Blatchington Manor

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 safe at Blatchington Manor, and relative feedback reflected this. Some minor areas of improvement were required, especially around incident and accident analysis, and deployment of staff throughout the service. Although the management team had oversight of accidents and incidents, regular monthly checks to identify patterns and trends were inconsistent. Staff levels needed review to ensure they were always sufficient throughout the day. The management team were receptive to this feedback and began to review processes straight away. Staff demonstrated a good knowledge of safeguarding and how to recognise and report any concerns they had. People and relatives told us they felt safe at the home and would not hesitate in raising any issues they may have. Risks to people had been assessed and measures put in place to minimise these. Staff knew people well and how best to support them to keep them safe. There was a positive culture of learning within the home and regular handovers and meetings allowed any changes to people’s needs to be shared.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their relatives told us they felt safe at Blatchington Manor. One person explained that they had a mat near their bed that let staff know if they were up and needed help, they said, "I feel safe with that." Relatives told us action was taken when incidents occur. One told us, “There have been falls and incidents, they always tell us about them but it’s not always clear how they can prevent it happening, but I know they do try. [Person] now has a mat that alarms and staff can respond, I know to keep them active they have to balance the risk, we accept that as long as [person] has a bit of a life.”

Staff were supported to learn lessons when things went wrong. For example, a pattern of medicine errors was identified, so staff had further training and additional competency checks to minimise future risks. Staff spoke positively of being able to raise concerns with management. One told us, “We do not de-brief as such after a fall or other incident, but we do get informed of changes either in care or environment, I think we are on the ball here, we try but we can’t stop people moving about or restrict them as that’s worse. We try to prevent or minimise risk by using floor level beds and sensor mats.” Another staff member said, “We’re now more proactive in looking for prevention, we dip people’s urine and take their temperature to rule out infections and if we need to, we can ring GP surgery and get antibiotics”.

Processes were in place to ensure lessons were learnt following incidents however some improvement was needed to ensure these were robust and effective. Staff were aware of changes made to the people’s care based on lessons learnt and told us these were discussed, usually at hand over or staff meetings. Some staff felt communication could be improved because if they have been off, they don’t get enough time to read care plans and risk assessments. The management team told us they analysed incidents, accidents and complaints to identify any common themes, patterns and lessons learnt. However, we did not see any overarching monthly audit or overview of this at the time of the assessment visit. These have since been produced by the management team. The management team had identified that there had been an increase in people being diagnosed with sepsis, and from that information, have developed an audit to monitor and use to mitigate risk to people. For example, in June 2024, there had been 6 people diagnosed with chest infections and 5 people with a urine infection. The outcome of the audit was to monitor and document fluid intake, ensure people had increased personal care and for those that had a chest infection, that they were sitting up in good position with a good air flow, and at night the nursing profile bed heads were raised.

People were supported to safely access systems and transition between services as needed. Relatives spoke positively about the process leading to their loved one’s admission and of access to services once they were living at the home. One relative told us, “There was lots of liaison before [person] moved in and a full assessment was done. We chose the home because it’s in a lovely position and we were made to feel very welcome. Staff came to see [person] and asked us lots of questions, I think to ensure they could look after them.” Another relative said, “We filled in a questionnaire about [person’s] health and social needs, it was very professional. We were told ‘they can see a GP, Nurse, Chiropodist and Hairdresser.’ I know that they arrange appointments and ensure they attend them. We are informed and consulted about health appointments, it’s all very good here.”

Staff and leaders demonstrated good knowledge of referring to external professionals when needed. Referrals to the multidisciplinary team had been requested via the GP, these included requests for support from Speech and Language therapists (SALT), the community nurses and the community mental health team. The management team advised that all people were assessed before admission to ensure their needs could be safely met. They met people face to face with their relatives if needed to ensure a robust assessment. Staff told us how they were supported by the community nursing teams to provide good wound care and followed instructions to aid healing. They also explained how they worked closely with physiotherapists and occupational therapists to prevent risk of people falling. We saw evidence of one person being transferred to another service and there was a transfer of care documented completed to ensure good continuity of care.

Visiting professionals spoke of a positive relationship with the home and we saw that community nurses were informed of all new admissions and a GP visit arranged as soon as possible. One professional told us, “It’s a solid home, when people get poorly, they liaise with us to ensure it’s a good decision to move on.” Another added, “We have a good relationship with the team, and they make sure appointments are attended. We support with blood tests and any wounds that need looking at. Staff are now doing urine tests and contacting us early if people have a urine infection, they do oxygen levels and temperatures if someone is unwell, it really helps us.”

