This inspection took place on 10 May 2017 and was unannounced. The last inspection took place on 17 May 2016 and at that time we found the home was not in breach of any Regulations but was rated ‘required improvement’ This inspection was carried out to see whether improvements had been made and/or sustained since the last inspection. At this inspection we found the provider had made and sustained improvements in the required areas.

Cliffe Vale is located close to the centre of Shipley. The home provides personal care to a maximum of 27 people and caters predominantly for older people and people living with dementia. It is a detached property and provides accommodation on three floors. The home does not have a passenger lift, though there are a number of stair lifts which provide access to the upper floors.

The home had 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 the service was safe. Staff had a good understanding of safeguarding and knew how to report any concerns about people's safety and welfare. We found safeguarding concerns were being referred to the local safeguarding team and the Commission.

The registered manager and provider followed a robust recruitment procedure to ensure new staff were suitable to work with vulnerable people. Staff training and support had improved and the majority of staff were up to date with training on safe working practices. Staff supervision and appraisals were in place.

Risks to individuals were identified and we saw action was being taken to manage risks. We found people's medicines were managed safely. Although records did not always show when creams and lotions known as ‘topical medicines’ were applied and how often; this issue was addressed by the registered manager during the inspection.

The home was working in accordance with the Mental Capacity Act which meant people's rights were protected. We found people’s health care was met and relevant referrals to health professionals were made when needed.

Staff responded to people’s individual needs and delivered personalised care. People’s care plans and other records showed their needs had been initially assessed and care was planned. We found care plans had been reviewed and updated.

People had their nutritional needs met and were offered a choice at every meal time. People were offered a varied diet and were provided with sufficient drinks and snacks. People with specific nutritional needs received support in line with their care plan.

A range of activities were offered for people to participate in and people told us they enjoyed these.

There were systems in place to ensure complaints and concerns were fully investigated. The manager had dealt appropriately with all complaints received.

The premises and equipment were appropriately maintained and we noted safety checks were carried out regularly.

People, relatives and staff spoken with had confidence in the registered manager and felt the home had clear leadership. We found there were effective systems to assess and monitor the quality of the service, which included feedback from people living in the home and their relatives.

The inspection took place on 17 May 2016 and was unannounced.

Cliffe Vale is located close to the centre of Shipley. The home provides personal care to a maximum of 27 people and caters predominantly for older people and people living with dementia. It is a detached property and provides accommodation on three floors, the home does not have a passenger lift, there are a number of stair lifts which provide access to the upper floors.

There were 16 people living at the home when carried out this inspection.

The last inspection was in October 2015. At that time we found the provider was in breach of a number of regulations and the home was placed in special measures. The breaches of regulation were in regard to person centred care, safe care and treatment, safeguarding people from abuse, premises and equipment, complaints, staffing, staff recruitment and governance. We carried out this inspection to check if the required improvements had been made.

The home did not have registered manager in post at the time of the inspection. 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 company secretary was in day to day charge of the home at the time of the inspection. They confirmed it was their intention to appoint a new manager without delay.

People told us they felt the service was safe. Staff had a good understanding of safeguarding and knew how to report any concerns about people’s safety and welfare. We found safeguarding concerns were being referred to the local safeguarding team but the Commission was not always being notified about this. The provider acknowledged this as an oversight and assured us it would not happen again.

There were enough staff to meet people’s needs. We talked to the provider about the need to review staffing levels as people’s needs changed and/or when more people moved into the home. New recruitment procedures were in place to make sure all the required checks were done before new staff started work. Staff training and support had improved and the majority of staff were up to date with training on safe working practices. More training was planned to focus on the needs of people living at the home. Staff supervision was in place but appraisals had not yet taken place.

The home was clean and odour free. The concerns about the environment raised at the last inspection had been addressed. We found more needed to be done to create a more dementia friendly environment to support people’s independence, the provider had already identified this as an area for improvement.

Risks to individuals were identified and we saw action was being taken to manage risks. We found people’s medicines were managed safely.

Improvements had been made to the way people were supported to meet their nutritional needs. The meal time experience for people had also been improved by creating a designated dining room. People’s weights were checked and advice was sought from other health care professionals. Some people who were known to be at risk were having their food and fluid intake recorded. We found the food diaries provided a detailed picture of what people had eaten but the fluid charts were not completed to the same standard.

The home was working in accordance with the Mental Capacity Act which meant people’s rights were protected.

People had access to a full range of NHS services. A bedroom had been changed to a treatment room which meant visiting health care professionals had somewhere to discuss peoples care and/or see people in private.

People living in the home, relatives and visiting health care professionals spoke very positively about the attitude and approach of care staff. During the inspection we saw

The inspection took place on 21 October 2015 and was unannounced. There were 25 people living at the home at the time of the inspection.

