Archived: Cliffemount Community Care

Cliffemount Community Care is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Cliffemount accommodates up to five people with a learning disability or autism. At the time of our inspection there were four people living at the service. The service was last inspected in August 2017 when it was rated as 'requires improvement'; however, there were no breaches of the of Health and Social Care Act 2008 at that time.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a new manager in post at the home who was in the process of registering with the CQC. A registered manager is a person who has registered with the CQC 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 new manager was supported by a new Chief Operating Officer (COO) whose role was financial management and oversight of the service.

The inspection was prompted in part by the receipt of information of concern from a whistle blower who had worked at the service. This information indicated potential concerns about the provider’s financial management and oversight of the service.

The overall rating for this service, following this latest inspection, is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe, so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This may lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

During this inspection we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to the lack of clear guidelines and for the use of physical intervention, staff training for the use of physical intervention, the lack of pre-employment checks with the Disclosure and Barring Service (DBS), the governance and oversight of the service and the fitness of the provider, Cliffemount Community Care Limited, and its director to fulfil their statutory responsibilities.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

We found serious concerns about the financial management of Cliffemount Community Care by the provider, (Cliffemount Community Care Limited) and its director. Bills for utilities had not been paid resulting in bailiffs’ letters stating that they would seize goods at the property if payment was not made. Council tax had not been paid over a period of five years and a court order had been made to set a payment plan. We saw a letter stating the providers public liability insurance was to be cancelled in August 2017 due to non-payment of premiums. The COO arranged for new public liability insurance to be bought after our inspection, meaning the service did not have suitable insurance in place for a period of nine months. We had also been contacted by an external investigator prior to this inspection. This matter was still on-going and we were awaiting the outcome from this.

Information had been removed from the staff personnel files. We were told this was by the previous manager. Staff DBS checks had been completed for all staff in April 2018. The COO said the previous manager had not processed the DBS checks for new staff. However, our investigations showed Cliffemount Community Care Limited had not processed any DBS checks for a period of three years, which preceded the previous manager’s employment with the service. This meant staff had been employed at the service without the required pre-employment checks being made to check they were suitable to work with vulnerable people.

Care plans and risk assessments were in place and had been regularly reviewed. These provided guidelines for staff to follow when supporting the people living at the service. Behaviour support plans were in place, where required, which detailed potential triggers for any behaviours and details of the distraction techniques to be used to reduce people’s anxieties. However, one behavioural support plan did not provide any details of the physical intervention techniques staff were to use. New staff had not received physical intervention training and so were not trained to use any of the physical intervention techniques that they may need to use.

Staff completed an induction when they started working at the home. A range of e-learning training was completed.

The provider did not have the governance systems in place to have clear oversight of the service regarding the lack of DBS checks, financial management and the destruction documents relating to staff information.

The pre-admission assessment and transition for one person moving to the home had gone well and they had settled at the home. However, for another person the information provided to the service was not the complete picture of the person’s complex needs, meaning the full information about their needs had not been established prior to their move. The service was told by the person’s family and the information from a previous provider, that the person’s epilepsy was well controlled, which was not the case. Epilepsy care plans were written following the person having a seizure. Staff described how they supported people during a seizure and when rescue medication should be administered.

Details of any incidents and accidents were recorded, including what happened before, during and after the incident. These were reviewed by the new manager and action taken to reduce the risk of further incidents where possible.

Medicines were administered as prescribed. People’s health and nutritional needs were being met.

The previous manager had completed supervisions and appraisals. The new manager planned to complete these every three months. Staff feedback about the changes in the management of the home were mixed. Some staff were very positive and said the new manager and COO were approachable and would listen to their ideas. However, other staff were unsettled by the changes and the reasons why they had occurred.

Clear details about how people communicated was included in the care files, including the use of individual signs and iPads where appropriate. We observed kind and respectful interaction between people living at the service and the members of staff.

The service was working within the principles of the Mental Capacity Act (2005). People’s capacity to consent to their care and support was assessed. Where people lacked capacity, decisions were made in their best interests.

People were supported to maintain their cultural beliefs and needs.

People were encouraged to complete tasks they could do for themselves. People engaged in a range of activities within the local community.

