Clifton View Care Home

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• 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

We have identified breaches in relation to governance. The governance, management and accountability arrangements required improvement in the service to be fully effective in identifying the shortfalls found during our site visit. Information and audits were not always used effectively to monitor and improve the quality of care. Staff understood their role and responsibilities. Managers accounted for the actions, behaviours, and performance of staff. Data or notifications were consistently submitted to external organisations as required. There were robust arrangements for the availability, integrity and confidentiality of data, records, and data management systems. The registered manager and deputy manager had a positive working relationship, which they worked hard to embed across the staff team. Our observations of their interactions with people, relatives and staff during the site visit indicated they were dedicated to improvement. We have asked the provider for an action plan in response to our concerns.

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.

There was a service improvement plan in place to track developments and ensure the required measures were taken to maintain the service to a high quality, safe standard. The nominated individual, registered manager, deputy manager and staff team all had responsibility for ensuring these actions were completed. We found that some of the identified actions in this plan had not been implemented in the required timescales. For example, the infection prevention and control measures, call bell and sensor maintenance and environmental shortfalls identified at our site visit.

The service had a clear business policy stating, “The pursuit of quality is continuous, and it is the commitment of Clifton View Care Home to utilise their quality management systems to identify any shortfalls or inefficiencies in their operating procedures and to take the necessary corrective action to achieving continuous improvement.” We found however, that the service had fallen short of their stated business objectives in some areas of our assessment.

The registered manager was absent at the time of our assessment site visit, which was facilitated by the deputy manager and nominated individual. The registered manager was responsive to concerns raised following our site visits. The nominated individual and providers had given their full commitment to investing in the service, acknowledging previous shortfalls found and ensuring a robust approach to improvements. Concerns which had been raised by staff were investigated by the registered manager and nominated individual. Assurances were provided that the service had an open and transparent culture.

Acknowledging previous shortfalls in the quality of care provided; the nominated individual had worked hard to ensure they now had robust systems in place to deliver a positive experience, and good quality of life for people. The service had plans in place to improve the living environment for people and ensure people’s care was safe and effective. The nominated individual had a service improvement plan in place, with allocated tasks and regular auditing being completed by the management team to assess progress.

Some staff gave feedback they had not felt listened to by the registered manager and the nominated individual when they had previously raised concerns around staffing levels, call bells and sensors. One staff member told us, “I understand sometimes we need to wait for repairs, but sometimes things need to be prioritised. People are at a really high risk of falls.” We raised our concerns regarding feedback around some staff feeling unheard when they shared concerns, with the nominated individual to investigate following our visit. They conducted a robust investigation, and provided assurance that they would continue to work closely with the registered manager and staff team to address the concerns raised.

The complaints process in the service was clear and was displayed in the main entrance. One relative told us, “I would speak to them if there was anything worrying me. They do all seem to get on together, I have never seen anything that concerned me, they work hard.” We saw the registered manager had reviewed and analysed themes and trends of the complaints or concerns received. The registered manager could demonstrate how they would prevent similar issues from happening again, as they learned lessons from previous outcomes. However, there was not a positive culture to promote speaking up, to encourage staff to raise issues.

The registered manager and deputy manager actively encouraged workforce participation and engagement. We saw there were regular staff meetings, handovers, and celebrations of ‘staff of the month.’ The registered manager and nominated individual acknowledged the concerns raised by staff who had not felt listened to. The registered manager gave feedback around the positive culture they worked hard to create and embed within the service. There were multiple avenues available for staff to raise concerns with the management team or externally, either formally or anonymously. We were assured by their response.

The provider showed a good knowledge and understanding of workforce equality, diversity, and inclusion within their recruitment process. All staff had completed training in equality and diversity and understood the importance of respecting differences and ensuring an inclusive workplace.

The service had a business continuity plan and good quality emergency plans in place. The nominated individual and providers explained how they were committed to investment in the service and staff cohort to ensure future service development.

