Cliveden Manor Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. This is the first full assessment for this service. This key question has been rated Good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

People’s needs were assessed, however information detailed in care plans was not always consistent. One person’s initial assessment referred to them by another person’s name and repeatedly misgendered them. Two people’s care plans contained inconsistent information around acquired pressure injuries and when they had occurred, or whether they were still present. Two people’s care plans held inconsistent information around whether the person required support with personal care.

Reviews of people’s needs did not always take place in line with the provider’s “resident of the day” initiative. Reviews of people’s needs did not always clearly show if the reviews had actually taken place. For example, 1 person’s care plan stated their sensory aids had been missing for over 4 years, and consequent reviews did not show whether they wanted sensory aids in place, changes, or escalation to healthcare professionals. One person’s care plan contained inconsistent information regarding whether they had a formal diagnosis of dementia. This meant staff were not always supported by consistent guidance to support people effectively.

A staff member told us, “I was hoping for a basic understanding of the resident’s needs. I was expecting to see 1 page profiles. I found that really hard, I had to ask the residents about their needs. I have been lucky to get to know the residents by spending time with them and from my colleagues.”

However, people’s risk assessments provided a step-by-step overview of identified risks associated with people's conditions and outlined the measures required to reduce those risks. People and their representatives were involved in assessments of their needs. Some people’s falls assessments contained a wealth of information which helped staff to support people from experiencing falls. The provider took action to address the shortfalls we identified regarding people’s care plans.

Staff demonstrated a strong understanding of people’s needs, specialist equipment used to support them, as well as people’s modified diets. Staff communicated people’s changing needs well. Staff told us that handovers were informative. Daily handovers containing up-to-date information regarding people they supported, and service updates were available to staff. This helped staff to understand people's individual needs, recognise when their condition may be changing, and respond appropriately to promote their safety and wellbeing.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Where people were at the increased risk of choking or had swallowing difficulties, appropriate risk assessments had been completed. These assessments identified potential risks associated with people’s medical needs and provided information for staff on signs and symptoms to be aware of, alongside the actions required if concerns were identified. We observed people eating foods modified as required.

People confirmed that staff spoke to them about their care needs and supported them to seek health advice where needed. A person told us, “[Staff] came round to see me this morning as they are worried about my [medical need]. I didn’t ask, they just noticed and came to check.” We observed staff visiting people in the service with the local GP at their request.

Where a person had declined the use of recommended safety equipment, records demonstrated that alternative measures had been considered and implemented to help keep them safe. Risk assessments reflected the person's choice and identified the steps taken to reduce associated risks. Care plans outlined the alternative support arrangements in place, enabling staff to balance people's rights to make decisions about their care with the need to promote their safety and wellbeing. This demonstrated a person-centred approach to risk management that respected individual preferences while ensuring appropriate safeguards were in place.

People who experienced skin breakdown had wound care plans in place to support them to heal, although records did not always hold consistent information regarding when they were acquired, or if they had healed.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

We observed staff supporting people to access local healthcare services within the home. Professionals consistently told us that staff knew people and their needs well. A professional told us, “The service always provide me with information to support my visits. I work well with [staff names] and they are always ready to support people during my visits.”

Another professional told us, “Staff work together to make sure that care needs, risks, medication, and personal preferences are understood before a person moves between services. Examples include effective handovers.” This meant people were supported to experience smooth transfers of care.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

The registered manager completed monthly audits to monitor people who had remained in bed for prolonged periods. These audits reviewed the reasons for extended periods in bed, ensuring there was a clear health-related rationale. The registered manager discussed this with people and their relatives where appropriate, to identify any actions that could be taken to prevent this. During our visits to the service, only 4 people were observed in bed during the day due to their health needs. This oversight helped the provider to identify any potential risks associated with reduced mobility and to ensure people were supported to maintain their independence and wellbeing. People were supported to attend activities where available to promote healthy living, such as exercise classes.

People were supported to access audiology, dental, physiotherapy and other health services within the service. Records evidenced involvement from relevant healthcare professionals, including GPs, where concerns had been identified. A person told us, “I have been for my physiotherapy this morning, and the GP comes round every Thursday.” People told us about activities in the home, regular encouragement from staff to join in to avoid isolation, to support their wellbeing.

A person’s care plan and risk assessment clearly outlined actions required to reduce the risk of falls, such as the use of appropriate equipment, environmental adaptations and staff support. This demonstrated a proactive approach to falls prevention, with identified risks being assessed, monitored and managed to help keep people safe whilst promoting their independence.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

People's skin integrity was regularly monitored and reviewed to ensure any concerns were identified and managed promptly. Risk assessments relating to skin health and pressure damage were in place and provided staff with guidance on the support required to reduce the risk of skin breakdown, although sometimes contained conflicting information. Where people were at risk of developing pressure ulcers, records demonstrated ongoing monitoring and evaluation of their skin condition. Staff used body maps and photographic records to document areas of concern and track the healing process over time. This enabled changes in skin integrity to be monitored effectively and provided evidence of the outcomes of interventions implemented to promote healing and prevent deterioration.

Records evidenced that people’s weights were monitored. Where people had experienced weight loss, records demonstrated appropriate and timely involvement of relevant healthcare professionals, including dietitians. Care plans outlined the actions required to support people to maintain or increase their weight, such as dietary interventions, fortified foods and regular monitoring. Records showed the effectiveness of these interventions, with one person successfully gaining weight following the implementation of the recommended support measures. This demonstrated a proactive approach to managing nutritional risks and supporting positive health outcomes.

However, records did not always contain updated consistent information regarding people's weight and body mass index (BMI). We identified discrepancies between weights recorded in care plans, monitoring records and assessments, which meant it was not always clear which information was the most current and accurate.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

Care records consistently demonstrated that consent documentation had been signed by previous managers on behalf of people. There was no detail included in consent documentation that consent had been sought from people to do this, or from people’s representatives where they lacked capacity.

People’s care records evidenced Mental Capacity Assessments (MCAs) were in place where required. However, records did not always show the provider assessed capacity in line with the principles of the Mental Capacity Act 2005. One record lacked sufficient detail about whether the person was given the opportunity to make decisions at the most appropriate time, in a distraction-free environment, or with any required communication support. While outcomes were recorded, assessments did not always fully evidence how capacity was determined or how individuals were supported to understand, retain, weigh, and communicate relevant information. Another person’s care records showed a mental capacity assessment had been initiated; however, the person did not have a recorded impairment of the mind. We gave feedback to the provider, and they took action to remedy this.

However, some mental capacity assessments were completed in full detail and had been carried out in a way that demonstrated people had been given the opportunity to fully understand information. People confirmed that staff asked them for their consent to provide support with care needs. We observed staff respecting people’s wishes when they declined support. People and their relatives did not express any concerns regarding staff acting without their consent.