We undertook this unannounced comprehensive inspection on 06, 07 and 14 November 2018. We last inspected Clevedon Court Residential Home in March 2017 and we had rated the service good. At this inspection we found the service had deteriorated significantly and was rated as inadequate.

Clevedon Court is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service is registered to provide care and support for up to 22 people with learning disabilities, autism and older people. The home is set out over three floors and there is a lift and stair lift for people to use. There is a ground floor dining room, lounge area and a garden area to the rear of the home. Most of the bedrooms offer ensuite facilities.

There were 19 people living in the service at the time of our inspection.

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.

People were at risk of serious harm from falls from heights and burns from hot surfaces. Most of the first and second floor windows were not restricted to a safe opening width and this placed people at risk of falling from these windows. Most of the radiators/heaters were either uncovered or only partly covered placing people at risk of burns should they come into contact with these potentially hot surfaces. No risk assessments were in place to reduce risks to people. Following the inspection, we wrote to the provider and registered manager requiring them to take urgent action to address these risks and protect people from further risks. Action was taken as required with window restrictors and most radiator covers fitted.

People were not always protected from the risk of abuse. There was no effective system being used to ensure that safeguarding referrals were made to the local authority and we identified that the service had not made referrals for some incidents when they should have. When safeguarding incidents had occurred, they were not always recorded as such and this meant that the service could not identify trends or themes.

Medicines were managed safely. Medicines were stored correctly, including medicines that required refrigerated storage and appropriate checks were completed. Staff members signed the medication administration records (MAR) when creams and ointments were applied.

Peoples dignity and privacy was not consistently respected. During our inspection we observed one person being assisted to use the toilet with the door open in a communal area. We also observed a person in a wheelchair being made to wait in a corridor while the person who had been assisting them answered the telephone and the door. No guidance or reassurance was offered to the person.

The service did not consistently recruit people safely. In one staff file we identified that a person who had disclosed a criminal conviction had been employed by the service without a photograph ID or risk assessment. This meant that people were not always protected from potential abuse.

Audits were not used effectively to identify potential risks to people. The audits we reviewed did not identify issues that we had found during our inspection. For example, the lack of window restrictors on windows throughout the home, the decorative state of the premises and the poor management of infection prevention and control.

The service maintained safe levels of staff. Although the registered manager did not use a staffing dependency tool, the deputy manager would increase their time spent delivering care as and when

This inspection took place on 29, 30 and 31 March 2017. The first day was unannounced. The last inspection of the home was carried out in November 2015 and we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The home was rated ‘Requires Improvement’.

The provider wrote to us with an action plan of improvements that would be made. They told us they would make the necessary improvements by March 2016. During this inspection, we found the required improvements had been made.

Clevedon Court is a care home that provides care and support for up to 22 people with learning disabilities or autism; they can also look after people as they get older so they don’t have to move to a different home. The home is set out on three floors and is close to local amenities. There were 21 people living in the home at the time of our inspection.

There is 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.

There were suitable recruitment procedures and required employment checks were undertaken before staff began to work at the home. Staffing levels and skill mix were planned, implemented and reviewed to keep people safe at all times. Any staff shortages were responded to quickly and appropriately. Staff received regular training and were knowledgeable about their roles and responsibilities.

Although staff did not fully understand the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) regulations, they were following the code of practice by giving people choices and respecting their decisions. The registered manager understood their responsibilities and made appropriate applications to the local authority.

Systems, processes and standard operating procedures around medicines were reliable and appropriate to keep people safe. Monitoring the safety of these systems were robust.

Assessments were undertaken to assess any risks to the person using the service and to the staff supporting them. This included environmental risks and any risks due to the health and support needs of the person. The risk assessments we read included information about action to be taken to minimise the chance of harm occurring. Relatives told us people were kept safe and free from harm.

Staff knew the people they supported and provided a personalised service. Care plans were in place detailing how people wished to be supported and families were involved in making decisions about their care.

People were supported to eat and drink. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

Staff told us the registered manager was accessible and approachable. Staff and relatives felt able to speak with the manager and provided feedback on the service.

