Archived: Cathedral Nursing Home

The inspection took place on 16 January 2017 and was unannounced.

The Cathedral Nursing Home is registered to provide accommodation and nursing and personal care for up to 38 older people or people living with dementia. There were 37 people living at the service on the day of our inspection.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons. Registered persons have the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act, 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect them. The management and staff understood their responsibility and made appropriate referrals for assessment. Several people living at the service had their freedom lawfully restricted under a DoLS authorisation.

Staff undertook appropriate risk assessments for all aspects of a person’s care to keep them safe from harm. Care plans were developed to support people’s individual needs. Staff knew what action to take and who to report to if they were concerned about the safety and welfare of the people in their care. People received their prescribed medicine safely from staff that were competent to do so. The registered provider ensured that there were always sufficient numbers of staff on duty to keep people safe.

People were supported to have a healthy and nutritious diet and hot and cold drinks and snacks were available throughout the day. People had their healthcare needs identified and were able to access healthcare professionals such as their GP and dentist. Staff knew how to access specialist professional help when needed.

People were at the centre of the caring process and staff acknowledged them as unique individuals. Relatives told us that staff were kind and caring and we saw examples of good care practice. People were always treated with dignity and respect. People were cared for by staff that were supported to undertake training to improve their knowledge and advance their skills to enable them to perform their roles and responsibilities effectively.

People were supported to have an active life and were encouraged to take part in hobbies and interests of their choice. Relatives commented that their loved ones were well looked after.

People where able, were supported to make decisions about their care and treatment and maintain their independence. People and their relatives had access to information about how to make a complaint. Relatives told us that they could approach staff with concerns and knew how to make a formal complaint to the provider.

The registered provider had introduced robust systems to monitor the quality of the service and make improvements. Staff had access to professional development, supervision and feedback on their performance. People, their relatives and staff found the registered manager approachable.

Overall, we found that the registered manager had led their team to introduce and sustain improvements to the service, such as medicine management, infection control and monitoring the quality of the service.

Cathedral Nursing Home is registered to provide accommodation and nursing and personal care for up to 38 older people or people living with dementia. There were 37 people living at the service on the day of our inspection.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had not ensured proper and safe management of medicines; did not ensure the service was clean and properly maintained; did not work within the requirements of the Mental Capacity Act 2005; did not ensure that people were treated with dignity and respect and there were weaknesses in the monitoring of the quality of the service. You can see what action we told the registered provider to take at the back of the full version of the report.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act, 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect them. The management and staff understood their responsibility and made appropriate referrals for assessment. Five people at the time of our inspection had their freedom restricted under a DoLS authorisation.

People’s safety was not always maintained, because staff did not always follow safe medicine administration guidance, putting people at risk of harm. There were not always enough staff on duty to meet people's care needs in a timely manner. Also, the provider did not always ensure that the service was consistently clean and that safe infection control procedures were adhered to.

People were cared for by staff that were supported to undertake training to improve their knowledge and skills. People were provided with regular and home cooked meals. Although people had their healthcare needs identified, they were not always referred to healthcare professionals such as their GP and dentist. Staff did not always seek consent from people for their care and treatment and did not fully understand the key requirements of the Mental Capacity Act 2005.

Staff did not always involve people in decisions about their care. People were not always treated with dignity and respect and staff did not challenge poor care practices. People were not enabled to pass their time in a meaningful way and were not supported to maintain their independence. Staff provided care centred on tasks rather than on the person’s needs and preferences.

There was no evidence of visible leadership and the registered provider did not have effective systems in place to monitor the quality of the care and treatment people received.

There were 35 people living at Cathedral Nursing Home on the day of our visit. We spoke with four people who lived at the service and two relatives who visited the service during our inspection. We also spoke with eight staff members during our visit. We looked at three care plans and other records about the care people received. We spent time observing care being given by staff.

We considered our inspection findings to answer questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found-

Is the service safe?

The service had policies and procedures in relation to the Mental Capacity Act (2005) MCA and Deprivation of Liberty Safeguards (DoLS). The MCA states that every adult has the right to make their own decisions about their care and treatment and must be assumed to have capacity to make them unless it is proved otherwise. The Deprivation of Liberty Safeguards are part of the MCA. DoLS supports people in care homes and hospitals to be looked after in a way that does not unlawfully restrict their right to freedom.

The home had policies and procedures in relation to safeguarding vulnerable adults and whistle blowing. We spoke with care staff who understood what was meant by abuse and knew how to report their concerns.

We saw that the service had a programme of regular audit and risk assessments to ensure people were cared for in a safe environment.

We saw robust staff recruitment procedures were in place and protected people from being cared for by staff who lacked the skills to do so safely and effectively.

The service was safe, clean and hygienic. We saw regular checks were made on the cleanliness of the building. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk. We observed regular maintenance was carried out, for example on electrical and fire equipment

Is the service effective?

We saw quality assurance systems were in place. People told us they were listened to. We saw copies of recent satisfaction surveys completed by relatives and staff.

Our observations found that members of staff knew people's individual health and wellbeing needs. There was a process in place to ensure staff were aware of people's changing needs. Staff told us that they had a handover at the beginning and end of each shift and a communication book and diary to record information shared.

We found staff had attended training to meet the individual needs for people living with a range of conditions such as diabetes and dementia.

Is the service caring?

We observed staff speak to people in a kind and caring way and we noted that they gave them time to answer questions. We saw that no one was rushed and staff helped people to do things in their own time. We saw all staff groups, including the kitchen and housekeeping staff had a very good rapport with people and there was a lot of chat and laughter.

We spoke with relatives who told us staff were very kind and caring. One relative said, 'Cannot fault them, well cared for, well fed, did not eat this much at home, staff all good very caring.'

The people we spoke with told us that the staff were very caring. One person told us, 'Lovely bunch of girls on the whole, we are well looked after.'

Is the service responsive?

We saw that care was responsive to people's individual needs. We saw one person liked to have cold drinks so they had a fridge in their bedroom with a supply of soft drinks. Another person had their own telephone in their bedroom, this helped them maintain their independence and keep contact with family and friends.

We saw that when care workers raised concerns about people's health and social care needs the provider contacted appropriate health and social care professionals. The individual care files identified this and a record of each referral, professional visit and outcome were recorded.

We saw that one person had risk assessments for financial abuse and the manager had alerted the local safeguarding authority of their concerns. A legal process was put in place for this person to have someone appointed by the courts to look after their money.

We saw that the provider had contingency plans in place in event of an emergency situation.

Is the service well led?

We saw people were supported by a registered nurse and at least one senior carer on duty each shift.

The manager had introduced lead nurse and buddy roles. This meant that all staff were supported by senior staff for areas of care such as nutrition and infection control.

Staff told us that the manager and deputy manager were approachable and supported them with professional and personnel problems.

Relatives and residents said the manager and deputy manager were approachable. One person told us, 'XX [the manager] is good, she tells me things."

We spoke with people who told us the home was clean. One person said, 'It always smells nice and fresh.'

We saw an infection control lead had been appointed. One staff member said, 'We now have direction, we're given instruction. People know what to do.'

We spoke with staff who told us there had been great improvement in the standard of cleanliness since our last visit. One staff member said, 'Staff are now more conscientious. People talk about keeping the home clean."

We saw people had their care needs assessed and care delivered in accordance with their plan of care.

We observed staff interact with people at lunch time and lunch was a postitive experience.

We saw there was not suitable systems in place to reduce the risk of infection.

We saw there were effective recruitment processes in place and staff went through appropriate checks.

People told us they were happy with their care, but would not hesitate to speak with a member of staff or the manager if they were unhappy.