Cavell Court

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Overall, we felt improvements had been made at this service following concerns identified by the local authority and the homes internal audit processes. Staff recruitment was robust, and the proportion of new starters was not excessive. Overstaffing was used to mitigate risks associated with last minute absences and sickness. Whilst this tended to work well not all staff agreed they were overstaffed and felt at times they were extremely busy and rushed. Some staff felt care over 24 hours could be compromised depending on night staffing levels and whether agency staff were on duty. Our observations of staffing was that deployment and oversight of staff practices were not yet working effectively. The manager said since our assessment observations of staff practice had increased. We were assured that people received safe care and treatment with staff following up on changes in people’s needs. For example, one relative told us, “Dad had a skin rash. They noticed and got someone in.” Another described how the team leader noticed their relative decline in their swallowing ability and made a referral. Staff told us handovers between shifts included if there had been any medication changes, anything from the GP round, if any medicines had been booked in, residents’ weights, any dietary requirements, or anything relevant for the speech and language (SALT.) Information was shared via handover sheets, clinical risk register, daily heads of department meetings, weekly clinical risk meetings and regular liaison with health care professionals. Relatives were also kept in the loop of any changes. The environment was well organised, well maintained, spacious and generally safe.

This service scored 72 (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 they had input into their care with some people and, or relatives having access to care plans and staff willingly sharing relevant information with people. Regular meetings and other forums gave relatives and people opportunity to influence the care, and all felt communication was good and relatives informed about changes to their family members needs. The service was progressive in the sense that tangible improvements were noted since external reviews and the home had its own internal monitoring which helped improve peoples experiences.

Staff told us they were supported through induction, training and shadowing which helped them deliver safe and effective care. There were systems in place to measure the quality and safety of the service and ensure lessons were learnt and help ensure improvements across the service. Most staff acknowledged there had been recent improvement at the home and attributed this to having more regular staff. When inspectors were talking to regular staff it was clear that they knew peoples needs.

When it was identified that staff were under performing this was being addressed through mentoring and additional training. There were systems to monitor the quality of care, but staff mentioned greater management oversight on each floor would be advantageous. Internal quality audits helped to identify risk and analyse data. For example, falls data indicated the number of falls had fallen because steps had been taken to mitigate risks wherever possible by considering patterns and trends and adapting the service accordingly.

Relatives said that they were involved in decisions and assessments of their family members needs and said they were kept up to date. One family member raised a concern about the admission process and the settling in process where they felt the home was quick to say it was the wrong environment although within time the person settled. Another relative said their family member had moved from one floor to another as their needs had changed and said this had been advantageous.

Staff told us how they supported people in a holistic way with regular input from other health care professionals to ensure their physical needs were met. Well -being was promoted throughout the day with a programme of activity and designated well being leads. Staff told us there was some community engagement which they felt could be extended further and consideration given to those choosing not to engage.

Concerns had been expressed by health care professionals and the local authority about improvements that needed to be made to ensure people experienced safe transitions. Weekly meetings and improved handover and risk analysis had helped ensure people received better joint up care.

Initial assessments, care plans and risk assessments helped to determine peoples needs and any actions to take to mitigate and monitor peoples needs. For example, people with unintentional weight loss were weighed weekly and offered a fortified diet. Information about people’s clinical risks were discussed at the weekly clinical risk meetings and there was a register in place which was reviewed to see how the risks were being reduced. Daily meetings between staff and a meeting at heads of department level helped ensure information was shared. Regular input from nurses and other professionals helped ensure a holistic approach to health care and regular meetings were held with health care professionals to plan how to meet need.

People did not raise concerns either about staff or other people using the service. Some people would and had raised concerns. Others would rely on staff or family members to raise concerns on their behalf. There were opportunities for people to influence their care delivery and staff said any emerging or actual risk such as a fall and or bruising would be documented and escalated.

