Cavell Court

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

The service offered a high-quality environment which was safe, clean and well maintained. There was good oversight of risk across the leadership team and a risk register which highlighted people’s main needs and concerns. The risk of falls was reducing and although there was analysis of falls and steps taken to prevent falls such as: bed sensors/ mats, calls bells and bed rails, individual factors such as flooring, lighting, hydration, medication and general health was also important when evaluating level of risk. The recording system in the home was repetitive and difficult to navigate across both electronic and paper records. Handover between staff was a bit fragmented. For example team leaders handed over to team leaders who them handed over to carers and different meetings across the day meant information dissemination was the role of management and information could get missed in a busy environment particularly when staff changed floors or had been off for some time. The key worker system had not fully evolved and the resident of the day was not as effective as it could be in involving all key members of staff and ensuring actions identified were carried out. Reliance on agency staff had decreased recently and staff told us teamwork had improved but there were times where they were working with staff who were underperforming. We were confident that the manager was addressing this and had recently recruited to team leader vacancies who would be required to have visibility of the floor they managed to ensure staff were deployed across the day correctly. The manager has some ambitious plans in place for the service but we spoke about the importance of embedding good practice first which underpinned person centred care.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Whilst most people and relatives were complimentary about the care received and provided, we received some comments about staffing, continuity and aspects of care which had fallen short of expected standards. These concerns had been dealt with and there were lots of ways that people and their relatives could feedback. People using the service told us staff were kind and we saw some nice interactions. We did note differences on the individual floors and some staff expressed concern that not everyone who might have participated in ‘activity’ were given the opportunity. Recent changes in the staffing team meant staff had been deployed onto different floors in line with their needs and the needs of the service which meant some staff were still finding their feet.

Staff were encouraged to feedback, and surveys were completed. Management were approachable and responsive, and completed walk arounds, although some staff said this did not take place daily. The management team had a shared direction and culture which was difficult to embed across the service because staff meetings were poorly attended, and staff were not always forthcoming in sharing their ideas about service improvement. A key worker system and a staff champion system was not firmly embedded which might help staff feel more invested. The homes manager had a clear vision for the service, and this was shared with staff. There were systems in place to safely recruit staff and induct them. The service was currently inducting a number of new staff including team leaders. Each unit had a team leader and unit manager when fully staffed. Vacancies had put pressure on senior staff and had meant oversight of staff practice had been diminished. Since our inspection the manager had increased observations on the floors and had looked at deployment of staff to ensure the unit manager directed staff at busiest times of the day to ensure care and support was delivered effectively.

In discussion with relatives, all felt that there was someone they could talk to within the organisation and knew how to escalate concern. All felt well informed about their family member’s care. All were aware of the processes in place for them to give feedback which included surveys and relatives’ meetings both held online and face to face. Minutes from meetings were readily available and it was clear at a glance what was happening at the service from activities to staffing. Improvement based care was illustrated by ’ you said we did.’ Staff were asked about management and staff said the manager was approachable and when not in the office stated where she was. Staff said senior management had not often been visible on the floors, but other members of the external provider quality team evidenced that they visited the service to monitor the quality of the service and spoke with staff, people using the service and relatives. They completed a monthly report to identify any improvements they saw necessary or highlight good practice issues.

During our inspection and feedback the senior management team were responsive and took actions to address any issues raised. They had taken into account feedback from the local authority quality monitoring team and had responded to concerns. They had listened to concerns from other professionals and had been proactive in trying to improve communication. The manager was long standing and had the necessary experience. Additional management had been temporarily appointed to support the manager and posts for team leaders and unit managers were being filled. Staff new to their roles or staff underperforming were being supported. Most staff were very open and welcoming, and interactions were mostly positive. There was robust processes to measure the quality and effectiveness of the service which incorporated the views of others. Staff were actively encouraged to contribute their ideas and feedback.

All of the family members interviewed knew where to go with any concerns or problems which was generally to the team leader or the Customer Relations Manager. One family had a complaint which was not resolved at home level, so they escalated in line with the complaints procedure and took it to company level where it was resolved. Several relatives raised the fact that some of their concerns were repetitively raised and felt this was to do with change over of staff/ floor which effected the continuity of the service.

Speak up posters were around the service and people felt able to speak up although it was clear some people would need staff or family to advocate for them. Staff spoken with were aware of the whistle-blowing policy and said they received training on identifying and acting on abuse. This was evidenced through the training matrix. The organisation had support for staff including an internal whistle blowing line, human relations department and a robust training, induction, supervision and appraisal process. Staff told us they could raise concerns. Concerns were raised about pockets of poor practice which the manager was aware of and dealing with. Mental health first aiders were available in the service to provide impartial support.

