Claydon House

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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question as good. At this assessment the rating has remained good.

This meant people were safe and protected from avoidable harm.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Accidents and incidents were reported and recorded in line with service policy however not all lessons learned were shared with all staff. Also, not all forms were fully completed. Some forms were unsigned and few had any summary notes or indication of steps that would be taken next. Relatives told us they were notified following any accident or incident. Staff knew the actions they needed to take in the event of an accident and the need to record what had happened. Although these details were captured and recorded within people’s care plans, there was no formal process of analysis and capturing and sharing learning to minimise the chance of recurrence. Staff told us that information from the previous shift was passed on to them at handover meetings, but said there were no formal lessons learned meetings.

The service had established positive working relationships with other health and social care professionals. A relative told us, “They organise a GP going every Tuesday afternoon, have arranged [for person] to be assessed for continence pads and sort out all of [person’s] prescriptions.” Care plans contained ‘hospital passports,’ a summary of their key health issues and support needs as well as key points of contact. A staff member said, “We send all our residents to hospital with the hospital passport.” Staff also told us how they work closely with the community rehabilitation team to prevent the risk of people falling. A visiting professional told us that communication had improved a lot in recent months and that they were informed of new admissions and that GP and community nurse visits were then promptly arranged. Professionals also told us that the service now took prompt action when responding to safeguarding issues and that this had improved in recent weeks. Policy documents were in place to support collaborative working arrangements.

People lived safely at the service, protected from avoidable harm. Comments from people and their loved ones included, “Yes, without a question they are safe” and “Very safe.” Staff had received safeguarding training and were able to tell us the situations that could amount to a safeguarding incident and the steps they would then take. A staff member said, “If it’s staff I’d have a word first. See if something could be done in a better way. Would speak to a senior if needed.” Another added, “Raise concerns with the clinical lead or lead nurse. If not happy I know I go outside the company for support.” Staff were aware of the whistleblowing process and told us they were confident to use this if necessary. Call bells were answered promptly and staff were attentive to people’s needs and requests. Policies were in place and were accessible to staff covering safeguarding and whistleblowing.

Although staff knew people well and were knowledgeable about people’s specific needs and risks, some risk assessments were missing and others only contained basic information. A relative said, “Yes, unsteady on feet at times and staff are very person focused so have foot stool to put her feet up and keep an eye on her and regularly checked by nurses.” We looked at twelve care plans and associated risk assessments. There were no oral health care plans or assessments. There were no assessments in place to monitor people’s behaviours. There was a lack of follow up with diabetes risk assessments, some people were shown as having high blood sugars but there was no follow up recorded. We spoke with three kitchen staff and none were aware that some residents lived with diabetes. This situation was immediately rectified when highlighted to the registered manager. Personal emergency evacuation plans (PEEPs) were in place in care plans and in a grab bag close to the front entrance for easy access. Fire drills had been regularly carried out and an independent firm had carried out an environmental ‘walk around’ and had reported positively on health and safety management at the service. Staff were attentive to people’s needs.

The service presented an environment that was safe and free from any trip or other obvious hazards. People and their loved ones told us they felt the home environment was safe. A maintenance book was managed each day with issues being addressed promptly. All fire equipment was in date and staff had regular fire drill exercises. The most recent fire service report had actions all of which had been addressed. Certificates were in place for all electrical equipment and other safety areas for example, legionella. Regular health and safety meetings took place with actions recorded and dealt with. People’s bedroom size varied but all contained personal effects including small items of furniture and photographs and all were safe with no dangers or risks. Temperature testing was carried out daily in the kitchen. Policies were in place to support all environmental matters.

There were enough staff on duty every shift. People’s support needs varied with some requiring a lot of staff time which resulted in fewer staff being available to respond to people’s immediate needs. However, staff were able to fulfil their duties and people were not left waiting for support. Most people and relatives told us they thought there was enough staff at the service. One person said, “Yes, staff are busy but there is a lot of them.” However another told us, “They don’t get enough interaction, the number of staff seem to have dropped off.” The registered manager explained that the service used dependency tools to calculate the numbers of staff required each shift. Agency staff were used to fill any gaps. Staff told us they had received an induction when they first joined the service and this along with the various training modules they had completed, provided them with the tools and information to support people safely. Agency staff received a shorter version of the induction process. Staff were supported with regular supervision meetings and staff told us they could raise any issues and concerns they might have if needed. We looked at four staff files and all contained the correct documents including, references, photographic identification and Disclosure and Barring Service (DBS) checks.

There was a team of domestic staff responsible for cleaning the service that worked every day and the service was clean and well presented throughout. A relative said, “The place looks like it’s been recently decorated and it’s always clean. No issues there.” Staff wore personal protective equipment (PPE), gloves, aprons and masks, appropriately and staff told us there were plenty of supplies. The kitchen had been awarded the highest rating for hygiene standards. There were policies in place relating to infection prevention and control and cleaning rotas that had been completed each day.

People did receive their medicines safely however there were issues relating to the medicines room, PRN (as and when required) medicines and the recording of details on the medicine administration records (MAR). Medicines were stored safely, however the clinical room was cluttered and untidy. Emergency equipment such as suction machines were not easily assessable in an emergency. Room and temperature checks for safe storage were not consistently recorded. There were areas found during the assessment that indicated/highlighted improvements were needed. For example, Protocols for 'as required' (PRN) medicines such as pain relief and anti-anxiety medicines were in place, but were not person centred and staff were not recording outcome/effect of the medicine and as pain charts were not used consistently, staff were unable to monitor people’s pain and discomfort. Medicine administration charts showed that not all staff were following good practice guidance as there were hand written entries which were not double signed and dated, to ensure errors were not transferred. Running totals of medicines were inconsistent and staff signatures not always legible. Some of these issues had been identified during a recent medicine audit and an action plan was in place. People and relatives said, “Staff keep us informed of any changes, let us know what the doctor says. I trust them totally and get informed of changes. I have no concerns,” and “I get my medicines on time and never missed.” The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Senior care staff, (who were medicine givers)told us they complete training before administering medicines and then have to pass a regular competency assessment. One staff member said, “We all receive really good training and support from the registered nurse, so we are well supported.” Risk assessments were in place for certain medicines.