This unannounced inspection was carried out on 31 January 2017. Clifton Manor Residential Home provides accommodation and personal care for up to 74 older people. On the day of our inspection visit there were 43 people who were using the service.

On the day of our inspection visit there was not a registered manager in place. The previous registered manager left the service in November 2016. A new manager had been recruited who had started the process to become the registered manager of 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 supported by staff who understood the risks they could face and knew how to keep them safe. Risks to people’s health and safety were identified and assessed. Action taken to reduce risks which were known by staff and recorded in people’s care plans. People received their medicines as prescribed and these were managed safely.

People were supported by staff who received appropriate training and supervision and had an understanding of people’s care needs. People were supported to make choices and decisions for themselves. When people were assessed as lacking mental capacity most people had capacity assessments and best interest decisions in place.

People were provided with a nutritious diet which met their needs. However, they required more support to protect them from the risks of inappropriate nutrition and hydration. Staff understood people’s healthcare needs and their role in supporting them with these.

People were cared for and supported by staff who respected them as individuals. Staff had friendly relationships with people and respected their privacy and dignity. People were involved in planning and reviewing their own care and some people were supported by relatives in doing so.

People received individualised care and they were able to participate in meaningful interaction and activities. People knew how to raise any complaints or concerns they had and felt confident that these would be dealt with

We saw that staff worked well as a team and were supported by management to make improvements in the service. The new manager had made a positive impact and was supported by people who used the service and staff. There were systems in place to monitoring the quality of the service.

This inspection took place on 1 December 2015 and was unannounced. There were no breaches of legal requirements at our previous inspection in November 2014, but we did ask the provider to make some improvements to the service.

Clifton Manor Residential Home provides accommodation and nursing care for up to 47 people who have nursing or dementia care needs. There were 42 people living there at the time of our inspection. We spoke with six people living at the home, six relatives, six care staff, one senior care staff and the manager.

There was no registered manager at the service; a manager is required to register with us by law. 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.

At our last inspection in November 2014 we found that, there was no registered manager in place and there were also a number of other improvements required. People were not supported to have sufficient to eat and drink. Activities did not always reflect people’s needs. People did not always receive responsive care and staff did not always feel confident that concerns raised would be dealt with.

At this inspection we found that the provider had made some improvements.

Staff were not always deployed appropriately as people raised concerns and said staff presence was sometimes limited in areas of the home where they were needed. The provider recruited staff with the right skills and where required they took appropriate action to ensure people were kept safe.

People received their medicines as prescribed and in a timely manner. There was no system in place to ensure people who required prescribed creams and lotions had them applied correctly. Medicines were not always stored in a safe way.

People felt safe living in the home. Their relatives were confident people were safe and knew how to raise any concerns. Safeguarding issues were reported and investigated appropriately. People were able to take informed risks and these were managed by staff.

People gave positive feedback about the staff skills and knowledge to do their job. The provider was following the requirements set out for the MCA and DOLs and acted legally in people’s best interests if they did not have the mental capacity for particular decisions. However, some staff were not fully aware of what this meant for people.

People were supported to have a balanced diet that promoted healthy eating and drinking. They had access to other health care professionals and referrals were made if staff had concerns regarding people’s health.

People experienced a positive caring relationship with the staff who supported them. People were involved in making decisions about their needs and felt they were given choices and preferences. People were treated with dignity and respect at all times.

People’s feedback was positive about the care they received, but staff were not consistently responsive to people’s personalised needs. People participated in activities that helped stimulate them. Systems were in place for people to share their views and experiences. Complaints and incidents were addressed and dealt with in a timely manner.

The manager of the service was not registered with CQC at the time of our visit. We received positive feedback from people, their relatives and staff on the approachability of the manager and how they felt supported by them. Improvements had been made in regards to the quality monitoring of the service. There had been improvements identified, however to ensure this was consistent further monitoring was required. Management had discussed shortfalls and concerns at team meetings. The vision and values of the home were more positive.

This inspection took place on 12 November 2014 and was unannounced. There were no breaches of legal requirements at our previous inspection.

Clifton Manor Residential Home provides accommodation for up to 47 people who are older people, some of whom have dementia needs. There were 43 people living there at the time of our inspection.