Processes were in place to ensure robust assessments of people’s needs took place before they moved into the home or returned from hospital to ensure their care needs could be met. This included ensuring the room the person was due to move into or return to remained suitable. People's care records and feedback from health professionals showed referrals were made to healthcare professionals where concerns had been identified. For example, where there were concerns about a person’s dietary intake or mental health, referrals had been made to appropriate professionals. Records showed staff followed any recommendations made. The management and staff team worked to ensure continuity of care, including when people moved out of the service and on to new placements. When people were supported to go to hospital, either through routine and planned admission, emergency admission or consultation day visits, an ‘emergency pack’ on their computerised care plan would be generated to accompany them. The emergency pack contains all important information to assist hospital/care staff important information about them, communication needs and their health when they go to hospital or to a different care home.

People and their relatives told us that Blatchington Manor was safe. One person said, "I feel safe here, I don’t have to worry about anything.” Relative comments included, “[Person] is absolutely safe, I’m completely confident in that,” and, “I have no worries, all staff are kind and if I was worried, I would speak to the person in charge straight away.”

Staff were aware of the signs of abuse and how to report safeguarding concerns. Staff confirmed that they had read the policies as part of their induction and refreshed at subsequent safeguarding training. They were confident the management team would address any concerns regarding people’s safety and well-being and make the required referrals to the local authority. Staff had a good knowledge of whistleblowing procedures and would use them if they felt their concerns had been ignored. One staff member said, “I would report it to management. We do have procedures and I would contact the local authority if I thought it hadn’t been reported.” Another staff member told us, “We do training every year, and we get regular updates.”

People were supported by staff who knew them well. We saw staff supporting people with kindness, respect and following good practice guidance when assisting them. Staff were mindful of people’s characteristics and promoted their dignity. People were observed to approach staff for assistance and staff responded appropriately to ensure safety. For example, we observed one person becoming distressed, a staff member talked calmly to them and acknowledged that the person was feeling not right and wanted to go home. Distraction techniques were effective such as, talking about things on the table and looking to pick up some colouring.

Safeguarding policies and procedures were in place and readily available for staff, this included a whistleblowing policy. Staff confirmed they had read the policies as part of their induction and training. We saw that procedures had been correctly followed, and the provider had made referrals as required to the local authority and notified CQC appropriately. 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 Act 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 MCA. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). Staff received training in the principles of the MCA and understood their role and responsibility in upholding those principles. The manager kept an overview of all DoLS, applications and those that are completed, pending and those that were refused. People were asked for their consent and were involved in day-to-day choices and decisions. Some minor improvements were required to the documenting of people’s fluctuating capacity especially at certain times in the day. This was reported to management who were receptive to the feedback and started making updates to care plans.

People were seen to be comfortable at Blatchington Manor. Relatives shared their views on the management of risks for their loved ones. One relative told us, “[Person] is at risk of pressure areas. They are doubly incontinent. Staff have provided the right bed and chair for them but hoping to get a better chair soon.” Another said, “I am concerned about [person’s] mobility as this has deteriorated. Staff do encourage them to come down for activities, but I think they could do more.” A third said, “Staff have said I can come whenever, I have never had any problems or found anything wrong. [Person] does fall, but they did at home as well.” Management were responsive to feedback and have been taken action to minimise risks, especially around falls.

Staff were able to tell us about people and the risks associated with their care. They told us how they supported them safely. This included pressure area management, safe mobility and what to do when people become distressed. Staff told us “We read care plans and risk assessments; we are good at responding to risk. We pick up when people are not themselves. We also check peoples’ skin daily.” We discussed with staff, certain people who had either bruising or dressings on and they were able to discuss their treatment plans and any potential risks. Staff told us that additional checks were in place for people at risk of falls. These included sensor mats, location checks, appropriate footwear checks, and ensuring people were wearing their glasses if needed.

During the assessment visit, we observed staff engaging positively with people. There was a calm and relaxed atmosphere between staff and people. The rooms including bedrooms were generally a good size and bright. Call bells were seen to be mostly in reach in people’s bedrooms and communal bathrooms but were not always in sight in communal areas. This was reported to the management team and action taken to address it. We saw call bells were answered promptly during our site visit.

The management team and staff demonstrated a good understanding of risks relating to people's care when discussing the people they supported. Care plans and risk assessments identified specific risks to each person and provided written guidance for staff on how to minimise or prevent the risk of harm. This included risks such as skin integrity, weight management, nutrition and falls. People with mobility problems had clear guidance of how staff should move them safely. People with fragile skin had guidance on how to prevent pressure damage, for example, regular movement, continence promotion and monitoring. Daily record checks for continence care were seen. For people identified at risk of dehydration and malnutrition, there was evidence of monitoring their input however for people who couldn’t drink and eat independently records were inconsistent, therefore not identifying or managing potential risk. This was acknowledged and addressed during the assessment process. The manager undertook an analysis of incidents and accidents and referrals were made for additional support where required, for example, in reach team, falls team, assistive technology, and GP involvement. We identified that an overview of accidents and falls would be beneficial to identify trends early to aid prevention. Risks associated with the safety of the environment and equipment were identified and managed appropriately. Regular fire alarm checks had been recorded, and staff knew what action to take in the event of a fire. People’s ability to evacuate the building in the event of a fire had been considered and each person had a personal emergency evacuation plan (PEEP).

