Archived: Cleeve Court Community Resource Centre

People’s experience of using this service and what we found: People were supported by a staff team who were kind and caring. Staff had good relationships with people and knew them well. We saw many examples of staff taking time to ensure people were well cared for.

The provider and senior staff had completed audits on the home to support quality checks. These checks had helped improve the quality of service provision.

There were enough staff to meet peoples' needs. Staff training was provided and ensured people's specific needs were covered. Staff recruitment procedures were followed appropriately, and staff received regular supervision.

Care plans were person centred and there was guidance within peoples' risk assessments for staff to follow.

Medicines were administered safely. We have made a recommendation about the storage of medicines.

People were supported to access healthcare professionals. People had access to the local community and activities focused on people’s preferences.

The environment had been decorated and designed to enable people living with dementia to navigate their way around the home with ease, and to keep them occupied with items of interest.

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.

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

Rating at last inspection and update: The last rating for this service was Requires Improvement (published 2 July 2018) and there was one breach of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Cleeve Court Community Resource Centre 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.

Cleeve Court Community Resource Centre accommodates up to 45 people across two separate floors Lansdown View and Kelston Rise, each of which have separate adapted facilities. The service specialises in providing care to people living with dementia. At the time of our inspection there were 42 people living at the service.

There was a registered manager in post. 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.

At the previous inspection we found medicines for return or disposal were not stored safely. This had been rectified and these medicines were now stored safely, however, we found shortfalls in the recording of medicines. This was a breach of regulation.

The provider had not always notified us of all the incidents that occurred at the service. This was a breach of regulation.

Staff at the service were trained and supervised and were positive about the care they delivered. However, morale was mixed due to changes in the staff contract.

People and their relatives were complimentary about the care delivered by staff. The service delivered care using the Butterfly Model which focussed on people’s emotional well-being. Staff were warm, caring and respectful in their interactions with people. It was evident people were at ease and felt safe with staff. Relatives told us, and compliments received by the service confirmed, that they had been happy with the way their loved ones had been cared for.

Staff treated people with warmth and kindness. They respected people’s privacy and dignity and supported people to be as independent as possible.

The environment had been adapted and decorated to support the needs of people living with dementia. Signage was clear and easy to understand. Different areas of the service had been decorated to give a homely feel and furnished with familiar objects for people to see. The service had received a number of awards previously for the care delivered.

People were supported to eat and drink enough, and alternatives were available if they did not like the meal choices. Drinks were available throughout the day.

People’s health care needs were met; the service had good links with the GP, district nurses and the community mental health team. There was positive feedback about the service from these professionals.

We found one breach of the Health and Social Care Act and one breach of the Registration Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report

There was a registered manager for the service. 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.

At the last inspection on 17 and 22 December 2014, we asked the provider to take action to improve some areas of the service. This was in relation to staffing levels and for Mental Capacity Act 2005 (MCA) assessments to be undertaken for each person to determine their capacity to make decisions. Improvements were also needed around care plans as some lacked detail about all aspects of people's health and welfare needs. At this inspection, we found the provider had completed the actions they said they would do in their action plan and were compliant in these areas.

We found that medicines that were to be disposed of were not stored safely. This was because there was not an accurate record of medicines were no longer required. This also meant there was a risk that people had not had their medicines if there were no clear stock audits in place.

People had their needs met by enough staff. However, there was a shortfall in the numbers of permanent support staff. This had meant a reliance on agency staff and ‘bank’ staff who work for the provider. These are staff who work at the service on an occasional basis. The provider had a recruitment and retention strategy in place to employ and keep more staff. We requested a copy of this to review the actions that were being taken.

There were now detailed and specific mental capacity assessments in place for each person. These protected the rights of people who did not have the mental capacity to make informed decisions in specific areas of their life. For example, certain people sometimes declined any assistance with personal care despite needing staff support.

Care plans were now much more informative and guided staff so that they knew what actions to follow to meet people’s range of support and personal care needs. Staff knew what was written in each person’s care records. They explained how to provide care that was flexible to each individual and met their needs. Care plans were produced with input from people who used the service. The plans were reviewed and updated regularly. This was to make sure they were up to date and reflected the current needs of people.

People were encouraged to be included in deciding how they wanted to be supported with their care needs. The families and other representatives of people were involved in decision-making. This was when it was judged to be in the best interests of the people concerned.

People said that they liked the food and we saw they were offered choices visually at each mealtime to help them chose the meal they wanted .People at the home and the staff had built up positive and caring relationships. This was also the case with relatives and friends who spoke very highly of the caring attitude of the staff towards them.

The environment was adapted and personalised with a number of features that were beneficial for people who lived there. There was a hair salon, a secure sensory garden with plants that were pleasant to smell and comfortable seating areas. There was also a variety of decorative items to make the place seem more homely. We saw people using and responding in an animated way to all of these features of the premises during our visit. Many people at the home were living with dementia. Because of this activities were planned with people in a very informal way. People were able to take part in a wide variety of lively and informal one to one and group activities.