A range of audits were in place for health and safety and medicines. A monthly overview of the service was written for the COO. There had been a gap since April 2018 in these being completed due to the changes in manager and staff at the home. These were due to restart in June 2018.

Cliffemount Community Care is registered to provide accommodation for up to 5 people who require support with a range of complex care needs including personal care. The service states it specialises in supporting younger adults with a learning disability and autistic spectrum disorder

to increase their independent living skills. The service is based in Hale Barns, within walking distance of local facilities including, shops, cafes, restaurants, parks and leisure facilities.

At the time of our inspection there were two people living at the home.

The previous inspection had been carried out in January 2017 where the service had been rated as inadequate and placed in special measures. During this inspection we found improvements had been made in all areas, with the service meeting the requirements of the Health and Social Care Act (2008) Regulations. This means the service is no longer in special measures.

The manager of the service was in the process as registering with the Care Quality Commission. 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 manager was supported by a team leader.

People and their relatives said they felt safe and happy with the service and the support they received. Staff said they enjoyed working in the home and were positive about the changes the manager had made.

Staff had completed training in the use of distraction, breakaway and physical restraint techniques. A full training programme was now in place, including courses to meet people’s specific needs, for example alcohol awareness.

Care plans and risk management plans were in place and regularly reviewed. These gave guidance for staff in how to meet people’s needs. Potential triggers of challenging behaviour and signs for staff to recognise that the person was becoming anxious were identified. Ways to reduce people's anxiety and de-escalate potential incidents were recorded.

Incidents were fully recorded and were reviewed by the manager to identify any patterns. We saw the role and working hours of one staff member was being changed to provide additional support around meal times, as this had been identified as a time when one person became anxious.

There were sufficient staff on duty to meet the needs of the people currently living at the service.

A new admission process had been developed since our last inspection. This included a full assessment, with information from the person, their family and relevant health and social care professionals. Visits to meet the new person in their current care provision, as well as the person visiting the home to meet the existing people living at the service, would be arranged. We were told this process had been followed for one person referred to the service, although they had not moved to the service.

The service promoted people’s independence. One person was supported to use an ipad to aid their communication. Their family said this had reduced the person’s frustration as they were now able to communicate their needs more easily. Another person was being supported to self-medicate their own prescribed medicines.

A new quality auditing system had been introduced since our last inspection. This gave an overview of the service, including health and safety, medicines, staff supervisions, care plan and risk assessment reviews.

Medicines, including controlled drugs, were safely managed at the service. Staff were safely recruited and followed an induction process when first joining the service.

We found the service was working within the principles of the Mental Capacity Act (2005). Applications for Deprivation of Liberty Safeguards (DoLS) were appropriately made. Staff offered people day to day choices about their care and support. Staff supported people to plan their activities for the week. Each person had a full activity programme including activities in the local community and within the home.

People’s health and nutritional needs were being met by the service. Referrals were made to health professionals when required.

The home had been re-decorated and was well maintained. Regular checks were made of the fire systems and equipment.

Cliffemount Community Care is registered to provide accommodation for up to 5 people who require support with a range of complex care needs including personal care. The service states it specialises in supporting younger adults with a learning disability and autistic spectrum disorder

to increase their independent living skills. The service is based in Hale Barns, within walking distance of local facilities including, shops, cafes, restaurants, parks and leisure facilities.

At the time of our inspection there were two people living at the home. A third person had moved into the service for three weeks from the 18 December 2016. They had moved out following a serious incident at the service.

The previous inspection was carried out in May 2016 and the service was given an overall rating of Good. The Care Quality Commission had received a serious safeguarding alert from the local authority and brought this inspection forward as a result.

The registered manager of the service had been off work since March 2015. The nominated individual was the acting manager. A deputy manager had been appointed in May 2016, but they had left the service in January 2017. A new deputy manager was in post and we were told they were going to apply to become the registered manager.

During this inspection visit we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to staff training, the recording of controlled drugs, the transition and staff knowledge of the person’s needs when they joined the service in December, quality assurance and auditing systems and the openness and integrity of the nominated individual. We also found breaches of the Care Quality Commission (Registration) Regulations 2009 relating to not submitting the required notifications to the CQC. A notification is information about important events which the service is required to send us by law.

