We carried out a review of the data available to us about Cathedral View House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Cathedral View House, you can give feedback on this service.
Cathedral View House is a care home that provides personal and nursing care and is currently registered for up to 60 primarily older people. There were 50 people using the service at the time of our inspection. The service comprises of two separate units, one residential, one nursing, separated by a garden area.
People’S experience of using this service and what we found
At the previous inspection we found medicine systems and processes were not robust. At this inspection we found improvements had been made. People received medicines as prescribed. Staff had received additional training in supporting people with medicines. Management had oversight of medicine systems and followed best practice guidelines.
At the previous inspection we found care plans did not always report on when people’s needs changed and information in care plans was not always up to date. At this inspection we found improvements had been made and care planning, reviews and staff understanding of people’s needs were current. Staff told us they had the information they needed to support people. Improvements had been made in auditing systems and processes.
At the previous inspection we found risks to people were not always being monitored and recorded accurately. Staff did not always follow guidance provided, such as when to re-position some people. Pressure relieving mattresses were not always set correctly. At this inspection improvements had been made. There were records showing risks and monitoring of equipment was in place.
At the previous inspection we found infection control measures were not effective. There was no clear system for staff to ensure effective cleaning of equipment. At this inspection we found improvements had been made. There were processes in place to prevent and control infection at the service.
At the previous inspection we found people living with dementia did not have pictorial signage to support them to navigate their environment. At this inspection improvement had been made. Signage for bedrooms, bathrooms and communal areas supported people to navigate around the service independently.
Safeguarding processes were in place to help safeguard people from abuse. Risks associated with people's care had been assessed and guidance was in place for staff to follow. Medicines were safely managed.
The service’s recruitment practices were safe and there were sufficient numbers of staff available to meet people’s care needs. People told us, “If you need them, they come quickly, they are very quick” and a relative said, “The carers, they are amazing”.
People’s capacity had been assessed following the principles of the Mental Capacity Act 2005 (MCA). Where people lacked capacity there had been applications made to the local authority for any Deprivations of Liberty Safeguards that were necessary to keep people safe and protect their rights.
Staff were using PPE correctly and following current infection prevention and control guidance to help keep people safe. All staff had been provided with additional training in relation to the Covid-19 pandemic and arrangements made to enable relatives to safely visit.
The registered manager provided effective leadership. Staff told us they had been well supported and reported the registered manager had made significant improvements within the service.
The service’s quality assurance systems were effective, and action had been taken to address and resolve the breaches of the regulations identified at our last inspection.
Feedback from people and relatives about the service’s performance was valued by the registered manger and any issues raised had been investigated and resolved. The duty of candour was understood by the registered manager and relatives told us the service communicated with them effectively.
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 Requires Improvement. (Published 8 November 2019)
Why we inspected
We undertook this inspection to check previous breach of regulation had been met.
Cathedral View provides accommodation with personal care for up 60 people. There were 59 predominantly older people using the service at the time of our inspection. The service comprises of two separate units, one residential, one nursing, separated by a garden area.
People’s experience of using this service and what we found:
Medicine systems and processes were not robust. We were not assured that people always received their medicines as prescribed. Staff did not always follow best practice guidelines in the management and administration of medicines.
People were provided with the equipment they had been assessed as needing to meet their needs. Pressure relieving mattresses were provided to help reduce the risk of pressure sores. However, these were not always set correctly according to people's last recorded weight.
Risks had been identified, assessed and reviewed. However, specific risks were not always robustly monitored and recorded accurately. Staff did not always follow guidance provided, such as when to re-position some people.
People were not always protected from the risk of cross infection. There was no working sluice in the residential building. The was no clear system for staff to ensure effective cleaning of equipment.
The service held personal money belonging to people living at the service. This was not held appropriately. The registered manager addressed this immediately.
The provider had no effective system to ensure they had oversight of the service provided. There were no regular auditing processes in place at Cathedral View to monitor the quality of the service provided. This meant the provider was not aware of the concerns identified at this inspection.
Records relating to care and support provided to people were not always completed as required.
Some records were not accurate. Information provided at the inspection, regarding staff supervision was not up to date. This was reviewed and sent to us after the inspection. The registered manager told us that two statements seen in care records were ‘not right’.
Staff had received appropriate training and support to enable them to carry out their role safely. The registered manager held information about the training staff had completed. However, this was not always held together in one place.
There were people living at Cathedral view, living with dementia, who were independently mobile. There was no pictorial signage to help support people to be independent in accessing bathrooms, toilets and their own bedrooms.
The service had been through a period of staff shortages. The registered manager told us, “It has been very challenging getting the right staff. Some start then leave quickly and we have to start all over again.” There were enough staff available to meet people’s needs at the time of this inspection.
Staff were recruited safely in sufficient numbers to ensure people’s needs were met.
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; the policies and systems in the service supported this practice. Any restrictive practices were regularly reviewed to ensure they remained the least restrictive option and were proportionate and necessary.
