This unannounced inspection took place on 9 and 10 August 2018.

At our last inspection in November 2017 we identified breaches of regulations relating to safe care and treatment, good governance, meeting people’s nutritional needs, premises and equipment, person-centred care and submitting notifications of significant incidents to CQC. We rated the service ‘Requires Improvement’ overall and in each key question and we served the provider with requirement notices and warning notices. At this inspection we found the provider had taken the necessary action and was now meeting the legal requirements.

Clifton House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Clifton House accommodates up to 16 older people in one adapted building.

The provider was a partnership. One of the partners was also the 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. For the purposes of this report where we have referred to the provider we are referring to the person that is also the registered manager.

The provider undertook a range of risk assessments to keep people safe. These included reviewing risks related to people’s specific needs and the care home environment. The registered manager reviewed risk assessments and risk management plans to ensure they reflected changes and continued to be relevant. Staff understood the provider’s safeguarding procedures and the actions they should take to keep people safe. Safe recruiting procedures were in place to ensure they were suitable to deliver care. Staff followed appropriate infection prevention and control practices when delivering care, cleaning the environment and managing food.

People were supported with an assessment of their needs prior to admission and their needs were reassessed on an ongoing basis or when their needs changed. Staff received induction and ongoing training and were supported by the registered manager with supervision and appraisal. People’s nutritional needs were assessed by healthcare professionals and staff following guidelines to meet people’s eating and drinking requirements. Staff supported people with timely access to healthcare professionals and monitored people’s health needs.

People received their care and support from staff they described as kind. Staff encouraged people to be independent and promoted their dignity. Staff ensured that visitors were made to feel welcome and people received the support they required around their spirituality.

People’s care plans were personalised and reflected their preferences for care and support. The service provided activities for people to participate in at home and in the community and people were protected from social isolation. People had access to the provider’s complaints procedure.

The registered manager and leadership team took decisive action to address the shortfalls we found at our last inspection. Good governance was in evidence in the provider’s quality assurance processes and staff felt supported. The views of people, relatives, staff and visiting health and social care professionals were gathered and used to shape service delivery. The provider worked in partnership with other services to secure positive outcomes for people.

This inspection took place on 1 and 2 November 2017 and was unannounced. The last Care Quality Commission (CQC) comprehensive inspection of the service was carried out in October 2015. At that inspection we gave the service an overall rating of ‘good’. However when answering the key question 'is the service safe?’ we rated the service as 'requires improvement' because we found the provider in breach of the regulations. They had not formally recorded the outcomes of safeguarding referrals investigated by the local authority so they could not be certain that these outcomes enabled people to feel safer or reassured.

Clifton House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Clifton House accommodates up to 16 older people in one adapted building.

The provider was a partnership. One of the partners was also the 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. For the purposes of this report where we have referred to the provider we are referring to the person that is also the registered manager.

At this inspection we found new risks to the health, safety and wellbeing of people at Clifton House. The provider’s arrangements for assessing and managing risks to people posed by their healthcare conditions and by the environment were ineffective. They had not considered the impact of changes in people’s health and how these posed new risks to people’s safety. Environmental risks were not appropriately managed. Aspects of the environment posed a risk of injury or harm to people from trip and slip hazards, missing or inappropriate restrictors on windows, potential exposure to sharp items and poor cleanliness and hygiene around the premises. The provider had not considered risks posed to people from furniture and items they had stored inappropriately around the environment and from the use of free standing oil filled radiators brought in to provide additional heating. Notwithstanding these issues we found the provider continued to maintain a servicing programme of the premises and equipment used by staff so had taken action to ensure those areas of the service covered by these checks should not pose unnecessary risks to people.

People’s care records and associated risk assessments were out of date and/or inaccurate so staff did not have access to current information about how to keep people safe. Staff did not fully understand how to support people with their healthcare needs and conditions and the provider did not use best available evidence to ensure people experienced good health outcomes. Staff did not always respond quickly when people's health changed to seek appropriate medical support and assistance. People were not involved in planning their care and support needs and their records showed limited information about their preferences and likes and dislikes. This meant people may have experienced support that did not reflect their diverse needs, wishes and choices for how this was provided.

