Clipstone Hall & Lodge

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• 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

During our assessment of this key question, we found concerns around staffing which resulted in a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can find more details of our concerns in the evidence category findings below. There was not always enough trained or competent staff available to support people timely or safely. Staff told us they had reported their concerns the provider and registered manager, but no action had been taken. During the inspection we observed people in unsupervised communal areas and periods of time where people struggled to locate a staff member. People and their relatives were involved in their care planning. Care plans identified risks and provided staff with guidance on how to support people in their chosen way. However, staff told us that due to the staffing levels and the deployment of staff around the home they were not always able to meet people needs safely or timely. We raised this issue with the registered manager who acted immediately to investigate the concerns. Staff understood their duty to protect people from abuse and knew how and when to report any concerns they had to managers. When concerns had been raised, managers reported these promptly to the relevant agencies and worked proactively with them, to make sure timely action was taken to safeguard people from further risk. People told us they felt safe living at the home. Staff were recruited safely. Records showed pre-employment checks and a Disclosure Barring Service (DBS) were undertaken prior to staff starting employment. Disclosure and Barring Service (DBS) checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff were supported by a comprehensive training package and completed the care certificate. Refresher training was offered in-line with requirements or when issues had been identified which ensured staff had ongoing learning and understanding. Monthly risk and accident reports and analysis were completed which highlighted areas of concern and developed processes to ensure lessons were learned and information was shared with staff members. This ensured people were safe as risks from issues being repeated were minimised. For example, where falls had occurred people and staff were supported to understand why and to manage risk with the support of equipment such as sensor mats. There was a complaints policy in place which was fully accessible to people and staff.

People told us they felt safe at the home. Comments received around safety included, "Safe yes, if anything is wrong, they are there, always somebody to care for you." and "I would always raise my concerns with the manager." Relatives told us feedback had been acted upon. For example, issues were raised at a relatives’ meeting about the standard of the upstairs kitchenette and the provider had responded and upgraded the area.

Staff feedback received was mixed. While staff confirmed they were able to raise concerns, some staff felt their concerns were not always acted upon. Staff onsite during the inspection raised concerns about unsafe staffing levels. Staff stated there was not enough staff to meet people’s needs and gave examples of repositioning not being completed on time or safely. Staff stated the downstairs unit had a mix of dementia care and residential care which made it hard to respond to people’s needs in a timely manner. One staff member said, “I raised the issue about staffing, but the stock answer is ‘we are over dependency’ I don’t understand how.” Another staff member said, “[Because of staffing] the care is really poor at times, but we are trying our best.” All staff stated there were regular meetings where lessons learned were shared. Staff knew how to report their concerns and were knowledgeable about safeguarding processes.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

Care plans were person-centred and risks had been assessed and mitigated with clear guidance for staff to support people in their chosen way. Where people had been identified as having additional nutritional or hydration needs these were clearly documented and staff completed food and fluid charts to monitor people’s intake to ensure they remained safe. Where people were identified as at risk of falls there were appropriate risk assessments in place and guidance to support staff with equipment requirements such as sensor mat and hoists. Records showed where staff had identified concerns, they had sought additional support of other medical professionals such as GPs and district nurses. For example, monthly weight monitoring had showed a person at risk of excessive weight loss and a GP had been contacted. Their recommendations had been documented and followed appropriately. Daily and weekly audits were completed to ensure people remained safe, these included checks on daily repositioning requirements. Where gaps had been identified these had been addressed with staff via flash meetings and individual 1-2-1s.

Staff told us they were not always able to meet people’s needs and manage risks safely. We received mixed feedback from staff during the inspection. One staff member said, “I don’t get time to read care plans, I rely on handover meetings for urgent risk updates.” However, another staff member said, “I am able to sit with people, review risks and update their care plans as needed. Management are supportive when changes are needed.” A recent staff survey showed all staff had responded positively when asked if people they cared for were supported to be active and independent in their chosen way.

People were not consistently supported to manage risks and meet their care needs in a safe and supportive way. Most people told us they were included in their care planning and received updates from staff members. Where specific support was needed it was not always clear whose responsibility this was or how often it should be completed. One person told us they required support with physiotherapy exercises daily and said, “I need help daily, but it has been at least 4 days since someone last helped me.” We raised this with the registered manager who responded immediately to ensure the person received the support required.

