Cloisters Care Home

Cloisters Care Home is a care home with nursing for up to 58 older people. At the time of our inspection 55 people were living at the service. There were two units. One unit was designed for people living with the experience of dementia. The other unit was for older people with nursing needs. The provider also offered care and support for people at the end of their lives and those receiving palliative care.

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

People using the service and their relatives told us they were happy and felt safe. They liked the staff and felt their needs were being met. Some relatives told us people's health and wellbeing had improved since they moved to the service.

Risks to people's safety and wellbeing had been assessed, planned for and monitored. There was equipment designed to keep people safe and staff were appropriately trained to use this. We saw people being supported in a safe way. There were systems to learn when things went wrong, for example following accidents and complaints. The staff made changes to help keep people safe from further harm and minimise risks.

People received their medicines as prescribed from trained staff. The staff worked closely with other health care professionals to monitor people's needs and respond to changes in their health and wellbeing.

There were enough staff working at the service to keep people safe and meet their needs. The provider had systems for safe recruitment and training staff. The staff explained they felt supported and had the information they needed to care for people.

The environment was suitable. It was clean and there were systems for managing infection control and prevention. These had been updated in 2020 due to the COVID-19 pandemic. The staff wore personal protective equipment (PPE) and made sure they followed procedures to prevent the spread of infection.

People were cared for by staff who knew them well. Their needs were assessed and recorded in care plans. The staff had consulted people about their care plans and the review of these to make sure their choices and views had been captured. People were supported to take part in a range of different activities and events. There had been changes to visiting arrangements in 2020 due to the pandemic, but relatives we spoke with were happy with the arrangements and told us they had opportunities to see their family members. Care was provided in a personalised way, taking account of people's individual needs, such as their religion and cultural needs.

The provider offered care to people at the end of their lives. This meant sometimes people moved to the home from hospital for a short time before they died. The staff worked with palliative care teams and other professionals to make sure people were safe, comfortable and pain free during this time.

The registered manager was supported by a team of senior staff. They had regular meetings and discussions to help make sure they had a consistent approach and provided coordinated care. There were effective systems for monitoring and improving the quality of the service, including making changes following adverse events, such as complaints, falls and safeguarding alerts. The staff worked closely with other stakeholders and consulted people using the service and their representatives so they could make improvements based on their feedback.

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 good (Published 10 March 2018).

Why we inspected

The inspection was prompted in part due to concerns received about people's care and safety. A decision was made for us to inspect and examine those risks.

As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. Therefore, we did not inspect them. Ratings from the last comprehensive inspection for those key questions were used in calculating the overall rating at this inspection.

We found no evidence during this inspection that people were at risk of harm from these concerns because the provider had made the necessary improvements to the service. Please see the safe, responsive and well-led sections of this full report. The overall rating for the service has not changed. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cloisters Care Home on our website at www.cqc.org.uk.

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.

The last inspection was on 20 June 2017 when we rated the service Requires Improvement overall and in the key questions of Safe and Responsive. We did not find any breaches of Regulation, but we found that the provider needed to make improvements in order to achieve a Good rating overall.

At this inspection we found the provider had made the necessary improvements and we have rated the service Good in all key questions and overall.

Cloisters 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.

Cloisters Care Home is registered to accommodate up to 58 people in one building. The building has two units. The ground floor is for people living with the experience of dementia who may also have physical healthcare needs. The first floor is for people whose primary needs are physical healthcare needs, including people who are being cared for at the end of their lives. At the time of our inspection 54 people were living at the service.

The provider, Advinia Health Care Limited, is part of the Advinia Healthcare Group, who manages 16 care homes in the United Kingdom.

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 and associated Regulations about how the service is run.

People were happy living at the service. They told us their needs were met and they were treated with kindness and respect. Visitors explained they thought the service was well run and met people's needs. People were involved in planning their own care and were able to make choices about this.

The staff were happy working at the service. They felt supported. They had the training and information they needed to carry out their roles and responsibilities.

People received their medicines in a safe way. The risks to their safety and wellbeing had been assessed and planned for. The provider learnt from incidents and accidents and had made improvements at the service following these.

The environment was safely maintained, suitable and comfortable. The staff carried out checks on safety and on equipment being used.

There were procedures designed to protect people from the risks of abuse. People knew how to make a complaint, they felt the registered manager and provider listened to their concerns and took action when needed.

People were cared for in a way which met their needs and reflected their preferences. The staff worked alongside other professionals to make sure healthcare needs were being met. People had enough to eat and drink. They were able to participate in a range of social activities. There was evidence that some people's health and wellbeing had improved since they had lived at the service. People receiving care at the end of their lives were treated with dignity and respect.

The registered manager and provider's representatives were visible and well known. They operated effective systems for monitoring the quality of the service and making improvements. These systems included asking people using the service and other stakeholders for their views and opinions.

