This unannounced comprehensive inspection took place on the 8 January2018. The last comprehensive inspection took place on the 5 January2016. The service was meeting the requirements of the regulations at that time.

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.

Clovelly House Care Home is situated in close to the centre of Newquay. The service provides single room accommodation for up to nineteen predominantly elderly people who need assistance with personal care, including those with a dementia related illness. At the time of the inspection there were fourteen people using the service. The service is situated over two floors which are serviced by a passenger lift. There are a number of rooms with en suite facilities and enough bathrooms including assisted baths on both floors. A lounge and dining room are situated on the ground floor with a conservatory at the front of the service. There are a range of aids and adaptations to support people with limited mobility.

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.

People’s risks were being managed effectively to ensure they were safe. Records recorded changes in people’s level of risk and how those risks were going to be managed.

We observed staff providing support to people throughout our inspection visit. The staff were kind, patient and treated people with respect.

We found staff had been recruited safely, received on-going training relevant to their role and supported by the registered manager. They had the skills, knowledge and experience required to support people in their care. Staffing levels were sufficient to meet the needs of people who lived at the home.

People and family members all spoke positively about the service. They told us that they or their relative was safe living at the service and that staff were kind, friendly and treated people well. They told us that the manager was always available and approachable. Comments included, “[Relative] is in the best place. We leave here knowing [Person’s name] is safe. It gives us so much comfort,” and “I love living here because get all the help I need.”

Safeguarding procedures were in place and staff had a good understanding of how to identify and act on any allegations of abuse.

The manager used effective systems to record and report on, accidents and incidents and take action when required.

The service was suitably maintained. It was clean and hygienic and a safe place for people to live. We found equipment had been serviced and maintained as required.

Staff wore protective clothing such as gloves and aprons when needed and there were appropriate procedure in place to manage infection control risks.

There was a complaints procedure which was made available to people on their admission to the home and their relatives. People we spoke with told us they were happy and had no complaints.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included regular audits, staff, relative and ‘resident’ meetings to seek their views about the service provided.

We carried out this unannounced inspection on 5 January 2016. The service was last inspected in September 2014; we had no concerns at that time.

Clovelly House is a care home that can accommodate up to 19 older people. At the time of our inspection there were 18 people living in the service.

There was a registered manager in post who was responsible for the day-to-day running 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 and associated Regulations about how the service is run.

People told us they felt safe living at Clovelly House and with the staff who supported them. People said, “I feel safe living in the home” and “I am safe living here.” A relative commented, “I can’t fault the service.”

On the day of our inspection there was a calm and relaxed atmosphere in the service. We observed people had a good relationship with staff and staff interacted with people in a caring and respectful manner. People told us, “They [staff] are all good to me” and “Staff are very good and respectful.”

People were able to take part in a range of activities of their choice. There were sufficient numbers of suitably qualified staff on duty and staffing levels were adjusted to meet people’s changing needs and wishes.

Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge. Staff knew how to recognise and report the signs of abuse.

Health professionals told us staff had good knowledge of the people they cared for and made appropriate referrals to them when people needed it. Visitors told us staff always kept them informed if their relative was unwell or a doctor was called. Relatives said, “They [staff] keep me informed” and “They [staff] always ring me if Mum is not well.”

Staff supported people to maintain a balanced diet appropriate to their dietary needs and preferences. Staff asked people where they wanted to eat their lunch and most people chose to eat in the dining room. People told us, “The food is really good” and “There is always plenty of food and I can ask for more.”

Care records were up to date, had been regularly reviewed, and accurately reflected people’s care and support needs. Details of how people wished to be supported were personalised to the individual and provided clear information to enable staff to provide appropriate and effective support. Any risks in relation to people’s care and support were identified and appropriately managed.

People were assessed in line with the Deprivation of Liberty Safeguards (DoLS) as set out in the Mental Capacity Act 2005 (MCA). DoLS provide legal protection for vulnerable people who are, or may become deprived of their liberty. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals when appropriate. Staff applied the principles of the MCA in the way they cared for people and told us they always assumed people had mental capacity.

People and their families were given information about how to complain. There was a management structure in the service which provided clear lines of responsibility and accountability. Staff had a positive attitude and the management team provided strong leadership and led by example. Staff said, “The management are fair”, “I love working here, it’s not like going to work” and “I would feel comfortable raising any concerns with management.”

People, visitors and healthcare professionals all described the management of the service as open and approachable and thought people received a good service. Relatives told us, “We choose this home,

In June 2014, the Care Quality Commission issued a compliance action to the registered persons regarding the handling of medication.

When the Care Quality Commission inspects health and social care services the inspector works to answer five key questions; is the service safe, effective, caring, responsive and well-led?

At our inspection in June 2014 we were concerned there had been incidents where staff had not followed correct procedures regarding the administration of nine individual dosages of medication. As a consequence we issued a compliance action as overall we could not judge the service was safe. We were however able to state the service was effective, caring, responsive and well-led. We refer the reader to our report published in June 2014 which outlined our findings from that inspection.

