Cleveland House

Updated 4 November 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was conducted by an inspector

Service and service type

Cleveland House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Cleveland House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 30 August 2022 and ended on 14 September 2022. We visited the location’s service on 30 August 2022.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make.

During the inspection

We spoke with all six of the people who lived in Cleveland House. They were unable to tell us verbally about their experiences. However, we observed their care to understand their experiences. We also spoke to six relatives of people. We spoke with eight staff members, including the registered manager.

We reviewed a range of documents including; two care plans, recruitment and training records, audits, complaint records and risk assessments.

Updated 4 November 2022

About the service

Cleveland House is a residential care home providing a regulated activity of personal care for up to six people. The service provides support to people with learning disabilities and autism. At the time of our inspection there were six people using the service.

Cleveland House accommodates six people in an adapted building. All accommodation is located on the ground floor wing of the building, providing people with access to outdoor space.

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

Improvements were required to keep people safe. Environmental risks to people were not consistently identified and mitigated. Infection prevention control systems were not effective at mitigating the risk of infection. We found medicines were not being stored safely and care plans lacked details of activities undertaken and people’s enjoyment of them. Infection prevention control measures were not consistently applied placing people at risk of harm. The movement of staff across locations was overseen by members of the management team to ensure sufficient numbers of trained staff were always available.

People were looked after by kind and caring staff who knew them well. Staff ensured people had new bedding, furniture, clothing and opportunities to participate in a range of regular activities such as shopping, gardening, day centres, swimming and days out to the zoo and theme parks. We reviewed photos of activities undertaken by people and their relatives told us they were happy and settled in the home. They said, “staff genuinely care and arrange trips…they (the staff) look after (the person) really well.”

Staff and relatives spoke positively about the accessibility and support they received from the registered manager and staffing team. Staff and relatives knew who to contact if they had concerns and had confidence in them being addressed and resolved.

Improvements were required to ensure the service was consistently well led. Governance processes were ineffective and failed to consistently hold staff regularly to account. Fire safety, infection prevention control measures and medicine audits had failed to identify risks and mitigate them. Inconsistencies in the quality of care plans and daily records had been addressed with staff. We found some records were incomplete as they failed to accurately reflect risks or the experiences of people. However, staff told us they had confidence in the management of the service and felt supported. We found the registered manager acted with integrity and demonstrated a commitment to get thing right. They cared about the staff and the people.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support: People received good quality care, support and treatment because trained

staff and specialists could meet their needs and wishes. Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing. Staff told us what people enjoyed doing. One person enjoyed the feel of paper, for another person it was important the order they did activities, “They (person) like going for a walk, then they have their drink and come home.” We saw a person completing a puzzle and saw staff supporting and engaging with the person.

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 available to support people who wished to go for shopping locally. Relatives told us their family member “has a good balance” of activities and quiet time.

Right Care: Staff understood peoples’ preferences and the importance of keeping to their daily routines. A relative told us their family member is a creature of habit and “is always happy to go back… (the person) is happy with the staff.” Staff knew their relatives likes and dislikes, commenting the person always wore a “light long-sleeved shirt, not a t-shirt.” Staff told us how they respected people’s choices being respectful not to sit in their favourite chair.

Staff showed patience when supporting people to communicate using preferred methods of communication such as Makaton and picture exchange.

Right Culture: Care was consistently provided by the same staff team. A staff member told us “I’ve known them (the people) for years…they love consistency.” Staff told us the people have known and lived together for years, “they walk around laughing, joking and talking to their peers.” Relatives told us this was important to their family member who was cared for and settled in the home. We saw people looked settled and took time to show us their rooms and things of value to them such as photos of their family and friends and their DVD collections.

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

This service was registered with us on 12 May 2021 and this is the first inspection.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

We have identified breaches in relation to identifying, assessing, monitoring and mitigating risks to people, the management of medicines and control of infections at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.