People and their relatives felt safe within the environment at Blatchington Manor. One person told us, “I spend time in the gardens, they are lovely and peaceful, I like to sit there and enjoy the peace.” Other comments included, ‘I think it’s clean, safe and stylish’; ‘I have no concerns regarding the home, it smells nice and is always well kept. I know my relative is safe’; and ‘They have good equipment, all clean and well serviced I believe.’ One relative told us, “I come at all different times and never have concerns”.

Staff demonstrated a good knowledge of the environment and how to keep this safe for people. Regular training was undertaken in areas such as fire safety to promote good, safe practice. One staff member told us, "We get training in health and safety, fire, first aid and moving and handling, we also do fire evacuations and tests". Another added, “We have systems to make sure the environment is kept safe. If we have a problem, we write it in maintenance log and its sorted. We all have to look at risk assessments for the environment, if something doesn’t work, such as the lights or equipment, we report it. It gets sorted pretty quick.”

The service was clean and well maintained. Care equipment was in good working order. There was no clutter, and the home was accessible for people with mobility needs and safe for those who walk with purpose. The corridors were wide, and people’s names or items of reference were on people’s doors which helped them to orientate themselves in the home. Communal areas were light and airy, with a good supply of activity equipment. We saw appropriate signage to guide people throughout the home and there were also posters such as ‘how to raise a safeguarding’ should these be needed by people or their visitors.

Processes were effective to ensure the environment was safe and well kept. Health and safety checks had been undertaken to ensure safe management of utilities, food hygiene, hazardous substances, moving and handling equipment, staff safety and welfare. There was a business continuity plan which instructed staff on what to do in the event of the service not being able to function normally, such as a loss of power or evacuation of the property. There were detailed fire risk assessments, which covered all areas in the home. People had Personal Emergency Evacuation Plans (PEEPs) to ensure they were supported in the event of a fire. These were specific to people and their needs. Premises risk assessments and health and safety assessments were reviewed on an annual basis, which included gas, electrical safety, legionella and fire equipment.

Feedback from people and relatives regarding staffing levels was mixed. One relative told us, “Staffing levels are good, I think. There will always be times when they could do with more but generally all is ok. I’ve seen them chatting to [person] throughout the day.” Another relative said, “We asked for something specific, and they agreed, but when we arrived nothing was in place. Staff sometimes appear to be struggling, there’s clearly not enough.”

Feedback from staff regarding staffing levels were mixed. One staff member told us, “Staffing is an issue. They tend to split the team in two on first floor but 4 is not enough. Breakfast has to finish by 9.30 and there’s not enough time to do all personal care before then. Lunch is generally at 12.30 but the first staff break is at 1 so always seem short at lunch.” Another staff member told us, “Staffing is ok. I think sometimes we need more staff, but it depends on people’s needs, if they are poorly, they can be more confused but generally its ok.” A further staff member said, “Enough staff now usually, it’s better than when I started. It can be difficult as one person needs hoisting for all moves, and this can take 3 staff. This can leave us short.” This feedback was provided to the management team who were going to review the deployment of staff. Staff were supported in their roles however some staff spoke of not feeling supervision was useful. We saw evidence that supervisions were being undertaken and the effectiveness of these were improving. Staff told us that they received a robust induction when they started which was two weeks long and included shadowing.

Our observations throughout the day confirmed that staff deployment could be improved. For example, at lunch time some residents were given their meals, but there was a delay in drinks being given as other people needed additional support with their meal. Some residents needed more staff input and encouragement with eating as they didn't touch their meal. The dining area would have benefitted from additional staff moving around the room chatting to residents, checking how their day is and encouraging residents with meals. From 3pm staff were busy assisting people in their rooms and the communal lounge and dining area was left unattended by staff. The management team agreed to review staff deployment. Our observations at other times of the day were more positive and showed us that staff were visible and available to support people’s requests for help and take the time to sit with people. People did receive timely care when needed, and call bells were answered promptly.

Staff numbers and the deployment of staff had ensured people’s needs were met in a timely manner and in a way that met their preferences. Care delivery was supported by records that evidenced that people’s care needs were being met. However, we noted that in the afternoon, staff were not always visible in the communal areas. This was due to staff assisting people with toiletry needs and walking with those who walked with purpose. Staff told us that some people lived with ‘Sundowners’. Sundowners is a condition where people who live with dementia become increasingly anxious and agitated as the day progresses. Therefore, people needed additional support later in the day. This was fully discussed with management who agreed the delegation and number of staff needed in the afternoon would be reviewed. Staffing levels were consistent and where needed regular bank staff were used to cover sickness and holidays. Agency staff were not used unless in an emergency.

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.