The inspection took place on 30 October 2017 and was unannounced. Mona Cliffe is a care home providing personal care and accommodation for up to 23 people. At the time of the inspection there were 20 people living at the home.

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.

There were sufficient staff to meet the needs of the people who used the service. The recruitment procedure was robust and measures were taken to help ensure employees were suitable to work with vulnerable people.

There were appropriate safeguarding and whistle blowing policies and procedures in place. Staff had undertaken training in safeguarding and were confident of the reporting procedure.

General and individual risk assessments were in place and health and safety records were complete and up to date. There was an appropriate medicines policy and procedure in place and medicines were managed safely at the home.

New staff undertook a thorough induction programme. Staff were up to date with training and refresher courses were undertaken on a regular basis.

Care files included appropriate information about people’s health and well-being. Referrals were made to other agencies when required and there was good partnership working with other disciplines.

People’s nutritional and hydration needs were met via a choice of good, nutritious home-made food. The service was working within the legal requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People who used the service told us staff were kind and treated them with respect.

We observed care at the home and saw that interactions between staff and people who used the service were friendly and respectful. Staff were mindful of people’s dignity and privacy.

Appropriate information was given to people who used the service and their relatives. Staff demonstrated a commitment to offering care in a way that respected people’s diversity.

There were regular residents’ meetings where people who used the service had the opportunity to make suggestions and raise any concerns. People were encouraged to be as independent as possible and were involved in care planning and reviews.

People who used the service felt their needs were responded to in a timely way. Care plans were person-centred, included people’s preferences and were reviewed on a monthly basis.

There were a number of activities at the service for people to access if they wished to. People were supported to continue to follow their spiritual and religious beliefs.

There was an appropriate complaints process which was displayed prominently within the home. There had been no recent complaints made. The home had received a number of compliments and thank you cards.

People told us the registered manager was approachable and very visible around the home. She was available to be called when she was off duty.

Staff we spoke with told us they were well supported. Staff supervisions were undertaken regularly and we saw evidence of annual appraisals. We saw minutes of regular staff meetings

There were a number of regular audits and monitoring to help drive improvement within the service. Annual quality assurance forms were sent out regularly to ascertain people’s level of satisfaction with the service.

This was an unannounced inspection which took place on 28 January 2015.

We had previously carried out an inspection in June 2014 when we found the service had breached two of the regulations we reviewed. We made compliance actions that required the provider to make the necessary improvements in relation to: care and welfare of people and safety and suitability of premises.

Following the inspection in June 2014 the provider sent us an action plan telling us what steps they were going to take to ensure compliance with the regulations.

Mona Cliffe is registered to provide accommodation for up to 23 people who require support with personal care. At the time of this inspection there were 13 people living at the service.

There was a registered manager in place at Mona Cliffe. 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 who used the service told us they felt safe in Mona Cliffe and that staff looked after them well. We found there were sufficient numbers of staff on duty to meet people’s needs. Recruitment processes were robust and should help to ensure that people who used the service were protected from staff who were unsuitable to work with vulnerable people.

Staff had received training in safeguarding vulnerable adults and were aware of the process to follow should they have any concerns about people who used the service. Staff were also confident to report poor practice and considered they would be listened to by the registered manager.

Improvements had been made to the premises, including the replacement of some carpets and the redecoration of some bedrooms. An on-going refurbishment programme was in place for the service. This should help protect people from the risk of premises which had not been adequately maintained.

Appropriate arrangements were in place for the safe administration of medicines.

Staff were aware of the needs, wishes and preferences of people who used the service. Care plans provided good information about the support people required to meet their needs. Records we looked at showed staff were aware of the action they should take to ensure people’s health and nutritional needs were met.

We saw that staff had received the necessary training to be able to carry out their role effectively. Staff also received regular supervision and an annual appraisal. This should help ensure that people who used the service were supported by staff with appropriate knowledge and skills.

Staff were aware of the principles of the Mental Capacity Act (MCA) 2005; this legislation provides legal safeguards for people who may be unable to make their own decisions. The registered manager had assessed the capacity of people who used the service to consent to the care and treatment they required. Where necessary, applications had been made to the local authority to ensure any restrictions in place where legally authorised under the Deprivation of Liberty Safeguards (DoLS).

Our observations showed that staff were kind and caring in their approach to people who used the service. We saw that positive feedback had been provided about staff in the satisfaction surveys we reviewed.

We saw that people had opportunities to comment on the service they received. We found that staff understood the need to provide personalised support and that adjustments had been made to the care people received in order to best meet their individual needs.

Improvements had been made to care plans to ensure they better reflected people’s wishes and preferences. More activities had also been introduced in the service.

There were a number of quality assurance systems in place in Mona Cliffe. The registered manager had plans in place to continue to drive forward improvements in the service.

