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

People were protected from risks of harm. The provider prioritised safety. Risks were dealt with willingly as an opportunity to put things right, learn and improve. Incidents and complaints were appropriately investigated and reported. There was a good understanding of safeguarding and how to take appropriate action.

This service scored 47 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us they had opportunities to feedback, and they were invited to attend meetings with the management team and hospitality staff. However, we received mixed feedback, some people told us they did not always feel their feedback was promptly actioned by management. Comments included, “They do ask me what I like and what I don’t like. They tell me, but nothing has changed” and “I’m afraid I’m the one who does speak up whether they like it or not. I’m very outspoken. They have monthly meetings for food and for general. I tell them that I don’t believe they have any intention of taking any notice. Sometimes I just sit in disgust, or I’ll have a tussle. They are very tolerant.” Other people told us how well they thought the management and staff listened to them and learnt from feedback. Comments included, “They treat you as an individual, there’s always someone I can talk to,” “The opportunity is always there. You can always go to the open council meeting and have your say. We get minutes of the meeting so we can query it at a later date” and “Oh yes, I’ve just been reading the minutes of the meeting. [Name of manager] is the manager of the place and she encourages questions. The change over to the different company, there have been moans and groans that it’s not like it used to be but there’s nothing to worry about.” We provided feedback to the manager to further encourage open dialogue with people about their experiences.

Staff felt they were encouraged to reflect on incidents to prevent it happening again with discussions taking place in meetings to further promote learning. A staff member commented, “Our reporting system, is very effective for report running and collating information. The system supports a weekly clinical risk meeting which the care managers hold. They discuss all the recent accidents, incidents within the last week and the patterns that may be forming. This identify what the risks may be and how they can support to avoid them.”

Systems were in place for the manager and provider to monitor risks posed to people. We found incidents forms were completed and routinely analysed to look for trends. There was a clear emphasis on learning from accidents and incidents to prevent harm. The service had introduced the Safety Huddle document. This was a document to be used after serious incidents. It works as a debrief to support the team but also allows quick analysis of the incident and ensures immediate learning and actions are captured to prevent further incidents.

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.

People told us they felt safe living at Cliveden Manor Care Home. Comments included, “I’m safe because I live here,” “Yes, as we seem to be watched all the time. I can tell they’re looking for people, we can’t run away” and “I feel safe, definitely, the door’s locked.” This was supported by what relatives told us. A relative commented, “I am clear about channels of communication regarding (person’s) care, and I have always felt confident that he is safe at Cliveden Manor. They are very quick to inform me about (person’s) falls and to reassure or seek confirmation of their proposed actions.”

Staff confirmed they were trained in safeguarding and were aware of their responsibilities to safeguard people. A staff member commented, “If I witnessed a person being subject to mistreatment, I would report it to my line manager immediately. If I didn’t feel comfortable to report it to them, I would raise it to the Buckinghamshire Safeguarding team. There is a poster/booklet in our staff room informing staff of the safeguarding policy and the contact details if we were to raise anything externally.”

We observed people were supported by staff who understood how to protect people from harm. One person was being closely monitored by staff. This was carried out in a respectful manner.

There were effective systems, processes, and practices to make sure people were protected from abuse and neglect. The management team regularly reviewed safeguarding concerns, these were discussed in daily staff meetings and monthly management meetings. The provider had good oversight of safeguarding concerns.

People told us they knew staff were aware of risks posed to them. For instance, the risk of people falling, “I had a number of falls before I came here, so they always make sure I have what I need” and “My only problem is falling so I don’t have any rugs or sharp edges around. I think it was discussed before I came in but I’m pretty well.” People felt communication about risk could be improved. One person told us “There’s always the risk of fire and they never explained what they’d do even though I’ve asked.” Other people told us they did not think the staff had discussed risk management with them, but generally they knew staff were on hand to support them. One person told us “No, but the carers are on hand if you can’t manage sometimes. There is always someone to help. I’ve fallen over a couple of times and pressed my button and they’ve come quickly.” The manager was made aware of this feedback to act on.

