The inspection was unannounced and took place on 27 June 2018. At the last inspection the service had not stored medicines for disposal safely which was a breach of the Health and Social Care Act (HSCA) 2008. At this inspection we found these were now stored safely, however, there were other shortfalls in the safe management of medicines.

Cleeve Court Community Resource Centre 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.

Cleeve Court Community Resource Centre accommodates up to 45 people across two separate floors Lansdown View and Kelston Rise, each of which have separate adapted facilities. The service specialises in providing care to people living with dementia. At the time of our inspection there were 42 people living at the service.

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.

At the previous inspection we found medicines for return or disposal were not stored safely. This had been rectified and these medicines were now stored safely, however, we found shortfalls in the recording of medicines. This was a breach of regulation.

The provider had not always notified us of all the incidents that occurred at the service. This was a breach of regulation.

Staff at the service were trained and supervised and were positive about the care they delivered. However, morale was mixed due to changes in the staff contract.

People and their relatives were complimentary about the care delivered by staff. The service delivered care using the Butterfly Model which focussed on people’s emotional well-being. Staff were warm, caring and respectful in their interactions with people. It was evident people were at ease and felt safe with staff. Relatives told us, and compliments received by the service confirmed, that they had been happy with the way their loved ones had been cared for.

Staff treated people with warmth and kindness. They respected people’s privacy and dignity and supported people to be as independent as possible.

The environment had been adapted and decorated to support the needs of people living with dementia. Signage was clear and easy to understand. Different areas of the service had been decorated to give a homely feel and furnished with familiar objects for people to see. The service had received a number of awards previously for the care delivered.

People were supported to eat and drink enough, and alternatives were available if they did not like the meal choices. Drinks were available throughout the day.

People’s health care needs were met; the service had good links with the GP, district nurses and the community mental health team. There was positive feedback about the service from these professionals.

We found one breach of the Health and Social Care Act and one breach of the Registration Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report

Cleeve Court Resource centre is registered to provide accommodation and personal care for up to 45 people. On the day of the visit, there were 41 people at the home.

There was a registered manager for the service. 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.

At the last inspection on 17 and 22 December 2014, we asked the provider to take action to improve some areas of the service. This was in relation to staffing levels and for Mental Capacity Act 2005 (MCA) assessments to be undertaken for each person to determine their capacity to make decisions. Improvements were also needed around care plans as some lacked detail about all aspects of people's health and welfare needs. At this inspection, we found the provider had completed the actions they said they would do in their action plan and were compliant in these areas.

We found that medicines that were to be disposed of were not stored safely. This was because there was not an accurate record of medicines were no longer required. This also meant there was a risk that people had not had their medicines if there were no clear stock audits in place.

People had their needs met by enough staff. However, there was a shortfall in the numbers of permanent support staff. This had meant a reliance on agency staff and ‘bank’ staff who work for the provider. These are staff who work at the service on an occasional basis. The provider had a recruitment and retention strategy in place to employ and keep more staff. We requested a copy of this to review the actions that were being taken.

There were now detailed and specific mental capacity assessments in place for each person. These protected the rights of people who did not have the mental capacity to make informed decisions in specific areas of their life. For example, certain people sometimes declined any assistance with personal care despite needing staff support.

Care plans were now much more informative and guided staff so that they knew what actions to follow to meet people’s range of support and personal care needs. Staff knew what was written in each person’s care records. They explained how to provide care that was flexible to each individual and met their needs. Care plans were produced with input from people who used the service. The plans were reviewed and updated regularly. This was to make sure they were up to date and reflected the current needs of people.

People were encouraged to be included in deciding how they wanted to be supported with their care needs. The families and other representatives of people were involved in decision-making. This was when it was judged to be in the best interests of the people concerned.

People said that they liked the food and we saw they were offered choices visually at each mealtime to help them chose the meal they wanted .People at the home and the staff had built up positive and caring relationships. This was also the case with relatives and friends who spoke very highly of the caring attitude of the staff towards them.

The environment was adapted and personalised with a number of features that were beneficial for people who lived there. There was a hair salon, a secure sensory garden with plants that were pleasant to smell and comfortable seating areas. There was also a variety of decorative items to make the place seem more homely. We saw people using and responding in an animated way to all of these features of the premises during our visit. Many people at the home were living with dementia. Because of this activities were planned with people in a very informal way. People were able to take part in a wide variety of lively and informal one to one and group activities.

People were suppo

We considered our inspection findings to answer questions we always ask; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records. If you would like to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us and our observations showed, there were enough staff on duty to meet people’s needs. The home had detailed systems for assessing environmental risks and hazards.

Audits on cleanliness of the environment were performed. We saw the areas audited were clean and smelt fresh. Some areas were not included in the audit, for example cleanliness of wheeled equipment and procedures in relation to laundry. The areas which were not documented needed attention to ensure safe infection control practice.

The home had appropriate storage facilities and records relating to medicines. Medicines were not secured at all times. This was because medicines trolleys were not locked when in communal areas of the home. We found there were discrepancies in documentation relating to medicines, including controlled drugs.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. No applications have needed to be submitted from this home. Relevant staff we spoke with were aware of appropriate actions to follow in relation to these safeguards.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to safe management of medicines and infection control.

Is the service effective?

People we spoke with said the home met their needs. One person told us “oh yes, this is a nice place.” We saw staff supporting people, including people living with dementia, in an appropriate way. A person told us about the help they received in the home. They had improved to the extent where they did not need to see the district nurse regularly. Another person had changes in their mobility. Their care plan had been revised and we saw the person using their walking aid in a safe way.

Is the service caring?

