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CQC report explained · a residential care home

What the CQC found at Caldy Manor

Goodpublished 12 March 2019, 7 years ago

Rated Good: inspectors found the home performing well and meeting their expectations.

The five questions inspectors ask
Safe?
Good
Inspectors were assured that infection risks were being managed, including safe admissions, use of protective equipment, testing, social distancing and cleaning.
Effective?
Good
This area was not assessed in this targeted inspection.
Caring?
Good
This area was not assessed in this targeted inspection.
Responsive?
Outstanding
This area was not assessed in this targeted inspection.
Well-led?
Good
This area was not assessed in this targeted inspection.
The latest report, explained

What inspectors found, March 2021

Caldy Manor was inspected but not rated; inspectors found strong infection prevention measures during the pandemic.

This was an announced, targeted inspection on 2 March 2021. It looked at how well the home was prepared to prevent and control infection during the coronavirus pandemic.

Inspectors found that people were admitted safely and that visitors, residents and staff were supported with infection control. They found effective use of personal protective equipment, testing, social distancing and cleaning.

The home was clean and hygienic. Staff had infection control training and access to guidance from the local community trust. The inspection did not give an overall quality rating.

What inspectors praised
  • Infection control

    The home had procedures, staff training and contingency plans to prevent and manage infection outbreaks.

    “There was an IPC policy and procedures in place. Contingency plans were in place for future service disruption, including due to infection outbreaks and winter pressures.” from the report
  • Protective equipment and testing

    Inspectors found that protective equipment was readily available and used correctly. Testing was in place for staff, residents and visitors.

    “Personal protective equipment (PPE) was widely available and used correctly and there was an extensive testing program in place for staff, people using the service and visitors.” from the report
  • Clean surroundings

    The home was clean and its layout had been changed to support social distancing.

    “The home was clean and hygienic throughout. Areas in the home had been redesigned to enable effective social distancing.” from the report
  • Support for residents

    People and relatives were helped to understand isolation and infection control measures. The home also provided supervised visits and contact by phone or video.

    “The service helped to alleviate people feeling lonely, by providing access to safe supervised visiting, in accordance with national guidance, and video and telephone calls with friends and loved ones.” from the report
What inspectors were concerned about

Inspectors raised no specific concerns in this report.

Questions to ask them, based on this report
  1. 01How are infection prevention and control procedures kept up to date now?
  2. 02How often do staff receive infection prevention and control refresher training?
  3. 03What testing arrangements are currently in place for residents, staff and visitors?
  4. 04How are visits managed, and what support is available if a resident feels lonely?
  5. 05What contingency plans are in place if there is an infection outbreak or staff shortage?

This was a targeted inspection of infection prevention and control during the coronavirus pandemic; it did not assess the other four care areas and the service was inspected but not rated. This explanation was written from the published report of 13 March 2021 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.

An earlier report, explained

What inspectors found, March 2019

Caldy Manor was rated Good overall; inspectors found especially responsive care, with safer medicines but a dementia-friendly environment still needing attention.

This was an unannounced comprehensive inspection on 22 January 2019. Inspectors observed care, spoke with people, relatives and staff, and reviewed care records, staff files, medicines and quality checks.

The overall rating was Good. Safe, Effective, Caring and Well-led were rated Good. Responsive was rated Outstanding. Inspectors found that medicines management had improved since the previous inspection, when Safe was rated Requires Improvement.

People and relatives gave consistently positive feedback. Staff were described as kind and respectful. The home provided varied activities, strong community links and thoughtful support for people and families during end of life care and bereavement.

There was no registered manager because the previous manager had recently left. A deputy manager was running the home while recruitment took place. Inspectors also identified that parts of the building could be confusing for people with dementia.

What inspectors praised
  • Meaningful activities

    People could take part in activities linked to their interests and maintain community connections. This included school links, pen pals, celebrations and visits from local emergency services.

    “There were many opportunities for people to take part in a wide range of individual and organised activities and maintain the interests they had enjoyed before coming to live there.” from the report
  • End of life support

    Care plans considered people's wishes and spiritual needs. The home also supported relatives during difficult times and held remembrance events.

    “Staff recognised the importance of people's emotional needs and responded quickly as people's conditions changed and as they approached the end of their lives.” from the report
  • Kind and respectful care

    Inspectors saw staff treating people with patience, kindness and respect. Staff knew people's personal histories, interests and preferences.

    “Throughout our inspection, we observed people being treated in kind, thoughtful and respectful ways.” from the report
  • Improved medicines safety

    The report says medicines were safer than at the previous inspection. Records were complete and checks were used to identify and address problems.

    “The records we checked were fully and accurately completed.” from the report
What inspectors were concerned about
  • Management vacancy

    needs fixing

    There was no registered manager at the inspection because the previous manager had left. A deputy manager was acting in the role while recruitment was under way.

    “There was no registered manager in post, as the manager had left a few weeks before the inspection.” from the report
  • Dementia-friendly environment

    needs fixing

    Some people with dementia lived in an area that was not dementia friendly. Inspectors said the corridors and limited signs could make it confusing to find the way around.

    “There were people in the home diagnosed with dementia, but the part of the home they were living in did not have a dementia friendly environment.” from the report
Questions to ask them, based on this report
  1. 01Is there now a registered manager in post, and how was the management vacancy covered after this inspection?
  2. 02What changes have been made to make the areas used by people with dementia easier and less confusing to navigate?
  3. 03How do you check that staffing levels remain adequate when people's needs change?
  4. 04How are medicines checked now, and what happens if a medicines error or record shortfall is found?
  5. 05How are residents and relatives involved in planning activities and reviewing each person's care?

This was an unannounced comprehensive inspection covering all five key questions and the overall rating. This explanation was written from the published report of 12 March 2019 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.

The story over the years

Every inspection of Caldy Manor

2 rated inspections over 3 years: the service has held its Good rating throughout.

  1. March 2021Inspected but not ratedcurrent rating
    Safe: Inspected but not rated

    Read what inspectors found at Caldy Manor →

  2. March 2019Goodstayed Good
    Safe: GoodEffective: GoodCaring: GoodResponsive: OutstandingWell-led: Good

    Read what inspectors found at Caldy Manor →

  3. September 2016Good
    Safe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good

    Read this report on cqc.org.uk

  4. August 2013

    Report published without a new overall rating.

    Read this report on cqc.org.uk

  5. January 2013

    Report published without a new overall rating.

    Read this report on cqc.org.uk

  6. November 2011

    Report published without a new overall rating.

    Read this report on cqc.org.uk

  7. February 2011

    Registered with the Care Quality Commission on 15 February 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.

Next steps

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