Caton House Residential and Nursing Home

Caton House Residential and Nursing home is a residential and nursing home providing personal and nursing care for up to 62 people. The service provides support to older people including people living with dementia. At the time of our inspection there were 52 people using the service.

Caton House Residential and Nursing Home is split across two floors. People have access to their own personalised bedrooms and en-suite toilets and share communal areas such as lounges, dining areas, bathrooms and a garden.

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

Some people expressed their personal care needs were not always being met in a timely manner, resulting in some people waiting prolonged periods for staff availability.

The service had a dedicated activities team made up of volunteers to provide opportunities for engagement and interaction and reduce isolation. However, comments we received from people and observations made during the inspection indicated some people’s social needs were not being met.

Staff competency to perform their job roles was monitored effectively. People’s medicines were safely managed, although one person’s care records did not have specific details on how staff were to administer their medicines via a Percutaneous Endoscopic Gastrostomy (PEG) feeding tube. This was addressed immediately during the inspection.

Staff were recruited in line with current legislation. Safeguarding incidents and accidents were reported to the correct authorities and actions taken were effective.

Care plans and risk assessments identified individual risks, for people and how they were to be managed. For example, risks of falls, skin pressure damage and poor nutrition and hydration. Staff supported people in line with the guidance in their care plans and risk assessments.

Infection control systems were in place to reduce the risk of transmissible infections.

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.

People and relatives were asked for feedback about the service and staff worked with other professionals to help people achieve good outcomes.

The registered manager completed audits on all aspects of the service that were overseen by senior management.

The registered manager and provider were passionate about the service and supporting people in the best way they could. We discussed our findings with the registered manager who said they would immediately review people’s care plans, staffing levels and staff deployment throughout the home. With the aim to ensure people’s personal preferences, social and emotional needs were met.

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 18 June 2018).

Why we inspected

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Caton House Residential and Nursing home on our website at www.cqc.org.uk

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Caton House is located in a residential area of Milton Keynes and is registered to provide accommodation and personal care to people who may or may not have nursing care needs. They provide care for older people who may also be living with dementia and can accommodate up to 64 people at the service. When we visited there were 57 people living at the service.

At the last inspection in May 2016, the service was rated Good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. 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.

Staff had a good understanding of abuse and the safeguarding procedures that should be followed to report abuse and incidents of concern. Risk assessments were in place to manage potential risks within people’s lives, whilst also promoting their independence.

The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service. Adequate staffing levels were in place. Staffing support matched the level of assessed needs within the service during our inspection.

Staff induction training and on-going training was provided to ensure they had the skills, knowledge and support they needed to perform their roles. Specialist training was provided to make sure that people’s needs were met and they were supported effectively.

Staff were well supported by the registered manager and senior team, and had regular one to one supervisions. The staff we spoke with were all positive about the senior staff and management in place, and were happy with the support they received.

People's consent was gained before any care was provided. 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

Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes. Care plans reflected people’s likes and dislikes, and staff spoke with people in a friendly manner.

People were involved in their own care planning and were able to contribute to the way in which they were supported. People and their family were involved in reviewing their care and making any necessary changes.

A process was in place which ensured people could raise any complaints or concerns. Concerns were acted upon promptly and lessons were learned through positive communication.

The provider had systems in place to monitor the quality of the service. Actions were taken and improvements were made when required.

The inspection was carried out by two inspectors and an expert by experience.

Caton House Residential and Nursing Home provides nursing and personal care for up to 64 older people. Most people who use the service are living with dementia. Caton House Residential and Nursing Home is owned and managed by Sanctuary Care Limited.

There was a registered manager in post.

A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. 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.

People felt safe. Staff had received training to enable them to recognise signs and symptoms of abuse and how to report them.

People had risk assessments in place to enable them to be as independent as they could be.

There were sufficient staff, with the correct skill mix, on duty to support people with their needs.

Effective recruitment processes were in place and followed by the service.

Medicines were managed safely. The processes in place ensured that the administration and handling of medicines was suitable for the people who used the service.

Staff received a comprehensive induction process and on-going training. They were well supported by the manager, deputy managers and the provider and had regular one to one time for supervisions.

Staff had attended a variety of training to ensure they were able to provide care based on current practice when supporting people.

Staff gained consent before supporting people.

People were supported to make decisions about all aspects of their life; this was underpinned by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff were knowledgeable of this guidance and correct processes were in place to protect people.

People were able to make choices about the food and drink they had, and staff gave support when required.

People were supported to access a variety of health professional when required, including opticians and doctors.

Staff provided care and support in a caring and meaningful way. They knew the people who used the service well.

People and relatives, where appropriate, were involved in the planning of their care and support.

People’s privacy and dignity was maintained at all times.

People were supported to follow their interests and join in activities.

A complaints procedure was in place and accessible to all. People knew how to complain.

Effective quality monitoring systems were in place. A variety of audits were carried out and used to drive improvement.

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This is a summary of what we found:-

Is the service safe?

People were being cared for in an environment which was clean and hygienic. People’s needs had been assessed on admission to the home and risk assessments were in place.

Is the service effective?

On our arrival, we found the manager to be away on holiday, the deputy manager was in charge and lead with the inspection.There were nine care staff, one senior care and two nurses to provide care for the 61 people living in the home. They were supported by a number of staff providing catering, domestic, administrative and maintenance support.

It was clear from our observations that staff had a good understanding of the needs of the people who used the service. We found that care plans were written in a ‘person centred’ style which reflected people’s individual personal needs and preferences. Activities were offered on a daily basis and there was a ‘friends’ association which offered additional activities and raised funds.

Is the service caring?

One person who used the service told us “They look after me very well”. We observed positive interactions between staff and people who used the service. Staff showed patience and understanding and encouraged people to be as independent as possible.

Is the service responsive?

We spoke with relatives of people who used the service. All were happy with the care their relatives received, one relative told us “I had a recent small issue which I raised, but it was resolved quickly, my relative gets all the care required”.

Recently returned relatives surveys showed people were able to speak to staff who were providing care to their relatives.

Is the service well-lead?

Quality assurance processes were in place to ensure that people received a good quality service. Records showed that staff had attended training and were supported with regular supervisions by the manager.

We saw staff interact positively, respectfully and with genuine warmth towards people. We saw that people were enjoying the entertainment that was provided. We observed staff providing care to people and we spoke with staff that were very knowledgeable about peoples needs. We saw that medicines were stored and administered safely. We noted that when complaints had been raised these had been responded to and investigated promptly.

We found that the atmosphere on the first floor was not as relaxed as it could be as the noise of bleeps, and loud telephone bells was quite overpowering. Relatives also mentioned that it was a noisy atmosphere sometimes. We were told that the provider had plans to change the call system to something quieter which will be beneficial to people who use the service.