Clifftop Care Home

Clifftop Care Home is registered to accommodate up to 32 people and provides care and support for older people. The service is split over three floors which were all accessible by stairlift, stairs or a lift. There were 28 people using the service at time of inspection.

People’s experience of using this service and what we found

People told us they felt safe, supported and happy living at Clifftop Care Home. Since the last inspection improvements had been made to medicines management, accident and incident recording and management oversight of the home.

There was a homely, relaxed, family atmosphere in the home. People were supported by staff who knew how to recognise and raise concerns. The systems in place meant that concerns were raised and referred to the relevant agencies. The home was clean, tidy and comfortable. Staff were recruited safely, and staffing levels were kept under review by the registered manager. Lessons were learnt by the home and it was important to them to continually improve.

The staff demonstrated a good understanding of how to meet people’s individual needs. People’s outcomes were known, and staff worked with people to help achieve these. People were supported and encouraged to maintain their independence and live their lives as fully as possible.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff were respectful, and consent was sought. People had access to a wide range of health and social care professionals to support their general health needs.

People’s needs were assessed, and staff had access to care plans which were person centred and involved the person. People’s hobbies, wishes and desires were recorded, and staff worked to achieve these for the person. People were occupied and enjoyed the social aspects of the home. People and their relatives thought staff were kind, compassionate and caring.

People were supported to maintain contact with those important to them including family and friends and they felt included within the home. Staff knew people well and gave individualised care and support. People knew how to make a complaint; the home had a complaints policy, and this was followed to people’s satisfaction. The registered manager knew it was their duty to be open, honest and transparent when things went wrong.

The management of the service was respected, people and staff had confidence in them. Staff had a good understanding of their roles and responsibilities. The staff team worked and got on well together demonstrating team work. Staff were proud to work at Clifftop Care Home and told us that they were family.

Quality and safety checks helped ensure people were safe and protected from harm. This meant the service could continually improve. Audits were robust and helped identify areas for improvement and this learning was shared with staff. The home worked well with external professionals and agencies and continued to build their links within the small community.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 5 February 2019).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

Since the last inspection we recognised that the provider had failed to comply with display ratings requirement under Regulation 20A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Offence under Regulation 22 of the 2014 Regulations. This was a breach of regulation and we issued a fixed penalty notice. The provider accepted a fixed penalty and paid this in full.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Clifftop Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Clifftop Care Home is registered to accommodate 32 older people. The home is split over three floors with all floors having access via stairs, lift or a stairlift. On the ground floor there is a large lounge leading into a conservatory and a separate dining room. There was level access to the outside patio areas of the home. There were 24 people living at the home at the time of inspection.

Medicines were not always managed safely. Assessments had not been carried out to assess the competency of staff who gave medicines. The correct procedures for medicines were not always followed and some medicines were not stored securely. The registered manager took action during and following the inspection to address this.

We have made a recommendation about the management of medicines.

Accidents and incidents were recorded and action carried out. However, the registered manager had not analysed them to identify trends, learning or reduce the likelihood of reoccurrence.

Audits were not always completed in full. Shortfalls had not been identified. Quality assurance systems were not in place to enable the home to monitor the standard of care they provided. Feedback received from people had not been addressed. The registered manager had a number of improvements planned but it was unclear what their priorities were.

Staff had received an induction and continual learning that enabled them to carry out their role effectively. Staff received supervision and felt supported, appreciated and confident in their work. People and their relatives had been involved in assessments of care needs and had their choices and wishes respected including access to healthcare when required. The service worked well with professionals such as doctors, nurses and social workers.

People were protected from avoidable harm as staff received training and understood how to recognise signs of abuse. Staff told us who they would report this to both internally and externally. Staffing levels were sufficient to provide safe care and recruitment checks had ensured staff were suitable to work with vulnerable adults. When people were at risk staff had access to assessments and understood the actions needed to minimise avoidable harm.

Staff were clear on their responsibilities with regards to infection prevention and control and this contributed to keeping people safe.

People had their eating and drinking needs understood and met. People told us they enjoyed the food and thought the variety and quantity was good.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People, their relatives and professionals described the staff as caring, kind and approachable. People had their dignity, privacy and independence respected.

People had their care needs met by staff who were knowledgeable about how they were able to communicate their needs. Their life histories were detailed and relatives had been consulted. The home had a complaints process and people were aware of it and knew how to make a complaint. Activities were provided and these included staff, people and their relatives. Individual activities were provided for those that preferred them.