There was not an accurate record held by the registered manager, of which powers of attorney were held by family members. This meant it was not clear what legal powers were held by relatives. Consents were signed on behalf of people, by family members who did not have the legal power to do this.
An activity co-ordinator provided planned activities for people in both units. However, it was not possible for people to be supported to go out in to the local community as the service did not have suitable transport available.
People received care and support that was individual to their needs and wishes. Care plans were regularly reviewed and updated.
We observed many very kind and caring interactions between staff and people. Staff spent time chatting with people as they moved around the service. People told us, “I’m well cared for, certainly,” “Yes, they (staff) all treat me well, are friendly and will have a chat with me” and “I can’t fault it. They have all been very good. I’m fortunate and am happy to be here.”
The complaints procedure was available to people. The registered manager told us there were no on-going complaints at the time of this inspection.
People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately.
All the people, relatives and healthcare professionals told us they were happy with the care and support provided at Cathedral View. Relatives told us, “[Person’s name] is happy and safe here, they are brilliant to them and I would say it’s one of the best homes in the country” and “Yes, they have got the skills, there are some top nurses here.”
Visiting healthcare professionals told us, “This is one of the better homes, I cover the whole county and this home is good. I have no concerns,” “Cathedral View has a very good reputation, I would be happy for my family to be cared for here” and “The staff are very vigilant, report to us appropriately and are knowledgeable about the people here.”
Rating at last inspection and update:
At the last inspection the service was rated as good (report published 26 April 2017)
Why we inspected: This was a scheduled inspection.
We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.
Follow up: We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
We found no evidence during this inspection that people had been harmed. The registered manager has told us of action they will be taking to help ensure they meet the requirements of the regulations at the next inspection.
You can see what action we have asked the provider to take at the end of this full report.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
There was a registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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. The nursing home is managed by a matron who reports directly to the registered manager.
We inspected Cathedral View on 27 and 28 February 2017. The inspection was unannounced. The service was last inspected in July 2014 when it was found to be meeting the requirements of the regulations, and was overall rated as Good. In addition the Key Question on Caring was rated Outstanding. Therefore at this inspection we confirmed that the Quality of Caring at the home remained at this quality.
People told us they felt safe at the service and with the staff who supported them. Comments we received included: “We have no issues regarding (relative’s) safety. Staff are respectful and considerate about her needs and confusion. Her possessions are carefully looked after and items of clothing for laundry are always named and returned.” An external professional said: “(Cathedral View) seems very safe.”
People told us they received their medicines on time. Medicine administration records were kept appropriately and medicines were stored and managed to a good standard.
Staff had been suitably trained to recognise potential signs of abuse. Staff told us they would be confident to report concerns to management, and thought management would deal with any issues appropriately.
Staff training was delivered to a good standard, and staff received updates about important skills such as moving and handling at regular intervals. Staff also received training about the needs of people with dementia. Staff told us they received “Loads” of training, “We always have training courses, training is very good,” and “They are very good at training.”
Recruitment processes were satisfactory as pre-employment checks had been completed to help ensure people’s safety. This included written references and an enhanced Disclosure and Barring Service check, which helped find out if a person was suitable to work with vulnerable adults. One person told us: “Staff are very well chosen for their qualities, caring, dedication and sense of humour.”
People had access to medical professionals such as a general practitioner, dentist, chiropodist and an optician. People said they received enough support from these professionals. We were told by a health professional: “I feel that the care received is excellent and the treatment people receive is extremely effective and safe….I have only ever heard of or received positive feedback regarding this home.”
There were enough staff on duty and people said they received timely support from staff when it was needed. People said call bells were answered promptly and we observed staff being attentive to people’s needs. An external professional said: “Residents seem happy and well entertained and looked after. They are complimentary of the care they receive and never complain of having to wait to be attended to.”
Care was provided appropriately and staff were viewed as very kind and caring. We received a significant number of positive comments about people’s care which included: “Staff are very good and helpful,” and “They are very good they make me laugh.” Relatives told us: “We have been delighted with the care and support (our relative receives),” “The staff are not only caring and supportive but kind, considerate and thoughtful. I could not ask for more care and consideration. I cannot emphasize this enough they are brilliant,” and “Staff are friendly, welcoming, caring and welcoming.” External professionals said “They have a lovely approach to clients. They make people very welcome,” and ”I have always witnessed wonderful care, compassion, and professional conduct mixed with comfort and a warm atmosphere.”
Activities were organised by a dedicated activities organiser. Relatives told us activities provided included sessions each morning looking at the newspaper and discussing world events, quizzes, bingo, piano recitals which were played by one of the people who lived at the service, knitting, scrabble sessions and a film afternoon. There were trips out to local places of interest. Some entertainers visited the service. Relatives told us: “(My relative) has vascular dementia and is given a variety of stimuli including foot spas, balloons, gardening and music,” and “I am amazed at the variety and volume of activities which the home provides. For example visits from choirs, flower arranging and recitals. In addition a minibus takes them out on trips.”