Staff spoken with had a good understanding of risk and safety. They were aware of how to escalate concerns and what constitutes abuse. One staff member told us, “Its keeping people safe from harm, bullying, harming people physically or psychologically." Safeguards were in place to ensure peoples rights were upheld such as deprivation of liberty safeguards Dols where appropriate and staff were aware of these and the principles behind the Mental Capacity Act 2005. We observed staff engaging with people and offering them choices in the least restrictive way.

Through our observations we identified a few people whose distress behaviours were not overseen by staff in a positive way. One person was disorientated to time and place, another was banging cutlery etc. on the table. Staff acknowledged people’s distress but did not actively engage with people to try and create a distraction or other means to reduce their anxiety. This had the potential of creating an unsafe situation as other people using the service were reacting verbally to these behaviours. One person care plan did not have clear strategies for minimising their distress. The home had provided dementia training for staff and had a dementia coach to support staff with their approaches to people living with distress.

Whilst at the service we identified an inappropriate moving and handling technique which did not cause the person any harm, but this was fed-back to the manager who took immediate actions. The manager kept a spreadsheet of any safeguarding concerns and actions they had taken including escalating those concerns to the local authority safeguarding team and the CQC. Investigations were carried out and appropriate actions taken. This might include staff disciplinary actions. Concerns over people’s safety were discussed and shared as appropriate with the team so lessons could be learnt. In addition to face-to-face meetings staff received internal communication to ensure they remained informed of changes in policy or risk.

People spoken with said most staff were aware of their needs and felt well supported. One person told us “There’s always someone around.” People had equipment to help them stay safe and mobilise such as wheelchairs and walking frames which were regularly checked by maintenance staff. People told us staff observed their diets and were aware of people who were unintentionally losing weight and were therefore on modified diets and weighed weekly. People raised concerns about falls they had experienced. The risk of falls was assessed, and assistive technology used wherever possible to reduce the risk of further falls. One person described themselves as falling when they tried to mobilise independently having used the call bell and it not being answered, they tried to take themselves to the toilet. We reviewed their risk assessment which indicated other falls in the past but did not provide a detailed risk assessment showing clearly what had been reviewed. Whilst at the service we observed a person falling after missing the chair. Staff checked them over and having confirmed there was no obvious injury and the person was not taking anticoagulant medicines they were assisted up safely using lifting equipment. The fall was handed over and 72 hours falls monitoring chart put into place. Our only observation was no one sat with them, or offered them a cup of tea.

Staff were aware of people’s needs and risks associated with their care. They told us they carried out regular checks to ensure peoples safety and completed daily records which included checks on people’s skin care, nutritional and hydrational checks where a risk had been identified and people’s general wellbeing. one staff member told us there had been issues with the ordering of continence aids. Another said it was difficult to keep every one hydrated when so many people needed assistance. We recommend nutrition and hydration champions. Staff told us they had received recent manual handling training and there were assessments to ensure they were competent. A staff member told us, “I am happy with the training I receive and do feel it meets people’s individual needs. “

We observed people mobilizing or being supported to mobilize. We observed a lot of people left in wheelchairs which we did not feel appropriate. This meant people were sometimes at the wrong height when sitting at the tables for meals, but also, we observed some people left in their wheelchair for a long time which could impact on people’s skin integrity and general wellbeing. Exercise classes like yoga were offered at the home but these might not be suitable for people with cognitive issues. Around the home there were snacks and hydration stations as well as a café on site. Staff monitored people’s food and fluid where necessary and we observed minimal supervision at lunch time but felt this needed to be more robust. Where people were being supported this was being done in a dignified way.

The manager had systems and processes in place to review falls, unintentional weight loss, unintentional injury and pressure care. The falls analysis showed falls were reducing and under the national average. Reasons for falls were analysed including a break down of where they occurred and at what time. In line with this information call bell audits were completed to see how quickly staff responded to peoples needs Regular meetings helped ensure risks were identified quickly and all key staff were aware. Information sharing across the home involved all heads of department.