The last comprehensive inspection of the service took place on 17 May 2016 when we found breaches of Regulation in relation to person-centred care and privacy and dignity. At the inspection of 20 June 2017 we found the provider had taken action to meet these breaches. We carried out a focussed inspection on 28 February 2017 to look at the way in which medicines were managed. This was following an incident relating to medicines management which was also investigated under the local authority safeguarding procedures. At this inspection we found that the service was managing medicines safely. We found this was still the case during our inspection of 20 June 2017 but we found that medicines were not always being stored at safe temperatures.

Cloisters Care Home is a nursing home for up to 58 older people. The ground floor is for people who are living with the experience of dementia and also have nursing needs. The primary needs of people living on the first floor were nursing needs, although some people also lived with the experience of dementia. The majority of people living on the first floor had complex needs with a variety of different medical conditions. Some people were being cared for at the end of their lives. At the time of our inspection 53 people were living at the service. The home is managed by Advinia Healthcare Limited, a private company who are part of a group which manage 16 residential and nursing homes and home care services in England and Scotland.

The registered manager had been in post since February 2017. They had previously worked at and managed other residential and nursing homes. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run.

Some of the records at the service were not up to date and did not accurately reflect changes in people's needs. We discussed this with the registered manager who was aware of the situation and was in the process of addressing this issue. We found that despite some records not reflecting the most up to date needs of people, the staff were aware of their needs and met these.

We found some aspects of the service were not always safe. For example, we observed an incident where a member of staff almost gave someone a drink which was not safe for them. We also found concerns about medicines storage temperatures and the provider had not sought assurances from their pharmacy before we alerted them to do this. Some people felt that the service did not have enough staff. We found that there were enough staff to meet people's needs but at times the staff were under pressure to make sure people's needs were met when they needed. The environment was safely maintained but there was a malodour in some areas of the building.

People were mostly happy living at the home and felt their needs were being met. The staff were kind, caring and polite. They offered people choices and took account of their wishes and preferences. People's health was monitored and the staff worked closely with other healthcare professionals to meet these needs. People were able to make choices about a range of freshly prepared meals. People's capacity to consent had been assessed and the provider acted within the principles of the Mental Capacity Act 2005.

The staff were appropriately trained and supported. They worked well as a team and had the information they needed to carry out their roles.

The culture of the home was open and inclusive and people using the service, their visitors and staff were able to contribute their ideas and felt listened to. The provider had a number of audits which helped to monitor and improve the quality of the service. There had been improvements since the last inspection and the provider had demonstrated a commitment to maintaining these.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for 'Cloisters Care Home' on our website at www.cqc.org.uk.

The last inspection of the service was 17 May 2016. At this inspection we rated the service Requires Improvement because we found that people did not always receive care which met their social and emotional needs. Some of the staff did not always care for people in a person centred way or take account of their needs associated with having dementia. The staff did not always treat people with respect. The provider sent us an action plan telling us how they would make the required improvements.

The inspection of 28 February 2017 did not include a review of these previous concerns because it was a focussed inspection carried out by a pharmacist inspector to look at the management of medicines only. We will review other areas of the service at our next comprehensive inspection. Therefore we have not reviewed or changed the rating of the service at this time.

Cloisters Care Home is a nursing home for up to 58 older people with nursing needs. The ground floor was also for people who were living with the experience of dementia. The home is managed by Advinia Healthcare Limited, a private company who manage 16 residential and nursing homes and home care services in England and Scotland.

At this inspection we found that the provider had made suitable arrangements to ensure people were protected against the risks associated with the inappropriate treatment of medicines. People received their medicines as prescribed. Medicines were stored, administered and recorded appropriately.

The inspection took place on 17 May 2016 and was unannounced.

The last inspection took place 13 and 19 October 2015, when we found breaches of three Regulations relating to person centred care, good governance and the deployment of staff. At the inspection of May 2016 we found improvements in some areas, however, there were still risks that people did not receive care which was appropriate, met their needs and reflected their preferences.

Cloisters Care Home is a nursing home for up to 58 older people with nursing needs. The ground floor was also for people who were living with the experience of dementia. At the time of our inspection 52 people were living at the home. The home is managed by Advinia Healthcare Limited, a private company who manage 16 residential and nursing homes and home care services in England and Scotland.

There was a manager in post. She was in the process of applying to be registered with the Care Quality Commission. 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 and associated Regulations about how the service is run.

People did not always receive care which met their social and emotional needs. Some of the staff did not always care for people in a person centred way or take account of their needs associated with having dementia.

The staff did not always treat people with respect.

You can see what action we told the provider to take at the back of the full version of the report.

People told us the staff were kind and caring. Most people felt their needs were met and people had consented to their care. We saw that people had detailed care plans which reflected their needs and preferences. Some of the care people received was kind and respectful. People were given the support they needed to stay healthy and eat well.

There were enough staff to support people and meet their needs. However, some of the time the staff did not work in a coordinated way so people had to wait for care. The staff received the training and support they needed to care for people and to understand their needs.

The service was appropriately managed and there were systems to audit and monitor the care people received. The provider responded to concerns raised by people, including taking action where we found they were not meeting the Regulations.

