Clifton Lodge

Updated 13 March 2019

The inspection:

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection team:

The inspection team consisted of three inspectors on the first day of the inspection. There was one inspector on the second day of inspection.

Service and service type:

Clifton Lodge 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. At this inspection 30 people were living there.

The service had a manager registered with the Care Quality Commission. This means they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection:

This inspection took place on the 8 and 9 January 2019 and was unannounced.

What we did:

We reviewed information we held about the service in the form of statutory notifications received from the service and any safeguarding or whistleblowing incidents, which may have occurred. A statutory notification is information about important events, which the provider is required to send us by law.

We used the Short Observational Framework for Inspection [SOFI]. SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We spoke with four people who used the service and three relatives about their experience of the care provided. We spoke with three members of staff [including the activities coordinator], the chef, a senior nurse, the service’s matron, the service manager and the manager. We reviewed four people’s care files and three staff recruitment files. We also looked at a sample of the service’s quality assurance systems, the registered provider’s arrangements for managing medication, staff training records, staff duty rotas and complaint and compliment records.

Updated 13 March 2019

About the service:

Clifton Lodge provides accommodation and personal care for up to 35 older people living with dementia and/or mental health needs. At the time of the inspection there were 30 people living at the service.

People’s experience of using this service:

Improvements were required to the service’s governance arrangements to assess and monitor the quality of the service, because the current arrangements had not identified the issues we found during our inspection.

Care plans did not adequately address people’s mental healthcare needs and the impact this had on their overall health and wellbeing. People’s end of life care needs were not recorded. Not all risks to people’s safety and wellbeing had been identified. Suitable control measures were not always considered and put in place to mitigate the risk or potential risk of harm for people using the service.

Improvements were required to the service’s medication arrangements as discrepancies relating to staff’s practice and medication records were found. The principles of the Mental Capacity Act 2005 to make a specific decision had not always been assessed and best interest assessments completed.

People told us they were safe and had no concerns about their safety and wellbeing. Suitable arrangements were in place for the recruitment of staff and there were enough staff available to provide the care and support people needed. Staff received regular training opportunities to enable them to meet people’s needs. Newly employed staff received a robust induction and staff told us they were valued and supported; and received regular supervision.

Staff worked well with other organisations to ensure they delivered good joined-up care and support. Individuals were complimentary about the care and support they received and about the staff team and received good person-centred care. People’s healthcare needs were met and people were supported to have access to a variety of healthcare professionals and services as required. The dining experience was positive and people had their nutritional and hydration needs met. People were supported to have their social care needs met and relationships with family and friends maintained.

The service was clean and hygenic and staff followed the service’s infection control policies and procedures.

Rating at last inspection:

This was the service’s first inspection since being newly registered as a care home on 23 November 2017.

Why we inspected:

This was a planned inspection in line with our scheduled programme of inspections.

Improvement action we told the provider to take:

Please see the action we have told the provider to take section towards the end of the report.

Follow up:

We will continue to monitor intelligence we receive about the service until we visit again in line with our inspection programme and scheduling. If any concerning information is received we may inspect sooner. The provider will be required to send us an action plan.