Clifton Gardens Resource Centre

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 did not always live in a safe or well-maintained environment. Risks to people's safety and wellbeing had not always been assessed, planned for or mitigated. Not enough suitably trained staff were deployed to meet people's needs and keep them safe. Medicines were not always well-managed. Some of the practices did not ensure good infection prevention or control. We have identified breaches in relation to safe care and treatment, premise and equipment and staffing. Systems to monitor and respond to accidents, incidents and complaints were not always followed. This meant people sometimes had negative outcomes when they raised concerns. There were systems designed to safeguard people from abuse and these were effectively operated.

This service scored 44 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The staff told us they were involved in discussions around lessons learnt and how to improve the service following any incidents and complaints. They said this had improved in recent months and they felt able to speak up and work together to resolve issues.

People and their relatives did not always feel safe when raising concerns. A relative told us they had raised a concern when the provider had failed to meet the needs of a person. They said the response they had received was dismissive and did not show the concerns had been taken seriously.

We saw one person had raised two concerns during a review of their care. Records showed their concerns had not been fully resolved or responded to. We spoke with the person who confirmed they did not feel the issues had been resolved to their satisfaction. The provider had systems for investigating complaints and other adverse events. We saw the records of some investigations and how the issues had been resolved. There was also evidence of discussions during staff meetings to share learning. The provider had taken steps to make changes to the service because of incidents. For example, they had improved building security and monitoring of people's wellbeing and whereabouts following a missing persons incident.

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 using the service and their relatives told us they felt safe. They knew who to speak with if they had concerns about safety or potential abuse.

Staff told us they had undertaken training in safeguarding. Records viewed at the inspection visit showed some staff had not undertaken refresher courses in safeguarding for several years. Following our visit to the service, the provider sent us a record which showed staff had completed recent training regarding safeguarding. Staff were generally able to explain how to recognise and report abuse, although some staff did not understand about whistleblowing or when they needed to speak up about poor practice. We discussed this with the registered manager who agreed to raise this in a team meeting to make sure the staff could refresh their knowledge and learn together.

There were systems for safeguarding people from the risk of abuse and these were effectively operated. The staff and registered manager had worked with the local safeguarding teams to investigate and respond to allegations of abuse. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. 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 (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS) We found the service was working within the principles of the MCA and if needed, appropriate legal authorisations were in place to deprive a person of their liberty.

The staff were not always able to describe how they managed risks for individual people. There was a lack of guidance for staff. This meant people were at risk of unsafe or inappropriate care.

People were not always kept safe because risks to their personal safety, and within the home environment, had not always been assessed, monitored, or met.

The risks to people's safety and well-being had not always been assessed or planned for. Information within care files was inconsistent. For example, the records for some people recorded they had high risk healthcare conditions, were prescribed high risk medicines or were at risk of weight loss, falling or injury. The assessments of these risks were not personalised and included information which was not always relevant to the person. Furthermore, the plans to mitigate risks were basic and did not give enough guidance to help make sure staff kept people safe. There were no risk management plans for some people who were known to express themselves through agitation or aggression. The incidents of this had not been fully recorded within people's care files so the staff could learn how to best support people. The staff had created plans to be followed in the event of an emergency evacuation. However, these plans had not been kept in an accessible place to share with emergency services or for staff to easily access during an emergency event. We told the management team we were concerned about this. The provider took action and rectified this on the day of our visit. Failure to assess, monitor and mitigate risks was a breach of Regulation 12 (safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The staff had not made sure cleaning products, chemicals, and other high-risk items, including dishwasher tablets, were secured. These were left in unlocked cupboards within the areas accessed by people living at the service. Some of these items were not properly labelled and therefore presented a further risk.

Staff explained that problems with the building resulted in poor outcomes for people and sometimes led to additional risks. For example, staff explained they had to carry bowls of hot water to people's bedrooms to support them to have a wash. The staff also told us people did not want to be restricted to one floor without access to the garden. We discussed some of the building issues with the management team. The registered manager told us they were in the process of addressing some of the concerns with hot water, décor and furniture. They told us they had purchased a new smart television which was due to be installed in the first-floor lounge.

The provider had not developed risk assessments in relation to the problems with the building. Failure to ensure the premises and equipment were clean, secure, suitable for the purpose and properly maintained was a breach of Regulation 15 (premise and equipment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following our inspection visit the provider took action to rectify some of the concerns we identified and make further improvements to the environment.

The building was not always well maintained or thoroughly cleaned. Reusable adhesive putty had been left on walls after displays had been taken down. Some curtains were coming away from their rails. There was rubbish left in the gardens and car park. Only one shower room was accessible for people with walking frames or mobility needs. Staff and people using the service told us there was there was no hot water in this shower meaning it could not be used. A bathroom on the ground floor had an accessible bath. A roof garden was not safe to use as the safety rail was not tall enough. The steps to and tiles on the roof garden were covered in moss which was not safe to walk on. The registered manager told us this area had been locked to help mitigate risks. Some of the soap and paper towel dispensers were broken, as were some kitchen areas within the units, with broken cupboard doors and drawers. The lift, which started working during our visit, had not been working for several weeks. Some of the woodwork and tiles in bathrooms and toilets were damaged. There were also limescale marks within sinks and baths. The registered manager sent us evidence of some repairs which had taken place following our inspection site visit. They also explained there was a programme of renovation and redecoration.

