Cavell Court

Cavell Court is a purpose-built building set out over three units, with each bedroom having an en-suite facility. Each unit has a kitchenette, dining room and lounge(s). The service also has access to communal areas including a ground floor coffee bar, cinema, activity rooms, hair salon and outdoor garden space.

People’s experience of using this service and what we found

The registered manager had systems in place to manage risks and keep people safe from avoidable harm.

Staff used personal protective equipment, such as gloves and aprons to prevent the spread of infection. Visitors were required to complete health questionnaires, have their temperature taken and provide a negative COVID-19 test before entering the service.

Staff assessed and reduced people’s risks as much as possible. There were enough staff to support people with their care and support needs. The provider carried out key recruitment checks on potential new staff before they started work to ensure they were suitable.

People received their medicines and staff knew how these should be given. Checks were in place to ensure that medicines were given safely and stored correctly.

The service was well managed by a registered manager with regular input from the provider. The senior staff team were passionate about giving people a high-quality service.

Systems to monitor how well the service ran were carried out. People and relatives were asked their view of the service and action was taken to change any areas they were not happy with.

The registered manager was open and honest when things went wrong. They shared any learning from these events with people, staff and professionals and used their learning to change practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (19 December 2018).

Why we inspected

This was a planned focused inspection based on our ongoing monitoring of the service. This report only covers our findings in relation to the key questions safe and well-led.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Cavell Court on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Cavell Court accommodates people across three floors, each of which have separate facilities including a dining room and lounge. One of the floors specialises in providing care to people living with dementia and another in nursing care. At the time of this inspection there were 68 people living in the service.

Our last inspection at Cavell Court, in January 2018, was the third inspection since 2017 where we had rated the home Requires Improvement overall. At that inspection we were concerned about the continued lack of effective oversight of the home which meant the necessary improvements had not been made. We therefore rated the service as Inadequate in Well-Led. At that inspection in January 2018 we were also concerned that there continued to be failures with the safe management and administration of medicines which placed people at risk of harm. These concerns had been highlighted in previous inspections and were therefore a repeated breach of the regulations.

Also at our last inspection we found there were insufficient staff to meet people’s needs in a timely manner. A lack of staff presence meant that people were not getting the care and support they required. Concerns were also raised with us about how the provider responded to complaints and the high use of agency nurses to deliver people’s care which meant that people were not always having their assessed care needs met.

You can read the reports from our previous comprehensive inspections, by selecting the 'all reports' link for Cavell Court on our website at www.cqc.org.uk

The service is required as part of its registration to have a manager registered with the CQC. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they 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. There was a registered manager, who commenced employment shortly after our last inspection, in post at the time of this inspection.

At this inspection a number of improvements had been made. The management of medicines was safer and we were now confident that people were receiving their medicines as the prescriber intended, however we did find that the registered manager and staff had not considered the risk of people living at the service accessing topical creams and causing themselves accidental harm.

Improvements had been made to the staffing levels and these were now sufficient to provide responsive care to people. Recruitment checks had ensured they were suitable to work with people using this service. Staff were supported through training and supervision to perform their roles effectively. The staff were knowledgeable about the support people required to enjoy their meals and drinks safely and this was provided.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were treated in a kind and caring way by the staff team. Their privacy and dignity was respected. Staff interacted with people in a caring, respectful and professional manner. Staff had developed relationships with people and were attentive to their needs.

The service was now well managed and the provider had invested extensive management time at the service since our last inspection. A new registered manager was now in post and there were effective quality assurance arrangements in place to monitor care and plan ongoing improvements. People's views about the running of the service were sought and changes and improvements took account of people's suggestions.

This inspection took place on 23 and 24 January 2018. The first day of the inspection was unannounced.

Cavell Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Cavell Court accommodates up to 80 people across three floors, each of which have separate facilities including a dining room and lounge. One of the floors specialises in providing care to people living with dementia and another provides nursing care. At the time of our inspection there were 54 people living in the service.