The inspection was carried out by an inspector over two days. This helped answer our five questions;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Care plans had details of people's needs and how these were to be met. These plans were regularly reviewed by staff. Risk assessments related to the care and support being provided and were regularly reviewed to ensure people's individual needs were being met safely.

The medicines prescribed to people using the service were stored in a secure appropriate manner. We saw that the Medicines Administration Records (MAR) charts for all the people using the service were correct and information was clearly recorded.

The service had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). This meant that the service had clear processes in place that managers and staff could follow if they were required to access the Deprivation of Liberty Safeguards.

Is the service effective?

There was no evidence that people using the service and their relatives were involved in the development and review of care plans so they could ensure that the plans were tailored to their needs.

The home did not have a system in place to identify and review people’s resuscitation and end of life plans. There were no care plans describing people’s wishes and what support they wanted at the end of their life.

Is the service caring?

We saw that staff did not always communicate and interact with the people using the service when providing care and support to them. People were not always treated with dignity and respect and were not involved in decisions relating to their daily care and activities.

Is the service responsive?

The home worked closely with the local palliative care nursing team to provide support for people using the service and their relatives.

Is the service well led?

The service had a quality assurance system in place. Records seen by us showed that any issues identified in relation to the quality of the care provided were acted on and as a result the quality of the service was continuingly improving.

Regular audits of the care plans and risk assessments were carried out and any identified actions had a completion date. This allowed staff to identify if the care provided met the needs of each individual using the service.

We saw that staff had not completed training courses or refresher training identified as mandatory by the provider. Records showed that staff did not have annual appraisals with their manager.

Following our inspection the manager submitted an action plan telling us what action would be taken to ensure these issues were addressed. The manager told us that the home would be fully compliant by 2 September 2013.

During this inspection we spoke with the manager, two other members of staff and five people who use the service. We found that people were involved in their care planning and supported to make choices with regards to their daily routines. People told us that staff treated them well. One person we spoke with told us, "staff treat me respectfully and I respect them too." Another person said, "they're absolutely brilliant, they [staff] come and chat with me, I am happy here."

We looked at training records and saw that staff had attended training in a range of areas to support them in developing/refreshing their skills and knowledge so that they could meet people's needs effectively.

We found that systems had been implemented to ensure that staff received regular supervision and annual appraisals to monitor their performance and identify any areas for development to support them in their role.

We carried out an early morning visit to the home. When we arrived at 5:30am we found that all of the people using the service were in their beds and most people were still sleeping. We spoke with one of the nurses on duty and two other members of staff. We also looked at three people's care records and viewed the daily progress notes for all of the people with dementia care needs accommodated on the ground floor.

The staff we spoke with told us that there were a few people who were early risers but that everybody was supported to get up in the morning when they chose to do so. Staff also told us that there had been previous discussions between the day and night staff about expectations in relation to how many people were supported to get up by the night staff to reduce the workload of day staff in the morning rather than basing these decisions on people's individual needs. This meant that people's individual needs and preferences were not always considered in terms of staff practice discussions in the home.

We found that people's responses were mixed in relation to the staff working at the home. For example, one person said, "the girls (staff) are good" but another told us, "there are a few staff who are rough when they are helping me and say things like 'get over' but sometimes I am well looked after". Other people we spoke with also said that they had mixed feelings about the staff or made comments like, "they're (staff) ok I suppose, I don't like to criticise". Therefore people were not always treated respectfully and in a dignified manner by staff.

People's needs were assessed and care plans developed that took account of their likes, dislikes and preferences. Any identified risks were assessed and action taken to minimise these risks and keep people safe. People's health needs were met.

The home was clean and warm at the time of our visit and appropriate maintenance and health and safety checks were taking place to ensure that people were kept safe.

At our previous inspection staff were not receiving formal supervision. We found that a plan had been put in place and this was being addressed, however staff had not received adequate training and no staff appraisals had taken place.

Quality assurance systems were in place to monitor areas such as medication, pressure area care, nutrition and the use of bedrails. However, the records viewed did not show what action was taken to address any identified issues.

People told us they were pleased with the care they received at the home. They said staff were attentive to their needs and ensured these were met. Comments we received included, 'everyone looks after me well' and 'I can go home and have peace of mind that [my family member] is being well looked after'.

People's care plans generally addressed their needs but information about their backgrounds was not always available to ensure staff understood them as a 'person'. Some of the arrangements to ensure people received safe and appropriate care were not adequate to ensure their welfare and safety.

Staff were aware of the need to maintain people's privacy and dignity and people who talked with us said these were respected. However, their care plans did not address how their privacy and dignity would be maintained, such as when they were in bed with their bedroom doors left open.

People received information about their care and were given opportunities to make choices. However, care records did not always make clear how people or their relatives were involved in the care people received.

Staff received appraisals but did not always receive training and supervision in a timely manner to ensure they were appropriately supported in their job. The manager said they had plans to address this.