About the service:

Cavell House is a residential care home providing personal and nursing care to a maximum of 52 people in one adapted building over two floors. At the time of the inspection 43 people were living at the home including two people having short term stays. The people living there are older people with a range of physical and health related needs including people living with dementia. At the time of the inspection the home was working in partnership with a local hospital to enable people to have a community placement in the care home while a suitable care environment or safe discharge home could be made.

People’s experience of using this service:

¿ The outcomes for people living at Cavell House were personalised and reflected the caring values of the people supporting them. People told us they felt safe and were comfortable with staff and were cared for in a safe, friendly and calm environment. People and their relatives told us that staff were caring and upbeat. One person told us, “The staff always treat us well. They ask me what I want to do for myself. They always encourage me to be as independent as possible. They are very kind, they honestly can’t do enough for you.” A relative told us. “They are wonderful staff, really kind and lovely to my relative. It’s feels like family and my relative is very content.”

¿ Improvements had been made since the last inspection. People and their relatives told us that staff responded to their needs in a timely way, and the provider had put in place more regular checks for people who were unable to use a call bell. A relative told us, “They used to take ten minutes to respond to call bells, now there’s no reason to use them, the staff are just more attentive.” There were sufficient numbers of staff to meet people's need.

¿ People’s needs, choices and preferences were known by staff and their care plans were personalised. Staff and managers were approachable and knew people well. Staff were provided with the guidance they needed to meet people’s needs safely. One person told us, “I can’t speak highly enough of the care. I’m not mobile and I have to have a hoist to get me into the wheelchair. It’s always two staff and they are very patient and make sure I’m comfortable and safe.”

¿ People were safe from the risk of abuse. Guidance enabled staff to provide the care and support that people living with physical, health and dementia needed in relation to their health and emotional wellbeing. Relatives and social care practitioners were reassured by the completeness of records. “When I go away for a few days and I don’t worry about my relative one little bit because I know they look after them so well.”

¿ People had access to a range of activities that met their interests and reflected their diverse needs and cultures. People were supported to maintain a healthy nutritious diet and had access healthcare services and professionals as and when needed.

¿ The registered manager led by example in providing person centred care and interacting with everyone at the home and ensured that relative and visitors felt welcomed and included. Staff and the registered manager felt well supported by each other and the provider. Complaints were recorded and responded to in an open and transparent way and there was a culture of learning from accidents and feedback.

¿ The quality assurance systems included detailed audits that ensured the registered manager and provider maintained a good clinical oversight of the home and identified themes and trends to inform improvements when required.

Rating at last inspection:

At the last inspection the service was rated Good. The report was published on 22 July 2016

Why we inspected:

This was a scheduled comprehensive inspection based on the previous rating.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. ongoing monitoring; possibly more about how we will follow up

For

The inspection took place on the 15th and 16th June 2016 and was unannounced. Cavell House is a care home with nursing. The people living there are mostly older people with a range of physical and mental health needs. Some people living at the home were people living with dementia. Cavell House is a modern building with two downstairs wings and a first floor area. The service is registered to provide support for45 people. On the day of our inspection there were 40 people living at the home.

The service had a registered manager. 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. The registered manager was away on the days of our inspection.

We carried out a previous inspection of Cavell House on 15 and 16 June 2015. Breaches of legal requirements were found and we identified two breaches of regulation in relation to consent and complying with the Mental Capacity Act 2005 (MCA) and the provision of meaningful activities. The provider wrote to us to say what they would do to meet the legal requirements in relation to these areas.

Following this we undertook a comprehensive inspection on 15 and 16 June 2016 to follow up whether the required actions had been taken to address the breaches identified and to see if the required improvements had been made. The report covers our findings in relation to those requirements. We found improvements had been made in both areas and the breaches of regulation had been met. However further areas needing improvement were identified.

People told us that they felt safe living at Cavell house and this was in relation to areas that included being at ease and comfortable with staff, receiving medicines safely, cleanliness and hygiene and moving around freely and safely. One person said of staff “They will always do their best to sort out anything they can for you. If you ask [the registered manager] and she can’t she’ll find someone who can and [deputy manager] you can speak to either of them”. However we observed that people’s access to call bells and the allocation of staff to meet people’s needs in a timely way was not always consistent and we have identified this as an area that needs improvement.

Improvements had been made in adhering to the MCA and where needed peoples capacity had been considered and recorded in people’s records. Where needed a best interests decision was made and recorded. Staff were trained in this area and were knowledgeable. The principles of MCA were displayed in staff areas to raise awareness.

