This inspection took place on 04 April 2017 and was an unannounced comprehensive rating inspection. The location was last inspected in May 2016 and was rated as ‘Requires Improvement’.

Clifton House is a registered care home providing accommodation for up to 39 people who require support with personal care. At the time of our inspection there were 38 people living at the home.

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.

People’s rights to privacy and confidentiality were not always respected by the staff that supported them.

People were kept safe and secure, and relatives believed their family members were safe from risk of harm. Potential risks to people had been assessed and managed appropriately by the provider.

Staff had been recruited appropriately and had received relevant training so that they were able to support people with their individual care and support needs. People received their medicines safely as prescribed to them.

Staff sought people’s consent before providing care and support. Staff understood when the legal requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) should be followed.

People had a variety of food, drinks and snacks available throughout the day. They were able to choose the meals that they preferred to eat.

People were supported to stay healthy and had access to health care professionals as required. They were treated with kindness and compassion and there were positive interactions between staff and the people living at the location.

People’s choices and independence were respected and promoted. Staff responded appropriately to people’s support needs. People received care from staff that knew them well and benefitted from opportunities to take part in activities that they enjoyed.

The provider had management systems in place to audit, assess and monitor the quality of the service provided, to ensure that people were benefitting from a service that was continually developing.

This inspection was carried out on 16 February 2016 and was unannounced. The service was last inspected in May 2014 and we judged them to be compliant with the assessed regulations.

Clifton House provides care and accommodation for to up to 39 people. Some people live in the home on a temporary basis following discharge from hospital whilst plans for their future are made. Some people living in the home are living with dementia. At the time of our inspection there were 39 people living in the home.

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.

Staff actions did not always show that people were valued and treated with care and dignity. People did not feel staff were always responsive to their needs.

People enjoyed their meals but actions were not always taken to ensure their choices were facilitated. Referrals were not always made in a timely manner to ensure that people that had lost small amounts of weight regularly over a period of time received advice and support as needed.

The systems for quality monitoring and sharing the findings with people needed to be improved so that systems were robust and was easier to understand for people.

People were protected from harm because staff understood their responsibility to take action to protect people and the provider had systems in place to minimise the risk of abuse.

People were involved in planning their care and management of any risks identified in relation to the care they received. People received care and support from staff that were trained and supported to carry out their roles.

There were sufficient staff available to meet people’s needs and recruitment process ensured that suitable staff were employed.

People were supported to receive their medicines as prescribed.

Staff worked in line with the Mental Capacity Act and Deprivation of Liberty Safeguards to ensure people’s human rights were protected.

People received support from healthcare professionals to monitor their ongoing health conditions and emergency treatment as needed.

We visited this service and talked with people to gain a balanced overview of what people experienced, what they thought and how they were cared for and supported. There were 37 people living in the home at the time of our visit. We spoke with nine people, two members of staff and five relatives during our inspection. We observed how people were cared for and how staff interacted with them during our visit to get a view of the care they experienced.

We considered all of the evidence that we had gathered under the outcomes that we inspected. We used that information to answer the five questions that we always ask;

Is the service safe?

We saw that people's individual needs had been assessed and that there were enough suitably trained staff to care for people.

We saw that people generally received good and safe care and all the relatives spoken with told us that they were happy with the care provided. The relatives of one person who was moving on told us, “It has been brilliant, staff are caring. Mum’s been safe.”

CQC monitors the operation of the Deprivation of Liberty Safeguards (DOLS) which applies to care homes and hospitals. No applications to restrict anyone’s liberty had been made. The manager understood how this legislation applied to people and protected their rights.

The premises were well maintained and equipment used by staff to provide care and support was maintained to ensure people were kept safe.

Staff were alert to the signs of or potential for, abuse of vulnerable adults and procedures were in place, which were reviewed regularly to prevent abuse.

We saw that the provider regularly monitored the quality of service provision.

Staff were supported to meet the needs of people through the provision of regular training, supervision and staff meetings that enabled good practice to be developed.

Recruitment procedures ensured that only appropriate people were employed in the home. This meant that people were safe from harm.

Is the service effective?

People’s care and health needs were assessed, planned and delivered in a personalised way. We saw that people’s changing needs were monitored and care and support appropriately adjusted. This meant that people’s care was planned and delivered in line with their individual needs.

The environment was safe and clean and met the needs of the people living there because the appropriate adaptations were in place to support people to move around freely and for their needs to be met appropriately.

Staff training was sufficient to meet all the needs of people using the service. People living in the home were supported to meet goals and improve their skills.

Is the service caring?

