Cliftonville Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We assessed the following quality statements: Safeguarding, Involving people to manage risks, Infection prevention and control and Medicines optimisation. People spoken with said they felt safe at Cliftonville Care Home and with the staff who supported them in a kind and caring manner. Staff knew how to recognise and report abuse and told us they had received safeguarding training. Incidents were recorded, analysed, and learnt from. There was a good safety culture that encouraged staff to report these. Improvements were needed to ensure care plans and risk assessments had sufficient information and guidance for staff. The provider had identified this and was working to improve care records. Staff were working with people and relatives to be more involved in developing and reviewing their care plans. Staff had a person centred approach to medicines. The staff ensured that medicines and treatments were safe and met people’s needs, capacities and preferences by enabling them to be involved in planning, including when changes happen. ‘When required’ PRN medicine protocols were in place to help staff give these medicines correctly. These protocols were not always detailed enough and on occasion missing from the care plan although present in the eMAR. However, the provider was working through these protocols at the time of the assessment and updating them where needed in care plans with more information. There were enough staff to support people. We observed there were enough staff available to respond to people’s needs. There was a safe recruitment process in place. People and relatives told us the home was clean and staff wore personal protective equipment (PPE). All areas of the home looked clean and smelt fresh. Staff told us they had received infection control training. Mental capacity assessments, best interest decisions and deprivation of liberty safeguards were in place where needed.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their relatives told us staff and managers kept them informed and when they had raised issues, the agreed actions had been carried out. A person told us they had a named member of staff who they said they could speak to if needed, but knew they could speak to anyone if there was an issue. Another person said, "The laundry service is brilliant [at Cliftonville Care home], sometimes things get mixed up and I take it to reception and say it’s not mine, and [staff] soon sort it out". Evidence of learning was provided to ensure peoples experience was improved. We observed staff discussing with a person who needed their walker, actions that could be taken to support their independence safely.

The manager was focussed on continuous improvement and learning from when things went wrong. Incidents and accidents reports were monitored and reviewed daily so that appropriate actions could be taken, and any learning put in place. Incident reporting systems were in place, and staff understood their role in ensuring that incidents were raised appropriately. Reports viewed were clear, detailed, considered any safeguarding risks and identified any learning. There were processes to ensure that lessons are learnt when things go wrong, and from examples of good practice. The manager and regional manager told us how the current staff team had inherited a comprehensive action plan, which had been developed from previous shortfalls as identified by last Care Quality Commission (CQC) inspection and subsequent provider quality visits to the service. This action plan had been reviewed weekly to ensure improvements and progress was being made by the provider.

There were processes in place to learn from any accidents, incidents, or safeguarding concerns. These were reviewed, with learning shared at meetings, handovers and through messages on the provider's electronic care system. A process was also in place to share learning across the organisation. During the assessment, we shared the areas for further improvement with the manager. These were acted upon during the assessment. The manager told us that they were using a reporting system to develop trends analysis and gave the example of falls analysis as an example of improved learning. Complaints system and processes were in place. The manager stated that being available and always accessible for relatives helped to resolve issues as they arise. Duty of candour was followed by staff and managers when accidents or safeguarding incidents had occurred. Duty of candour is a requirement that ensures providers are open and transparent with people who use services.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People and relatives told us people received safe care and support. One person told us, “It’s a nice place, I can’t fault it, whatever you ask for, they get it, I would recommend it, you can have a laugh too”. One relative had some worries about their family member’s safety due to some health needs. “It’s got better, we give constructive criticism, and in the early days they had a high turnover of staff, now there are more regular staff”. The manager and staff were working with the person and their family to ensure they received safe support. People’s experience could differ on the different floors. People in nursing beds spent the majority of their time in bed in their rooms, people living in the dementia area were encouraged out of their rooms spent time in communal areas where staff provided support with exercise games, attending a church service held in a different part of the service. People in the residential area spent time both in their rooms and in the communal areas. Staff gave people choices and people were able to personalise their rooms. People’s mental capacity was assessed and where appropriate families were involved in their care and any best interest decisions.

A safeguarding policy was in place and records showed that staff had received training in safeguarding. People’s mental capacity had been assessed and best interest meetings documented in their case notes. For example, staying in a secure environment, the use of bed rails, high risk of falls and end of life care. Applications had been made in relation to Deprivation of Liberty Safeguards (DoLS), but no authorisations had been granted. The provider kept a record of applications made, however there was not always the evidence that best interest decisions being made on other issues such, as when a person living on the the nursing unit was declining repositioning support. The manager and staff looked into how this could be improved. We saw evidence relatives had been asked to provide proof of lasting power of attorney (LPA) for their loved ones.

