Cassandra House

Cassandra House is a residential care home providing accommodation and personal care for up to 43 older people in one adapted building, including people living with dementia. At the time of our inspection 34 people were living at the service.

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

A system was in place to monitor the quality and safety of the service. However this was not always effective in identifying and addressing issues.

The provider had systems in place to report and respond to accidents and incidents. However, not all accidents, incidents or safeguarding concerns had been explored to identify any potential themes, trends or lessons learnt.

Medicine practices were not always in line with best practice guidelines.

Care plans were not always fully complete or lacked relevant details about people's care needs. However, people and relatives told us staff treated people with dignity, respect and in a person-centred way.

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; policies and systems in the service did not always support this practice.

People felt staff provided safe care, and systems were in place to report concerns. Staff had been safely recruited and had received training on how to recognise and report abuse and staff knew how to apply it.

People were regularly asked their views on the service provided and action had been taken when suggestions were made.

People were supported to have access to healthcare services to monitor and maintain their health and well-being. We observed kind and caring interactions between people and staff during the inspection.

There was a positive culture within the service. Staff interactions with people were kind and compassionate. Staff knew people well and were responsive to their needs. People and their relatives were involved in their care.

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

Rating at last inspection

The last rating for this service was good (published 17 October 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

Enforcement and Recommendations

We have identified a breach in relation to good governance at this inspection.

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.

We found the following examples of good practice.

The provider had clear signage in place for safe visiting procedures, they had installed hand washing facilitates at the entrance of the building to ensure effective hand hygiene from any visitors.

The provider had used reflective practice to review outbreaks of COVID-19 and used the findings to develop and improve practice.

The provider had used the COVID-19 pandemic to recognise and learn how to improve the service in the future. For example, ensuring visits are taken place in appropriate places and not disrupting other people living at the service and having accommodation available for any future outbreaks.

We last inspected the service in July 2015 and rated the service as ‘Good.’ At this inspection we found the service remained ‘Good’.

There were safeguarding procedures in place. Staff were knowledgeable about what action they should take if abuse was suspected. The local authority safeguarding team informed us that were no on-going organisational safeguarding matters regarding the service.

The premises were clean. Maintenance and servicing had been completed to ensure that the premises and equipment were safe. Medicines were managed safely.

Recruitment checks were carried out to ensure that staff were suitable to work with vulnerable people. There were sufficient numbers of staff deployed to meet people’s needs. Records confirmed that training was available to ensure staff were suitably skilled. Staff were supported though a supervision system.

People's nutritional needs were met and they were supported to access healthcare services when required.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

We observed positive interactions between staff, people who lived at the service and their relatives. Staff promoted people's privacy and dignity.

Care plans were in place which detailed the individual care and support to be provided for people. Arrangements for social activities met people’s individual needs.

There was a complaints procedure in place. Nine complaints had been received since our last inspection which had all been responded to in line with the service policy and procedures.

Audits were carried out to monitor all aspects of the service. Action plans had not always been developed but the manager highlighted to us any areas which required improvement and told us about their plans for improvement, which we could see were already underway. Staff were very positive about working for the provider who was also the registered manager and the deputy manager. They said they felt valued and enjoyed working at the service. We observed that they applied this positivity in their roles when supporting people.

Further information is in the detailed findings below.

People told us that they received the support they needed and that staff were 'Friendly' and 'Helpful'. Care plans reflected the care and support needs of the person concerned and were updated regularly to make sure that staff had current information to work with.

Each person's nutritional needs had been met and people told us they enjoyed the meals at the home and that they received a choice of meals.

Staff were employed following safe recruitment and selection processes and they then received appropriate training that equipped them to carry out their role. Staff told us that they were well supported by managers.

Quality monitoring systems had been introduced to measure the quality of the service provided and to give people who lived at the home and others the opportunity to comment on the care they received and express their views.

On this occasion we did not speak with people who lived at the home. We spoke with them at the last inspection and they did not express any concerns about the care they received. We observed that appropriate care was being provided by staff.

At this inspection we found that care plans had been kept up to date so staff had the information they needed to ensure they could provide the care that people needed. Care plans were being developed in a timely manner for people who were admitted to the home.

Action had been taken to ensure that staff had updated their knowledge on safeguarding adults from abuse pending attendance at training courses booked during 2013.

Training records had been updated and some refresher training had taken place since the last inspection. Training had also been booked for staff during 2013. Further work needed to take place to evidence that staff had undertaken all of the training they needed to keep their practice up to date.

We saw that people were encouraged to make day to day decisions for themselves. They were supported to make appropriate decisions when they were not able to do this for themselves. People's individual lifestyles were promoted.

We saw that the home was maintained in a clean and hygienic condition and that there were appropriate policies and procedures in place to promote the prevention of infection. People who lived at the home told us that it was always clean. One person said, 'The beds are always lovely and clean' and another said, 'Staff clean my room nearly every day'.

However, we were concerned that important information had not always been recorded in a person's care plan to ensure that staff had up to date information about their care needs and that some information about a person's care provision had not been recorded.

There were training opportunities available for staff but records were out of date and there was a lack of evidence about which staff had attended which training course. Records available on the day of the inspection showed that some staff had not received training for a number of years.