and ensured people or an appropriate representative consented to care and treatment. No one was subject to a DoLS at the time of our inspection.

People were offered meals that were suitable for their individual dietary needs and met their preferences, which minimised risks to their nutrition. People were supported to eat and drink according to their needs and staff understood the importance of helping people to maintain a balanced diet.

People were cared for by kind and compassionate staff who understood them. Staff knew about people’s individual preferences for care and their likes and dislikes. Staff ensured people obtained advice and support from other health professionals to maintain and improve their health or when their needs changed.

People and their representatives were involved in planning and agreeing how they were cared for and supported. Care was planned to meet people’s individual needs, abilities and preferences and care plans were regularly reviewed.

The provider’s vision and values were understood and shared by all staff. The management team demonstrated the skills and quality of leadership to inspire and support staff effectively.

The provider’s quality monitoring system included consulting with people, their relatives and other health professionals to ensure planned improvements were focussed on people’s experience.

The registered manager made regular quality checks of people’s care and health, medicines management, meals and suitability and management of the premises. Accidents, incidents, falls and complaints were investigated and actions taken to minimise the risks of a re-occurrence.

Relatives we spoke with told us, 'The manager is very friendly', 'This place is fantastic' and 'X and Y (named staff) lead by example.' We invited people to share their views with us via a comments box that was left at the home, but no-one completed a comments card.

We saw that staff were compassionate and spoke reassuringly with people. They explained what was happening throughout the day. Staff encouraged people to make decisions about how they were cared for. When one person told a care worker their leg hurt, we heard the care staff ask if they would like the nurse look at it.

Staff recorded when other, external health professionals visited people. Records included the advice that was given and how the person responded to the recommended treatments. When people needed to transfer to hospital, information was readily available to make sure their physical and psychological needs were known and understood by hospital staff.

The manager checked that people were happy with the quality of the service through surveys, informal conversations with people and their relatives and observing staff.

In the four care plans we looked at we saw that people or their relatives had signed to say they had agreed how people should be cared for and treated. The care plans were detailed and had clear instructions for staff to follow.

We found that there were policies and procedures in place to make sure that medicines were managed appropriately and safely. We saw that the clinical lead person regularly checked that staff followed the procedures.

We saw that staff recorded every time they asked for advice from other health professionals. A visiting health professional that we spoke with told us they had confidence in staff's ability to notice when people when became unwell. They said, 'Staff recognise the subtle changes in people.'

We looked at three staff files and found the manager recorded the checks they made before staff started working at the home, as well as the ongoing training and support staff were given. A member of care staff told us they had regular one to one meetings with the manager and that both the manager and deputy were very approachable and supportive.