Cliveden Manor Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. This is the first full assessment of the service. This key question has been rated Good. This meant people were safe and protected from avoidable harm.

This service scored 69 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff reported safety events when needed, which were routinely investigated by the management team. Lessons learned were identified and communicated to staff in team meetings, supervisions and handovers. The provider also shared lessons learned from safety events from other services to ensure organisational learning. The provider demonstrated compliance with the duty of candour by being open and transparent when things went wrong and ensured all notifiable incidents were reported as required by regulation. Professional partners consistently confirmed the service contacted them regarding safety events and sought support if needed.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People shared positive feedback about moving into the service. A person told us they “settled in quickly” to their new home. Another person told us, “I came here for respite, and then I came back to stay permanently. I chose my room and now I have the best one in the house.”

The provider worked with professionals who visited the home to ensure people could access healthcare services. A professional told us, “Any therapy notes are put onto their electronic system and made available to all carers. Any recommendations I have that I need care staff to support me with are put into an email to the senior care team and handed over at their team meetings.” They also told us, “I receive referrals via email from the staff team in a timely fashion. Sometimes if a new person is arriving and staff are aware they would like therapy input I contact them or their relatives before they arrive.” This ensured people experienced safe, consistent, transfers of care aligned with their needs.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People were supported by trained staff who understood their safeguarding responsibilities. The provider worked closely with professional partners to report and investigate safeguarding concerns. People and their relatives told us they felt safe in the service. The management team provided an overview of the processes followed to ensure compliance with regulatory requirements. This included the use of a checklist to review referrals, which was signed and documented, and confirmation that relevant authorities had been notified, and duty of candour followed where required.

The provider had a safeguarding policy which was discussed throughout staff and management meetings, ensuring lessons learned and recommendations put in place were widely shared. Staff told us they would report safeguarding concerns to members of the management team to ensure appropriate action was taken and referrals made where required. Staff were also aware of alternative reporting routes if they felt unable to raise concerns internally. They described using the organisation's whistleblowing procedures and were able to identify senior leaders they could contact to escalate concerns further. Staff also understood they could raise concerns with external agencies, including the Care Quality Commission (CQC), if necessary. A person told us, “I feel safe. You won’t find anything wrong here.”

Where required, the service applied the principles of the Mental Capacity Act 2005 and supported people subject to Deprivation of Liberty Safeguards (DoLS). This meant people were kept safe from the risk of abuse or avoidable harm.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People were supported by staff to move safely around the service in a way that minimised risks to their health, safety and wellbeing. Staff demonstrated appropriate skills and competence when assisting people with transfers, using safe moving and handling techniques. This included the use of specialist equipment, such as hoists, to support people to transfer safely between beds, wheelchairs and other seating. One relative told us, “I trust the staff explicitly with my [relative], their mobility isn’t good. [Name requires assistance from 2 staff. There are always 2 staff assisting whenever I have observed transfers, and they are very gentle.”

People were supported to take positive risks in a way that promoted their independence, choice and dignity while maintaining their safety. For example, 1 person required a modified diet due to risks associated with choking. Staff supported the person to make choices about their meals and how they ate, whilst following appropriate risk management measures to minimise the risk of harm and ensure their wellbeing. Where people chose to smoke, appropriate measures had been implemented to enable them to do so as safely as possible. For example, people were supported to use fire-retardant smoking aprons.

People told us what measures had been put in place to ensure people remained hydrated and cool in the heat, and staff had encouraged them to drink fluids regularly. This meant people were supported to understand risks to themselves.

Risk assessments were in place and had been reviewed; however, these were not always updated in line with the provider's expected review schedule. Some assessments did not consistently contain sufficient detail or reflect people's current needs and risks. However, staff demonstrated a good understanding of people's individual support needs. We gave feedback to the provider, and they took action to remedy this.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

Oxygen canisters were stored outside in direct sunlight, next to combustible materials, increasing the risk of a fire. People’s Personal Emergency Evacuation Plans (PEEPs) contained conflicting information about how they should be evacuated or when. We gave feedback to the provider, and they took action to resolve this.

