• Care Home
  • Care home

Archived: Cadogan Court

Overall: Requires improvement read more about inspection ratings

Barley Lane, Exeter, Devon, EX4 1TA (01392) 251436

Provided and run by:
The Royal Masonic Benevolent Institution

Important: The provider of this service changed. See new profile

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Background to this inspection

Updated 19 August 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on 30 June and 1 July 2016 and was unannounced. The inspection team comprised of one inspector, a specialist advisor with expertise in nursing care, and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection we reviewed the information we held about the service. We looked at the information we had received from the service including statutory notifications (issues providers are legally required to notify us about) or other enquiries from and about the provider.

Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We looked at the information in the PIR and also looked at other information we held about the service before the inspection visit.

We looked at a range of records related to the running of the service. These included staff rotas, supervision and training records, medicine records and quality monitoring audits.

We looked at the care provided to people, observing how they were supported, looking at six care records and speaking with 11 people to help us understand their experiences. As several people were unable to comment directly on their experience of the service we spent time observing care in the communal areas and used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We had feedback from five relatives, and spoke with fourteen staff including care staff, nursing staff, the registered manager and a trainer. After the inspection we had feedback from five health and social care professionals who supported people at Cadogan Court

Overall inspection

Requires improvement

Updated 19 August 2016

The inspection took place on 30 June and 1 July 2016 and was unannounced. We carried out our last comprehensive inspection on 8 and 10 July 2014. We found the service was compliant with the standards inspected and no breaches of regulations were found.

Cadogan Court is registered to provide accommodation with nursing and personal care, for up to 70 people. The service is offered to older people, including those who may have support needs due to dementia. At the time of the inspection there were 62 people living at Cadogan Court. The provider is The Royal Masonic Benevolent Institution (RMBI), who provides care for older Freemasons and their families as well as some people in the community.

There was a newly registered manager in post. Like registered providers, registered managers are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The home had been without a registered manager for five months, and health professionals told us it had been “without leadership for a long time”. This had impacted significantly on the quality of the service. A comprehensive service improvement plan was in place, and actions were being taken to address the failings identified. However, at the time of the inspection it was it was not possible to determine how effective these actions would be in keeping people safe and improving the quality of service provision.

The needs of people in the home varied. Some people had complex nursing needs and remained in bed; some had mental health needs and needed constant support and supervision while others were relatively independent and needed little support. A lot of staff had left, and the home had relied on agency staff to maintain staffing levels for over a year. People, relatives and staff expressed concern that agency staff did not always have the knowledge and skills to meet people’s needs safely. In addition, agency staff required additional support, which doubled the workload of the permanent staff. This situation had the greatest impact on people with higher support needs.

People’s legal rights were not always fully protected because some people had restrictions in place, such as bed rails or pressure mats, but there had been no consideration of whether these restrictions were in their best interests. In addition some ‘blanket’ best interest decisions had been made relating to ‘all aspects of care’, rather than a specific decision, which indicates the MCA was not well understood. Staff training needed to improve to ensure people received a service from staff who were appropriately trained.

People had access to healthcare services for on-going healthcare support, however health and social care professionals did not always know if their recommendations had been shared with staff or acted on due to a breakdown in communication. This meant there was a risk people’s healthcare needs would not be met.

Although some care plans were comprehensive and detailed, this was not consistent, which meant they did not always provide the guidance staff needed to meet people’s care needs safely and effectively. This lack of information increased the risks for people, particularly if staff were less familiar with the person, for example when a person without the capacity to understand the risks, refused to be supported by care staff.

Prior to the inspection there had been a significant number of medication errors at the home and people had been put at risk. The registered manager was acting decisively to manage this risk, and the service improvement plan aimed to ensure people’s medicines were managed so they received them safely.

The newly registered manager provided strong leadership. A recruitment drive was underway, which would decrease the need to use agency staff. They had introduced clear boundaries and discipline for staff, and were developing clear lines of accountability and responsibility. They were proactive in building a culture of transparency and openness at the home. People, relatives, staff and external professionals had confidence in their ability to ‘turn things around’. A member of staff told us, “[Registered manager] is bringing structure and clarity. They have reinforced that we are a good team. We all need to work as a team over the next six months. They are approachable. They listen”. The registered manager had taken action to improve staff support and training, and was using increased monitoring and audit processes to identify what was working well and where improvements needed to be made. They were acting to improve information sharing across the staff team and with agency staff, by introducing ‘wardrobe’ care plans which summarised people’s support needs, and ensuring recording, handovers and staff meetings were more responsive and effective. They were also proactive in improving communication with external agencies, building positive working relationships with local GPs, pharmacists, health care specialists, volunteers and community for the benefit of the people living at Cadogan Court.

At the time of the inspection the ‘Dementia House’, was near completion. This was a separate wing of the home catering for people living with dementia who had more complex support needs.

Staff promoted people’s independence and treated them with dignity and respect. One person said,” I'm quite contented here, very well looked after". A relative commented, “The permanent staff are ‘over’ and ‘above’. They are amazing, wonderful and compassionate”. People were supported to make choices about their day to day lives, such as what to wear and how they wanted to spend their time.

People were supported to maintain ongoing relationships with their families and friends. Relatives told us they were kept informed about the well-being of their family member, and felt able to visit them at any time.

The registered manager encouraged people and their relatives to voice any concerns, either using the provider’s complaints process or at one of the regular residents/relatives meetings. Relatives told us about concerns they had raised, and how the registered manager had resolved them. Comments included; “I would raise concerns. They are very approachable” and, “The manager wants to know so they can deal with things”.

People’s individual nutritional requirements were assessed and they received a diet appropriate to their needs and wishes. The catering staff worked hard to make mealtimes an enjoyable and sociable experience for people. The catering manager told us, “There are not many things that people look forward to more than their food. It’s a social event, and we need to make that experience as pleasant as possible”.

People could choose to participate in organised activities and were supported to organise their own activities if they wanted to. There was a wide range of activities, organised by activity co-ordinators and external volunteers and organisations. Activities staff worked to involve everybody according to their individual needs and ability to participate.

There were systems in place to make sure the premises and equipment were safe for people.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.