Claydon Lodge Care Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement.

This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of legal regulation in relation to governance at the service.
 

This service scored 57 (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 clear vision, strategy and culture which promoted transparency, equality, equity, diversity, inclusion and respect for people's human rights. The provider's mission statement outlined its commitment to delivering outstanding care and support, with a particular focus on meeting the needs of people living with dementia.

Whilst the service had high values and aspirations, these were not fully demonstrated or embedded across all aspects of care provision. For example, the shortfalls identified during this inspection in relation to medicine management and supporting people who displayed agitation and distress.
 

The service benefited from the leadership of a long-standing registered manager who was supported by a deputy manager. The registered manager spoke passionately about the service and demonstrated a commitment to the wellbeing of people living there. They had a good understanding of relevant regulations and described the support available from the provider, who was visible within the service and carried out regular visits to provide oversight and support.

People did not always feel they could speak up and that their voice would be heard.

Whilst the provider had mechanisms in place to encourage people and staff to share feedback, raise concerns and contribute to service improvement, these were not always utilised by people and their relatives. Some told us they felt unable to share their concerns, due to fears of any repercussions and them being treated unfairly if they did speak up.

However, the provider had a complaints policy in place, and where complaints were received, they were investigated by the registered manager.
 

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

The provider promoted equality, diversity and inclusion within the workforce. Policies and procedures were in place to support fair and inclusive employment practices. The provider had processes in place to address any concerns relating to discrimination, bullying or harassment.

Staff were provided with opportunities to speak up through team meetings, regular supervision sessions and staff surveys.
 

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

The provider’s audit systems were not effective in identifying issues found during this inspection, therefore we could not be assured that clear governance processes were in place to evidence suitable management oversight.
 

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement. The service worked with the local community, for example, local schools to drive inclusion

The provider did not always focus on continuous learning, innovation and improvement across the organisation. They did not always actively contribute to safe, effective practice and research.

Whilst there was evidence of learning from incidents, improvements were needed to strengthen quality assurance processes. This would help ensure the service was able to identify concerns promptly and continually improve.

However, the registered manager demonstrated a commitment to learning and improvement.