At our previous inspections in May and August 2017 we found that the service was in breach of regulations regarding the management of medicines. At this inspection we found that this breach continued. Our inspection of May 2017 also found that the service Required Improvement in the areas of Safe, Effective, Responsive and Well-led. At this inspection we found that the service still Required Improvement.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.