There were enough staff deployed during our inspection to keep people safe. But staff did not always have time to spend with people in a meaningful way and support them to communicate their needs and wishes. There was not enough for people to do to meet their social and physical needs and people who chose to spend time alone were at risk of becoming socially isolated. The provider did not routinely assess and review staffing levels as the level of dependency at the service changed. This meant they could not be assured that there were enoug

We inspected Clifton House on 5 October 2015. The inspection was unannounced. At the previous inspection of 9 December 2013 the home had met all the required standards.

Clifton House provides accommodation and personal care for up to 16 older people, including people living with dementia. At the time of the inspection there were seven people living in the home.

The home was managed by 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 service provided safe care for people. People we spoke to told us they felt safe and well cared for. Records showed that people who lived in the home had been involved in risk assessments and in planning the support they needed as far as they were able. Safeguarding issues had been appropriately raised with the local authority. However, the provider did not have robust systems in place to demonstrate the audit trail of each safeguarding event. It was not always possible to identify a clear pathway between the time a safeguarding alert was raised and how this had been concluded. This meant that the provider could not ensure that the people using the service had had the most appropriate individual response suitable for them.

You can see what action we told the provider to take at the back of the full version of the report.

We saw that people’s health and nutrition were regularly monitored. People were supported at mealtimes and had choice regarding their preferred meal. Food was nutritious and hot. There were established links with GP services, hospitals and local authority.

Care records were individual to each person and contained information about people’s life history, their likes and dislikes, and information which would be helpful to hospitals or other health support services.

There were sufficient numbers of trained staff working in the home at all times and staff were supported by the manager and deputy manager. Staff had completed mandatory training and there were clear details as to when this training should be refreshed.

Where people lacked the capacity to make decisions for themselves staff had followed the requirements of the Mental Capacity Act 2005. Staff had received relevant training. The manager understood their responsibilities in relation to the Deprivation of Liberty Safeguards (DoLS) and knew how to apply it to people in their care.

There was an open and inclusive atmosphere in the service. People who used the service and staff told us they found the manager to be approachable and supportive. Staff were able to challenge when they felt there could be improvements.

The provider had a clear set of values that included the aims and objectives, principles, values of care and the expected outcomes for people who used the service. The service had quality assurance systems in place. These ensured people continued to receive the care, treatment and support they needed. There were also meetings between the home and people who lived there as well as meetings with relatives.

At our previous inspection of Clifton House, which we carried out on 11 June 2013, we found that although people who used the service were happy with the care they received; we identified that action needed to be taken by the provider to ensure information staff required to meet people’s needs was always available in the home. We also found that staff had not refreshed the training for sometime.

During our follow up review we found that the provider had taken appropriate action to address the aforementioned issues which were identified in the services previous inspection report. We spoke with two people who used the service. They both told us they felt the staff who worked at Clifton House treated them well. One person said “the staff are all very good here”. Another person told us “I think the staff are really good at their jobs”.

We also talked to the proprietor, the registered manager and two other members of staff. We found managers and staff were able to access information we had requested quickly and had the right mix of up to date knowledge and skills to meet the needs of the people who lived at Clifton House.

During our inspection we spoke with five out of the ten people who were living at Clifton House. They told us they were happy with the care and support they received at the home and that the staff who worked there were kind and caring. People also said they felt safe living at Clifton House and able to talk with staff and the new owners if they were concerned or unhappy about anything at their home. One person we spoke with told us “It’s quite good here. The food’s excellent. I am glad I moved in”. Another person said “It’s not a bad place to live. Most of the staff are usually very helpful and friendly. They definitely listen to me”. We saw staff treated the people who used the service with respect and dignity.

However, although people receiving services in the home told us they were happy and we saw that they were well supported by staff; we found that failures to maintain certain records and ensure staff had access to all the information they required meant the needs of the people who used the service might not be fully met. We also found that people’s needs may not always be met because staff had not continually refreshed their training in some key aspects of their role.