The inspection visit at Cleveleys Nursing Home was undertaken on 19 June 2018 and was unannounced.

This is a care home that provides nursing for 32 older people. The home comprises of three floors with lift access. Rooms have en-suite facilities and there are a number of bathrooms and toilets on each floor. The first floor has separate dining and lounge areas. Car parking facilities with disabled access to the building is available. At the time of the inspection visit there were 30 people who lived at the home.

Cleveleys Nursing Home is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

A registered manager was in place. 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 2008 and associated Regulations about how the service is run.

At the last inspection in May 2017 we rated the service as Requires Improvement. This was because breaches of legal requirements were found. These related to incidents that affect the health, safety and welfare of people who lived at the home. Furthermore, the provider failed to ensure care planning and risk assessments were accurately recorded and personalised to ensure people did not receive inappropriate or unsafe care. In addition, medication procedures were poor and people were at risk of unsafe medication procedures that may affect their health. Also, the management team failed to properly assess the quality assurance of the service provided.

We further made recommendations for the provider to improve people’s safety and welfare. These concerned improving care and domestic staffing levels. In addition to improve infection control procedures and put processes in place to maintain the building and keep the home clean.

During this inspection, we found the provider had made improvements to ensure they met legal requirements. However further improvements were required and we made recommendations to ensure the safety of people was maintained.

At this inspection visit we found the management team had improved medication procedures. However, there were still gaps in their recording systems that were needed to ensure people received their medication safely.

We have made a recommendation about safe medicine procedures

At this inspection visit we found care plans and risk assessments required further development to ensure the right care and support was provided for people to keep them safe.

We have made a recommendation the provider seeks guidance to ensure people’s care plans and risk assessments were accurate and up to date.

Furthermore, we found they had improved their quality monitoring systems of the home in terms of more audits and seeking the views of people who lived at Cleveleys Nursing Home. Improvements were still required in terms of audits being carried out in a timely manner. The management team ensured us they were in the process of introducing systems to gain better service oversight.

We found, the building required further updating in terms of decoration and refurbishment. This would enable people to live in comfortable, pleasant surroundings. A relative we spoke with said, “The presentation of the home is below standard. It needs lots of redecorating.”

The registered manager made improvements to assessing staffing levels in relation to domestic staff being deployed. In addition, sufficient care staff were now on duty and infection control processes met people’s needs. Staff we spoke confirmed extra staff had been deployed and more time was spent with people who lived at the home.

We spoke with people who lived at Cleveleys Nur

The inspection visit at Cleveleys Nursing Home was undertaken on 8 May 2017 and was unannounced.

This is a care home that provides nursing for 32 people. The home comprises of three floors with lift access. Rooms have en-suite facilities and there are a number of bathrooms and toilets on each floor. The first floor has separate dining and lounge areas. Car parking facilities with disabled access to the building is available. At the time of the inspection visit there were 29 people who lived at the home.

During this inspection visit we found administration of safe handling of medicines was poor. The management team had not managed people’s medicines with a consistently safe approach. For example medicines records did not consistently provide a clear, auditable record of the treatment people had received.

This was a breach of Regulation 12 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Safe Care and Treatment.

Care records were not consistently kept up to date. For example a referral was identified of a person requiring an appointment with a dietician. We asked the nurse if this was carried out as no documentation could be found to confirm this. The nurse informed us this had not been carried out.

This was a breach of Regulation 12 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Safe Care and Treatment.

Since the inspection we have been informed that the person has now had input from the dietician. The person had responded to the action plan in place and their weight was now stable.

The provider failed to ensure quality assurance was up-to-date and fully assessed people’s experiences of living at Cleveleys Nursing Home. Audits failed to pick up concerns we found.

This was a breach of Regulation 17 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Good governance.

During this inspection, people who lived at the home told us they felt safe whilst at the home. However, the reduction of domestic staff and lack of upkeep of the building may put people’s safety and health at risk. For example we found waste bins not emptied until late in the day. Also, a soap dispenser was empty and not refilled from the morning when we checked late afternoon. Other areas of the building we found windows not cleaned outside and general up keep of the building was in need of updating.

We have made a recommendation the provider seeks guidance about safe domestic staffing levels.

The registered manager had procedures in place to minimise the potential risk of abuse or unsafe care. Staff spoken with were able to identify the different types of abuse and had received training in safeguarding adults. We confirmed this by talking with staff and looking at training records.

Risk assessments were in place to minimise the potential risk of harm to people during the delivery of their care.

The registered manager understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards. The registered manager discussed the applications which had been authorised and the restrictions in place to make sure people were safe.

We received mixed responses in relation to food provided and the way lunch was served. Comments included, “Oh yes there is always plenty of food and drink around if you want it.” Also, “There’s no choice.” Another person who lived at the home said, “The food is good but it is not a good atmosphere.”

The registered manager had a range of training to assist staff development, skills and understanding. Staff told us access to training courses was good. The registered manager had completed a training programme for staff to follow to make sure they were well trained and equipped to support people.

