Caer Gwent

Caer Gwent is a residential care home providing personal and nursing care to up to 61 older people with a range of health care needs, including some living with dementia. At the time of our inspection there were 54 people using the service. The home was purpose-built and care is provided within separate units of the home and over two floors, accessible by lifts and stairs. Communal areas include lounges, dining rooms, a library and gardens.

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

Some medicines used to treat two people’s eyes were being used beyond the time recommended by the manufacturer. These were immediately removed and replaced by the registered nurse on duty. Other aspects of medicines management were managed safely and people received their medicines as prescribed. People’s risks were identified and assessed, with guidance for staff on how to mitigate risks. Overall, the home provided a safe, physical environment.

Auditing systems were not sufficiently robust. The medicines audit had not recognised how medicines needed to be discarded to prevent the risk of them being used outside of safe timeframes. Recording of when one person’s fluids were required to be thickened was inaccurate which put the person at risk of choking if they received fluids that had not been thickened. Additional information for people at risk of falls had not been included when they received anti-coagulant medicines and were at higher risk of bleeding.

People’s dietary needs were met and people were positive in their comments. One person said, “The food is perfectly all right. I don’t expect home-cooking, but it’s good and it’s very edible”. Another person told us, “The food is very good. You get a good variety, with alternatives”. People had access to a range of healthcare professionals and services. The home was adapted to meet people’s needs. 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.

People were looked after by kind and caring staff who knew them well. People were complimentary of staff and the care they received.

Care was personalised and responsive to people’s needs. A range of activities was organised to provide mental stimulation for people. People were supported to stay in touch with families and friends, and social media was used to advantage. People could live out their lives at the home and their wishes were recorded and respected.

People and their relatives were asked for their feedback about the home and the care they received, and comments were positive.

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 this service was requires improvement (published 24 February 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections. At this inspection we found the provider remained in breach of regulations.

Why we inspected

This inspection was undertaken to look at the actions taken by the provider since the last inspection in January 2020 and to see whether improvements had been made.

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.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well Led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have found breaches in relation to the disposal of medicines and audit, and accurate recording within people’s care records at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Caer Gwent provides accommodation, personal care and nursing care for up to 60 older people. At the time of our visit 56 people were living at the service. Seven of those people were living at the service on short or long-term respite.

Accommodation was provided over two floors in an adapted building. Rooms were in four separate units, but all communal areas were shared across each unit. There were communal areas including lounges, dining rooms, a restaurant, a piano room used for entertaining and socialising, and an adapted garden. People were able to move freely around the home and had access to three lifts.

People’s experience of the service:

People gave us mixed feedback about whether staff were always caring or kind. This feedback was shared with the provider. During our visit, we observed positive interactions between staff and people. We observed people were treated with respect. We observed people were happy and relaxed in the presence of staff.

From people’s feedback and in their responses to a recent resident survey, there was mixed feedback about whether staff were deployed appropriately to meet people’s needs and to give them support when they needed. For example, we received some feedback from people about waiting for call bells to be responded to.

Quality assurance reviews to measure and monitor the standard of the service and drive improvement were not always effective.

At this inspection, we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2004 regarding Good governance.

A relative told us, “We have been absolutely delighted with the care [Person] receives and incredibly grateful to the staff for their outstanding compassion, hard work and commitment.” A visiting friend told us, “It’s more like a hotel than a home, it has everything [Person] needs.”

People and relatives knew how to make a complaint. Formal complaints were investigated and acted upon. People gave us mixed feedback about whether they felt confident that their feedback, such as a informal complaints or concerns, was listened to and acted upon.

People had enough to eat and drink and had choices in what they ate and drank. There was mixed feedback, however, about people always getting food that was consistent with the choice they had made or with what they had told staff they disliked. Staff accommodated any specific dietary requirements such as allergies.

Staff were knowledgeable and experienced to deliver care including nursing. People were supported by staff to have maximum choice and to make decisions about their care.

Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place.

People were protected from infection by staff that kept the premises clean and used appropriate protective equipment when needed. Medicines were managed safely and in accordance with current regulations and guidance.

Recruitment processes continued to be robust. Staff knew how to keep people safe in an emergency.

People took part in structured activities. People were supported to pursue their own hobbies and there was time for activities and care staff and volunteers to spend one to one time with people.

Visitors were made welcome and interactions between staff and visitors were warm and friendly. Family and friends were able to visit freely without restriction.

Care plans described people's needs and preferences and guided staff about people’s needs and how to meet them. Health and social care were accessible for people.

Staff told us they felt supported, records showed they had regular supervision and annual appraisals.

The overall rating for the service was Requires Improvement. This is based on the findings at this inspection. More information is in the ‘Detailed Findings’ below.

Rating at the last inspection: The last rating for this service was Good (published 25 April 2017).