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.

The two people living at the service told us they felt safe. Staff knew their needs well and detailed care plans and risk assessments were in place. These included guidelines for staff as to what support people required and what tasks people could complete themselves. Where applicable behaviour management plans were in place, providing details of potential triggers to behaviour and signs for staff to observe that the person was becoming anxious. Ways to reduce people’s anxiety and de-escalate potential incidents were recorded.

We were told staff had been trained in the use of physical intervention techniques. However we found that the nominated individual’s accreditation for facilitating this training was not current. The staff had not received the full training course. Therefore they were not fully trained in the use of physical restraint.

We were told staff were completing on-line training workbooks. However we found that the subscription to the training provider’s courses had lapsed. Staff had not completed all the required workbooks. This meant staff did not have all the training they needed and their competency had not been assessed.

The nominated individual showed us training certificates for mandatory courses. They said staff had completed these through Leeds City College. However when we contacted Leeds City College the assessor named on the certificates was not known to them and they did not offer all the courses claimed by the certificates seen. The certificates did not have the Leeds City College logo on them.

There were discrepancies between what the nominated individual told us about waking staff being on duty when the third person was at the service and what other staff told us and what the local authority had been advised at the point of commissioning the placement. The nominated individual had told us prior to the inspection there was a waking night and sleep-in staff on duty at night when the third person had moved to the service. During the inspection they said the waking night was only on duty if the person had been agitated during the day. Staff, including the previous deputy manager told us there had only been a sleep-in staff on duty. The rotas only showed a sleep-in staff being on duty.

Following an unsubstantiated allegation against staff the nominated individual took statements from the staff on duty, saying a waking night staff had been on duty when the allegation was made. The previous deputy manager also took a statement from one of these staff members which stated there had only been a sleep-in. During our inspection staff told us only a sleep-in had been working at that time.

This meant we could not have confidence in the information given to us by the nominated individual.

Medicines were safely stored. We saw one medicine administration record which had not been signed for one tablet for a month. We were told that the GP had stopped the medicine and then re-started it. We could not find any evidence of this in the person’s care file. Controlled drugs were safely stored; however they were not recorded in a separate log, with a running total of tablets in stock noted as required by law.

A premises audit was completed weekly. However other quality assurance systems were not in place. For example medicines, manager daily record and analysis of antecedent- behaviour-consequence charts to look for patterns and learn from potential triggers.

There was only a three week assessment and transition period for the third person who moved to the service in December. The person had complex needs and a history of challenging behaviour. Comprehensive information was provided by the person’s school placement. A training session on the person’s needs was provided by the community learning disability team. This was four days before the person moved to the service and was the first time the Cliffemount staff team had been given any information about the person’s needs.

The nominated individual and the previous deputy manager only met the person on one occasion each. The school offered for Cliffemount staff to shadow their staff team to get to know the person prior to them moving but this opportunity was not taken.

This meant the Cliffemount staff did not have time to understand the person’s needs and didn’t have the training required to support them safely.

We found the service was working within the principles of the Mental Capacity Act (2005). Applications for Deprivation of Liberty Safeguards (DoLS) were appropriately made. Staff offered people day to day choices about their care and support.

All required checks with the disclosure and barring service (DBS) were made when recruiting staff and two references were obtained.

People were registered with a local GP and appointments were made to medical professionals when required. People were involved in planning their meals and all their nutritional needs were being met.

The two people living at the service had a full week of activities within the local community planned. They enjoyed being able to go swimming and do voluntary work.

The home was clean and furnished to a high specification, with a Jacuzzi style bath available for people to use. Regular checks were made of the fire systems and equipment. The current gas safety check certificate was not available at the time of our inspection; we were told it had been completed by the same company that serviced the fire alarm system.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, it will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Cliffemount Community Care is registered to provide accommodation for up to 5 people who require support with a range of complex care needs including personal care. At the time of our inspection there were two people residing at the home. Two bedrooms have en-suite bathrooms and people have access to shared facilities including a Jacuzzi bath, which they said they enjoyed.