Staff’s interaction with people was focused on getting the task completed rather than talking with them, but it was positive and pleasant. Staff did know people and responded positively to people. A person who was deaf was able to communicate with staff through use of a whiteboard and lip reading, staff were able to describe how they were able to communicate with the person. We met with the person and saw the whiteboard in place and the person confirmed they were happy with their care, they felt safe and staff were kind and caring. They also felt able to raise concerns if they needed to. Staff explained to inspectors they gave people choices as to what they wished to wear, where they spent their day, meals etc.

A safeguarding policy was in place and records showed that staff had received training in safeguarding. People’s mental capacity had been assessed and best interest meetings documented in their case notes. For example, staying in a secure environment, the use of bed rails, high risk of falls and end of life care. Applications had been made in relation to Deprivation of Liberty Safeguards (DoLS), but no authorisations had been granted. The provider kept a record of applications made, however there was not always the evidence that best interest decisions being made on other issues such, as when a person living on the the nursing unit was declining repositioning support. The manager and staff looked into how this could be improved. We saw evidence relatives had been asked to provide proof of lasting power of attorney (LPA) for their loved ones.

Known risks to people’s care and support were managed well. For example, 1 person told us how they had been prescribed 2 inhalers, “staff leave them here, they are laying down, when I have done it, I stand them up, when staff go past, they can see if have had it or not, simple but it works". The person also told us, their family are told if anything happens or there are changes with them. Relatives told us they were happy with the care and response from care staff and that their loved ones were settled at Cliftonville Care Home. One relative said “You seem to be able to mention [any concern at Cliftonville Care Home], and it gets actioned [by staff]".

People and relatives were encouraged to be actively involved in the care planning process. Care plans were reviewed at least monthly, with people actively contributing to these plans. There was a designated section within the care plan that allowed for people to make comments, provide feedback or raise questions they might have about the care they were receiving. The management team were transparent and said they were still finding inconsistencies of staff recording in peoples care records. Managers were supporting the staff to make sure they had the support so they could progress and continue to make improvements. The manager told us all the heads of the different departments come together to share and review risks for people, including the carrying out of 72 hour post incident reviews where necessary. The provider also carried out a weekly performance call with the management team to discuss progress/actions taken/actions required.

We saw where equipment had been identified as a measure to mitigate risk, this was in place, for example sensor mats and profile mattresses. We observed staff supporting people to be mobile. For example, a person was being supported by a visiting physiotherapist and later seen with care staff.

People’s needs had been assessed and any risks identified had plans in place to mitigate the risk. For example, for people who were at risk of falls, staff had sensor mats in place in their rooms to alert staff. Oral hygiene plans were in place. Information was recorded in relation to skin integrity and risk of pressure damage. Several audits were used by staff and the provider to assess the safety in the service. Inspectors did find for one person, that staff had not always recorded on the care records when they needed repositioning in order to prevent skin damage. This had not been picked up by the provider in relation to people declining re-positioning. The management team told us they had put actions in place to address the shortfall and amended the person's care plan accordingly.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Most people and relatives told us they felt there were enough staff in place to provide safe care. A small number said they felt more staff were needed at different times. People and relatives felt staff were well-trained, experienced, and understood how to provide safe care that met their or their family member’s individual needs.

The manager stated that they felt that some staff would say that more staff would be needed or desired but felt that they had fostered an open culture in their time as manager where staff could feed back any concerns in this area. Staff felt there were enough staff in place to provide safe care. Staff felt well-trained, and they told us they received regular supervision of their role. The manager told us they felt they had sufficient numbers of staff to manage the service effectively and to provide high quality, safe care for people.

Staff responded quickly when people needed them. Call bells were responded to within minutes meaning people were not left waiting for long periods of time. Staff were visible throughout the home in communal areas; they visited people in their bedrooms and there was a calm atmosphere throughout. Staff knew people well. They understood people’s needs and people responded well to them. Staffing was more prominent in communal areas where people had gathered to relax and where support was being provided.

The provider had processes in place that ensured there were enough well-trained, experienced, and suitable staff to provide safe care for people. Staff training requirements were monitored, and any gaps or training needs addressed quickly. The provider’s policy stated staff were required to receive a set number of supervisions and an appraisal in the calendar year. Records showed the provider was on track to meet this requirement. This will ensure people continued to receive care from well-trained and competent staff. The provider’s dependency assessment calculated how many staff were needed to provide people with the care they needed safely and effectively, however further development was taking place by the provider on their tool, to ensure assessments were inclusive and allowed managers to bespoke to each service when and where appropriately, so this was also clearer for staff working in the service. Staff were recruited safely. Checks on staff identification, right to work, past employment and criminal records were completed before people commenced their role. All inexperienced staff shadowed an experienced member of staff until they were deemed competent to conduct their role alone. These processes helped to ensure people received safe care from competent and suitable staff.

