CQC report explained · a nursing home
What the CQC found at Caer Gwent
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Two eye medicines were used beyond the recommended time. Records about thickened fluids and some risk assessments were not accurate, although staffing, safeguarding, the environment and infection controls were generally found to be safe.
- Effective?
- Good
- People's dietary needs were met and they received support from healthcare professionals. Staff had relevant training and supervision, and consent and best-interest decisions were managed lawfully.
- Caring?
- Good
- Staff were observed to be kind, caring and respectful. People were involved in decisions about their care and were encouraged to remain independent.
- Responsive?
- Good
- Care was personalised around people's histories, preferences and communication needs. Activities, family contact, complaints handling and end-of-life wishes were supported.
- Well-led?
- Requires improvement
- The management team had made some improvements, but audits did not identify problems with medicines, fluid records or risk assessments. The provider remained in breach of the good governance regulation.
What inspectors found, June 2022
Caer Gwent is rated Requires Improvement; inspectors found kind, personalised care but safety checks and records were not reliable enough.
Inspectors visited on 28 and 29 April 2022 without announcing the visit. They spoke with people, relatives and staff, and checked care plans, medicines records, staff files and management records. They also checked infection prevention and control.
The home was caring, responsive and effective overall. People said staff were kind, their care was personalised, food was good and call bells were answered promptly. People had access to activities, visitors, families and healthcare professionals.
There were important safety and management problems. Two eye medicines were being used beyond the manufacturer's recommended time. Records about thickened drinks were inaccurate, and one falls assessment did not include the higher bleeding risk linked to an anti-coagulant medicine. The home was in breach of Regulations 12 and 17 and remained rated Requires Improvement overall.
Kind and respectful staff
People were treated with kindness, dignity and respect. Staff involved people in decisions and encouraged them to do what they could for themselves.
“At this inspection, we observed staff were kind and caring with people and attentive to their needs.” from the report
Personalised care
Care plans included people's histories, choices and preferences. Staff used this information to provide care that reflected individual needs.
“People received personalised care that was responsive to their needs and preferences.” from the report
Improved call-bell response
Inspectors found enough suitably qualified staff on duty. People and relatives said call bells were answered promptly.
“There were sufficient, qualified staff on duty to meet people's care and support needs.” from the report
Good food and healthcare support
People could choose their meals and where to eat. Their dietary needs were considered, and they had access to several healthcare professionals.
“People's dietary needs and their risk of malnourishment were catered for.” from the report
Medicines used too long
seriousTwo eye medicines were still being used after the safe period stated by the manufacturer. They were removed and replaced during the inspection.
“The use of eyedrops or gel beyond four weeks after opening meant they might not be effective in treating people's eye conditions.” from the report
Risk of choking
seriousFluid records showed that thickening had not been recorded on ten occasions for one person who needed thickened drinks. The report says this inaccurate recording created a risk of choking, although the person was not harmed.
“If the person had received fluids that had not been thickened, they were at risk of choking.” from the report
Weak management checks
seriousAudits failed to identify the medicines problem, the inaccurate fluid records and the missing bleeding risk in a falls assessment. The provider was still in breach of the good governance regulation.
“Auditing systems were not robust to ensure the service was managed safely and to drive improvement.” from the report
- 01What changes have you made to check that eye drops and eye gel are discarded within the manufacturer's recommended time?
- 02How do staff now record and check that this person's, or any person's, drinks have been thickened when required?
- 03How are falls assessments updated when someone takes an anti-coagulant medicine?
- 04What evidence can you show that the new medicines and care-record audits are identifying problems promptly?
- 05How will you demonstrate that the improvements required in the action plan have been completed and maintained?
This was an unannounced inspection focused on checking action taken since the January 2020 inspection and included infection prevention and control; the report says the previous comprehensive inspection should be read for the full earlier assessment. This explanation was written from the published report of 22 June 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, February 2020
Rated Requires Improvement; inspectors found good personalised activities and medicines management, but concerns about call bell delays, kindness, food choices and oversight.