We observed staff were kindly and caring when they supported people. A person told us “I’ve got a bell and if I need them, I just ring and they are there.” We saw a person requested to go to the toilet urgently during a meal. A member of staff promptly supported them. A person told a care worker how much their arthritic knees were hurting. The care worker helped the person to go to their room, explaining they would then apply some pain-relieving gel to their knees.

Is the service responsive?

We saw there were staff available to support people in pursuing recreational activities. In one sitting area, a care worker was engaged with two people holding a general discussion about holidays, in a relaxed and easy manner. We observed a person asking a care worker what their medicines were for. The care worker took time to explain this to the person. All 12 staff we spoke with reported they received help very quickly from other members of staff if they found a person who needed urgent assistance.

We saw there were a lack of written care plans for people who were admitted on a short term basis. This meant all staff would not be aware of how to respond to these people’s needs. Where people were self-medicating or prescribed medicines on an “as required” basis, there were no assessments or care plans to direct staff on how they were to respond to people’s individual needs. There were a lack of protocols where people had requested staff to lock their rooms when they were not in them. This meant the home could not demonstrate all relevant persons had been consulted and risks for people responded to.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to people admitted on a short term basis, assessments and care plans relating to medicines and development of protocols in relation to locking of people’s bedroom doors.

Is the service well led?

The home had not had a registered manager for an extended period of time. A new manager had been appointed. This person was in the process of applying to the CQC to be the registered manager. The provider had quality audit processes in place, for example in relation to maintenance of the building and health and safety matters. The new manager had set up systems for consultation with people, relatives and staff. Staff told us they knew how to raise issues with management and reported they were listened to if they did this.

We made a follow-up visit to Cleeve Court at Bath Community Resource Centre to check improvements the provider told us had been made to peoples' records. We visited the two units of the home in the company of senior staff. We observed care provided to people and saw it was delivered with kindness and warmth.

To check improvements to people's records, we looked at seven sets of care plans. We found improvements had been made and there were now records being maintained, for example, for people's nutrition and hydration needs, continence needs, and assessments for people at risk of pressure ulcers. These records guided staff on how to support people consistently. Audits of records were now being carried out each month to ensure all the information required was being effectively recorded.

We found there were some areas where consistency of information still needed some work. We judged this was not impacting directly on people's care, but some guidance staff needed was not effectively recorded. We made the manager of the care home and senior support worker aware of these areas where work still needed to be done.

We inspected Cleeve Court. People told us they liked living in the home and they were respected. One person told us “there’s nothing the matter with it”. A relative told us “this is by far the best”. A person told us “there’s plenty going on if you want to join in” about the activities.

We saw staff were always polite to people and friendly in approach. At lunchtime we observed cheerful banter between people and staff. Staff we met with knew about people's needs in detail and clearly knew them as individuals. For example one care worker told us about a person’s visual difficulties and how this increased their risk of falling.

Staff were aware of the risks of abuse to vulnerable people, particularly where they had behaviours associated with dementia. There were clear systems, which staff knew about, for reporting any concerns relating to abuse.

Staff were trained and supported in their roles. One member of staff described supervisions as a “two way process”, telling us “I can feed in my ideas too.”

The home had clear systems for reviewing the quality of its service provision, which included involving staff as well as people living in the home and their supporters.

People had records about their care needs, but staff did not consistently document relevant matters. This included not changing a person’s care plan to reflect how staff were meeting their current needs; and not completing monitoring records on people's conditions after they had fallen.

This inspection took place unannounced on the 17 and 22 December 2014. The previous inspection took place in April 2014 and we found breaches of Regulation 9 Care and welfare of people who use services, Regulation 12 Cleanliness and infection control and Regulation 13 Management of medicines. We asked the provider to tell us how compliance with these regulations was to be achieved. The provider wrote to us with an action plan of improvements that would be made. On this inspection we found improvements in the care planning process, the cleanliness of the property and the management of medicines.

Cleeve Court provides personal care and accommodation for up to 45 people. The accommodation was arranged over two floors. On the first floor (Kelston Rise) there were 24 people living with dementia and on the second floor (Lansdown View) 20 people were accommodated.

The day to day management of the home was from a registered manager. 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 told us they felt safe and gave us examples on how this feeling of safety was achieved. Members of staff told us they had attended safeguarding adults training and the procedure on display told people and their relatives how to report suspicions of abuse. We found safe systems of medicine management and good standards of cleanliness. Staffing levels were not always maintained at peak periods and we saw people were not supported in a timely manner.

People told us the staff were kind and knew how to care for them. They told us the types of decisions they were able to make and who helped them make complex decisions. Mental Capacity Assessments 2005 (protects and supports people who may lack the mental capacity to make their own decisions about their care and treatment.(MCA)) were not undertaken for each person. This meant people’s capacity to make decisions was not always established. Applications to the supervisory body for Deprivation of Liberty Safeguards (DoLS) authorisation were in progress for people subject to continuous supervision.

Staff told us the essential training they attended to meet the needs of people. They told us one to one meeting was held with a line manager (supervision) but it was not regular for all staff. This meant staff were not able to discuss their performance, training needs and concerns with their line manager on a regular basis.

People told us the staff were caring and kind and that the meals were good. They told us care plans on how staff were to care for them were in place and they were kept in their rooms. Care plans were devised on all aspects of people’s daily living. The care plans for people with mental health care needs did not include the signs of deterioration. This meant staff may not take prompt action because they did not recognise the early signs of deterioration. People told us they knew who to approach with their complaints.

The views of people and their relatives about the service were gathered using surveys. Their feedback was to be used to improve the care and treatment provided. There was an effective quality assurance system in place to assess the quality of service provision.

Staff were knowledgeable about the vision of the service but they said the re-organisation of roles across three services may have an impact on staff which had caused uncertainty.