Water flushing was not always consistently recorded on a weekly basis as required. Water temperature checks had exceeded the recommended temperature of 41 degrees in 2 people’s rooms, and 1 where the water temperature was very low in a person’s shower. Records did not contain any follow up actions taken however; we did not identify any impact to people.

The environment presented as clean, tidy, and free from malodours. The service was well maintained and met people’s needs. The provider carried our regular checks of people’s assistive equipment, as well as fire, and electric checks. The provider had begun a refurbishment programme within the home as they noted that some of the décor had needed work. Design schemes were available for people to consult and provide feedback. People told us, “It’s a lovely environment” and, “The garden area is lovely with all the new furniture.”

Staff had received fire safety training on a regular basis as the provider had identified this was an area where staff’s confidence needed to be improved.

Appropriate dementia-friendly signage was available throughout the service, meaning people were supported to navigate their way round their environment.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked well together to provide safe care that met people’s individual needs.

Robust recruitment systems were in place, with all required checks including Disclosure and Barring Service (DBS) checks and references in place. All staff received supervision with their heads of department, as well as appraisals by management team. Competency assessments for staff were completed by senior members of the team, including those with nursing qualifications.

Staff rotas contained a mixture of skills required to care for people in the home. Staff told us there had been some vacancies; however, these had been recently filled, and levels were starting to improve.

We observed staff receiving face-to-face training in falls prevention and moving and handling on the day of inspection. Staff’s training compliance was continuously monitored, with levels of compliance with training consistently at 97%. People told us staff were well trained to carry out their roles. A person told us, “Training is done exceptionally well, it is carried out in house. [The provider] take staff training seriously.” Another person told us, “[Staff] are always doing training days.” This meant people were kept safe and supported by staff who were confident in their roles.

Staff provided mixed feedback regarding staffing levels. Several staff told us they felt people's needs had increased over time and that staffing levels did not always reflect the dependency of people living at the service. Staff explained that some people were assessed as being relatively independent prior to admission; however, upon moving into the service, their support needs were sometimes greater than anticipated. Staff told us this could make it challenging to meet people's needs in a timely way. We did not observe people waiting for assistance or care during our visits, meaning they were working well to provide support.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff followed infection prevention and control (IPC) policy and procedures, wore Personal Protective Equipment (PPE) when needed and disposed of it appropriately, ensuring they did not wear it in communal areas. IPC audits had identified hand hygiene as an area for improvement. The provider responded proactively by delivering additional hand hygiene training and making relevant guidance accessible to staff. Staff used a "Glitterbug" training solution during practical sessions to assess the effectiveness of their handwashing technique under ultraviolet (UV light.) This helped staff to recognise areas requiring greater attention and supported the provider's efforts to improve infection prevention and control practice.

There had been no outbreaks of infection or viruses within the home. People’s apartments and rooms were clean, tidy and free of malodours. We observed staff cleaning and completing checks of the service where necessary. This meant people were protected from the increased risk of harm from infections.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

Daily records showed that people did not always receive prescribed medicines, and actions taken in response were not consistently documented. For example, records did not clearly show whether missed medicines had been escalated to senior leaders or healthcare services. We did not identify any impact to people.

Care plans did not always contain accurate and up-to-date information about prescribed medicines. For example, daily notes showed that 2 people’s medicines had changed in recent months, but their care plans had not been updated. One person prescribed anticoagulants did not have a specific care plan in place, while another person’s anticoagulant care plan referred to 2 medicines when only 1 was prescribed. This increased the risk of harm as staff could be confused by conflicting information. We gave feedback to the provider, and they took action to rectify this.

However, we observed people being supported to take their medicines appropriately. Risk assessments were in place for people who chose to administer their own medicines without support from staff on site. Medicines were stored safely and temperature controls and checks were in place. Staff had identified errors in stock control and had carried out appropriate investigation to assure that people had not been put at the increased risk of harm.

Staff highlighted improvements to medicines management systems. They told us a recently introduced electronic medicines system had improved organisation, record-keeping and escalation processes. One staff member said, “The new system for medicines is working really well. It's better with escalating things, and we don't have to wait too long to get prescriptions back. It's very organised with files and structure.”