A single inspector carried out this inspection on 10 September 2014. As part of this inspection we spoke with the registered manager, deputy manager, a family member, members of staff and we reviewed information given to us by the provider. We met and spent time with eight of the 14 people who lived at Cleeve House. Below is a summary of what we found. The summary is based on our observations during the inspection, observations of people using the service, the staff supporting them and from looking at records. We used the evidence we collected during our inspection to answer the five questions.
Is the service safe?
From our observations and the information we saw in care plans, policies, procedures and audits, the provider's safety monitoring systems were adequate. Staff training records showed that staff received regular training on safeguarding. Staff showed they had a clear understanding of their role in providing care and in safeguarding the people they supported. Staff demonstrated that they knew people well and understood their support needs.
We saw evidence that when people lacked the capacity to make decisions on important areas of their lives, best interests and safeguarding discussions had taken place.
CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We saw that, where necessary, people who lived at the home had a mental capacity assessment. There were no current Deprivation of Liberty Safeguards orders in place at the time of our inspection. The registered manager told us that they would review the safeguarding requirements for all people who live at the home in the light of the recent changes to the legislation.
Staff rotas showed that management had taken people's care needs into account when making decisions about the number of staff required and the skills and experience staff would need. The night time staffing levels and on call system showed that the provider had taken steps to ensure the staffing provision was safe.
Issues of concern had been raised on a previous inspection which related to the stock control of medicines kept at the home, infection control audits and risk assessments following incidents. During this inspection we found that these issues had been addressed by the provider and the appropriate systems were in place and were safe.
There were systems in place to make sure that management and staff learned from events such as accidents and incidents, complaints, concerns and investigations. This meant that people were benefiting from a service that was taking on board lessons learnt.
Is the service effective?
We saw that people's care needs had been assessed and detailed care plans had recently been reviewed and updated. There was evidence that people and their families were involved in the assessments of their needs and care plan reviews as much as possible.
Staff we spoke with, and activity plans we looked at, provided evidence that people were supported to maintain active lives.
We saw evidence that people were supported by a wide range of health care professionals. This meant their health and welfare needs were being met.
Is the service caring?
We observed that staff supported each person in a way which met their individual needs. Staff showed warmth, consideration and respect for people. One member of staff we spoke with said, 'I worked here for many years, I left, but I came back, as I really enjoyed working at this home. It is like a family'. The registered manager told us, 'We want to provide a home which people would feel happy to leave a family member'. Another member of staff said, 'It is a friendly place to work, we have a good staff team here, we try to make the place like home for the people who live here'. We saw that staff ensured people's dignity was maintained at all times.
We spoke with one of the people who lived at the home, they said, 'It is very comfortable here. I have what I need and I can look after myself but the girls are here if I need them. The staff have time for me'.
The registered manager and staff we spoke with told us they were committed to provide a good caring service to support and look after people. Staff we spoke with demonstrated that they were aware of potential risks, people's rights and their responsibilities.
Is the service responsive?
We saw that care plans and risk assessments had all recently been reviewed and were focused upon the current needs of the individual. The care plans contained detailed information about people's choices and preferences. The information showed that each person had an individual support plan which was adapted regularly to meet their changing needs. We saw that people's health and support plans were regularly updated to reflect people's changing health care needs.
There was evidence of regular support provided from health care professionals. This meant that people's health and welfare was regularly reviewed and monitored.
Staff we spoke with said if they had any concerns, they could always talk with the managers and that they would always listen and address anything they raised. We saw that staff received regular training which equipped them with the knowledge and skills to meet people's support needs.
Is the service well-led?
The home had a clear management structure in place. The registered manager, deputy and staff we spoke with were very knowledgeable about people who used the service, changes to legislation and developments in care provision. The registered manager and deputy manager were working to ensure all appropriate monitoring systems were in place.
We saw on the staff rota that senior staff were on duty to give advice and support. We saw that there were systems in place to provide feedback to staff about changes to people's care plans and developments within the service provided.