We undertook an unannounced inspection of Clifton Gardens Resource Centre on 22 February 2018.

Clifton Gardens Resource Centre is a care home and is run by the London Borough of Hounslow. It provides accommodation for up to 43 older people in single rooms. The majority of people at Clifton Gardens Resource Centre are older people living with dementia. The home is situated within a residential area of the London Borough of Hounslow. At the time of our visit there were 29 people using the service with one person in hospital.

We previously inspected Clifton Gardens Resource Centre on 1 and 2 June 2017 and rated it Requires Improvement. We identified breaches of regulations in relation to safe care and treatment (Regulation 12) and good governance (Regulation 17). We carried out a focused inspection on 7 and 8 September 2017 following a large number of notifications of incidents and accidents being submitted by the provider during July and August 2017. During this inspection we looked at the key questions of Safe and Well-led. We found repeated breaches of Regulation 12 and Regulation 17. The overall rating for the location remained as Requires Improvement. We issued two warning notices in respect of these repeated breaches telling the provider to make improvements by 15 December 2017.

A registered manager was 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 provider had made improvements in the recording of incidents and accidents. There were records of any actions taken and any changes to the person’s support needs to ensure the care being provided met those needs.

Most of the staff interactions with people were positive and showed staff respected people. Staff praised the positive atmosphere in the home. There were a few instances where staff did not demonstrate they showed respect to people.

People told us they felt safe when receiving care. Medicines were managed safely and risk management plans were in place providing guidance for care workers on how to minimise risks for people using the service.

The provider had a robust recruitment process in place and there were enough care workers on duty to provide support. Care workers received the training and supervision they required to provide them with the knowledge and skills to provide care in a safe and effective way.

Assessment of peoples support needs were carried out before the person moved into the home. People were supported to eat healthy meals that met their dietary, cultural and religious needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and the policies and systems in the service supported this practice.

The care plans identified the person’s wishes as to how their care was provided and were up to date. A range of activities were organised and we saw people enjoyed taking part in these.

Improvements had been made to the quality monitoring system including audits. All staff we spoke with told us that the senior management team was approachable and supportive.

Further information is in the detailed findings in the main body of the report.

We undertook an unannounced focused inspection of Clifton Gardens Resource Centre on 7 and 8 September 2017. We carried out the focused inspection due to concerns raised with the Care Quality Commission (CQC) by social workers in relation to how the care plans and other records were maintained in relation to people’s care. We also received 18 notifications during a five week period relating to a range of events including falls and incidents between people using the service. Registered providers need to send notifications to the CQC about certain changes, events and incidents that affect the service or the people who use it. This number of notifications was higher than expected for this size of service and over this time period.

Clifton Gardens is a care home and is run by the London Borough of Hounslow. It provides accommodation for up to 43 older people in single rooms. The majority of people at Clifton Gardens Resource Centre are living with a diagnosis of dementia. The home is situated within a residential area of the London Borough of Hounslow. At the time of our visit there were 36 people using the service.

We previously inspected Clifton Gardens Resource Centre on 5, 6 and 7 April 2016 and we identified issues in relation to the recording of the management of medicines and quality assurance. Following the inspection in June 2017, we found improvements had not been made in relation to the issues that were identified at the previous inspection. We issued the provider and registered manager with two warning notices relating to safe care and treatment of people using the service (Regulation 12) and the good governance of the service (Regulation 17) ) requiring them to make the necessary improvements by 1 September 2017.

At the inspection on 7 and 8 September 2017 we found improvements had been made in relation to the administration of medicines as well as audits relating to medicines. Improvements had also been made to the recording of the daily checks carried out on pressure mattresses settings. We did identify there were still issues in relation to the accuracy of records relating to the support needs of people using the service and how they were audited.

There was a process in place for the recording of incidents and accidents but this information was not always reviewed by the registered manager to ensure appropriate action had been taken. Also the information relating to falls was not always recorded on the falls monitoring form. The care plans and risk assessments were not updated to reflect any changes in support needs or any actions taken to reduce future risks.

At the time of the inspection 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.

There was a clear recruitment process used by the provider to ensure checks were carried out on new care workers to ensure they were suitable and had the necessary skills to provide the care required by the people using the service.