Staff confirmed they had effective systems in place such as handovers and they had access to people’s care records to enable them to be kept up to date on changes in people to minimise risks. A staff member commented, “Detailed risk assessments are completed for anything deemed a risk. We can access these, and we share them with the team so they are aware of anything that they may be exposed too. The care plans are regularly updated with risk assessments and the care team have access to read them, so they are aware.”

We observed staff supported people in safe way. People who were at risk of pressure damage or risk of falling from bed had appropriate equipment in place. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA). We observed some people had restrictions placed on their movement, this was to promote their safety and prevent harm.

People were protected from potential harm. Individual risk assessments were in place to protect people when receiving care and support. Risk assessments were routinely reviewed. We found care plans contained risk assessments regarding falling, pressure damage, malnutrition as examples. Systems were in place to discuss any changes to people’s risk of harm. We found referrals to external healthcare professionals were made in a timely manner. We checked whether the service was working within the principles of the MCA, whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met. We found good systems in place to monitor legal authorisations.

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

We received mixed feedback from people about staffing levels. Everyone we spoke with told us their call bell were being answered, however, some people made reference to long waits. People who provided positive feedback about staffing numbers told us “Absolutely, there are a range of different carers, but they are all very good. Not noticeably different at weekends,” “I think so, occasionally it varies and sometimes I feel there are agency staff here but I’m not sure about that. They do come round to see if you’re alright at night” and “Yes, there’s usually someone around. Adequate at weekends but less of them I would have thought.” People who were less positive told us, “Early morning is a bit tricky. I’ve only called once in the morning, and it took a while,” “Staffing has been a major problem. You do realise you are looking at a care home that has changed ownership in the last year” and “It’s a bit slower at weekends but I make allowance for that.” We have discussed this with the manager to explore further.

Staff confirmed agency staff use had reduced and that staffing levels were sufficient, with the same staffing levels provided at the weekends. Staff commented, “Always enough staff on shift to provide care and if short notice sickness agency staff are provided,” and “I feel our staffing levels are sufficient, we provide very high-quality care, and the staffing levels reflects this.” Staff confirmed they had access to training and on-going support. A staff member commented, “The training provided is outstanding.”

We observed people needs were met by the staff. We observed staff responding to calls bells. We found staff often stopped to acknowledge people as they passed. We observed people living with dementia responded positively to staff when they spoke with them. We found staff were kind and gentle in their approach and were meaningful and respectful with their physical touch on people.

Sufficient staff were provided with the staffing levels flexible and kept under review which enabled them to be responsive to changes in people's needs. The service had additional domestic, catering, administration and activity staff. The catering staff supported with serving the meals and the managers assisted on shift when required. On call support was provided at the weekends. The provider followed safe recruitment processes and staff were suitably supported, trained and skilled in their roles. All staff had access to training considered mandatory by the provider such as moving and handling, safeguarding, dementia, health and safety, infection control and basic life support. Alongside, this staff had training specific to their roles such as training for the registered nurses in taking bloods, tissue viability and emergency first aid. The training matrix showed a high percentage of staff had the required training with further training scheduled to ensure all new staff had the required training.

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.

People told us where possible they were able to self-administer their medicine. People told us staff supported them with taking medicines as required and at time which the medicine was prescribed for. Comments from people included, “I sort of know, because they are what I took before I came here. Yes, they do discuss it, but I know all about them. They come whatever time they are supposed to,” “I don’t know but apparently, I’ve got 12 tablets in the morning. I’m supposed to get them once a day in the morning, which I do” and “I do know, and they discuss them. I get them when I should, and I never run out.”

The staff informed us they received training and their competency had been assessed to handle medicines safely. They told us they felt supported by the management team to carry out their role safely.

The service ensured that medicines and treatments were safe and met people’s needs, capacities, and preferences by enabling them to be involved in planning, including when changes happen.