People on the ground floor had large rooms overlooking the garden where on the ground floor. Environments were generally safe with very little clutter. Family members spoken with felt the environment was good and were happy with security across the home. Risks associated with the environment were generally eliminated with regular walk arounds, audits and health and safety checks. Some people used mobility aids which were regularly checked and stored away when not in use. People’s records showed where they required lap belts or other equipment to promote their safety this was assessed, documented and checked to ensure it remained fit for purpose. Relatives placed a lot of confidence in the team leaders and felt most staff were competent and well trained although several relatives spoke about risks associated with carers not having common sense principles or being familiar with every day routines including meal preparation.

We spoke primarily to the head of care, team leaders and head of department who were all involved in information sharing meetings and aware of wider risks. Checks were in place for fitted window restrictors and there were measures in place to ensure prompt action in the event of a fire. Staff had attended fire drills, and, on each shift, there was a fire marshal and first aider. First aid equipment and fire safety equipment were tested regularly. There was a generic risk assessment for emollient creams.

The environment was well maintained, and we did not identify any hazards to people’s safety other than the gardening room which was key coded and left open which meant people could enter and potentially get locked in. There were also gardening tools etc. in there. Other doors which were meant to be locked were and there was minimal clutter around the home. We did not identify any trailing wires or substances being left out including cleaning materials or creams. Call bells were in reach of people but there were times people were left unsupervised in communal areas. We noted people being reminded to use the walking frame or wait for staff. All equipment had stickers on to indicate when they had last been tested and there was clear information about fire evacuation. We sampled a number of windows which were adequately restricted. We received some negative feedback about the water flow which was being addressed. Thermostatically controlled valves helped to control the temperature of the water, so it was not too hot and regular checks were carried out.

The home had heads of department meetings daily to discuss the health and safety of people in line with the management of the environment. There were regular audits, and health and safety checks and risk assessments. There was designated maintenance and heads of housekeeping and catering. These teams were working well. Action and improvement plans made sure continuous improvements were being made. The kitchen was awarded 5 stars last year by environmental health and there were adequate safety systems in regard to food preparation and storage.

People told us they liked the staff and they supported them in line with their needs. However, some people told us they had to wait for care and staff could be rushed which affected response times. One relative told us,” Day shifts can be sufficiently staffed if there are a good mix of experienced carers. On the days when there are newer, less experienced staff on shift, we know there are going to be issues with toileting etc.“ Relatives said it can lead to anxiety when people need support at the same time and have to wait. One person told us, "staff are nice but it does feel there are not enough of them at times, particularly in the morning when they tend to rush about." A relative told us that they felt there were enough staff, but said, " with lots of news ones, It takes time for them to find their feet."

We received mixed feedback about staffing. Most of the relative feedback we received was from people living on the ground floor who actively supported their family members. Staff raised concerns that people on the ground floor had a tendency to stay in their rooms and only a small group of people joined others in the communal areas. We had concerns that the other floors saw more people being supported out of their rooms but less evidence of activity or engagement. This was particularly the case at mealtimes. On the ground floor we were told one person needed assistance with meals, whilst on the other floors people needed a lot more encouragement and support to eat to reduce the risks of malnutrition and hydration. Staff told us generally there were enough staff, but they could be understaffed as much as they could be overstaffed and there were times of the day when they could be rushed including morning and after tea when a lot of people required assistance with personal care. Staff said when they flagged concerns about staffing, they were told they had enough staff and in fact were usually overstaffed due to the reduced occupancy within the home. We agreed however there were pinch points across the shift when staff were struggling to provide person centred care. Staff did say in recent months there had been a reduction in agency staff which had helped.