People were supported by a team of well-trained staff the majority of whom had been on training that was specific to helping to support people who live with dementia. The staff had attended a variety of other regular training and were developed and supported in their work. This helped them to improve and develop their skills and competencies. Staff received supervision which helped to ensure they were competent in their work. Staff spoke positively about working as a team and the good morale between them.

People and those who represented them were supported to be able to to complain and make their views known The provider actively sought the views of people and their families. Suggestions were acted upon and changes were made to the services when needed.

Feedback about the home from people and others involved in their care was positive. Regular reviews were carried out to find out where improvements were needed and how the service could be further developed. There were systems in place to monitor the service to ensure people were receiving care that was safe and met their needs.

Staff spoke positively of the management structure of the organisation they worked for. They said that the registered manager provided dynamic and caring leadership. The staff team told us they felt that they were well supported by the registered manager, who was very positive about the challenges of their role.

Quality audits had identified that there were shortfalls in the management of medicines that needed to be returned to a pharmacist. Actions had been identified to address this shortfall in the management of medicines.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records. If you would like to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us and our observations showed, there were enough staff on duty to meet people's needs. The home had detailed systems for assessing environmental risks and hazards.

Audits on cleanliness of the environment were performed. We saw the areas audited were clean and smelt fresh. Some areas were not included in the audit, for example cleanliness of wheeled equipment and procedures in relation to laundry. The areas which were not documented needed attention to ensure safe infection control practice.

The home had appropriate storage facilities and records relating to medicines. Medicines were not secured at all times. This was because medicines trolleys were not locked when in communal areas of the home. We found there were discrepancies in documentation relating to medicines, including controlled drugs.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. No applications have needed to be submitted from this home. Relevant staff we spoke with were aware of appropriate actions to follow in relation to these safeguards.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to safe management of medicines and infection control.

Is the service effective?

People we spoke with said the home met their needs. One person told us 'oh yes, this is a nice place.' We saw staff supporting people, including people living with dementia, in an appropriate way. A person told us about the help they received in the home. They had improved to the extent where they did not need to see the district nurse regularly. Another person had changes in their mobility. Their care plan had been revised and we saw the person using their walking aid in a safe way.

Is the service caring?

We observed staff were kindly and caring when they supported people. A person told us 'I've got a bell and if I need them, I just ring and they are there.' We saw a person requested to go to the toilet urgently during a meal. A member of staff promptly supported them. A person told a care worker how much their arthritic knees were hurting. The care worker helped the person to go to their room, explaining they would then apply some pain-relieving gel to their knees.

Is the service responsive?

We saw there were staff available to support people in pursuing recreational activities. In one sitting area, a care worker was engaged with two people holding a general discussion about holidays, in a relaxed and easy manner. We observed a person asking a care worker what their medicines were for. The care worker took time to explain this to the person. All 12 staff we spoke with reported they received help very quickly from other members of staff if they found a person who needed urgent assistance.

We saw there were a lack of written care plans for people who were admitted on a short term basis. This meant all staff would not be aware of how to respond to these people's needs. Where people were self-medicating or prescribed medicines on an 'as required' basis, there were no assessments or care plans to direct staff on how they were to respond to people's individual needs. There were a lack of protocols where people had requested staff to lock their rooms when they were not in them. This meant the home could not demonstrate all relevant persons had been consulted and risks for people responded to.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to people admitted on a short term basis, assessments and care plans relating to medicines and development of protocols in relation to locking of people's bedroom doors.

Is the service well led?

The home had not had a registered manager for an extended period of time. A new manager had been appointed. This person was in the process of applying to the CQC to be the registered manager. The provider had quality audit processes in place, for example in relation to maintenance of the building and health and safety matters. The new manager had set up systems for consultation with people, relatives and staff. Staff told us they knew how to raise issues with management and reported they were listened to if they did this.

To check improvements to people's records, we looked at seven sets of care plans. We found improvements had been made and there were now records being maintained, for example, for people's nutrition and hydration needs, continence needs, and assessments for people at risk of pressure ulcers. These records guided staff on how to support people consistently. Audits of records were now being carried out each month to ensure all the information required was being effectively recorded.

We found there were some areas where consistency of information still needed some work. We judged this was not impacting directly on people's care, but some guidance staff needed was not effectively recorded. We made the manager of the care home and senior support worker aware of these areas where work still needed to be done.

We saw staff were always polite to people and friendly in approach. At lunchtime we observed cheerful banter between people and staff. Staff we met with knew about people's needs in detail and clearly knew them as individuals. For example one care worker told us about a person’s visual difficulties and how this increased their risk of falling.

Staff were aware of the risks of abuse to vulnerable people, particularly where they had behaviours associated with dementia. There were clear systems, which staff knew about, for reporting any concerns relating to abuse.

Staff were trained and supported in their roles. One member of staff described supervisions as a “two way process”, telling us “I can feed in my ideas too.”

The home had clear systems for reviewing the quality of its service provision, which included involving staff as well as people living in the home and their supporters.

People had records about their care needs, but staff did not consistently document relevant matters. This included not changing a person’s care plan to reflect how staff were meeting their current needs; and not completing monitoring records on people's conditions after they had fallen.