About the service: Cleeve house is a residential care home that was registered to provide personal care for up to 23 people. At the time of this inspection 22 people were living there.

People’s experience of using this service:

People received safe care and support as the staff team had been trained to recognise signs of abuse or risk and knew what to do to safely support people. People received support with their medicines by competent staff members. The provider followed effective infection prevention and control procedures.

The provider supported staff in providing effective care for people through person-centred care planning, training, supervision. They ensured the provision of best practice guidance and support met people's individual needs. People were promptly referred to additional healthcare services when required. People were supported to maintain a healthy diet. The physical environment within which people lived supported their mobility and orientation needs.

People received help and support from a kind and compassionate staff team with whom they had positive relationships with. People were supported by staff members who were aware of their individual protected characteristics. People were supported to maintain their independence.

People took part in activities that they found interesting and stimulating. People were provided with information in a way that they could understand. The provider had systems in place to encourage and respond to any complaints or compliments from people or visitors.

The provider had effective systems in place to monitor the quality of the service they provided and to drive improvements where needed. The provider and management team had good links with the local community which people benefited from.

More information in Detailed Findings below.

Rating at last inspection: Good (published 09 March 2018)

Why we inspected: This was a planned inspection based on the rating at the last inspection, ‘Good.’ At this inspection we found the service remained good in all key questions with an overall rating of ‘Good.’

Cleeve House is located in Malvern. The service provides personal care and accommodation for up to 23 older people. On the day of our inspection there were 15 people living at the home.

The inspection took place on the 3 and 5 February 2016 and was unannounced.

There was a registered manager at this home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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 and their relatives said they were happy with the support that staff provided. They told us staff were caring and promoted people’s independence. People told us they were able to maintain important relationships with family and friends. We saw people had food and drink they enjoyed and had choices available to them, to maintain a healthy diet. They were supported to eat and drink well in a discreet and dignified way. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage them. People and their relatives told us they had access to health professionals as soon as they were needed.

Relatives we spoke with said they felt included in planning the support their relative received and were always kept up to date with any concerns. The registered manager had identified that relatives were not consistently involved with reviews of people’s care needs, so she had put a system in place to improve this. This was a new system that had not been in place long enough to measure the improvements. People living at the home were able to see their friends and relatives as they wanted. They knew how to raise complaints and felt confident that they would be listened to and action taken to resolve any concerns. The registered manager had arrangements in place to ensure people were listened to and action could be taken if required.

Staff we spoke with were aware of how to recognise signs of abuse, and systems were in place to guide them in reporting these. They were knowledgeable about how to manage people’s individual risks, and were able to respond to people’s needs. Staff had up to date knowledge and training to support people. We saw staff treated people with dignity and respect whilst supporting their needs. They knew people well, and took people’s preferences into account and respected them.

Staff had the knowledge and training to support people. Staff were knowledgeable about ensuring people agreed to the support they received. They worked within the confines of the law to ensure they did not treat people unlawfully. There were no applications to the local authority to deprive people of their liberty at the time of our inspection.

The registered manager promoted an inclusive approach to providing care for people living at the home. People who lived at the home and staff were encouraged to be involved in regular meetings to share their views and concerns about the quality of the service. The provider and registered manager had systems in place to monitor how the service was provided, to ensure people received quality care.

A single inspector carried out this inspection on 10 September 2014. As part of this inspection we spoke with the registered manager, deputy manager, a family member, members of staff and we reviewed information given to us by the provider. We met and spent time with eight of the 14 people who lived at Cleeve House.

Below is a summary of what we found. The summary is based on our observations during the inspection, observations of people using the service, the staff supporting them and from looking at records. We used the evidence we collected during our inspection to answer the five questions.

Is the service safe?

From our observations and the information we saw in care plans, policies, procedures and audits, the provider's safety monitoring systems were adequate. Staff training records showed that staff received regular training on safeguarding. Staff showed they had a clear understanding of their role in providing care and in safeguarding the people they supported. Staff demonstrated that they knew people well and understood their support needs.

We saw evidence that when people lacked the capacity to make decisions on important areas of their lives, best interests and safeguarding discussions had taken place.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We saw that, where necessary, people who lived at the home had a mental capacity assessment. There were no current Deprivation of Liberty Safeguards orders in place at the time of our inspection. The registered manager told us that they would review the safeguarding requirements for all people who live at the home in the light of the recent changes to the legislation.

Staff rotas showed that management had taken people's care needs into account when making decisions about the number of staff required and the skills and experience staff would need. The night time staffing levels and on call system showed that the provider had taken steps to ensure the staffing provision was safe.

Issues of concern had been raised on a previous inspection which related to the stock control of medicines kept at the home, infection control audits and risk assessments following incidents. During this inspection we found that these issues had been addressed by the provider and the appropriate systems were in place and were safe.

There were systems in place to make sure that management and staff learned from events such as accidents and incidents, complaints, concerns and investigations. This meant that people were benefiting from a service that was taking on board lessons learnt.

Is the service effective?

We saw that people's care needs had been assessed and detailed care plans had recently been reviewed and updated. There was evidence that people and their families were involved in the assessments of their needs and care plan reviews as much as possible.

Staff we spoke with, and activity plans we looked at, provided evidence that people were supported to maintain active lives.

We saw evidence that people were supported by a wide range of health care professionals. This meant their health and welfare needs were being met.

Is the service caring?