There was no registered manager at the service; a manager is required to register with us by law. 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.

We found people felt safe with the staff that cared for them. The provider had suitable arrangements to keep people safe. We saw appropriate information was available to ensure people and their relatives were aware of what abuse was and how to stop abuse from happening. All risks to safety were minimised. We observed sufficient staff on duty on the day of our visit. The provider had systems in place to address any shortfalls. People received their medicines as prescribed and they were stored and monitored correctly.

People told us that they had plenty to eat and drink and we saw some people were supported at mealtimes. We saw that the home involved outside professionals in people’s care as appropriate and, the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of liberty safeguards were fully adhered to.

Staff received training, supervision and appraisals, which ensured they developed the right skills and knowledge suitable to their role.

People and their relatives told us staff were very caring and treated them with dignity and respect. They were encouraged to form relationships within the home and with others. People were encouraged to be independent where possible and fully supported by staff when needed.

People were proactively supported to express their views and be involved with decisions relating to their care. Staff communicated effectively and interacted well with people.

People did not always participate in activities that were relevant to their interests and hobbies.

We found risk assessments were in place and care plan reviews had been completed, but the records were not always up to date.

We found quality assurance systems were in place, but were inconsistently applied. People, their relatives and staff told us the culture of the home was open and transparent. People told us they felt the person in charge was approachable. Staff generally felt supported. People and their relatives were able to voice their concerns and raise complaints, which we found were dealt with in a timely manner and in line with the provider’s policies and procedures.

There was no registered manager at the service, but people, their relatives told us the culture of the home was open and transparent. People told us they felt the person in charge was approachable.

During our visit we observed staff speaking to people in a polite and respectful manner. We saw staff supporting people when required and helping them to make informed choices.

We spoke with six people who used the service, four relatives and two visitors during our visit.

People who used the service told us they had a choice when to get up and when to go to bed. All the people we spoke with commented that the staff were good. One person said, “I’ve made this my home.” Another person said, “We are all grown up’s, you know and I would not stay if I wasn’t” (treated with respect).

We looked at five care file and found risk assessments and plans of care to meet people’s needs. We saw where people and their families had been involved in the six monthly reviews of people’s needs and where changes and improvements had been made. We found care plans were reviewed on a monthly basis.

We found medication records to be accurate and relevant to people’s needs. Medication was stored correctly and staff training had been completed. Staff were able to show us the correct procedures they followed when administering medication and completed the records accordingly.

Staff told us there was enough training to help support them do their job. They said they completed an induction when they first started working at the home and felt supported by the management.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time. During our visit we observed staff speaking with people in a polite and respectful manner. We also observed that staff communicated effectively with people while they were being transferred from a wheelchair to a comfy chair.

We spoke with two people who were using the service during our visit. The people we spoke with said they liked living at the home and the care they received was appropriate. One person said, “The staff provide all the support I need, they are very good and know what I want.” Another person told us, “The care is ok and I find the staff are very nice.”

We conducted a tour of the building during our visit and observed the home to be visibly clean and with no unpleasant odours.

We spoke with two people who were using the service during our visit. One person told us, “Yes I think they have enough staff to cater to everybody’s needs.” The other person said, “I think maybe they could do with another person to help out. Sometimes I have to wait to go to the toilet.” During our visit we did not observe anybody having to wait for assistance and staff were visible in the communal areas of the home throughout the day. We saw that monthly "resident's meetings" were advertised on the main notice board.

When we inspected the home in June 2011 people told us, “The staff are always very nice, and very respectful, I cannot fault the place really”. People also told us they felt very safe and well looked after. A visitor to the home told us that the staff all do wonderfully well, and expressed no concerns about any aspects of service provision.

We did not speak to any people who used the service when we inspected the home in December 2011. The inspection was undertaken to determine if improvements had been made to the management of people’s care plans and people's financial records.

People told us “the staff are always very nice, and very respectful, I cannot fault the place really”. People also told us they felt very safe and well looked after.

A visitor to the home told us that the staff all do wonderfully well, and expressed no concerns about any aspects of service provision.

People told us that they felt their needs were being met and said that they receive the care and support they need.