The inspection team included an inspector and an expert by experience. The team gathered evidence to help us answer our five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive to people’s needs? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the visit, speaking with six people who used the service, five members of staff, the registered manager and one professional visitor. We also looked at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We spoke with six people who used the service. They told us they felt safe in Mona Cliffe and were happy with the care provided. Comments people made to us included, “I’m very happy here” and “They look after me very well”.

Care records provided staff with some information about the individual needs of people. However, we found improvements needed to be made to ensure people always received safe and appropriate care. We have asked the provider to take action to address this issue.

People had their medicines at the time they needed them and in a safe way.

Sufficient staff were available to be able to meet the needs of people who used the service in a safe and timely manner.

Some improvements needed to be made to ensure people were cared for in premises which were safe and secure. We have asked the provider to take action to rectify these matters.

Systems were in place to record and review complaints, accidents and incidents. This should help reduce the risk to people and help the service to continually improve.

Is the service effective?

People were assessed by a manager from the home before they were admitted to ensure their individual needs could be met.

To ensure that safe and effective care was provided, staff continued to update their skills and knowledge with regular training and updates.

Specialist dietary, mobility and equipment needs had been identified in care plans where required. Risk assessments were regularly reviewed and care plans amended to reflect people’s changing needs.

Is the service caring?

People we spoke with were complimentary about the care provided. One person told us, “Staff are very good”.

It was clear from our observations and discussions with staff that they knew people well and had a good understanding of their care and support needs.

Is the service responsive to people’s needs?

People who used the service were offered regular opportunities to comment on the care and support they received.

Information in the care records showed that the staff at the home involved other healthcare professionals in the care and support of people who used the service.

People knew how to make a complaint and were confident any concerns they raised would be dealt with by the home manager.

Systems were in place to ensure staff had access to up to date information regarding people’s needs. This should help ensure they were supported to respond appropriately to any changes to a person’s condition.

Is the service well-led?

The home had a manager who was registered with the Care Quality Commission and was qualified to undertake the role.

Quality assurance processes were in place in the home. Records we looked at showed us people had recently completed a satisfaction survey. We looked at the results of this survey and found all the responses were positive. Comments people had made included, “Very satisfied with the care at Mona Cliffe. Staff are very kind and helpful” and “Generally extremely happy with all aspects of care and very grateful to the staff”.

Regular meetings were held with staff. These provided the opportunity for staff to discuss any concerns or practice issues in the home. Staff told us they enjoyed working in Mona Cliffe and felt supported by the manager.

We spoke with two people who were using the services on the day of inspection. They told us they enjoyed living at the home and the care staff were very good. One person said “The staff treat me with respect and are pretty good.”

Both people felt safe living at the home and had no issues or concerns.

The people we spoke with told us they had not observed any issues in relation to their medication. We observed how people were given their medication and we spoke to the senior care worker who was administering medicines on the day of our visit. We also looked at records about their medication and the medicines in the home for them.

The purpose of our visit was to follow up on shortfalls identified during our previous visit to the home in August 2012.

We found that the manager had taken action to address some of the issues found. It was acknowledged that improvements made needed to be sustained ensuring people received a good standard of care.

Prior to our visit we had been informed that work to the environment would take some time to address. We informed the provider and manager during this visit that this would be followed up at a later date.

As part of the visit we again spent time observing staff interactions as well as speaking with people and a visitor. Staff appeared to have a good understanding of the individual needs of people.

We saw that people spent a lot of time sat in the lounge sleeping. The visitor told us that they rarely saw stimulating activities being offered. They said “I don’t see them (residents) doing a lot”.

More positive comments were received from the visitor about the care and support their relative received. They told us, “I’ve no concerns, [my relative] appears well cared for”, “My relative is always clean and tidy”, “Staff keep her clothes nice and her room clean and tidy” and “Staff keep in touch if there’s anything I need to know”.

The person living at the home we spoke with said, “I’m quite happy”, “They keep the place clean” and “The food is very nice, there’s plenty to eat”.

During our visit we spent time observing how care and support was provided. Due to their condition some people were unable to answer specific questions about the care and support they received.

From our observations staff appeared to have a good understanding of people’s needs. We saw one carer assisting people to the dining room. They had a gentle manner, were polite and respectful and offered lots of encouragement.

However we found that people living at Mona Cliffe were not offered meaningful opportunities or variety to their daily routine enabling and promoting their independence.

We also saw that relatives of people living at the home had provided comment in the surveys distributed by the home. Comments included; “People are happy and well looked after” and “Staff are caring and look after residents needs very good, my relative is happy”.

We spoke with one visitor during our inspection. They told us they were happy with the care being provided. They told us the environment looked clean and they could see refurbishment work had been undertaken but the home still looked old fashioned and sometimes there was an odour.

The person told us their relative looked clean, washed, well clothed and staff seemed friendly and nice.

There were no concerns in relation to medication; however, the visitor told us they didn’t have any interaction in this area.