Cliffe Vale is located close to the centre of Shipley. The home provides personal care to a maximum of 27 people and caters predominantly for older people and people living with dementia. The home is a detached property and provides accommodation on three floors, the home does not have a passenger lift, there are a number of stair lifts which provide access to the upper floors.

The home has 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.

The last inspection took place on 29 October 2014. At that time we found the provider was not meeting two regulations. These were the regulations relating to the Mental Capacity Act 2005 and monitoring and assessing the quality of the services provided. The provider sent us an action plan with details of how they were going to make the required improvements. They told us they would have completed the action plan by February 2015. New regulations came into effect on 01 April 2015 and we cross referenced the old regulations to the new regulations so that we could check the provider had taken appropriate action. We found the provider had not taken appropriate action and there were breaches of the new regulations.

We looked at how the service was working to meet the requirements of the Mental Capacity Act 2005 and found people were at risk of being deprived of their liberty unlawfully. This was a breach of the regulations because people must not be deprived of their liberty without lawful authority.

People living in the home and their relatives told us they felt safe. However, we found safeguarding incidents were not always recognised or reported to the right agencies, such as the Local Authority safeguarding team and the Commission. This was a breach of the regulations because it meant the provider did not have proper systems in place to make sure people were protected from abuse.

The provider did not always make sure the required checks were completed before new staff started work. This was a breach of the regulations because it meant people could be at risk of receiving care and treatment from staff who were not fit and proper persons to work in a care setting.

There were no housekeeping or laundry staff employed at the time of the inspection. The cook finished work after lunch and the activities coordinator only worked two hours a week. The care assistants were responsible for housekeeping, laundry and kitchen duties and were also responsible for providing social activities in addition to their caring roles and responsibilities. The home did not have enough staff and the staff that were employed were not properly supported by means of training, supervision and appraisals. This was a breach of the regulations because provider of care services must make sure there are enough staff deployed to deliver the service and that staff are trained and supported to carry out their duties.

People were at risk because medicines were not always managed properly. This was a breach of the regulations.

The standards of cleanliness were poor and this was a breach of regulation because it meant people were living in a home which was not clean.

The hot water temperatures were not maintained within safe limits and there were no bath thermometers to check the temperature of the water before people got into the bath which meant people could be at risk of scalding. This was a breach of regulation because it put people who used the service at risk.

People told us they were satisfied with the food. However, we found the choice of food was limited and people’s dietary needs and preferences were not always catered for. This was a breach of the regulations because the way people’s dietary needs were catered for did not demonstrate regard to their well-being.

We were concerned at how people’s weight and nutritional intake was monitored. This was a breach of regulation because it put people at risk of receiving unsafe care and treatment.

People who used the service and their relatives told us the staff were very caring and compassionate. During the inspection our observations supported this view. However, we found some working practices did not promote people’s privacy and dignity. For example, people were limited in their choice of bathroom. This was because the home had a “bath person” who worked two days a week to support people with bathing and always used the same bathroom. This was a breach of the regulations because the provider’s processes for monitoring the quality of the services provided had not identified this practice compromised people’s privacy and dignity.

People’s needs were not always assessed properly. People’s care plans were not person centred and did not have enough information to guide staff on how to meet their individual needs and preferences. This was a breach of regulation because there was a risk people would not receive care which was appropriate, met their needs and reflected their preferences.

People told us they knew the manager and were able to make a complaint if they needed to. They said they didn’t have any complaints. However, we found the complaints policy was not up to date and complaints were not always recorded and people were not always given feedback on the actions taken in response to their complaints. This was a breach of the regulations because the provider did not have proper systems for receiving and dealing with complaints.

Accurate and complete records were not maintained in respect of each person who used the service. For example, this was evident in people’s care plans, risk assessments and the food and fluid charts.

The systems for monitoring, assessing and improving the quality of the services provided and for identifying and managing risks were not effective. This was a breach of the regulations because of the lack of good governance.

We found the provider was in breach of eight regulations in relation to safe care and treatment, person centred care, safeguarding, staffing, recruitment, premises, complaints and good governance. You can see the actions we have asked the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service is in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We inspected Cliffe Vale Registered Care Home on 29 October 2014 and the inspection was unannounced.

The last inspection of this service was on 12 September 2013 and at that time the home was meeting all the regulations we inspected.

Cliffe Vale Care Home is located close to the centre of Shipley and is on a bus route. The home provides personal care to predominantly older people and people living with dementia. Nursing care is not provided. It is a detached, converted property and the accommodation is on three floors linked by stair lifts. Access for people using wheelchairs is provided at the rear of the building. There are 23 single and two shared bedrooms. The bedrooms do not have en-suite facilities, communal toilets and bathrooms are located throughout the building. Communal lounges and a separate dining room are located on the ground floor.

