Cavell Court

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Overall, the service had improved its effectiveness over recent months with increased oversight and auditing. The clinical risk register gave a good overview of people's needs and the risks associated with their care. Key members of staff were involved in planning and the management of risk. Health care professionals cited communication had improved and they held regular meetings. They said not all staff had a clear understanding of peoples needs. Through our observations we found records were not always accurate and whilst the service was using both paper and electronic records there was a lot of duplication. ca Staff said consistent staffing had been achieved recently. We found individual teams working well but staff did not work as a fully integrated team resulting in differential experiences for people particularly in relation to activities and community access. Some staff felt training for their roles was not yet right and relatives had concerns about inexperienced staff and how that impacted on their relatives’ care. We found staff had a good understanding of the Mental Capacity Act. Restrictions were minimal and where necessary had been implemented using best practice guidelines and were the least restrictive. During our site visit we found documentation variable and did not always explore what the person could or could not decide. Documentation did not always show the involvement and, or discussion with relatives who had power of attorney. The manager informed us that over 70 percent of care records had been updated to take into account feedback received by the local authority. Records showed people’s health care needs were monitored and discussed so risks could be escalated. Joint meetings helped to have a more holistic approach to peoples needs. We did not have concerns about pressure care, diabetic management or how people’s nutritional needs were being met.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us that staff consulted them about their needs and wishes and families said they felt involved in the care as well although they did their feedback was not always acted upon. Relatives were aware of the care plans and said information sharing was generally very good one person told us they had a copy of their care plan, and these were accessible at request. Needs were assessed on an ongoing basis, for example through residents’ meetings, one to one resident of the day review and care plans and risk assessments reviewed as required. Surveys were also issued with relatives confirmed they had received. A you said we did showed how the manager responded to feedback.

Staff told us information was handed over between each shift from team leader to team leader and then team leader to carers. There were also daily management meetings and head of department meetings. Carers were welcome to these but told us these coincided with their duties/ breaks so did not tend to attend. Information sharing about needs and risks was fragmented because some staff worked part time hours so were not involved in feedback and care staff generally had reduced opportunity to attend feedback. Staff spoken with all said they did not go to staff meetings due to shift patterns and other commitments. There were other ways of sharing information such as electronic updates, but these were about working practices rather than individuals.

Regular reviews were conducted and the home consulted with other health care professionals to ensure needs were met as holistically as possible to reduce the risk of long term ill health and, or disability. Risk meetings helped to focus staffs attention to changing or unmet needs.

People experienced good care and were supported by trained staff. We reviewed staff training which was comprehensive but did rely heavily on eLearning. Relatives spoken with did not have concerns about the training of staff but did feel the lack of experience and skills mix on the floor could sometime impact on people’s care.

Speaking with staff we felt they had a good understanding of people’s needs and the training they had received which they were able to embed into their practices. There were a few exceptions to this including manual handling observations and we had concerns about how person centred the care was. This was fed back to the manager who explained training had been rolled out to staff and coaching was being used to support staff who needed a bit more support. Training for dementia was standard and there was a dementia lead/ coach. However, this was another area of concern both throughout our observations and feedback from relatives about limited engagement and communication from some staff. A staff member told us activities were not inclusive for those living with dementia and this meant the programme was not fully inclusive. Observations were generally of an open and friendly service where staff were attentive, and we did not see people being rushed or staff stressed. The staff we spoke with about specific elements of their job role seems to have a good understanding particularly head of department.

Staff were supported through induction and training and there were policies to support staff deliver care safely.

We observed staff across the day and staff reported different experiences on each floor. Staff on the upper floors had less people to support but the level of dependency was a lot higher, and people required more supervision. We observed activity staff entering each floor but felt that activities were not robust and did not engage people for very long. There was a lack of meaningful occupation for people other than mealtimes where we observed staff trying to support multiple people at a time on the first and second floors. People requiring additional support with their meals were served first. Staff told us this did not work in practice because it meant that other people were waiting a long time for their meals. We observed some people waiting up to 40 minutes from the first serving. People told us they sometimes had to wait at busy times of the day and their support varied depending who was on. Relatives raised concern about continuity of care over time. Staff also raised concerns about night care and things not being done. The manager said they monitored the service over a 24 hour period.

The manager was open and honest and told us that some staff had left recently, and they had to review the skills and experience of staff. This had involved deploying staff in line with needs of people using the service and their skills and experiences. They said the home had faced a difficult period, but they were back on track with recruitment.

