Caldy Manor

It is registered to provide accommodation and personal care for up to 38 people. At the time of this inspection there were 16 people living at the home.

We found the following examples of good practice.

•The service had procedures and protocols in place which ensured people were admitted into the service safely.

•People and their relatives were supported to understand the isolation procedures and infection prevention and control measures. The service helped to alleviate people feeling lonely, by providing access to safe supervised visiting, in accordance with national guidance, and video and telephone calls with friends and loved ones. There was dedicated support time from their assigned staff members including activity time.

•Staff were supported in isolation/sickness absence by the provider. Staff support and wellbeing was considered and enhanced during the pandemic.

•Personal protective equipment (PPE) was widely available and used correctly and there was an extensive testing program in place for staff, people using the service and visitors.

•The home was clean and hygienic throughout. Areas in the home had been redesigned to enable effective social distancing.

•Staff were trained in infection prevention and control (IPC) and had frequent refresher training and guidance in COVID-19 guidelines. There were good links with the local community trust IPC team for guidance and support.

•There was an IPC policy and procedures in place. Contingency plans were in place for future service disruption, including due to infection outbreaks and winter pressures.

Caldy Manor is a listed building set in its own gardens in Caldy Woods just off the main road through Caldy Village. The home is decorated to a good standard throughout with accommodation provided across four floors. A passenger lift enables access to bedrooms located on the upper floors. All bedrooms are single occupancy with en-suite facilities. Specialised bathing facilities are also available. On the ground floor, there is a communal lounge and dining room with access to a garden and patio area. The lower ground floor of the home is called 'Memory Lane' and is reserved for people who require more support from staff with daily living activities.

There was no registered manager in post, as the manager had left a few weeks before the inspection. The home were actively recruiting for a new manger. 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.' A deputy manager was acting as home manager at the time of the inspection and participated fully in the inspection visit.

At the last inspection in July 2016 the service was rated overall as good, and in each of the key questions: is the service effective, caring, responsive and well-led. The key question safe was rated as requires improvement.

At this inspection, we found improvements had been made following the last inspection. We rated the key question: is the service responsive as outstanding. We rated the key questions: is the service safe, effective, caring and well led as good. The service overall, has remained good.

The management of medicines had been improved since the last inspection and we found medicines were safely managed and robust checks were in place to identify and take actions when shortfalls were identified.

The provider ensured people had access to a wide range of meaningful activities. This included trips out to places that people said they wanted to visit and parties and events. We saw many examples of where the involvement of the local community had enabled people to feel included and part of their community once again. People told us they looked forward to things and felt excited by activities, visits and events at the service. This demonstrated activities were truly meaningful for people.

People and their relatives gave consistent, positive feedback about the service. This included the approach of staff, the food, the events that took place in the home and the accommodation.

People were helped to exercise support and control over their lives. People were supported to consent to care and make decisions. The principles of the Mental Capacity Act (MCA) 2005 had been followed.

People had access to sufficient quantities of nutritious food and drink. People's special dietary needs were catered for and people's preferences were noted and acted upon. Everyone we spoke with said the food was “excellent”. We observed the serving of lunch. The food looked and smelled appetising and was served pleasantly by staff.

Staff were recruited robustly and safely. They received training which ensured they were up to date with the skills required for their roles. New staff received an in-depth induction to the service which included the support of more experienced staff.

Risk assessments and risk management plans were in place. Personal care was delivered in line with assessed needs and accurate monitoring records were maintained.

We looked at how accidents and incidents were managed and found that they were recorded and reported appropriately. We saw that appropriate actions were taken following incidents, such as contacting the GP, emergency services or referral to other professionals. We also saw evidence of learning from incidents being shared with staff through supervision.

Systems were in place for monitoring quality and safety. Where shortfalls or areas for further improvements were identified these were acted upon.

People were still supported by caring staff who showed genuine compassion and respect to those living in the home. We saw lots of positive interactions with staff and people, and we could see people enjoyed the company of staff. The chef spent time in the dining area ensuring people were enjoying the food, and just chatting to people about their day.

The management team had maintained an open and supportive culture in the home. Staff and people using the service told us they felt the managers were approachable and accommodating. Staff told us they were happy going to work and enjoyed their jobs. One staff member told us she had left the home, but returned within a week as she missed the staff and people living in the home so much.