Staff spoken with were sensitive to peoples needs and we identified some very good practice across the staff teams. Staff confirmed that shadowing, mentoring and training helped them develop themselves at work.

Cultural values were established, and staff received regular training and support to help them deliver person-centred care. Support at work helped staff to bring their best selves to work and staff told us they felt able to discuss their concerns and reflect on their working practices. There were some issues identified during the assessment about the culture of the service and pockets of poor practice which were immediately addressed by the manager and an action plan was put in to place based on our feedback. Some relatives raised concerns about different cultures and how this might impact on the job at hand when not all staff had an understanding of certain tasks/ communication barriers. One relative told us about how gay pride was celebrated within the home in recognition of equality and diversity in the workplace. They also said other events such as Amnesty International Day had taken place.

Over time this service had dipped in terms of both its rating and meeting peoples expectations. Almost everyone we spoke with felt the service had improved of late but talked about a differential experience, staff turnover and changes within the team. We received mixed feedback about activities with one relative saying they had improved and other relatives telling us there was not enough to occupy their family member. Staff told us because of improvements in staffing things were better but stated there were still some fluctuations. Staff particularly working on the first and top floor stated there were issues with staffing levels and keeping everyone adequately hydrated and managing pressure areas. Staff told us that at times it could be rushed and workload/ demand unreasonable. Although staff felt supported they also stated management did not often come on to the floor or actively listed to their concerns.

The manager attributed recent improvements to the service to better workforce planning and effective recruitment. They stated the service had seen a reduction in agency staff and overstaffing meant unplanned sickness could be covered, A risk register and dependency tool enabled the manager to adapt staff numbers on shift in line with peoples needs and occupancy levels. There had been a recent decline in falls which might be attributed to improved staffing. We were mindful across this inspection that despite assurances and obvious improvements there were still concerns about deployment and oversight of staff practice on shift, communication, records and peoples day to day experiences. The recent departure of a deputy manager may have had an impact on the managers ability to have good oversight of the whole home given its size and complexity. Recruitment of team leaders and the additional support of a deputy redeployed from another service had offered some stability with recent improvement in training and support. Our concern was about sustainability and ensuring the action plan and improvements being made were firmly embedded and the manager focusing on embedding the basics before trying to come up with elaborate plans for the service. Auditing and quality assurance was good and had identified areas for improvement and we found the manager and team responsive to our feedback when they started to take immediate actions.

People's consent had been sought for care and treatment and consent had been sought for information to be shared with family and other partners as required. Where people were unable to consent, best interest decisions were in place. People's needs were kept under review and people had access to the community, although some family said this was limited. People had choice and access to a range of services in line with their needs.

Staff understood people's needs and this was documented although some health care professionals talked about fragmentation and disorganisation which could affect peoples overall experience of care. Staff were mindful of how to report and escalate concerns and what changes were afoot.

Feedback was limited to a few professionals including the local authority who had identified improvements required and were supporting the home to make these. Improved communication through regular multi disciplinary reviews and a proactive risk register helped ensure people's health care needs were met. Improvements in diabetic care were noted, but due to previous concerns insulin administration was no longer a delegated task but carried out by the external nurses.

There was good integration and joint working with other health care professionals to ensure people received good outcomes of care. Ongoing review of peoples needs helped ensure changes could be met.

Staff feedback was varied and although most staff recognised improvements across the service some were not assured how these would be sustained. Staff said sometimes work was unmanageable which affected the quality of care they could provide to people and this was echoed by some relatives who had lost a bit of faith in the service over time. Not all staff felt all tiers of management were effective for example 1 staff member said about being overloaded and having too many demands on their time and felt they were not listened too, others said that 'management' were available to speak to but did not often 'support' on the floor. Staff training statistics were high but some staff felt training covered their basic needs and needed to be more advanced with more practical application, particularly for staff from different cultures and staff new to care. The role of champions had the potential to enhance peoples care but for such a large home there was not wide upscaling of champions and staff carrying senior positions did not feel they had adequate time for training or supporting staff.

Competency assessments and coaching helped ensure staff could embed their training, induction and training was adequate. Improvement was being encouraged by identifying good staff practice and using reward systems to incentivize staff. The manager told us the interview process had been revised and helped ensure that staff appointed demonstrated the right values in care and were committed to the principles of care, team work and passion for the role. The manager said the supervision and appraisal process helped measure staff performance and encouraged personal and professional growth. The human resources department could offer support to staff as required. A detailed action plan was in place showing what improvements had been identified and how these were being resolved. Following our inspection this had been revised to take into account our feedback and feedback of staff and relatives. Some issues of poor practice we identified were addressed immediately with retraining and supervision.