This inspection was completed to check suitable action had been taken to improve procedures regarding the handling of medication. We wanted to answer the question whether the service was now safe. We did not inspect other outcome areas at this inspection.

Below is a summary of what we found.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Yes, on the day of the inspection we judged the service was safe.

The registered manager provided us with a satisfactory action plan after our inspection in June 2014 regarding what actions would be taken to improve medication procedures.

At this inspection we checked what procedures were in place regarding the administration of medication and we judged these were to a good standard. For example medication administration records were completed correctly. When any medication had not been administered an appropriate record had been made as to why this had occurred, for example, the person had refused or they were out. The medication system was well organised and tidy.

This inspection was carried by one inspector over one day. During the inspection, the inspector worked to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Yes, overall we judged the service was safe although we did have concerns regarding medication administration

People told us they felt safe living at the home. Everyone we spoke with was very complementary about the support they received from the staff. We were told “they are very good…they are very honest and trustworthy,” “they are very kind here, I do not know what else they could do for us,” and “they are very helpful.”

Staff we spoke with said everyone in the staff team worked in a professional manner and the management had high standards regarding the care people in the home should receive. Both staff and people who used the service said managers at the home were approachable and would take appropriate action if there was any practice which was not seen as acceptable.

We saw that the home was well maintained, furnished and decorated to a good standard. Most of the equipment was well maintained and regularly serviced according to health and safety standards. However some records regarding fire equipment testing could be more detailed. Electrical equipment and the electrical circuit needed more frequent testing. There was no documented system of health and safety risk assessment.

We were concerned there were a number of incidents where dosages of medication were recorded as given to people although they remained in the medication system. In one case we were told this was because a person was asleep, although we were not able to account for other instances. There were no records to account for the omissions.

On the day of the inspection the home was very clean and there were no unpleasant odours. There was a comfortable and relaxed atmosphere.

We inspected the staff rotas, which showed that there were sufficient staff on duty to meet people’s needs throughout the day and night. People said call bells were promptly answered, staff were unrushed and patient with them. There was a need to improve training delivery, in some areas, for some staff.

Is the service effective?

Yes we judged the service was effective.

People all had an individual care plan, which set out their care needs. Care plans contained satisfactory information and were accessible to staff.

People had access to doctors, district nurses, chiropodists and opticians, although some improvement was required regarding documenting the support received from some external medical professionals. A relative told us if the doctor was called, staff would always contact them and keep them informed of any treatment.

People were very positive about the meals provided and they said staff provided them with regular snacks and drinks.

People who used the service said if they asked staff to help them, they responded promptly and politely. People said care was delivered in a way they wanted.

Is the service caring?

Yes we judged the service was caring.

People who used the service said they were supported by caring, kind and professional staff. There was a friendly, calm and pleasant atmosphere on the day of the inspection.

Comments from people who lived at Clovelly House Care Home included “It is very good…things could not be better…the carer’s are very helpful” and “I have no concerns, the staff are always nice.” A relative told us the care provided was “very good…excellent.” A visiting professional told us “There are absolutely no problems…I would be happy to put my parents here”.

Our observations of the care provided, discussions with people and records we assessed, enabled us to conclude individual wishes and needs were taken into account and respected.

Is the service responsive?

Yes we judged the service was responsive.

The people we spoke with all said the staff treated them with respect and dignity. The care practice we observed was professional and supportive. For example comments we received included “It is very good…things could not be better…the carers are very helpful,” and “Everything is top class. I have not one complaint about anything.”

People who used the service told us there were some activities available and these included a monthly trip out in a mini bus if people wanted to go out. If people did not want to get involved with organised activities this was respected. People could attend the local church on Sunday, and a religious minister provided communion on a monthly basis. The library visited the home, and people could have magazines and newspapers delivered.

People were positive about the care they received. People we spoke with said their care was unrushed and received in a way they wanted staff to provide it. From reviewing records we judged care plans as including suitable information to assist the staff who worked at the home. Records showed care plans were regularly reviewed and updated.

Is the service well-led?

Yes we judged the service was well led.

Staff, people who used the service, relatives and external professionals were all positive about the management of the home. People told us the management had high standards and would listen if they had any concerns.

The owner worked at the home on a day to day basis. The owner had a strong ethos which ensured quality standards were high, and the staff team had a good understanding of providing a person centred service. The owner ensured staff worked in a manner which resulted in people being well cared for and respected, while ensuring staff were respected and appropriately supported.

There was some evidence that the administration of medication and recording regarding external medical input could be improved. There was also evidence the provision of some staff and some health and safety standards (for example testing regarding electrical safety) could be improved.

The home had well established links with external professionals such as the district nurse service and the local general practitioners. We spoke to visiting professionals who were very positive about the staff and management of the home.