Archived: Cathedral Nursing Home

We undertook a comprehensive inspection on 24 and 25 July 2018. The inspection was unannounced.

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

The service is registered to provide accommodation for up to 38 younger adults, older people or people living with a dementia type illness. There were 22 people living in the service during 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.

At our last inspection of Cathedral Nursing Home in February 2018 we found five breaches of the regulations and the service was rated 'Inadequate'. This was because the registered provider failed to ensure that here were systems and processes in place to assess, monitor and improve the quality and safety of the service. The service was placed into special measures and we issued a Notice of Decision to impose conditions on the service, including a restriction on further admissions to the service and staff competency checks. At this inspection we found that overall improvements had been made and the service was now rated 'Requires Improvement.'

This is the first time the service has been rated ‘Requires Improvement’.

Staffing levels had improved and staff had security checks prior to starting work to ensure that they were appropriate to care for people. Medicines were administered by competent staff. All areas of the service were clean and improvements were being made to the environment, trip hazards and lighting.

People received care and support from staff who understood their care needs. The delivery of care was coordinated and person-centred. People were provided with their choice of food and drink. Staff referred people in a timely manner to other healthcare professionals when their condition changed. Staff followed the guidance in the Mental Capacity Act 2005 and people were lawfully deprived of their liberty.

People and their relatives were enabled to be involved in planning their care. Staff focused their care on the individual person, and there was little evidence of task oriented care. People were treated with kindness and compassion.

People received care that was responsive to their individual needs and preferences. Systems were in place to enable people to make a complaint if they wished to do so. Staff respected a person’s end of life care needs.

People, their relatives and staff had a voice and could contribute to the running of the service. Improvements had been made to the monitoring of the quality of the care provided. Policies and procedures had been reviewed and reflected nations guidance. There were visible leaders in post and staff knew who to turn to for advice and guidance. The registered manager had made significant improvements to the standards of care in the service.

We undertook a comprehensive inspection on 20, 21 and 28 February 2018. The inspection was unannounced.

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

The service is registered to provide accommodation for up to 38 younger adults, older people or people living with a dementia type illness. On day one of our inspection there were 29 people living in the service.

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.

This was a first inspection for the service under the new registered provider Hayworth Care Limited. At this inspection we found that the service was rated, ‘Inadequate’.

We found five breaches of the regulations. This was because the registered provider failed to ensure that there were systems and processes in place to assess, monitor and improve the quality and safety of the service.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

There was not always enough staff on duty with the right skill mix to keep people safe and respond to their care needs in a timely manner. People were at risk of harm from poor infection control practices and environmental issues. There were uneven floors in public areas, some areas were poorly lit and fire risks in the laundry were not identified or managed. Medicines management was not always practiced safely.

The provider followed national guidelines to lawfully deprive a person of their liberty. Care staff did not follow national guidelines when obtaining consent from people or record that they had acted in a person’s best interest. Care staff were not supported to read people’s care plans and often worked on their own initiative without supervision and leadership. People were not always provided with their choice of food.

People and their relatives were not involved in planning their care. Care was not person centred, but was task orientated and followed ritualistic practices. Staff had little insight into the needs of people living with dementia. The premises did not support their individual needs. Staff did not always treat people with privacy and dignity.

People did not always receive personalised care that was responsive to their needs.

People had access to a complaints procedure; however, most people would have difficulty reading it as the print size was small. Complaints were not always resolved in a timely manner. The service was supported by a community frailty team to provide end of life care, but staff did not always contact them in a timely manner so as they could be appropriately supported at the end of their lives.

There was a lack visible leadership and effective role models to support inexperienced staff. A range of audits were undertaken, but the outcomes did not lead to improvements in practice.