The home has 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 living at the home, their relatives and staff told us people were safe and well cared for. Staff had been trained on safeguarding and whistle blowing and knew how to recognise and respond to allegations or suspicions of abuse.

There were enough staff on duty to meet people’s needs. We observed staff were attentive to people’s individual needs. Staff were trained to care and support people safely and to a good standard. There were very few changes to the staff team which helped to ensure people received continuity of care. When new staff were recruited the required checks were done to make sure they were suitable to work in a care home.

People were supported to have their medicines safely. However, to reduce the risk of inconsistencies in the use of “as required” medicines there should be written guidance for staff to follow.

The home was clean, free of unpleasant odours and well maintained.

People who lacked capacity were not always protected under the Mental Capacity Act 2005 and the service was not meeting the requirements of the Deprivation of Liberty Safeguards. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

Daily routines were flexible to take account of people’s preferences. There was a varied programme of social activities which included card games, bingo and visiting entertainers. People’s dietary needs and preferences were catered for.

People’s health, care and support needs were assessed and there were care plans in place to show how people were supported to meet their needs. People had regular access to the full range of NHS services. The people we spoke with told us they were involved in discussions about their care and treatment, however, this was not always reflected in people’s care records. This was discussed with the manager who said they would address it.

One person we spoke with told us they had a complaint about the laundry service which they had raised with the manager. The rest of the people we spoke with said they had no reason to complain about the service. They all said they would not hesitate to speak to the manager if they had any concerns. The home had received one formal complaint in the last 12 months. This had been investigated and a response had been sent to the Local Authority. The complaints procedure was not up to date. The manager said they would change this immediately.

People living in the home, relatives and staff told us the manager was approachable. The manager told us they were involved in all aspects of the day to day running of the home and encouraged people to talk to them if they had any concerns.

During the inspection we observed the atmosphere in the home was calm and relaxed. People who lived in the home looked comfortable and at ease with the staff.

The manager told us there was a lot of informal consultation with people who used the service but this was not recorded. There were no meetings for people who lived in the home or their relatives. People were asked to complete a quality assurance questionnaire once year to share their views about the service.

Audits were carried out to check the quality of the service and identify any shortfalls. However, we found improvements were needed to the way the quality of the services provided were monitored.

This was a breach of Regulation 10 Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

During the inspection we observed care in the communal areas of the home, spoke with eight people who used the service and four staff. We looked at the care records for four people chosen at random.

Everybody we spoke with told us they were happy in the home and felt well cared for. One person told us “they will do anything for you here, they respond quickly when I need help.” Another person told us “they couldn’t be nicer, they treat me really well.”

We found people experienced care, treatment and support that met their needs and protected their rights. Appropriate risk assessments and care plans were in place and there was evidence they were updated reflecting people’s changing needs.

We found people were protected against the risks of inadequate nutrition and hydration as there was a choice of suitable food and drink available.

We found the provider had systems in place to ensure the safe management of people’s medicines.

We found the building was homely, well maintained with appropriate facilities to care for the needs of the people who used the service.

We observed part of the morning medicines round. Patient support was offered where people needed help when taking their medicines. People were asked whether they wanted their “when required” medicines and staff took time to explain to one person that they had started a new medicine. One person we spoke with managed one of their own medicines. They did not raise any concerns with us. However, we found a lack of written information in support of the safe administration of medicines that increased the risk of errors, or of inconsistency in medicines use. We also saw that the evening and night time medicines rounds were very close together. This means that people may not receive most benefit from taking their medicines, and are at greater risk of suffering side-effects.

We spoke with six people who used the service and they told us they enjoyed living at the home and were very complementary about the care and support provided by the manager and staff. Comments included "The home is clean and comfortable and everyone is so kind and friendly" and "I cannot fault the care and support I receive from the manager and staff."

We spoke with three visitors and they told us they had no concerns at all about the standard of care their relatives received. One person said "I have visited the home at various times of the day and I am always made to feel welcome by the staff". Another person said "The manager and staff keep me well informed of any significant changes in my relative’s condition and always find time to answer any questions I might have about their care."

All the visitors we spoke with told us they were aware of the complaints procedure and said if they did complain they were confident staff would listen to and act upon their concerns.

The care staff we spoke with told us that there were clear lines of communication and accountability within the home and they were supported by management to carry out their roles effectively through a planned programme of supervision, appraisals and training.

Despite the positive comments people made, we saw evidence that people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

People spoken with who live at the home commented that they were happy at the home and staff treated them well.