People received care and support in a clean and tidy service that reduced the risks to their health and safety from the spread of infection. People and relatives told us they felt the home was clean and tidy. One person said, “I would say something if it wasn’t clean". A relative told us, “[Cliftonville Care Home is] beautifully clean". Another relative said, “Yes, [Cliftonville Care Home] is clean and [staff] are always emptying the bins and cleaning". We spoke with the relative of person who had raised a complaint in the past, and they confirmed things had improved since they had raised their complaint and they were now happy with the care and support their loved-one was getting.

Staff felt the service was clean and tidy. Care staff supported domestic staff in keeping the home clean and tidy. They told us personal protective equipment (PPE) was available when needed. Domestic staff felt they had sufficient time and equipment to keep the home clean. The manager was proud of the cleanliness of the home. Staff had clear roles and responsibilities in keeping the home clean. They told us they checked the cleanliness each day and raised any concerns during meetings with domestic staff.

Cliftonville Care Home was clean and tidy throughout. This included people’s bedrooms which were well-maintained and free from unpleasant odours. We observed staff followed safe infection control protocols, using PPE when needed, changing it before providing care to a different person and disposing of it safely. The staff had access to a multitude of cleaning products that aided them in keeping the service clean and tidy. We found that people looked clean and well presented. Staff responded promptly, for example for a person who had been incontinent and required assistance to change their clothes. People had access to showers/baths and each room had an en-suite.

The provider had ensured there was an effective approach to assessing and managing the risk of the spread of infection. There were clear roles and responsibilities around infection prevention and control. All staff were made aware of what was required of them to keep the home clean and tidy. Staff were monitored by robust infection control audits. This helped to keep people safe from the risk of the spread of infection. Staff showed us cleaning charts they filled in as they completed cleaning tasks. This reduced the risk of infection spread. Staff told us there were always sufficient stocks of personal protective equipment (PPE) including gloves and aprons which they used when supporting people with personal care. People’s care records indicated people’s preference to whether they wished to have a shower/bath and how often. However, daily records only stated if someone had been assisted with personal hygiene, it was difficult to identify how often people had been showered/bathed in line with their wishes. Daily handover notes included a note as to whether someone had been showered/bathed. Inspectors discussed this with the manager and on the 2nd day of inspection, updated guidance had been given to staff around how they were recording in order for consistency at the service. ‘Resident of the Month’ was in place which included maintenance and deep clean of person’s room.

People were given their medicines how they preferred in a timely manner. The administration was recorded on an electronic medicine administration record (eMAR). Medicines used ‘when required’ (PRN) to support people did not always have detailed information in care plans. People, when asked about care, responded positively including medicines administration received from staff at the service. People’s allergies were accurately recorded and eMAR had up-to-date photos of people in the service. People’s behaviour was not excessively controlled by medicines. People were supported to self-administer their medicines where they were able and wished to do so. Risk assessments had been done to make sure this was safe and appropriate. ‘When required’ PRN medicine protocols were in place to help staff give these medicines correctly. These protocols were not always detailed enough and on occasion missing from the care plan although present in the eMAR. However, the provider is working through these protocols currently and updating them where needed in care plans with more information.

Staff were trained in medicines administration and the provider completed medicine competencies with appropriate staff annually to ensure they could safely administer medicines. Staff knew people well at Cliftonville Care Home. They told us information was available to them that allowed them to manage medicines safely for people. Staff were observed to be caring when a medicine round was observed. A staff member had an alarm set on their phone for a time-sensitive medicine to make sure the dose was given on time. Staff told us they received training to manage medicines and had their competency checked to ensure they were safe. Training records were provided to evidence this. Staff had dedicated time to manage medicines processes, such as ordering and receiving medicines. Staff understood and followed procedures to ensure people’s medicines were reconciled when they moved between services and when changes occurred by their local doctor or following a hospital appointment or admission.

There were processes in place to ensure the safe and effective use of medicines and staff followed these. The medicines policy was mostly followed. The provider did regular medicine audits to ensure medicines were managed safely. Medicines support (including administration) was recorded accurately and contemporaneously. An accurate record was made when medicines were not administered, for example: person asleep, medicine out of stock, refused. Medicines incidents were recorded, analysed, and learnt from. There was a good safety culture that encouraged staff to report these. On the day of inspection, a medicine error had been made over the weekend we were satisfied it had been dealt with appropriately. Fridge temperatures and ambient room temperatures were recorded to ensure the safe storage of medicines. Controlled drugs (CDs) were stored securely in line with legislation and policy. CD stock checks were carried out as per the provider’s policy. Medicines that were near the expiry date were not easily identifiable as being short dated. The provider did not have a procedure for identifying medicines that were near expiry. CD stock from people who had passed away was not segregated from in-use CD medicines. This was not in line with the provider policy that stated they must be stored separately to in-use medicines. The provider going forward has advised this will be done. Medicines with a limited shelf life, once opened, had a date of opening but were not always dated with an appropriate expiry date this would ensure medicines were not used passed the expiry.