This was a planned comprehensive inspection over 14 and 15 January 2020. Inspectors spoke with people, visitors, staff and health professionals. They reviewed care plans, medicines records, staff files and management records.
The home was clean. Medicines were managed safely. Staff understood people's health needs, supported access to health professionals and provided activities and personal care plans. Formal complaints were investigated, and visitors were welcomed.
However, some people experienced long waits for call bells. Feedback about staff kindness, night staffing, meals and whether concerns were acted on was mixed. Quality checks did not always identify or fix these problems. The home was rated Requires Improvement overall, with Responsive rated Good.
The ratings for Safe, Effective, Caring and Well-led had fallen from Good at the previous inspection. The home was not meeting Regulation 17 on good governance.
Safe medicines
Inspectors found that medicines were ordered, stored, given and disposed of safely. Staff had training and their competence was checked.
“Medicines were managed safely. Records showed that medicines were ordered, stored, administered and disposed of as required” from the report
Personalised care
Care plans described people's backgrounds, needs, likes and dislikes. People and relatives were involved in decisions about care.
“Care plans were person centred, they included information about the person's background, their current needs, their likes and dislikes.” from the report
Activities and relationships
People could take part in organised activities and individual hobbies. Visitors were welcomed without restriction, and staff helped people maintain relationships.
“A structured activities programme was available to people including external entertainers, word games nursery school visits and outings to a local pub, garden centre or restaurant.” from the report
Health support
Staff worked with health and social care professionals and responded appropriately when people became unwell. Care plans included relevant health risks and needs.
“Records showed that staff liaised with other agencies and health and social care professionals such as the GP or speech and language therapist.” from the report
Call bell delays
seriousSome people reported long waits for help, including one person who waited over an hour. Later records showed that call bells were not always answered within a reasonable timeframe.
“These showed that some people, when they pressed their call bell for assistance, were not always responded to in a reasonable timeframe.” from the report
Inconsistent kindness
needs fixingPeople gave mixed feedback about staff behaviour. Some said that staff could be short, unhelpful or not caring, particularly when busy.
“Ensuring that staff cared for all people and treated all people with kindness and respect was an area of improvement.” from the report
Food preferences
needs fixingSome people did not always receive the food or drink they had chosen, or food that reflected things they disliked. The provider agreed to review how preferences were recorded.
“Ensuring that people receive food and drink that reflected their choices and preferences was an area of improvement.” from the report
Weak quality checks
seriousThe home's governance systems did not always identify concerns about meals, listening to people or staff interactions. This led to a breach of Regulation 17.
“The lack of effective governance systems to monitor the quality of the service and to listen to feedback from people and make changes and improvements was a breach of regulation 17” from the report
- 01What changes have been made to call bell response times, especially at night, and can you show me the latest monitoring records?
- 02How do you make sure staff consistently treat people with kindness and respect, including when the home is busy?
- 03How are each person's food choices and dislikes recorded, shared with kitchen staff and checked at mealtimes?
- 04How are informal concerns from residents and relatives recorded, responded to and followed up?
- 05Who is currently responsible for management and quality checks, and how are you ensuring the Regulation 17 breach has been addressed?
This was a planned comprehensive inspection covering all five key questions; the previous inspection had rated the service Good in every question. This explanation was written from the published report of 25 February 2020 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Caer Gwent
4 rated inspections over 6 years: the service has held its Requires improvement rating throughout.
- June 2022Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- February 2020Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: GoodWell-led: Requires improvement
- April 2017Goodup from Requires improvementSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- February 2016Requires improvementSafe: GoodEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Good
- February 2014
Report published without a new overall rating.
- June 2013
Report published without a new overall rating.
- November 2012
Report published without a new overall rating.
- March 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 7 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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