Relatives and professionals had confidence in the service. The home had an open and positive culture that encouraged the involvement of everyone. Leadership was visible within the home. Staff spoke positively about the management team and felt supported. The registered manager actively sought to work in partnership with other organisations to improve outcomes for people using the service. The service understood their legal responsibilities for reporting and sharing information with other services.

Further information is in the detailed findings below.

The service is registered to provide care and accommodation for up to 32 people. On the day of our inspection there were 25 people living at the service. There was a registered manager in post at the time of this inspection. 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 told us they were safe and well cared for and appeared relaxed and comfortable throughout our inspection. People’s comments included, “I am quite happy, it is very good here”, “To be quite honest I think I am very lucky to have ended up here” and “I would certainly highly recommend this place to anyone.”

Staff said, “As far as I know everyone is perfectly safe here” and “People are definitely safe here. It is the best home I have worked in.” Health and social care professionals told us, “People are definitely safe here” and “I would like to come here myself when I am older.”

On the day of our inspection the service was fully staffed and the service had sufficient staff available to meet people’s care needs. People and relatives told us there were enough staff available and staff said, “There are enough staff” and “They have used agency staff in the past but we are fully staffed at the moment.” There was a stable staff team at the service and recruitment practices were safe and robust. The registered manager told us, “I can be quite choosy with who I employ.”

People’s care plans included risk assessments and staff had been provided with detailed guidance on how to protect people from each identified area of increased risk. Where accidents or incidents had occurred these had been documented, fully investigated and regularly audited to identify any areas of increased risk within the service.

All new staff completed formal induction training before there were permitted to provided care within the service. The registered manager told us, “They have to do all the training in the first 12 weeks, it’s a big ask but they have to do it so they know how to look after people.” While a recently recruited staff member said, “I shadowed for about four weeks so I did feel confident when I started on my own. There is a lot to remember here.” Records showed staff training was regularly updated and that managers provided appropriate supervision. Staff told us, “We get one [an online training course] to do every month”, “I don’t think I have ever had as much training as here” and “The manager does supervision every two months.”

The service used a digital care planning system and we found that people’s care plans were accurate and sufficiently detailed to enable staff to meet people’s care needs. Staff told us, “I love the computer system, there is a support team there if you need them” and “The assessment asks you questions, you answer them and that feeds into the care plan. It reminds you when updates are due, of people’s birthdays and appointments. I am happy with it.”

Staff knew people well and provided calm and compassionate support throughout our inspection. People told us, “I do get on well with them” and “The staff are excellent, kind, loving and caring.” Professionals said, “The staff are lovely” and “staff know people very well”. We saw that people requested support from staff without hesitation and that staff responded promptly to people’s requests.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA). The service had made appropriate applications for the authorisation of potentially restrictive care plans. However, we identified that one person’s care plan was potentially restrictive and the registered manager agreed to discuss these arrangements with the local supervisory body.

People told us, “I am in charge” and we saw that staff respected people’s choices and encouraged independence. Where people chose to decline care, these decision were also respected.

The service’s kitchen had a five star food hygiene rating and people told us, “The food is pretty good.” People were offered choices at meal time and kitchen staff had received guidance on how to meet people’s specific nutritional needs.

The service was well maintained and enjoyed panoramic views of Swanage Bay that people told us were “fabulous.” People’s bedrooms had been personalised with pictures, ornaments and furniture while communal areas were decorated in a homely style with numerous paintings and pictures.

People living at Clifftop Care Home were able to enjoy a wide variety of activities. During the afternoon of our inspection a pianist visited the service and people enjoyed listening to the music in the lounge. In addition, the registered manager ensured that the inspection process did not interfere with a planned game of scrabble. People told us, “They try very hard to amuse us and keep us interested” and “We have quizzes and scrabble and we play bridge as well.” People were encouraged to visits local shops and town centre when they wished and one person said, “Just ask and they will arrange a taxi for you and they pay half the fare.”

The service was well led. The register manager was supported by two assistant managers with clearly defined individual roles and responsibilities. Staff were well motivated and told us, “[The registered manager] is great” and “The registered manager is easy going and supportive. It is always quite calm here.” There were appropriate procedures in place to monitor the service’s performance. Residents meeting were held regularly and were feedback was provided, people told us this was quickly addressed.