Caldy Manor is a listed building set in its own gardens in Caldy Woods just off the main road through Caldy Village. The home is decorated to a good standard throughout with accommodation provided across four floors. A passenger lift enables access to bedrooms located on the upper floors. All bedrooms are single occupancy with en-suite facilities. Specialised bathing facilities are also available. On the ground floor, there is a communal lounge and dining room with access to a pleasant outside garden and patio area. The lower ground floor of the home is called ‘Memory Lane’ and is reserved for people who require more support from staff with daily living activities.

There was a registered manager 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.’ On the day of our visit, the registered manager had only been in post approximately six months but they participated fully in the inspection visit.

We reviewed three care records and saw that care plans gave staff clear person centred guidance on how to meet people’s needs safely in accordance with the person’s wishes. The majority of people’s risks were assessed and well managed and we saw that people received care from a range of other health and social professionals. For example, doctors, dentists, district nurses and chiropody services.

People who lived at the home said they were happy the support they received. They told us staff looked after them well and treated them kindly. Everyone held the staff in high regard and felt they had the skills and abilities to meet their needs. During our visit, we saw that staff supported people with patience and compassion whilst at the same time gently encouraging them to be as independent as possible. From our observations it was clear that staff knew people well and genuinely cared for the people they looked after. Support was person centred, warm and positive.

People we spoke with told us that they were able to choose how they lived their life at the home for example, what time they chose to get up / go to bed, and what they wanted to do during the day. A good range of activities were provided to interest people and we saw staff simply took the time to sit and chat to people socially in addition to meeting their support needs. This promoted their well-being.

We saw that some of the people who lived at the home, lived with mental health conditions that impacted on their ability to make decisions. Where people needed to be deprived of their liberty to protect them from harm, mental capacity assessments and deprivation of liberty safeguard applications had been submitted to the Local Authority in accordance with the Mental Capacity Act 2005. This ensured legal consent was obtained. Further work was required to ensure that these elements of good practice were routinely applied to other specific decisions about people’s care. It was clear however from people’s care records and our observations of people’s care, that gaining people’s consent to their care was important to the manager and the staff team.

People had access to sufficient quantities of nutritious food and drink. People’s special dietary needs were catered for and people’s preferences were noted and acted upon. The majority of people we spoke with said the food was good. We observed the serving of lunch. The food looked and smelled appetising and was served pleasantly by staff.

We observed a medication round and saw that medicines were administered safely. The majority of medication was stored securely but we found some prescribed creams in people’s bedrooms which meant they were accessible for unauthorised use. We spoke to the manager about this, who assured us this would be rectified without delay.

Staff were recruited safely and there were sufficient staff on duty to meet people’s needs. Staff received appropriate training and worked well in a team. Staff appraisal and supervision records however did not show that all staff had received adequate support in their job role. We spoke to the manager about this who, had already put a plan in place to address this prior to our visit.

People told us they felt safe at the home and they had no worries or concerns. Staff we spoke with were knowledgeable about types of potential abuse and the action to take if they suspected abuse had occurred.

The premises were safe, well maintained and clean but at the time of our visit, some of the equipment at the home had been identified as requiring repair in order to be safe to use. These repairs were still outstanding at the time of our visit. We spoke to the manager about this. Shortly after our inspection we received evidence that the repairs were organised and in progress.

The home was well led and the culture of management was open and transparent. There were a range of quality assurance systems in place to assess the quality and safety of the service and to obtain people’s views. A survey of people’s views had been completed in 2015 and showed people were happy with the service provided.

People received a choice of nutritious meals and appropriate action was taken to identify and address any concerns about nutrition.

People's medicines were well managed to ensure that they always received their medication as prescribed by their doctor.

Employment checks were carried out to ensure that new staff were safe and suitable to work with frail older people. All staff received annual training about safeguarding vulnerable people from abuse. A visitor told us 'The staff are great, they are so kind and caring'.

People living at Caldy Manor did not require 24 hour nursing care and people who had nursing needs received a service from district nurses. People had regular visits from their GP and from other health professionals as needed including dietician, memory nurse and continence advisor. A chiropodist visited the home regularly.

The home provided a high standard of accommodation which appeared to be well-maintained throughout. The maintenance person kept detailed records of all equipment and safety checks.

There were enough qualified, skilled and experienced staff to meet people's needs.