We have made one recommendation; that records are reviewed to ensure they are accurate, complete and up to date and provide all the necessary information for staff to follow.

People are able to give valid consent to the care and support they receive at Clevedon Court when they are able.

We spoke to three people who used the service at Clevedon Court. They told us that “the staff always ask us how we would like to be looked after”. This meant that people have been able to choose how they are cared for, and have given their consent to the care they received.

We saw that there were comprehensive assessments from which care plans were developed. These care plans were reviewed every month by the manager and signed by the person using the service. This meant that people were fully involved in deciding the care and support they received.

People told us that they liked their bedrooms and were able to personalise them with their own furniture, pictures and ornaments. The premises was well maintained and benefitted from a "wet room" recently installed. This meant that people could choose to have a shower whilst seated or a bath if they preferred.

There was an effective staff recruitment system in place and staff were suitably qualified and knowledgeable to undertake their role.

There were clear procedures for receiving, handling and monitoring complaints. People who used the service told us that they could speak to the manager or the deputy if they had a concern. They told us that the manager and deputy were very approachable.

On the day of our inspection there were 21 people living at the home. We spoke with eight people living at the home. We also spoke with the registered manager, deputy manager, four care staff and a member of the domestic staff at the home.

Everyone we spoke with told us that they liked living at the home and were able to make choices about their care and support.

People told us that they attended meetings with staff to discuss their care and support. They said that they felt listened to and were able to influence how their support was provided.

We saw that interactions between staff and people living at the home were positive and respectful. Staff took time not to rush people and listened to what they had to say.

People living at the home told us they were supported to attend health appointments. One person told us “staff will get the doctor to visit if you are not well enough but most of the time they will take us up to see the doctor”.

People we spoke with told us that they liked the staff and they felt safe at the home. Staff knew how to raise concerns and were confident that they would be dealt with by the management of the home.

Staff told us that they felt well supported in their roles and received regular training and supervision meetings.

We saw that people who used the service, their representatives and visiting professionals were asked for their views about the care and support provided and these were acted on.

This inspection took place over two days. The first day was 3 November 2015 and was unannounced. The second day was 17 November and was announced. This was because the registered manager manages two services and we wanted to be sure we were able to talk with them.

Clevedon Court is a care home that provides care and support for up to 22 people with learning disabilities or autism; they can also look after people as they get older so they don’t have to move to a different home. The home is set out on two floors and is close to local amenities. There were 21 people living in the home at the time of our inspection.

There is 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.

Automatic closures on doors were prevented from working because the doors were propped open. This meant the automatic closures would not work properly in the event of a fire. Fire alarm systems had not been tested in line with the home’s policy. This meant any malfunction in the system may not be detected and people could be at risk.

The decision to use bed rails for one person had not been made as part of a best interest process and this amounted to an unauthorised deprivation of their liberty. For most people, best interest decisions were made when they were unable to make decisions for themselves.

All staff received training in how to recognise and report abuse, however not all staff knew the correct reporting procedure. Staff were confident that any concerns reported to the registered manager would be fully investigated. Staff received training from experienced specialists for a range of topics. Where records showed staff needed to complete training, the registered manager had plans of how to achieve this.

Sufficient numbers of staff were available to meet people’s needs. Everyone we spoke with was very complimentary about the staff. People said, “I have a laugh and a joke with staff” Staff said, “We’re one big, happy family here.”

People’s medicines were stored and administered safely. Staff who gave medicines received regular training. The home used a telecare system which meant information could be shared with G.P’s and other professionals quickly.

People were able to express their views about their care and were involved in regular meetings with their key workers. People were supported to be as independent as possible. Staff knew people’s preferences; however these were not recorded in people’s care plans.

Everyone we spoke with, people using the service, relatives and staff, said the registered manager and deputy manager were approachable and they would be able to speak to them if they had any concerns. People said they could talk to the registered manager when they wanted to.

Although the registered manager told us they conducted audits to monitor the quality of care, there were no records of these. Changes had been made to staffing levels following analysis of incident records. This had stopped the incidents such as falls from occurring.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.