People's needs were not always met because they did not live in a safe and well-maintained environment. The hot water supply was not working in parts of the building. People using the service and staff told us some people had not always had showers when they wanted because of the issues with the hot water The lift had not worked for several weeks, and this had prevented some people from moving around the building safely. Some people could not access the garden and told us they wanted to. The sluice had broken, and this meant there were not proper facilities to wash and sanitise some equipment. Most people's rooms did not have en-suite facilities. Most people had commodes in their bedrooms. We saw these had not always been appropriately kept and there were instances where commodes were left without covers next to people who were eating or relaxing in their rooms.

People's needs were not always being met because staff were not deployed in way which provided person-centred care. People gave mixed feedback on whether they felt there were enough staff. One visiting relative told us, ''I think they could probably do with a few more staff.'' Other people told us staff came when they called for help or needed them. Their comments included, ''When I fell over they came quickly'', ''If they are short of staff they use agency'' and ''They come quickly if you call them.''

The staff told us there were times when there was not enough staff to meet people’s needs. For example, when people needed support with personal care. The staff also told us they also needed to complete some non-customer facing tasks, such as washing up, which took time away from the people who they were caring for. Staff told us the training they had undertaken was useful, although they had not had training to help them understand about specific needs including dementia and people who could become verbally or physically challenging.

We observed there were times of the day when staff were very busy, and it was hard for them to deliver timely care. For example, during and shortly after lunch, people did not always get support or care when they requested or needed this. We saw that whilst staff were present in communal areas at other times, they were not always well deployed. For example, there were long periods of time when no one was engaging with people using the service. This was because the staff were attending to other tasks.

The registered manager showed us a tool they used to help establish staffing levels. This indicated there were not enough staff to safely meet people's needs. For example, 11 people were recorded as requiring 2 members of staff for support and a further 23 people required the support of 1 member of staff. Eight members of staff were employed to offer support during the day and 3 at night. These staffing levels meant that people sometimes had to wait for care, particularly during busy times of the day when they were getting up, around mealtimes and going to bed. There was also a risk people would not receive safe care and support at night because there were not enough staff to meet their needs. The registered manager told us the management team were available to support staff when needed. The record of staff training indicated some staff had not undertaken enough training to ensure they had the skills and competencies needed to provide effective care. For example, less than half the staff had undertaken training in emergency first aid, falls prevention, dignity and respect, dementia care, learning disabilities, personal care and oral health care. Failure to ensure sufficient numbers of suitably qualified staff were deployed was a breach of Regulation 18 (staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Most people told us they thought the environment was clean. Their comments included, ''It always looks clean'' and ''They are always cleaning.'' Although a relative raised a concern that there were sometimes unpleasant odours. People did not always live in a clean and hygienic environment. Commodes in bedrooms were not always covered, the bathrooms and kitchen areas were not always well cleaned. There was rubbish left in communal gardens and the car park.

Staff told us they needed to hand wash crockery, cutlery and serving dishes after each meal because there was no dishwashing equipment. This increased the risks of contamination. The registered manager told us all units had dishwashers. However, staff were using a spare kitchen without a dishwasher when some parts of the building were not accessible due to ongoing problems with a lift. Following our visit, the registered manager advised us they now had purchased an additional dishwasher for the spare kitchen.

Some of the bathrooms and toilets had limescale stains, damaged woodwork and tiles. This meant these areas could not be sufficiently cleaned. Work surfaces, cupboards, and splash back areas in some of the kitchens were damaged and there was trapped dirt. The food stored in the kitchens in units was not always sufficiently labelled or packaged in a way to monitor and prevent infections. Staff washed their hands before serving food but did not always offer people using the service the opportunity to do this. We observed incidents where some people sneezed and coughed. Staff did not offer them tissues or opportunities to wash their hands after this. One person sneezed at the dining table and did not cover their face. The staff did not clean the area or cutlery where people were sitting at the table laid and ready for lunch. The registered manager sent us photographs to show improvements were made to the toilets and bathrooms following our inspection visit.

The disinfecting machine in one sluice was broken at the time of our visit. There was no dishwasher in one unit and care staff needed to hand wash cutlery and crockery in the sink in this unit. People did not always have access to hot showers and baths because of problems with the water supply. This increased the risk of health acquired infections and skin infections. Failure to assess the risk of, prevent and control the spread of infections was a breach of Regulation 12 (safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People did not always experience the right care and support with medicines because information about their needs had not been clearly assessed, planned for or reviewed. Medicines care plans were generic and did not have the necessary information to support people with their health needs and prescribed medicines. People told us the staff gave them medicines on time. Relatives explained they were informed about changes in people's medicines. The GP carried out regular reviews of people's medicines. Medicines were administered at the right time and staff kept accurate records of this.

Staff told us they needed clearer details on how to administer medicated creams. There was not enough information about how and where these should be administered from the doctor or within care plans. Staff undertook training to understand how to safely manage medicines. There was a system for assessing staff competencies and skills in handling medicines.

Medicines were stored securely, but not safely. Fridge temperatures were not monitored. This meant medicines stored in the fridge were at risk of being stored at the wrong temperature. This could impact their effectiveness. Although waste medicines were secured within a locked room and records were kept, they were not kept in a tamper-proof container. The staff carried out audits of medicines management. However, these had failed to identify when there were problems. People were prescribed medicines for pain relief, rescue medicines for seizures, and medicines for constipation to be taken on a when required (PRN) basis. Guidance in the form of PRN protocols were in place to help staff give these medicines consistently. The medicines administration recording system was fit for purpose and stocks of prescribed medicines were managed appropriately. The staff recorded the date of opening for liquid medicines. Failure to ensure the safe and proper management of medicines was a breach of Regulation 12 (safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.