Why we inspected: This was a planned comprehensive inspection that was scheduled to take place in line with Care Quality Commission (CQC) scheduling guidelines for adult social care services.

Follow up: We will review the service in line with our methodology for ‘Requires Improvement’ services. If any concerning information is received, we may inspect sooner.

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

Caer Gwent provides nursing care and accommodation for up to 61 older people with a variety of health needs. At the time of our inspection, 59 people were living at the home. Caer Gwent is a large home, situated away from the road and close to Worthing town centre. The home is divided into several units or suites comprising: Amberley, Goodwood, Arundel, Petworh and Parham. Each suite contains bathrooms, communal sitting and dining areas. A library room on the ground floor has a range of books for people to borrow. All bedrooms have en-suite facilities. There is a separate two bedroomed apartment serviced by a separate lift. The home has gardens at the rear which are accessible to residents and off-road parking.

A registered manager was 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.

People and their relatives felt that Caer Gwent provided a safe environment. Staff had been trained to recognise any signs of potential abuse and knew what action to take. People’s risks were identified, assessed and managed appropriately, with clear guidance for staff on how to support people safely. Staffing levels were sufficient to meet people’s needs and safe recruitment practices were in place. Medicines were ordered, administered, stored and disposed of safely. The home was clean and hygienic.

Staff had been trained in a range of areas and new staff following the Care Certificate, a nationally recognised qualification. Registered nurses completed specialised training. Not all staff had received regular supervision in line with the provider’s policy, that is, three supervisions per year and an annual appraisal if required. The registered manager was aware of this and that this was an area that required improvement. Staff felt supported and attended team meetings and some group supervision meetings were held. Staff had a good understanding of the legislation relating to mental capacity and Deprivation of Liberty Safeguards and put this into practice. People were supported to have sufficient to eat and drink and the lunchtime experience we observed was a relaxed affair. People were supported to have good health and had access to a range of healthcare professionals and services. Rooms were personalised and people commented on the comfort of their rooms.

Positive, warm and caring relationships had been developed between people and staff. There were several instances that were observed when staff responded to people’s needs in a sensitive and compassionate way. People and their relatives were involved in decisions relating to their care. People were treated with dignity and respect.

Care plans provided detailed information and guidance to staff on how to support people in a person-centred way. People’s personal histories were recorded. A range of activities was organised by the activities co-ordinator and some external visitors provided musical entertainment. Complaints were managed in line with the provider’s policy.

People and their relatives were encouraged to feedback about the quality of the care delivered and residents/relatives’ meetings were organised. A newsletter was published to update people on what was happening. Staff felt supported by the registered manager and enjoyed working at Caer Gwent. High quality care was delivered and a range of audits was in place to measure and monitor the service overall. However, the registered manager had not notified the Commission of three significant events and these were discussed at the time of our inspection.

People's views and experiences were taken into account in the way the service was provided and delivered in relation to their care. People had the opportunity to say how they preferred their care to be undertaken, and guidance was provided for staff on meeting their needs accordingly.

People told us they were happy with the care and support they received. One person told us 'Staff are always helpful. Staff treat you well.' People's needs were assessed and support and treatment were planned and delivered in line with their individual needs. Records showed that where needed people had been assisted to access medical support, such as General Practitioners (G.P.s) and physiotherapists.

There were arrangements in place to ensure that the risk of cross infection was minimised. We found that the service had acted quickly when a risk of cross infection had been identified.

Records showed that a programme of training for staff had been regularly provided. A member of staff told us 'there has been a lot of training.' Another member of staff said 'Managers keep an eye on when training is due and tell you. Managers are good at providing support.'

We found that the provider had regularly reviewed the quality of service at the home and obtained people's views on the service. Action taken by the service had led changes in the meals provided. Measures put in place had also reduced the number of falls recorded at the service.

We found that there were arrangements and safeguards in place for people who wished to self-medicate. We also found that there was clear guidance for people who needed PRN medicines.

People told us they were happy living there and that staff treated them with kindness and respect. People told us "the staff are friendly." People told us that staff understood their needs and provided appropriate support. We found that people were involved in their care planning.

People told us that the home's environment was maintained and cleaned to a high standard. One person said, "the cleansing business here is wonderful."

People gave mixed responses about the staffing levels in the home. While some people commented that staff were quick to respond and "there's always someone there to help," other people commented that there wasn't enough staff and they had to wait for assistance. One person said that staff responsiveness "depends on how busy they are and how short staffed they are." We found that staffing levels had tended to fluctuate but had stabilised in recent weeks.

We found that the provider did not have appropriate or consistent procedures in place for people who managed their own medicines and for people with as needed (PRN) medicines. This meant that people were not always protected from the risk of unsafe or unsuitable medicine administration.