We inspected Clifford House on 22 February 2016. This was an announced inspection. We informed the registered provider at short notice that we would be visiting to inspect. We did this because the location is a small care home for people who are often out during the day and we needed to be sure that someone would be in.Clifford House provides care and support to a maximum number of ten people who have a learning disability and/or physical disability. At the time of the inspection there were eight people who used the service.
The home had 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.
We looked at the arrangements in place for quality assurance and governance and found that the health and safety audit was insufficiently detailed and did not confirm what checks had been completed. There were no infection control audits. There was no evidence to confirm that the registered provider carried out their own quality monitoring.
People's care plans contained information about the medicines they were prescribed and the help they needed. We found that medicines were stored securely. Staff did stock checks on medicines and counted to make sure medicines tallied, however no other formal auditing in respect of medicines was completed. Appropriate 'as required' protocols and cream records were not in place and the temperature of the room in which medicines were stored was not recorded. Staff had received medication training but had not had their competency checked.
The registered provider had not carried out work as identified following a visit from the fire authority in September 2015. A test of the electrical installation had not been completed. The service did not have a business contingency plan. Checks of the fire alarm, fire extinguishers, gas safety and portable appliances had been completed to ensure health and safety.
Supervision with staff was not happening every two months as stated in the registered providers policy . Staff had been trained and had the skills and knowledge to provide support to the people they cared for. We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.
Decision specific mental capacity assessments had not been completed for all people identified as lacking in capacity. Staff understood about Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions.
Staff encouraged and supported people at meal times. We saw that people were provided with a choice of healthy food and drinks which helped to ensure that their nutritional needs were met. People were weighed on a regular basis, however nutritional screening was not undertaken.
There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of the action they should take if abuse was suspected. Staff we spoke with were able to describe how they ensured the welfare of vulnerable people was protected through the organisation’s whistle blowing and safeguarding procedures.
Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. Risk assessments had been personalised to each individual and covered areas such as moving and handling, falls, going out and choking. This enabled staff to have the guidance they needed to help people to remain safe.
Generally during the day there were five staff on duty and three at night, however due to staff sickness at the beginning of February to the date of the inspection visit there had been less staff on duty. This had not impacted on the care people had received but the frequency activities and outings had reduced.
There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. Staff were attentive, respectful, patient and interacted well with people. Observation of the staff showed that they knew the people very well and could anticipate their needs. People were happy and very well cared for.
People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments. We saw that people had health action plans. This provided hospital staff with important information they needed to know about the person who used the service and their health if they were admitted to hospital.
We saw people’s care plans were very person centred and written in a way to describe their care and support needs. These were regularly evaluated, reviewed and updated. We saw evidence to demonstrate that people and relatives were involved in all aspects of their care plans.
People’s independence was encouraged and their hobbies and leisure interests were individually assessed. We saw that there was a plentiful supply of activities and outings and that people who used the service went on holidays. Staff encouraged and supported people to access activities within the community.
The registered provider had a system in place for responding to people’s concerns and complaints. There was a keyworker system in place which helped to make sure people’s care and welfare needs were closely monitored.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to quality assurance and governance, consent to care, safe care and treatment and staffing. You can see what action we took at the back of the full version of this report.