The registered manager had not ensured the governance systems and processes in place were fully effective to identify the shortfalls found during our assessment. The lack of robust oversight of maintenance and the environment had left people exposed to the risk of harm. There was accident, incident and falls analysis in place which had not been robustly utilised to identify themes and trends to inform them of how to improve support and safety for people. Oversight of the staffing rotas and dependency needs had not identified the shortfalls in staff numbers. Concerns raised by staff had not been listened to in relation to staffing and their concerns about the risk this posed to people. There were irregular audits taking place of people’s care plans which meant the management team had no effective oversight. Therefore, people were placed at risk of having unmet needs. Medicines management audits had not identified the areas which required improving to ensure people received their medicines in a safe way. The registered manager and deputy manager showed evidence of lessons learned and improvements being implemented as a result of incidents that had occurred. The registered manager had ensured they reported notifiable incidents to the CQC as required by law.

People and their relatives felt involved in the service and able to share their views. One relative told us, “I have good communication with the management and would not hesitate to speak to them if there was a problem.” Another relative told us, “It’s very much an open-door place, the office is by the door so any concerns we can speak to them.” Another relative gave positive feedback about the culture of the service. They told us, “There seems to be a good professional relationship between staff and management.”

The nominated individual and deputy manager told us they were confident in asking for support from external agencies, such as the local authority and external health teams, where it had been needed.

We requested feedback from partners but received no feedback about Clifton View Care Home. We received no information to indicate any concerns.

There was evidence of effective partnership working at the service. There were systems in place to ensure professional input was sourced in a timely manner to improve outcomes for people. People who were at high risk of falls had referrals made on their behalf to support risk mitigation. External health team information regarding diabetes and nutrition support management was included in people’s care plans, ensuring their needs were effectively met. Contact with relatives was recorded. Incident records, such as falls records, included information about whether relatives had been contacted about the incident and any subsequent actions taken. It was clear the registered manager was following the duty of candour.

Staff gave examples where they felt the training provided for them could be improved. One staff member told us, “Our manual handling training was online, it’s interesting but I like to talk and learn from other people and their experiences. It also means some staff are not sure how to use slings correctly after training. This puts pressure on other staff.” Another member of staff gave similar feedback in regard to training quality, they told us, “The training is quite bad, it has swapped from face to face to online. I don’t think it sticks in your head; how can you do first aid online? For example, with new staff, we observed a new carer during their first few shifts trying to move a resident from their bed to a chair without a hoist, luckily another staff member saw this and intervened, but it’s not good.” Another staff member raised concerns around training and told us, “When new staff come in, they don’t know how to use the sensors, this is ongoing. I feel the induction is not adequate. Some staff still don’t know for weeks how to use the hoist even when working with us on the floor. And sensors are so important for the safety of the residents.” We discussed the concerns raised by staff regarding manual handling training with the deputy manager, who advised us they now carried out practical sessions with staff, which allowed them to experience being hoisted. They told us they also used an eye covering to embed the learning for staff around sensory loss and the hoisting experience. We were assured by their response.

The service had failed to implement a consistent approach to measure outcomes or monitor the impact and quality of care for people. The lack of effective systems to monitor equipment, risks and mitigate associated health and safety requirements had placed people at risk of harm. One staff member told us, “We’ve had a decrease in falls over last 6 months, with a new sensor system being rolled out. All relevant capacity decisions are in place for this. This system was in the process of being put into place, but the last CQC inspection kickstarted it.” The nominated individual responded to the shortfalls we identified at our site visit and confirmed that all call bells and sensors had been checked and replaced where required. This ensured that people were protected from the risk of harm, and staff could respond to people in a timely manner. Satisfaction surveys were completed and an action plan created by the provider, based on feedback from people. Resident meetings were held monthly to gather feedback from people. We will assess the effectiveness of the implementation of the responses from the service at any subsequent assessment visits.