Care workers used appropriate personal protective equipment (PPE) equipment including aprons and gloves when providing support.

We found a number of breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches relate to the safe care and treatment of people using the service (Regulation 12) and the good governance of the service (Regulation 17). Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We undertook an unannounced inspection of Clifton Gardens Resource Centre on 1 and 2 June 2017.

Clifton Gardens is a care home and is run by the London Borough of Hounslow. It provides accommodation for up to 43 older people in single rooms. The majority of people at Clifton Gardens Resource Centre are living with a diagnosis of dementia. The home is situated within a residential area of the London Borough of Hounslow. At the time of our visit there were 38 people using the service.

We previously inspected Clifton Gardens Resource Centre on 5, 6 and 7 April 2016 and we identified issues in relation to the recording and quality assurance of the administration of medicines. Following the inspection in June 2017, we found improvements had not been made in relation to the issues that were identified at the previous inspection.

At the time of the inspection 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.

There were procedures in place for the safe management of medicines but staff did not always complete records relating to medicines as required by the provider’s own process.

Risk assessments were in place but some people did not have risk assessments for specific issues related to their care. The registered manager confirmed these would be developed following the inspection.

The provider had a range of audits in place but those in relation to the recording of medicines were not effective in identifying issues.

There was a clear recruitment process in place. The provider had processes in place for the recording and investigation of incidents and accidents and responding to safeguarding concerns and complaints.

Care workers had received training identified by the provider as mandatory to ensure they were providing appropriate and effective care for people using the service. Also care workers had regular supervision with their manager and received an annual appraisal.

People we spoke with felt the care workers were caring and treated them with dignity and respect while providing care. Care plans identified the person’s cultural and religious needs.

Detailed assessments of the person’s needs were carried out before they moved into the home and each person had a care plan in place which described their support needs. Care workers completed a daily record of the care provided.

At the time of the inspection the service was waiting for a new activities coordinator to start so care workers were responsible for organising activities.

People using the service and care workers felt the service was well-led and effective. There were regular team meetings and care workers felt supported by their managers.

We found a number of breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches relate to the safe care and treatment of people using the service (Regulation 12) and the good governance of the service (Regulation 17). Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded

We undertook an unannounced inspection of Clifton Gardens Resource Centre on 5, 6 and 7 April 2016.

Clifton Gardens is a care home and is run by the London Borough of Hounslow. It provides accommodation for up to 43 older people in single rooms. The majority of people at Clifton Gardens Resource Centre are living with a diagnosis of dementia. The home is situated within a residential area of the London Borough of Hounslow. At the time of our visit there were 39 people using the service.

We previously inspected Clifton Gardens Resource Centre on 30 October and 5 November 2014

and the home was rated as Inadequate. Issues were identified in relation to infection control, staffing levels, unsafe care practices, staff training, assessments and quality assurance. Improvements have been made in relation to the care provided.

At the time of the inspection there was a registered manager in place. 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 had a policy and procedure in place for the administration of medicines but this was not always followed by care workers. Records did not accurately show then medicines were administered. Medicines audits did not identify that improvements in the quality of the service were required.

There were improvements in the level of staffing at the home but at times care workers were focused on completing tasks. The home was clean and there had been improvement in relation to infection control.

Care workers had received training in relation to the use of hoists and moving and handling. Risk assessments for specific issues were now in place and processes were in place in relation to pressure sore management.

People told us they felt safe when receiving support from care workers. Each person had an evacuation plan in place I n case of an emergency.

The provider had an effective recruitment process in place. Care workers had received training identified by the provider as mandatory to ensure they were providing appropriate and effective care for people using the service. Also care workers had regular supervision with their manager and received an annual appraisal.

The provider had policies and procedures in place in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People we spoke with felt the care workers were caring and treated them with dignity and respect while providing care. Care plans identified the person’s cultural and religious needs.

Detailed assessments of the person’s needs were carried out before they moved into the home and each person had a care plan in place which described their support needs. Care workers completed a daily record of the care provided.

A range of activities were arranged at the home and people told us they enjoyed them.

