- Care home
Cliveden Manor Care Home
This care home is run by two companies: Willowbrook Healthcare Limited and WR Operations 1 Limited. These two companies have a dual registration and are jointly responsible for the services at the home.
Report from 21 May 2024 assessment
Contents
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
Cliveden Manor Care Home was led by an experienced manager who had made positive changes to the service since their appointment. They were aware of their responsibilities as a manager, and they had developed the staff team to carry out their roles effectively to benefit people. Systems were in place and being developed further to get feedback on the care provided with good governance established to enable them to continuously assess and monitor the quality of the care provided.
This service scored 21 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.
We did not look at Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.
Capable, compassionate and inclusive leaders
Staff were complimentary of the changes brought to the service by the manager. They described the manager as open, with a positive approach and interacted with people using the service. Staff commented, “I feel things have improved, with staff morale and staffing levels better,” “The managers door is always open. They listen and show respect to carers with teamwork promoted,” and “I personally feel that [manager’s name] has supported me a lot within my role, I feel comfortable to be open and honest with them and any issues I report are addressed efficiently. The manager will always say that her door is open, and they have supported all the heads of departments that are new in post with learning the ropes and enabling them to succeed within their role.”
Systems were in place to promote effective communication with the team. A range of meetings took place across all disciplines of staff. The minutes of the meetings were comprehensive and showed staff were updated on changes within the service, including recruitment and training. New policies and procedures were discussed, and safeguarding and whistleblowing was a standing agenda item in meetings. Any actions from the meetings were delegated to named staff and actions were reviewed at the next meeting. Systems were in place to enable staff to provide feedback to improve care to people. A suggestion box was in use. Suggestions were reviewed at team meetings and actions agreed with explanations provided as to why a suggestion was not implemented. This promoted an inclusive management style which led to improvements within the service which benefited people.
Freedom to speak up
We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.
Workforce equality, diversity and inclusion
We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.
Governance, management and sustainability
Staff were aware of the auditing systems in place, which included the need for them to complete the relevant documentation in relation to the care provided, including any accidents, incidents. This enabled the provider to audit the quality of care provided. Staff told us senior managers of the organisation visited the service to observe practices and review systems to assure themselves of the quality of the care provided.
Systems were in place to promote good governance. A series of regular audits of practice took place. These included audits of medicines, health and safety, infection control, moving and handling, care practices observations, learning and development and resident, relative and staff wellbeing. Alongside this the manager and provider carried out home audits to enable them to assess the quality of care. Action plans were in place to address any shortfalls in audits. These were kept under review and signed off when completed, which promoted good quality sustainable care, treatment, and support to people.
Partnerships and communities
We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.
Learning, improvement and innovation
We did not look at Learning, improvement and innovation during this assessment. The score for this quality statement is based on the previous rating for Well-led.