The service is required as part of its registration to have a manager registered with the CQC. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they 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. On the dates of our inspection there was no registered manager in post and the prospective candidate resigned during our inspection. On the second day of our inspection the provider brought in a manager registered at one of its other services. They have told us that this manager will be registering with CQC to manage Cavell Court. This is the second time the service has been rated ‘Requires Improvement’.

We discussed the issues we had identified with the management team. They told us they had recently become aware of a failure in the management systems and told us the actions they were taking and had planned to address them. However, we concerned about the length of time this took to identify and the effective oversight of the service during this period which meant the breaches continued. We have therefore rated the service Inadequate in Well-Led.

At our previous two inspections we identified that medicines were not administered as prescribed. At this inspection we found that improvements had been made in some areas but that concerns persisted with the service’s management of medication. There were still medicine errors arising and we also observed, and were told about poor practice when staff were administering medicines which potentially placed people at risk of harm.

People told us there were not sufficient staff to meet their needs. We were given examples of how this impacted on people’s care, for example slow response to call bells. We also observed occasions where lack of staff presence meant that people were not getting the care and support they required.

Prior to our inspection we had received concerns from people about how complaints were dealt with and were given examples of where the service had failed to respond to complaints according to its own complaints policy. At the inspection we spoke with the management team about the service complaints policy and procedures. They explained to us why they believed there had been shortfalls at the service and what they were putting in place to address these concerns.

The service used a high number of agency nurses. Agency nurses did not always have full information about people’s care needs and this gave an increased risk of people not receiving their assessed care and support needs. The service had identified concerns with the quality of care provided by agency nurses and met with the agencies to discuss expectations.

Care documents contained care plans and risk assessments relevant to the care and support people provided. However, the risk assessments did not always contain sufficient information to ensure care was delivered safely. We found some instances where risk assessments and care plans were not being followed by staff when providing care and support. Care planning was inconsistent with some examples of good care plans and others lacking information.

Care staff we spoke with had a good knowledge of different types of abuse and how it should be reported. The management team explained how they would be addressing concerns raised with us about the service’s poor response to safeguarding investigations.

Staff knowledge relevant to the Mental Capacity Act 2005 (MCA) and associated Deprivation of Liberty Safeguards (DoLS) was inconsistent with some staff being able to give us a good explanation and others having no knowledge. The service had made DoLS applications to the local authority.

Staff received an induction into the service and relevant training in a variety of areas. However, we observed occasions where staff did not support people with dementia appropriately.

People had mixed views on the quality of the food provided. The provider had recognised this and had taken steps to address concerns with a survey and observations of the mealtime experience. Staff demonstrated a good knowledge of people’s dietary needs. However, recording of people’s fluid intake was inconsistent which meant that we could not always be certain that people were receiving sufficient fluid.

The environment met people’s needs. All rooms had en-suite facilities and there were quiet areas for people to meet family and friends. People told us that care staff were kind and compassionate and that their privacy and dignity was respected. Individual staff were able to tell us about people’s backgrounds and how they used this knowledge to develop relationships with people.

People had mixed views as to the quality of the opportunities for social engagement and activities. This was related to the area of the service people resided in with people living on the ground floor being more satisfied and engaged with activities than those on the nursing floor.

People were supported to make decisions about their preferences for end of life care. We received positive feedback from relatives about end of life care provided at the service.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they 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. There was an acting manager in post who was in the process of registering with CQC.

We carried out an unannounced comprehensive inspection of this service on 8 and 9 May 2017. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Cavell Court on our website at www.cqc.org.uk.

Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We found the provider was not ensuring the safe management of medicines in the home. A number of medicines were out of stock and this meant people had not received their medicines as prescribed. The provider had not taken timely or sufficient action to address this issue as we had found medicines were out of stock at our previous inspection in May 2017. This meant there was a continued risk to people’s health and wellbeing as people did not always receive their medicines as prescribed.