We carried out observations across two days on all units. We noted that staff were generally attentive to peoples needs. Breakfast was busy because people had a choice of cooked breakfasts or breakfasts prepared on the individual suites. People were being supported with personal care up until lunch time and we observed very minimal engagement with people which all appeared quite task focused, i.e. serving people food and drinks whilst the television was on or music was playing. Activity schedules were in place but limited in scope to two planned activities a day and no evening activities. We observed people asking what was happening today and staff telling us they did not know what the plan was. Several staff said they felt the activities for people living with cognitive difficulties were poor and people on the 1st and second floor often missed out. We observed a person being brought downstairs to join in an activity led by the volunteers. There were already about 7 people in this group. The person was very confused and kept saying, " why am I here." They did join in the activity briefly but were not supported to do so and it was not inclusive for that person. Staff also told us some people never usually joined in.

Staffing levels were reviewed in line with the risk register and there was a dependency tool. We found that the same number of staff were on each unit although the numbers of people living on each of the unit varied. Data about people’s primary need and what support they needed for example with manual handling, assistance with eating and drinking was reviewed and observations helped to ensure staff were working in line with these needs. Resident, relative and staff meetings were held and updates about staffing were given at these meetings. It was clear that staff recruitment and retention had improved but only fairly recently so some staff still felt apprehensive about staffing levels and the deployment of staff. Representation at staff meetings was significantly low so there were missed opportunities to give feedback about staffing levels. We observed senior management on the floor, but staff said in reality this didn’t always happen and staff felt more oversight and continuity was needed.

People experienced living in a clean, well-ordered environment with a lack of odours. Relatives commented on a dedicated house keeping team who worked hard across the day. One relative said, “The home appears very clean and I am not aware of any smell of urine etc.“ This was similar to other comments raised.

We spoke to one of the domestic staff who told us they were well supported and had access to all the relevant training. They said their role was well organised and they had the equipment they needed. There were additional staff for the laundry and good team work.

Over our two-day site visit we noted people’s rooms were airy and spacious. These were clean and well maintained, as was the home throughout. There were a few rooms with an odour but generally standards of cleaning appeared good with no obvious concerns. Kitchens in the suites meant staff could make drinks, toast etc and we noted cups etc at the sinks, but cups and plates were collected quickly and were not left hanging around in people’s rooms or communal areas. The bathrooms were clean including the underside of bath chair. Pads were stored discretely, and the cleaning trolley was well organised.

A housekeeper oversaw a team of staff and reported daily to the manager in the information sharing meeting. Any gaps in cleaning were quickly identified and cleaning schedules and audits were completed. All staff received relevant training in infection control and there were protective personal equipment stations where staff could access gloves and aprons. Whilst entering the kitchen we were asked to wear an apron and saw there were effective cleaning schedules for this area.

Over time, people had received a variable experience with receiving their medicines safely. Concerns were raised about the administration of antibiotics and other key drugs. However, during our inspection, we did not identify any concerns with medicines and were confident staff administering medicines were competently trained and assessed as competent. People told us medicines were given as required and staff took time to explain what they were administering. There were processes in place for people to continue to administer their own medicines if appropriate, but no one was doing so during our visit. We observed people being administered their medicines and this was done appropriately with staff explaining what was being administered and asking people if they required pain relief. We did not note creams etc. being left out in people’s rooms. The only concern from relatives was about the administration of time sensitive medicines. Staff administering medicines were aware of time specific medicines and medicines in the morning took about two hours with a medicines trolley on each suite.

Staff spoken with had a good understanding of peoples needs and were able to competently administer medicines. One staff member administering medicines was an agency member staff on their fifth shift but felt they had received a good induction, had relevant experience and felt confident. Staff confirmed they undertook regular medication training and had annual competency assessments which could be completed more often if there were concerns about their practices

Staff were medicine trained and had their competencies assessed before being able to give people their medicines. Daily counts of tablets were completed as well as monthly audits. The home worked closely with the GP, nurses and other professionals to review people’s medicines and ensure safe systems were in place. We checked peoples care plans which included body maps and cream and patch administration indicating where this should be applied. We checked a sample of peoples tablets to ensure numbers of tablets tallied with the stock balance. These were all correct. Creams and medicines were stored safely and correct temperatures.