Cathedral Care Centre

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

There were systems and processes in place to identify and manage risks associated with people’s care. Further work was required to ensure environmental risks were identified and mitigated.

People and their relatives told us they felt safe with the staff who supported them. Staff had received safeguarding training and were able to demonstrate their understanding and responsibilities to reduce the risk of harm to people.

People were supported by sufficient numbers of staff who had been recruited safely. People and staff provided positive feedback about the care they received from the service. People and relatives responded more negatively about the frequent changes in management, as this impacted on the level of communication.

People received their medicines from staff who had been trained to safely administer medicines.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this 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 requires improvement (published 9 January 2021). The service remains rated requires improvement.

Why we inspected

The inspection was prompted in part due to concerns received about risk management and leadership. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cathedral Care Centre on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Visiting procedures were robust to reduce the risk of COVID-19. All visitors were required to show a negative COVID-19 test and personal protective equipment (PPE) was worn by all visitors. People had also been supported to maintain contact with friends and family during the pandemic via window or garden visits and telephone calls.

The service was clean and hygienic and infection prevention and control, best practice guidance was maintained. This included regular cleaning of high touch areas.

Staff participated in the testing and vaccination programme. We observed staff wearing the correct PPE throughout our inspection. Information and ongoing government guidance in the management of COVID-19 was shared with staff.

People had been supported to participate in the COVID-19 testing programme and vaccination programme. COVID-19 related risk assessments had been completed, and contingency plans were in place to manage a COVID-19 outbreak.

Isolation, cohorting and zoning was used to manage the spread of infection. This meant people self-isolated in their bedrooms where necessary.

Cathedral Care Centre is a residential care home situated Lincoln, providing personal and nursing care to 27

people aged 65 and over at the time of the inspection. The service can support up to 36 people. The service had10 allocated beds for people who require transitional care between hospital discharges and going back to live in the community.

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

Risks associated with people’s care had not always been clearly recorded in their care plan or risk assessments with measures which were in place to reduce the risk of harm.

Medicine practices were not always in line with best practice guidelines.

Staff had received training in relation to safeguarding. Although, some were out of date, staff understood their responsibilities around safeguarding people.

There were enough staff deployed in the service to meet the needs of people. Additional staff were recruited in readiness for any staff shortages in relation to the COVID-19 pandemic.

The provider continued to have safe recruitment practices in place.

There were measures in place to reduce the risk of infection to people.

The provider had a clear process in place to assess quality of the service. However, some actions to improve areas, had not been completed in a timely manner.

The manager was highly spoken about by people, staff and relatives.

There was a positive culture developing in the service and the service had established links in the community.

Staff, people and relatives felt engaged in the running of the service.

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

Rating at last inspection (and update)

The last rating for the service was requires improvement (published on 05 March 2020) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been rated requires improvement for the last three consecutive inspections

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 04 February 2020. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has not changed and remains as requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cathedral Care Centre on our website at www.cqc.org.uk.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Cathedral Care Centre is a residential care home situated Lincoln, providing personal and nursing care to 26 people aged 65 and over at the time of the inspection. The service can support up to 36 people.

The service did not have enough staff to meet people’s needs and did not always use sufficient cover when shortfalls arose. Some potential risks were not always identified. People received their prescribed medicines. Accident and incidents were analysed, and action was taken to reduce reoccurrence. Staff received infection control training and used protective equipment to reduce the spread of infection. Safeguarding concerns had been referred to the relevant authority. We found a breach in regulation.

There was an on-going refurbishment and the environment was being improved. However, concerns had been identified in the kitchen and no action had been taken at the time of inspection. People did not always have a choice at meal times. The service did not always have enough food to meet people’s requests. Staff did not always have oversight of people. Staff received training. People’s needs had been assessed prior to admission to the service. Staff worked with other health care professionals. Peoples capacity had been assessed where required. We made a recommendation around the kitchen environment and meal choices.

People were not always supported to have maximum choice and control of their lives. However, staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff did not receive end of life care and felt they were unable to give quality end of life care. Some information was accessible to people, however, other picture boards in communal areas was not complete. The registered provider had a complaints policy. Staff felt they were able to raise a complaint. People’s cultural beliefs were respected. People received a choice of activities.

Some staff did not support people when they displayed distress. People told us they did have choice with elements of their care. Other staff interacted positively with people. Peoples dignity was considered by staff and they felt were treated well.

There was not a positive culture in the service and values were not embedded in to the staff team. Quality assurance processes did not always effectively address shortfalls in the service, however there were plans to improve this. Areas which required improvement were not prioritised to ensure timely action had been taken. The registered manager understood their responsibilities to be open and honest.

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 requires improvement (published 6 March 2019).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We identified a breach of regulation in relation to staffing at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

•A breach of Regulation 11 (1) of the Health and Social Care Act (Regulated Activities) Regulations 2014 was identified. This related to people who were subject to Deprivation of Liberty Safeguards not being appropriately transferred from the previous provider.

People received care from kind and compassionate staff.

• The service was clean, however some areas would benefit from redecoration and refurbishment.

• People were cared for by staff who were aware of the signs of abuse, neglect and discrimination.

• Staff knew people well. People and staff had a good relationship and were comfortable in each other’s company.

• People were enable to maintain their independence and have a say in some aspects of the service.

• Staff supported people to live their lives in the least restrictive way possible. The policies and systems at the service supported this practice.

• People were able to give their feedback on the service at resident meetings and were involved in staff interviews.

• People's care was personalised in response to their individual needs.

• The provider had processes in place to measure, document, assess and evaluate the quality of care. However, these processes did not always identify weaknesses in the assessment process.

• The service met the characteristics for requires improvement overall.

• More information about our inspection findings is in the full report.

Rating at last inspection: This was the first inspection for Cathedral Nursing Home since the current provider registered with CQC in October 2018.

About the service: The service provides accommodation and personal care 38 older adults, people living with dementia and younger adults. There were 29 people living in the service on the day of our inspection.

Why we inspected: Why we inspected: The inspection was prompted by a notification of an incident following which a person using the service was suffering abuse from the registered manager. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident.

However, the information shared with CQC about the incident indicated potential concerns about the management of risk of abuse. This inspection examined those risks.

Follow up: We will continue to monitor the service to ensure that people received safe, high quality care. Further inspections will be planned for future dates.