Care files contained information such as a care plan and these were regularly reviewed. The service had appropriate systems in place to assess people’s capacity in line with legislation and guidance, for example using the Mental Capacity Act (2005).
People were happy with their meals. Everyone said they always had enough to eat and drink. People said they were provided with some choice of meals. People said they received enough support when they needed help with eating or drinking. Comments included: “Food is very nice. You can have what you like. If you do not like something you can send it back and have something else.”
People we spoke with said if they had any concerns or complaints they would feel confident discussing these with staff members or management, or they would ask their relative to resolve the problem. They were sure the correct action would be taken if they made a complaint.
People felt the service was well managed. Comments about management included: “The manager is very approachable and capable,” and “Cathedral View is an extremely well run establishment. I visit several homes and this is by far the best I have been to.” The service had appropriate quality assurance systems.
We carried out this announced inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.
Cathedral View House is a care home for people who require nursing or personal care. It comprises of two separate buildings; the residential home provides accommodation and personal care for up to 33 people and the nursing home provides accommodation and nursing care for up to 27 people. At the time of the inspection there were 54 people living at Cathedral View.
There was a registered manager in post at Cathedral View House. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.
We inspected Cathedral View over two days. We saw people were happy living at Cathedral View. The atmosphere was friendly and relaxed and we observed staff and people using the service enjoying each other’s company. One person told us “Staff are definitely kind and compassionate and treat me with respect.” We saw visitors were welcomed by staff throughout our visit.
On both days of the inspection we saw people looked well cared for and their needs were met quickly and appropriately. People who used the service and their relatives were complimentary about the care they received from staff who they felt were knowledgeable and competent to meet their individual needs. For example one person told us “Staff are very particular, they keep everything to a very high standard and they all treat me like a friend.”
People told us they felt safe. One person told us, “I am secure here and feel so safe.” We found the service was meeting the requirements of the Deprivation of Liberties Safeguards. People’s human rights were properly recognised, respected and promoted.
Staff working at Cathedral View understood the needs of the people and we saw that care was provided with kindness and compassion. People and their families told us they were happy with their care. A relative told us “I would recommend this home to anyone, I was pleased that Dad was cared for here, I would not have wanted him to go to the local hospital. They not only cared for him, they cared for us too.”
Staff were appropriately trained and skilled and provided care in a safe environment. They all received a thorough induction when they started work at the home and fully understood their roles and responsibilities, as well as the values and philosophy of the home. The staff had also completed extensive training to ensure that the care provided to people was safe and effective to meet their needs.
People living at Cathedral View were supported to live their lives in the way they chose. People’s preferences in how they wanted to spend their day were sought, listened to and respected. We saw people were encouraged to take part in activities both in and outside of the home.
The views of people living at Cathedral View were actively sought out by an independent visitor and by the registered manager. One person told us “The activities lady is lovely. She’s always smiley. We fill out a form to say what we like and what we don’t like.” Another told us “I attend residents meetings where no staff are present. I am able to make my comments and make my own decisions.” Views of the staff team were actively sought out by the manager.
Care plans were well laid out and regularly updated to reflect people’s changing needs. People and their families were involved in the planning of their care and were treated with dignity, privacy and respect.
The premises were well maintained and comfortable. There were appropriate spaces so people could spend time taking part in activities, chatting together or on their own.
We found there were positive relationships between staff and management. One staff member told us “Everyone is treated respectfully. Staff get good support, the door is always open to management, if you have a problem you can discuss it and they are very supportive.” Everyone who worked at Cathedral View who we spoke with demonstrated compassion and respect for the people they supported.
The provider had employed skilled staff and took steps to make sure the care was based on local and national best practice. Individual staff had taken on special roles, such as tissue viability, continence, dementia awareness and motor neurone disease to make sure that best practice was followed by all staff in the home.
The registered manager assessed and monitored the quality of care consistently. The home encouraged feedback from people and families, which they used to make improvements to the service.
People we spoke with were all very happy with the home's standards. The comments we received included 'I like it here, it is very nice,' and 'the staff are exceptional, they are kind and caring'they have become our friends'the standards at the home are very good and the manager is very good.'
People's personal and health care needs were met to a high standard. The medication system was well organised and operated effectively.
There were satisfactory numbers of staff on duty. Staff recruitment processes were thorough. Everybody we spoke with told us staff were kind, supportive and treated people who used the service with respect and dignity.
The accommodation was furnished, decorated and maintained to a good standard. The home was very clean and there were no offensive odours.
The home had a satisfactory complaints procedure although nobody who we spoke with had any concerns or complaints.
When we inspected the home was clean and odour free. Accommodation was decorated, furnished and maintained to a good standard. At the time of the inspection staffing levels were satisfactory, and there was evidence that staff suitable recruitment checks and training were completed. There was a satisfactory quality assurance system in place.