Health care professionals did not feel information was always forthcoming or there were always staff available to support them when reviewing peoples needs. Regular multi disciplinary meetings had helped to improve communication. Health care professionals updated people's records but said it was not always easy to access people's infromation needed to make a judgement.

Each suite had a unit manager, who oversaw the care needs of people and checked records to ensure people remained appropriately cared for and hydrated. The recent recruitment of further team leaders will strengthen the service and ensure greater continuity of care and oversight. Their was a key worker system which was not yet firmly embedded and if working effectively would help ensure each person had a named member of staff to oversee their care. Resident of the day was in place and provided a good opportunity to thoroughly review the persons needs in a holistic way. Care plans, one page profiles including a person medical and social history gave enough information to help ensure staff provided care in a consistent way.

People reported being supported to access health care services as necessary including a mobile optician and chiropodist. There was regular input from nurses including the diabetic nurse and input from the 3 different surgeries used. Details of people’s health care was documented. When we asked relatives does your family member regularly see a dentist, optician, GP, chiropodist when requested and do staff inform you if they are ill, or if an incident has occurred. Relatives invariably said ‘Yes, these services are available’, and one relative told us their family member saw both the visiting dentist and optician by appointment.

Staff told us how they supported people to stay hydrated and there were arrangements in place for hot weather such as extra fluids and ice lollies, Soup everyday increased people’s fluid intake but staff told us a lot of people refused the soup. The cook told us milkshake was made available but not for every floor and this might be a viable alternative. Although exercise was part of the activity schedule, we noted people sitting a lot and not always encouraged to stay mobile across the day. This could impact on their overall health.

Records showed us oral health assessments were carried out, but it was not always clear how dental and gum issues would be identified or followed up as some people’s records showed they hadn’t seen a dentist for years. Regular health care reviews were in place and peoples health needs were known and acted upon.

People told us most staff understood their needs and their needs were clearly documented and kept under review.

Staff told us they received training and induction relevant to peoples needs and maintained oversight of peoples needs. The team leaders told us how they reviewed needs and risks on a daily basis.

Processes included records both electronic and paper which were inclusive and shared with professionals as necessary with the relevant permissions in place. Information was accessible and in line with legislation around The Data Protection Act 2018 and meeting accessible communication standards, 2016. Reviews took place as required and the resident of the day helped ensure peoples views and experiences were taken into account although suggestions were not always proactively responded to,

People were supported to make decisions in line with their needs. Most people living at the service were subject to deprivation of liberty safeguards (DoLS) and these had all been applied for, granted and renewed as necessary. People were involved in decision making and staff recorded people's involvement and how decisions had been reached. Everyone we observed were able to make simple decision such as what to wear, choices of meals and to give consent to see the GP. More complex decisions for those lacking capacity would be made involving other professionals. Sensory assessments were completed as necessary and care plans stated if people relied on aids to help them communicate, such as hearing aids. People told us they were not restricted and could go about the home and exit the home. External cameras were in place for people's safety. Key pads restricted exit but these could be overridden by those able to exit safely. At meal times staff offered visual choices of the meal options and choices were promoted in positive ways. We reviewed a care plan for someone who could have distress behaviors and thought the documentation around this was unclear as to how staff should support them consistently but staff understood the importance of routine and gender specific care for this person.

Staff had received training around the Mental Capacity Act 2005 and gave inspectors a good overview of their training and their understanding of the (MCA) and the 5 principles. Staff were observed offering people choices in a way that was right for them. Staff understood that people might struggle to make decisions but needed time and sometimes space to make those decisions. A records of peoples care included when people might have declined aspects of their care and support although staff told us no one regularly declined.

Whilst people had documentation in their file about their mental capacity and their ability to make decisions there were some discrepancies in the paperwork. In some cases, families and people had been clearly involved in decision making and in other cases not, i.e. Recommended summary plan for emergency care and treatment (RESPECT) forms and DoLS sometimes stated the person had no family when it was clear from people's records that they did have a next of kin and, in some cases, they held Power of attorney. Several (RESPECT) forms were signed by a single clinician and others were counter signed and showed inclusion of family members. There was a lack of consistency around the recording. I.e. one person’s records stated they were able to understand risks associated with their wheelchair but elsewhere in their care plan stated they lack capacity to assess risk. Following our review of records the manager assured us 70 percent of records had been updated in line with earlier feedback received from the local authority.