We observed lunch, people had enough to eat and drink. They were given choices of food from a menu. Drinks were available throughout the day. One person told us “We get regular drinks all day”. People were encouraged and supported to eat and drink enough to maintain a balanced diet. Staff monitored people’s weights and recorded how much they ate and drank to keep them healthy. People were supported to access health care professionals when needed and the optician and the dietician were visiting during our inspection.

Staff received training that was relevant to their roles and received specific training around areas such as supporting people living with dementia and end of life care. Staff were supported through regular supervision with a manager which ensured they were able to discuss any areas for development and identify training needs.

People told us that staff were kind, caring and approachable. One person told us about staff “They’re very kind and do their best”. A relative told us “The carers are very, very kind in all respects”.

The complaints policy was available to people. There had been no formal complaints responded to since the last inspection. There were relative

During our inspection we spoke with six people who used the service, we spoke with three relatives of people who used the service or visitors to the service. We used formal and informal observation to look at how care was delivered. We also spoke with the manager and six care, nursing and domestic staff. We looked at information, including residents' care files and other records, to help us understand how Cavell House operates.

We found care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We spoke with one relative of a person with dementia, they told us “I’ve got peace of mind because my relative is getting the best possible care.”

We looked at systems in place for assessing and monitoring of the quality of service provision. The provider had an effective system to assess and monitor the quality of service that people receive. A person who lived at Cavell House told us, “The manager will ask questions and want to know if everything’s all right. I would tell them if it wasn’t.”

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by an Expert by Experience (people who have experience of using services and who can provide that perspective) and a practising professional. We spoke with four people who lived in the home, five relatives visiting the home, and observed the care and support provided to others who were unable to communicate verbally. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

People told us that they felt comfortable and safe in the home. They said they liked the staff and found them to be respectful and professional. One person said, “it’s a wonderful place.” One family member said, “I’m very satisfied. My husband wouldn’t be here otherwise!”

People also told us that they thought the home was short staffed and they would like more assistance, particularly at meal times.

We spoke with the new manager of the home and three staff members. Staff said they had good access to training but they often felt there were not enough staff.

The inspection took place on the 15th and 16th June 2015 and was unannounced. Cavell House is a care home with nursing. The people living there are mostly older people with a range of physical and mental health needs. Some people using the service were living with dementia. Cavell House is a modern building with two downstairs wings and a first floor area. The service is registered to provide support for 46 people. On the day of our inspection there were 46 people living at the home.

The service had a registered manager. 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.

People told us that they liked living at Cavell House .One person said “It’s very nice here” and another said “I’m very happy here”. However there was not enough staff on duty on the day of our visit to provide support to people around meaningful one to one activities, particularly for people who stayed in in their rooms.

People were not always protected from infection and we have identified that this is an area that needs improvement.

Peoples consent was not always sought in line with the Mental Capacity Act 2005. People’s mental capacity to make decisions was not always assessed and best interest decisions were not recorded. This was particularly in relation to the installation of bedrails and administration of medicines.

Staff were appropriately trained, some of whom held a Diploma in Health and Social Care. All staff had received essential training. Staff had received training in supporting people living with dementia. Nursing staff maintained their nursing skills and could request training as needed.

We did not observe any activities taking place and could not see that individual one to one activities were planned for people who couldn’t or didn’t want to participate in group activities. We did not see any activities in place for people living with dementia.

People were safe as they were supported by staff that had been trained in safeguarding adults at risk procedures and knew how to recognise signs of abuse. There were systems in place that ensured this knowledge was checked and updated. Medicines were managed and administered safely. Accidents and incidents had been recorded and appropriate action had been taken and recorded by the manager

We observed lunch, people had enough to eat and drink. They were given choices of food from a menu. Drinks were available throughout the day. One person told us “The food is nice”. They were encouraged and supported to eat and drink enough to maintain a balanced diet. The service monitored people’s weights and recorded how much they ate and drank to keep them healthy.

People told us that staff were kind, caring and approachable. One person told us “I feel able to talk to staff”. Another person said “Staff are very nice, they look after me well”. We observed staff treating people with dignity and respect.

The registered manager responded to concerns and complaints in a timely manner. A positive culture was promoted and new staff had a good understanding of how to communicate with people in an accessible way. There was a range of audit tools and processes in place to monitor the care that was delivered and the registered manager worked in partnership with visiting professionals to the home.

We identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of this report.