Staff responded to people’s needs in a caring and appropriate way. Staff spoke with people in a tone that expressed friendship and support and offered people choices throughout the day. Conversations with staff showed that they considered them to be individuals and expressed concern and respect for them and their relatives.

We saw that people were supported to be involved in activities that ensured that their emotional and social needs were met. People were supported to dress and have hair styles that reflected their individual personalities. People were supported to maintain relationships that were important to them. They were supported so that their preferences, interests and diverse needs were met.

People living in the home told us they were happy and the carers were nice and kind. One person told us that they were able to have a shower when they wanted and were able to go out when they wanted.

Is the service responsive?

We saw that people’s care plans and risk assessments were reviewed on a regular basis to ensure that their changing needs were planned for.

We saw that actions were taken to protect people’s health as needed. We saw that staff had identified that one person’s health was deteriorating and were liaising with the doctor ensuring that the appropriate investigations were undertaken. One relative told us, “Any concerns they (staff) are on the ball.” Another relative told us, “Communications are good.” This showed that the service was responsive and kept relatives informed about people’s health.

We saw that there were systems in place to raise concerns and that these were responded to in a timely manner. One relative told us that when they had raised any issues they had been listened to and taken on board. This meant that the service responded to concerns and addressed them appropriately.

Is the service well led?

The registered manager had been in post since the home had opened. The manager was experienced and caring and provided good leadership based on how best to meet the needs of people in an individualised way.

There was a robust system in place to monitor the quality of the service they provided. This included regular audits of all aspects of the care and support given to people and the views of relatives and professionals who visited the home. Action plans were produced and implemented when necessary.

There were 38 people living in the home. We spoke with four people, two relatives, three staff and the registered manager and provider.

Everyone we spoke with told us they were happy with the care provided. One relative said, “People get good food, are washed and bathed regularly and we are kept in informed about how mum is. Management plans were detailed so that staff were able to care for people safely. This meant that people received the care and support they needed and were happy with the care provided.

We saw that food choices were available at mealtimes and special dietary needs were met.. This showed people were eating enough to remain healthy.

We saw that people received their medicines at the times prescribed. Two people living in the home and their relatives told us that people were able to see the doctor when needed. Records showed people were supported to access a variety of health professionals. This meant their health was monitored and treatment provided if needed.

All staff spoken with told us they felt supported by the manager and staff team. Systems were in place to ensure that staff received the appropriate training and support they needed to carry out their roles safely.

There were systems in place to monitor the service and make adjustments as needed. The views of people using the service were listened to and acted on when appropriate.

We carried out this visit on 11 June 2012 as part of our planned programme of inspection and also to check that the provider had taken action to address the compliance actions made following our visit in December 2011.

Some people living in the home were not bale to tell us about their experience of care at Clifton House. We used a number of different methods to help us understand the experiences of people using the service. There were 29 people living at the home on the day of our visit. No one knew we would be visiting. We spoke with seven people living in the home and one relative. We observed the interactions between people living in the home and staff. We spoke with two staff, the manager and the provider.

All the people we spoke with told us they were happy at the home. A relative told us that they were “Very happy with the care in the home.”

We found that people using the service and their relatives had been involved in the assessment procedure and drawing up of care plans. We found that the staff were knowledgeable about people’s needs. We saw that interactions between staff and people living in the home were friendly and people were spoken to respectfully and discreetly when needed.

We found that people were able to make choices about the food they ate and received the support they needed. Most people told us they liked the food. One person told us “Looked after wonderful. Food is great.”

Staff were trained in safeguarding procedures. Staff spoken with told us what they would do if they had any concerns about poor practices in the home. This ensured the well being and safety of people. One person living in the home said “I feel safe here.”

People got their medicines as prescribed. People were not assessed to see if they could continue to manage their own medicines. One person told us “I was not asked if I wanted to look after my medicines.”

There were sufficient numbers of staff to meet people’s needs. Staff had received a range of training so that they could meet people’s individual needs.

There were systems in place to monitor how the home was run so that people received a quality service and their individual needs were well met.

Clifton House was registered by us in September 2011. People started to move in to Clifton House in November 2011.

We visited the home because we received some concerns about the way in which the home was being run. Our inspection was carried out over two days in December 2011.

We spoke to seven people living in the home, one professional and four other visitors to the home. We spoke to two social workers about people living in the home.

The people living in the home and their visitors told us that they were happy with the service being provided. They found the care workers helpful and kind. They felt that there were enough care workers in the home to help people.

Satisfaction with food was variable. Some people were happy with the food and some were not. Some people said they were asked what they wanted to eat in the morning but others said they were not. One person was unhappy that they were being given custard regularly when they had told the care workers they did not want it. Another person told us that they could not have tea outside of the set times.