Risks were not always managed safely. One the inspection, we were able to access areas of the home freely, such as sluice room and storage rooms. This meant that people some of whom were living with dementia had access to chemicals and manual handling equipment that posed a risk to their safety. The home was undergoing renovations, and an unlocked room was found to contain tools and paint which could be freely accessed. We raised this with the registered manager who took immediate action mitigate the risks. This included installing self-locking doors to prevent reoccurrences.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People were not always supported by enough suitable trained and competent staff. We received mixed feedback from people we spoke with. People stated they felt would be supported in an emergency but at times staff were rushed and could not spend time with them. Others commented that some staff “didn't appear bothered” and “wanted to get off”. When asked if staff knew their needs and whether staffing was consistent people commented that, "Have to remind them about my care, two or three times a week.” and “I have a care plan I wonder if they read it or not.” We asked people whether staff were well trained and whether staff were knowledgeable about their condition. One person said, "Some are, some I have to remind them sometimes.” Others stated staff were kind and supportive. One person said, "The girls are lovely and can't do enough for you." People told us that agency staff were good and there was little or no difference in care standards or times between permanent or agency staff. Feedback from the local authority stated on a recent visit they had witnessed a lack of staff in communal areas and on wanting to leave the building had to wait 15 minutes to find a staff member. Their report stated, "Lack of staffing on the unit at our time of exit. 1 carer found in their designated area. We were waiting 15 minutes to no arrival of carer to let us out the unit. Interaction with residents in the dining room required to reduce risk of verbal altercation that was appearing to develop."

During the inspection 11 staff members were spoken with including the registered manager, deputy manager, domestic staff, senior care workers, care staff, administrator, maintenance and company director. Feedback received was mixed. Staff onsite during the inspection raised concerns about unsafe staffing levels. Staff stated there was not enough staff to meet people’s needs and gave examples of repositioning not being completed on time or safely. Staff stated the downstairs unit had a mix of dementia care and residential care which made it hard to respond to people’s needs in a timely way. One staff member described a person being left in bed longer than needed as 2 staff and a hoist was required and these were not always available when needed. All staff stated there were regular meetings where lessons learned were shared. Staff knew how to report their concerns and were knowledgeable about safeguarding processes. Recent staff surveys showed all staff had responded positively when asked if people they cared for were supported to be active and independent in their chosen way. Staff stated that deployment within the home was an issue. For example, the 'gentleman unit' (lodge middle) had 7 residents, of which 2 were high dependency and required 2 staff members for moving and handling and personal care but staff stated there was only ever 1 staff member assigned to this unit. Rotas confirmed this. The registered Manager stated a floating staff member was available. However, staff said this was not timely in locating them and awaiting them to be free to assist. Concerns were raised with management (registered manager and deputy manager) and both stated staffing matched their dependency tools. When issues were raised about communal areas being unsupervised the registered manager agreed to review and implement monitoring. Both stated staff had not raised concerns about staffing levels.

During the inspection there were substantial periods of time where inspectors were unable to locate staff members and people were left unsupervised in communal areas whilst requiring assistance meaning people’s needs were not met safely or effectively. We observed delays in people receiving support during lunchtime. For example, we saw one person struggling to manage their cutlery and food and a staff member advised they would support them ‘shortly’, however after 40 minutes this person had not received any additional assistance and was left alone in the dining room. We reviewed this person’s care plan which advised they required observation and support. This meant this person’s needs were not being met safely.

Systems and processes did not always ensure there were enough competent staff on shift. Risks were assessed but these were not always accurately reflected within the dependency tool. For example, one person was identified as high risk from choking within their care plan. The dependency tools recorded them as low risk. One person who was in receipt of end of life care and received timed checks and repositioning was categorised as medium dependency despite increased checks and needing support of 2 staff members. This meant we could not be sure that people were supported safely. Rota showed that staffing levels did not always meet the dependency tool. The registered manager stated there were 9 staff rostered each day which the dependency tool supported. However, records showed that week commencing 8 Jan 2024 this level was not attained. 8 Jan to 13 Jan 24 there were 8 staff per day and on 14 Jan 24 there were 7 staff. This was raised with the Registered Manager and although no one had come to harm the Registered Manager acknowledged the gaps and advised they would review rotas and the dependency immediately. Recruitment processes were followed and relevant checks were undertaken including references and DBSs. All agency staff received a comprehensive induction into the home and were included in update meetings and training events. Supervision and Appraisals were undertaken in a timely manner.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.