West Cliff Hall

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 requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. West Cliff Hall had a proactive and positive culture of safety, based on openness and honesty. Leaders had listened to concerns about safety and investigated and reported adverse events. Lessons were learnt to continually identify and embed good practice. Incidents were recorded, and discussed with people, their relatives and social care professionals. The registered manager provided us with examples of reflective meetings held with staff following incidents, to help identify any trends and reduce risk of reoccurrence. A staff member told us leaders, “listen to the care workers when we raise concerns about residents, recently we have introduced a second member of staff to be allocated to the lounge area as 1 staff member wasn’t able to support all the residents during the busiest times of the day.” Accidents, incidents and events were recorded on the provider’s electronic governance systems. The registered manager said, “When we identified an increase of concerns about the same event, we are able to get extra support from the learning and development team. For example, our falls training was previously online only, but we have now had some additional face to face training. Any time we identify an instance of staff needing specialist training, like specific to the health condition of a new resident, we are able to request this as an additional measure to keep residents safe.”

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. Staff ensured there was continuity of care, including when people moved between different services. People felt confident their needs would be met by staff and information would be shared to promote joined up care. A relative said, “I am happy with the way the home managed my loved ones falls, the management team had everything in place for my loved one’s safe return from hospital, a crash mat and extra alarms. It was all ready and waiting.” A staff member told us, “In my role, I feel fully involved in the running of home, I attend the daily meeting to be updated on a daily basis of resident’s requirements.” A social care professional said, “Despite the changes to the management team the home remained focused on continued improvement and how they plan to achieve this for residents of West Cliff Hall.” People’s needs, and care requirements were detailed within their care plans and risk assessments. A summary of a person’s needs was available in the event of an emergency evacuation, if the person went into hospital or moved to another care home. This supported continuity in care for people.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately. The registered manager demonstrated a commitment to taking immediate action to keep people safe from abuse and neglect. This included seeking support from the local authority safeguarding team. A staff member told us, “Managers at all levels at West Cliff Hall will act immediately if a concern was reported” We observed people happy and relaxed with the staff who supported them. People were able to move freely and any restrictions in place for the safety of people were appropriately risk assessed. 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 2005 (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA, whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met. The registered manager had oversight of these applications, authorisations, and conditions. This meant people’s rights were fully respected.

The service worked with people to understand and manage risks by thinking holistically. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. The registered manager told us how risk assessments were designed in collaboration with people so risks could be managed using the least restrictive practices. This was to ensure people maintained their independence. Risks to people had been identified and measures were in place to reduce the risks, records showed guidance for staff was clear. People’s care plans provided guidance for staff with prompts about how to communicate with people who wished to be responsible for their own personal care. Staff told us about daily tasks completed to keep people safe. These included checks of equipment safety, visual checks of the environment and reporting any concerns identified so these could be addressed. A staff member told us, “We have some residents always on the go and restless, you can't just tell them it's time to sit down. You need to check in with them. We follow the suggestions in the care plan to distract them and let them go where they want to walk but keep them safe by clearing the way.”

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Environmental checks and maintenance were completed as planned. Regular checks had been undertaken to ensure the home was safe in the event of a fire. Emergency plans were in place detailing arrangements to keep people safe in the event they needed to evacuate. The provider had systems in place to ensure water quality was checked and maintained to reduce the risk of water-borne bacteria, like legionella. Required works following an external risk assessment had been completed. The registered manager told us, “There is a programme of improvement works which include an upgrade of the call bell system, any identified improvement works are fully supported by the provider.”

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. The registered manager monitored and reviewed staffing levels to ensure staff were there when people needed them. We observed the home to have a calm atmosphere and there were sufficient staff on duty to support people without rushing. People and their relatives told us, “Staff are always here to help” and, “I only visit at the weekend, and I come here every weekend. There are staff all over, then more staff for times when people are having their meals.” The provider had effective processes in place to ensure staff had the necessary skills and competence to carry out their roles. A staff member commented, “During my induction I had weekly 1:1s and was always given feedback. Any criticism was constructive and designed to help me improve. All department managers are so approachable, and everyone here just wants to do their best for the residents, so we work flexibly.” Recruitment records showed staff were recruited safely. This included an enhanced Disclosure and Barring Service (DBS) checks for adults. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. Staff confirmed the service had identified clear roles and responsibilities around infection prevention and control. During our inspection, we observed signage used to inform people cleaning was in progress and correct personal protective equipment was worn. All areas of the service were visibly clean. There was a robust infection prevention and control policy in place. Cleaning schedules were available, and staff had a good understanding of these. A staff member told us, “To support residents having visitors we will make a note on the schedule they have a guest, and we go back later to clean their room.” Soap and paper towels were available to support good hand hygiene.

The service ensured medicines and treatments were managed safely and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened. Medicines oversight at West Cliff Hall had improved. Records showed that people received their medicines safely as prescribed. There were suitable arrangements for the storage, administration and disposal of medicines. When medicines were prescribed to be taken ‘as required’ there were detailed and person-centred protocols in place to guide staff when these might be needed. Staff told us that they felt well supported with medicines management, and they knew how to report any issues. They told us they had training, and competency checks to make sure medicines were given to people safely. They were confident the systems in place for managing people’s medicines worked well.