The service specialises in supporting younger adults with a learning disability and autistic spectrum disorder to increase their independent living skills. The service is based in Hale Barns, within walking distance of local facilities including, shops, cafes, restaurants, parks and leisure facilities.

The service had a registered manager in post although due to a serious health condition they had been off sick. The nominated individual who was also the provider of the service was acting as manager until the registered manager returned. 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.

Some people we spoke with had limited verbal communication. However, everyone very clearly indicated they felt safe and were happy living in the service, liked the staff and did the activities they liked to do.

Staff we spoke with had a clear understanding of safeguarding people and they were confident their managers and the rest of their team would act appropriately to safeguard people from abuse.

The support plans we looked at included risk assessments, which identified any risks associated with people's care, and had been devised to help support people to take positive risks to increase their independence. People's medicines were well managed.

The home was very clean and well maintained, although some communal areas were cluttered and in need of a clear out. There were effective health and safety audits in place.

The Mental Capacity Act 2005 (MCA) sets out what must be done to make sure that the rights of people who may lack mental capacity to make decisions are protected. MCA assessments and 'best interests' decisions had been made where there were doubts about a person's capacity to make a specific decision. An independent advocate had sometimes helped people with this. An advocate is someone who speaks up on people's behalf.

People were supported to have a good, well balanced diet and people's individual needs and choices were catered for. People were supported to cook independently if they wanted to. They also had good access to a range of health care services, and received good health care support.

Staff spoke to people in a caring and positive way and treated people with respect. There was a nice, relaxed atmosphere and people were smiling in the presence of the support staff.

There were very good care and support plans and information for staff about people's likes and dislikes and we saw that staff were very good at monitoring people's reactions and responses and responding to people in positive way. People were involved in choices about all aspects of their lives.

The care plans themselves were detailed and thoughtful, and included pictures and photographs to enhance people's understanding and involvement. They included different ways people communicated including sign language and pictures.

People had full lives, engaging in lots of activities, and this included in the evenings and at weekends. They were encouraged to keep in touch with the people who were important to them, such as their family members. People and their close family members, were encouraged to make their views known about their care.

The provider was very person centred in their approach. Person centred care is when staff understand what is important to the person and give them the right care and support to do the things they want.

There was a good range of quality and safety audits, undertaken by staff and managers.

There were enough staff to keep people safe and to meet people's individual needs, and the staff told us they received good training and support. However recruitment checks undertaken before staff started work in the service were not robust and we found improvement was needed.

When we arrived at the home some people were going out to do Christmas shopping. They told us they were happy living at the home and were able to have a laugh with the others. They said they were able to "do their own thing" if they wanted and staff would help with anything they were unsure about.

We looked at the care and support records for each person living at the home. We saw care was delivered effectively and respectfully.

Staff told us there was good communication between the team, staffing levels were good and they supported one another well.

They told us they loved working at the home and felt it a privilege to work with the people who lived Cliffemount. The people living at the home told us they liked the staff and they had keyworkers who knew them well.

We needed to make sure the correct procedures were being followed in relation to alerting the correct authorities if a safeguarding alert was raised and that the provider had proper procedures in place to keep people safe. We saw the correct procedures were in place to protect people in relation to decisions which were being made about their care and support and staff were able to tell us what they would do to raise a safeguarding alert.

Families said they were very happy with the care and support their relative received at Cliffemount and told us their X had progressed well.

The home had two lounges for people who used the service. Staff told us that this helped for easy separation if people who used the service needed it. There were several computers for people to use in a separate room. Staff confirmed there was security on these to protect the people who used the service.

Cliffemount had their pledge on display in the home.

There was a newly appointed manager. They were in the process of commencing their application to the CQC. The staff were recently employed to the home. We saw evidence of a mandatory training matrix.

There are currently three people living in the home. Cliffemount is registered for upto five people.

We spoke with one person who used the service. They confirmed to us that they felt 'happy" and that they felt "looked after'.

We looked at feedback sheets. Some staff comments seen were that they were 'getting on well, and no problems'.

One person who used the service said, they 'enjoy visits out'. One person told us that they were 'happy'.