There was not a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they 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. There was an acting manager in post who was in the process of registering with CQC.

At our last inspection on 5 and 6 July 2016, we found the service required improvements in all areas, and there were four breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection, we found that improvements to these areas had been made and caring was rated as good. Further improvements were needed within the other areas in order for them to become good.

At this inspection we found one 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.

There were several medicines that had become out of stock, and we could see that this problem had occurred before. Therefore people’s health and wellbeing was put at risk as people did not always receive their medicines as prescribed. Medicines administrated were recorded accurately and stored safely, and there was comprehensive guidance for staff about how to give them safely.

People’s care records contained information about risks to their safety and provided guidance on how to mitigate these. There were also risk assessments in place for people’s environment which contributed to keeping them safe. There were enough staff to keep people safe and meet their needs, and they were recruited safely. Staff had knowledge of how to keep people safe from harm and who to report concerns to.

Staff sought consent before delivering care to people, however improvements were needed to ensure that people’s capacity was assessed when required, and that decisions took place within people’s best interests.

Staff supported people to eat a healthy balanced diet and this was checked regularly. People were supported with specialist diets, however improvements were needed to communicate these needs across the staff team in a timely fashion. People had a choice of meals and received enough to eat and drink. People had access to healthcare when they needed.

People’s care records were not always consistent across the home, and some did not have enough guidance for staff with regards to their specific health needs, so improvements were needed in this area.

People had access to a range of activities within the home, and they felt comfortable to raise concerns with staff should they have any. Friends and family visited when they wished.

Improvements had been made since our inspection in July 2016 to the competence of staff. Staff were trained in areas relevant to their roles and carried these out effectively. Staff received enough supervision and support.

People were supported by staff who were kind and respected their choices. People were involved in planning their own care and making decisions. Staff respected people’s privacy and dignity, and promoted their independence where appropriate.

There were significant improvements with regards to the systems in place to check, monitor and improve the service. Audits in place had identified problems in most areas and therefore action had been taken. Some further improvements were needed to the auditing of care records and medicines ordering. The staff had a positive attitude and worked well together as a team.

Cavell Court is a service that provides accommodation, residential and nursing care for up to 80 people some of whom are living with dementia. At the time of the inspection, care was being provided over three floors. The top floor provided nursing care to people, the middle floor care to people living with dementia and the ground floor to people with nursing and residential needs, some of whom were living with dementia. There were a total of 44 people living over these three floors when the inspection took place.

There was no registered manager working at the service. The last registered manager left the service in April 2016. A new manager has been recruited but had not commenced working at the service at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the home is run. The home was being managed by the provider’s operations support manager with support of other representatives from the provider.

At this inspection we found four breaches 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.

The provider had ensured that the number of staff they had calculated as being required to work in the home had been regularly met. However, these staff had not always been deployed effectively to enable them to meet people’s individual needs in a timely way. People did not always receive care based on their individual needs and preferences. The high use of agency staff meant that people did not always receive care from staff who knew them well. Some people had not received their medicines safely.

The principles of the Mental Capacity Act were not always being followed when making decisions for people who lacked the capacity to consent to their care. Therefore, people’s rights may not have been protected.

Some staff lacked sufficient training to provide them with the skills and knowledge to provide people with safe and effective care. Most staff were kind, caring and compassionate but this was not consistently applied. Some poor care practice was demonstrated which meant people were not always treated with respect.

People were involved in making decisions about their care and they received enough food and drink to meet their needs. The staff supported people with their healthcare needs and the premises where people lived and the equipment they used were safe.

People’s complaints had been fully investigated. However, not everyone knew how to make a complaint or who to speak to if they had a concern.

The provider had recognised that a number of improvements were required to how the home was being run. Systems had been put in place to achieve this. However, these were currently not all effective at assessing and monitoring the quality of care provided.