During the day we observed many examples of staff maintaining people’s privacy and dignity. People who lived at the home told us staff were caring. Examples of this included staff knocked on bedroom doors before enterin

We spoke with a range of people about the home. They included the owner, manager, staff, relatives, district nurses and people who lived at the home. We also had responses from external agencies including social services .This helped us to gain a balanced overview of what people experienced living at Cleveleys Nursing Home.

During our visit we looked at care records, staff training schedules and undertook a tour of the building. We observed meal times and spoke with people staying at the home. We did this to confirm people were well supported and competent staff were providing the support people needed. We observed care practices and saw people were treated with respect and dignity. Comments from people were positive and included, “Mum was in here and I wouldn’t hesitate in staying here myself the staff are wonderful.”

The people we spoke with said they were receiving safe and appropriate care which was meeting their needs. One resident we spoke with said, “The staff are very good. They always have time to spend and chat.” Also a relative spoken with said, “We went to a few homes but this was the best by far.”

During the inspection process we contacted the Lancashire contracts monitoring team. They told us they currently had no concerns with the service being provided by the home.

We also spoke with the local environmental health agency. They told us at their last visit they had no issues with the service. They rated the kitchen area 5 star excellent.

We spoke with a range of people about the home. They included, the person in charge, staff and people who lived at the home individually and in a group setting and relatives. We also had responses from external agencies such as social services in order to gain a balanced overview of what people experienced. This home provides care for people who had nursing needs and they ensured a qualified nurse was on duty at all times.

Residents we spoke with told us they were treated respectfully by staff and felt safe and secure, comments included, "They all seem dedicated at what they do. The staff are polite and kind people." Also, "Its nice to feel safe with so many staff around to help."

We spoke with staff members about individual care needs of residents. They had a good understanding of what support and care was required for each resident we discussed. Families we spoke with confirmed staff always keep them informed of any changes in their relatives care. One said, "This is the best nursing home we looked at and it has proved to be that. They always let us know if mums health changes or something happens."

We spoke with Lancashire council contracts monitoring department and they had no concerns or issues with the service.

We spoke to people living at the home, the person in charge, staff, relatives visiting, and received comments from other professional agencies such as social services and the environmental health agency. Responses we received were positive and reflected how the home is run in the best interest of the people who live at the home. Comments from people living at the home about there experiences, care and support they receive included, " Its home from home". Also, "The care is first class provided by first class people".

Staff spoken to had a good awareness of individuals care needs and the importance of treating people with respect and dignity. One relative visiting the home said, "The staff have been here a while and are so respectful and understanding of people".

Everybody spoken to about the quality and provision of food said it was very good, comments included, "We are lucky we have a very good cook". And, "I must say the food is excellent". Also, "As you can see by my breakfast the food is good".

Lancashire Social Services spoken to have no concerns with the home and have not received any 'safeguarding' alerts recently.

Observation of walking around the building and talking to people confirmed there is a lack of storage facility for equipment such as electric scooters, hoists and wheelchairs. Additional space should be provided to prevent the risk of any potential accidents and ensure the safety of the people living and working at the home. One staff member spoken to said, "We do need more storage space for equipment".

The inspection visit at Cleveleys Nursing Home took place on 14 and 15 January 2015 and was unannounced.

This is a care home that provides nursing care for up to thirty two people who are elderly. The home comprises of three floors with lift access. Some of the rooms have en-suite facilities and there are a number of bathrooms and toilets on each floor. The first floor has separate dining and lounge areas.

There was a registered manager in place. 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.

Procedures and systems were in place to safeguard people against abuse. People who lived at the home and relatives we spoke with told us they felt safe and secure at the home. One relative said, “It’s a relaxed but busy atmosphere which is good. I sleep easy knowing my [relative] is safe here.”

We observed people were comfortable, relaxed and had freedom of movement around the home. Staffing levels were sufficient to enable people to go to their own rooms or any lounges and staff would be able to monitor movements of people regularly because of the numbers of staff on duty.

There was a training and development programme in place for staff. The programme identified when mandatory training courses were due and kept a record of training events individual staff had attended. This supported staff to have the skills and knowledge to provide safe and effective care for people.

We found over the two days people had access to food and drink throughout the day. People were asked what they wanted to drink and were given a choice of hot or cold beverages throughout the day. Comments about the quality of meals provided were positive. One person said, “The quality of food is excellent.” We observed support provided to people who required assistance at mealtimes was done so in a sensitive and dignified manner. There was sufficient staff around at mealtimes to give support to people who needed it.

We saw people were cared for by attentive and respectful staff. We saw that nurses and carers showed patience and gave encouragement when supporting people. At times of the day when staff were busy we found staff to be patient and caring towards people.

We found some people went out in the community themselves and attended community events. The staff and management supported people to be as independent as possible within a risk framework. For example one person attended regular meetings in the community for people who had similar health issues and attended these meetings on his own.

There were quality assurance systems in place to get the views of people who lived at the home. However there was a lack of consistent support from the provider to the registered manager. The registered manager had not received supervision for over 12 months. This meant the registered manager was unable to measure her own performance, develop skills and discuss the continued development and running of the home.