We found breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which related to the management of medicines and monitoring the quality of the service provided. You can see what action we told the provider to take at the back of the full version of this report.

At the time of our inspection there were 33 people using the service. We spoke with the manager, four other members of staff, a visiting relative and four people who were using the service. Many of the people using the service were unable to share their views of the home with us as they had complex needs. Therefore we used other ways of gathering information about people's experiences such as speaking with staff and a visiting relative, observing care and looking at care records.

We found that people and/or their representatives were involved in making decisions about the care and support they received. People were also supported to make choices with regard to their daily routines.

People's needs were assessed and care plans developed and implemented to enable staff to meet these. We observed staff interacting positively with people using the service. The people we spoke with made comments such as, "I like it here, they look after me" and "[staff] are very nice indeed, very helpful". A visiting relative we spoke with said the home had "very caring staff".

The home had a dog, two rabbits and four chickens. People were supported to care for these animals and offered the opportunity to hold and pet them. People told us that they enjoyed this and one person said they very much enjoyed the eggs that the chickens provided.

The environment was adequately maintained and maintenance issues were addressed promptly.

There were adequate numbers of staff available to meet the needs of people using the service.

There was an effective system in place for managing complaints about the home.

We used a number of different methods to help us understand the experiences of people using the service. This was because some of the people using the service had complex needs which meant not all of them could tell us their experiences. Therefore we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We found that people were comfortable with staff and we observed positive

interactions and engagements between them.

Two of the five people we spoke with told us the staff were “caring” and “did their best to look after us”. One person confirmed staff asked them for their views about how they wanted to be supported and said “staff listen to me”. We spoke to relatives of two people, who told us they were happy overall with the services provided. One relative commented that when there had been issues they felt confident to talk to the manager who would seek to resolve concerns raised by them. They also said some staff were “great” and were “kind”. Another relative said the staff were “competent and knowledgeable” in meeting the person’s needs.

The feedback we received from people who use the service was positive. They told us that staff were available when they needed them and supported them to take part in activities that they enjoyed. They said that staff treated them well and provided good care. People also said that staff helped them get medical treatment if they needed it and helped them to stay healthy.

People told us they could choose how they spent their time and that they could have privacy when they wanted it. They said they felt safe living at the home and that they would feel confident speaking to staff if they were unhappy about the way they were treated.

This inspection took place on the 30 October 2014 and 5 November 2014 and was unannounced.

Clifton Gardens Resource Centre provides accommodation and care for a maximum of 43 older people who may also be living with dementia. At the time of our visit there were 42 people using the service.

The service 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 and associated Regulations about how the service is run.

The provider met all of the regulations we inspected against at our last inspection on 27 February 2014.

We saw that the ongoing reviews of people’s support needs to ensure that the service could provide the care they required were not carried out as scheduled. We also saw that audits relating to the care plans and recording of medicines were not carried out consistently.

We saw there was a clear process and procedure in place for the storage, receipt and disposal of medicines that had been prescribed to people using the service. We saw the majority of Medicines Administration Record (MAR) charts were completed accurately but we did see the records for one person were not clearly recorded. We have made a recommendation about the management of medicines.

We had mixed comments relating to the food options available to people using the service with some people unhappy with the choice of food available in the evenings and other people were positive about the food available. The housekeeping staff helped support people eat who were on a soft diet but they had not received any formal training. We have made a recommendation about the staff training in relation to supporting people on soft diets.

People we spoke with told us they felt safe in the home and the provider had policies and procedures in place to respond to any concerns raised relating to the care provided. There was a clear process in place for the recording and investigation of any accidents and incidents that occurred at the home.

The manager understood that appropriate authorisation was required where a person might be deprived of their liberty and was in the process of making a Deprivation of Liberty Safeguards (DoLS) application to the local authority for people using the service. Initial assessments were being carried out to prioritise any applications.

We saw people’s care plans identified the person’s support needs and these plans were up to date. People told us they liked the activities that were organised at the home and we saw people enjoying different types of activity during our inspection.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These related to staffing levels, infection control, management of risk, staff training and support, reviews of care needs and monitoring the quality of the service. You can see what action we told the provider to take at the back of the full version of this report.