We observed that staff supported each person in a way which met their individual needs. Staff showed warmth, consideration and respect for people. One member of staff we spoke with said, “I worked here for many years, I left, but I came back, as I really enjoyed working at this home. It is like a family”. The registered manager told us, “We want to provide a home which people would feel happy to leave a family member”. Another member of staff said, “It is a friendly place to work, we have a good staff team here, we try to make the place like home for the people who live here”. We saw that staff ensured people’s dignity was maintained at all times.

We spoke with one of the people who lived at the home, they said, “It is very comfortable here. I have what I need and I can look after myself but the girls are here if I need them. The staff have time for me”.

The registered manager and staff we spoke with told us they were committed to provide a good caring service to support and look after people. Staff we spoke with demonstrated that they were aware of potential risks, people's rights and their responsibilities.

Is the service responsive?

We saw that care plans and risk assessments had all recently been reviewed and were focused upon the current needs of the individual. The care plans contained detailed information about people's choices and preferences. The information showed that each person had an individual support plan which was adapted regularly to meet their changing needs. We saw that people’s health and support plans were regularly updated to reflect people’s changing health care needs.

There was evidence of regular support provided from health care professionals. This meant that people’s health and welfare was regularly reviewed and monitored.

Staff we spoke with said if they had any concerns, they could always talk with the managers and that they would always listen and address anything they raised. We saw that staff received regular training which equipped them with the knowledge and skills to meet people’s support needs.

Is the service well-led?

The home had a clear management structure in place. The registered manager, deputy and staff we spoke with were very knowledgeable about people who used the service, changes to legislation and developments in care provision. The registered manager and deputy manager were working to ensure all appropriate monitoring systems were in place.

We saw on the staff rota that senior staff were on duty to give advice and support. We saw that there were systems in place to provide feedback to staff about changes to people's care plans and developments within the service provided.

A registered manager was not in place when we inspected. The provider had appointed an acting manager to run the home.

At our previous inspection on 2 May 2013, we identified that the provider did not meet the expected standards in ways they checked the quality of their services or how they maintained records. Therefore we set compliance actions which required the provider to make improvements.

We reviewed how the provider had progressed. We spoke with the manager, two members of staff and a medical practitioner. We also looked at four care plans and records that had been made and reviewed a recent questionnaire survey completed by people’s relatives. We found that the provider had improved in some areas but not in others.

The provider had improved some of the ways in which they checked the quality of the services they provided. However, we found that in other areas a system to check the standards and quality of care provided did not meet essential standards. Our checks found that some audits had not been completed and some that had were not effective. We also found that investigations to help staff understand why accidents had occurred had not taken place.

We found that record keeping had improved and provided sufficient information that demonstrated the level of support provided. We found an occasion when a record had not been made but the person was not at risk because staff were aware of what they needed to do.

Since our last inspection the registered manager had left their position in January 2013 and had been replaced by an acting manager.

During this inspection we spoke with staff, people who lived in the home and their relatives. We also spent time observing care being delivered in communal areas and we reviewed people’s care plans.

People who used the service told us that they felt safe and well cared for. Relatives told us that they felt that care was centered on people living there. One said about staff: “They are so caring.” They also told us that the service had improved since the new manager had been appointed. One relative told us that staff now take more time to explain what they are doing. We found that people were involved in planning their care and decisions that they made were respected.

Assessments of people’s needs had been completed and plans to meet people’s individual needs were in place. However, records we reviewed showed us that assessments had not always been fully completed and always did not contain accurate and up to date information. Managers told us that they were aware of this.

We found that training had been planned and completed by staff, although not all staff completed formal induction training. Staff had been trained in safeguarding vulnerable adults and knew what to do if they suspected a person was being abused. Staff we spoke with said they felt supported by their managers.

During this inspection we spoke with four people who used the service and four members of staff. We also spent some time in communal areas observing the interaction between staff and people who used the service.

People who used the service told us that that they were well cared for and we saw that people who used the service had good relationships with staff and that staff appeared to know them well. We found that people who used the service were encouraged to express their views and make decisions about their care and how they wanted to spend their time.

The individual needs of people were assessed and supporting plans had been developed to ensure those needs would be met by staff.

People who used the service were supported by staff that had received appropriate training to enable them to meet their needs.

Since our last visit to the service there had been some significant improvements to the environment and many areas had been redecorated and refurbished

We saw that there were arrangements for monitoring the quality of the service. People we spoke with told us that the registered manager was approachable. They said they felt confident to raise issues of concern with them if necessary and knew that they would be listened to.

We spoke with five people who live at Cleeve House and one person who was visiting, and we spent time observing how staff supported people. People told us that they were happy living at the home and that the staff were friendly. Comments included “they’re so kind” and “really caring, they work so hard”, although some people mentioned that a few staff “are a bit sharp”. They said that visitors were always made welcome and said that the home was “homely” and “has a nice atmosphere”.

People told us that they enjoyed being in the garden and that they had enjoyed a recent visit to the pantomime. Records showed that there was a varied range of activities, including Nintendo Wii Fitness; wine and cheese evenings and regular music sessions. One person said that they would have liked the opportunity to go out to the shops in Malvern.

The care plans showed a good knowledge of each person’s individual needs and included clear instructions for staff. Some care plans were not accurately completed.

We saw that people’s bedrooms were kept clean and there was evidence that checks were being carried out on a regular basis. There was evidence that infection prevention and control measures were not always in place.

We saw that the home was not in good decorative order. Much of the paintwork was chipped and some carpets were badly worn and stained.