Cavendish Court

Cavendish Court is a residential care home providing personal and nursing care to 35 people aged 65 and over at the time of the inspection. Some of the people accommodated were living with dementia. The service can support up to 43 people. The accommodation is provided over three floors, each of which has separate adapted facilities.

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

The service was not well-managed at the time of this inspection. We found improvements were needed to ensure people always received safe, effective, and responsive care that met their needs.

Risks to people’s health and welfare were not always identified or managed effectively. We found that one person was at risk because staff were unaware of safeguards that had been put in place to safeguard them from the risk of falls. Another person had remained at risk and had suffered falls because advice provided by their doctor had not been acted upon.

Information to be supplied to the fire service in the event of a fire contained inaccuracies. The housekeeping trolley, which held hazardous substances, was left unattended in the presence of vulnerable people.

Systems to safeguard vulnerable people from abuse where not always followed and two care staff spoken with were unclear on the provider’s safeguarding procedures.

Staff were employed in sufficient numbers but oversight in their management resulted in 12 vulnerable people being left unsupervised for a period.

Staff needed further training on the Mental Capacity Act to ensure people received the right type of support to assist them in their decision-making and the provider was not meeting the conditions upon which a person’s Deprivation of Liberty had been granted.

People and their representatives were not sufficiently involved in the care planning process and care plans were not always person-centred so did not confirm the relevant person’s needs or personal preferences.

The provider’s quality assurances systems had either not identified the improvements needed at this care home or sufficient action had not been taken in a prompt manner to address the improvements which were needed.

Although there were areas for improvement, all the people who lived at the home had something positive to say about the staff and the standard of care provided.

Nursing and care staff were seen to be kind and caring in their approach. They engaged with people sensitively before providing support and care and they listened and acted on what was said to them.

Medicines were managed safely, and a visiting doctor told us that managers and staff worked collaboratively with them to ensure people’s health care needs were met.

People’s nutritional needs were being met and comments about the standard of food were generally positive.

The registered manager worked diligently throughout the course of our inspection and instigated improvements. These included a series of person-centred reviews and monthly residents and relatives’ meetings going forward. This will help to ensure that people are supported to express their views and be involved in decisions about 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 and update

The last rating for this service was good (published 29 July 2021). At this inspection we found the provider was in breach of regulations. The service is now rated requires improvement.

Why we inspected

We received concerns in relation to the safe and effective care and management. As a result, we commenced a focused inspection to review the key questions of safe, effective, and well-led only. It became clear during the inspection that improvements were also required in the remaining key questions caring and responsive. We therefore broadened the inspection to include all key questions and in doing so completed a comprehensive inspection of the service.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cavendish Court on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, consent, person centred care and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

We have made recommendations about safe staffing levels and accessible information.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. 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 with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Cavendish Court is a residential care home providing personal and nursing care to 39 people aged 65 and over at the time of the inspection. The service can support up to 43 people. The accommodation is provided over three floors, each of which has separate adapted facilities.

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

Through this inspection we found improvements had been made and the provider was no longer in breach of regulations. However; further development was needed to demonstrate improvements were embedded into working practice. The provider was making improvements to the assessment process, reviewing how staff were deployed across the home and replacing the existing call bell system to ensure the quality of care could be better monitored for effectiveness.

The care delivered to people was person centred. Staff were described as, “kind”, “caring” and “excellent.” Checks were in place to ensure the safe recruitment of all staff employed at Cavendish Court.

Risks to people’s health and wellbeing were safely identified, monitored and reviewed. This included where people needed support with prescribed medicines or had diagnosed health conditions requiring specific plans of care.

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 were encouraged to personalise their bedrooms. A number of environmental improvements were being made which were designed to assist people living with dementia.

The home was visibly clean and well maintained. We were assured systems and practices were in place to manage any risks relating to the COVID-19 pandemic.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 04 July 2019) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about the safe management of pressure wounds and infection control. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Safe section of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Cavendish Court is a residential care and nursing home providing personal and nursing care to 35 people aged 65 and over at the time of the inspection. The service can support up to 43 people.

Cavendish Court accommodates people across three separate floors. Each floor provides care and support to people with different needs, including residential and nursing care.

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

Overall, we heard from people, relatives, staff and visitors that over the last few months the service had settled and improved under the leadership of the new and well-respected registered manager. We received positive comments, thoughts on further improvement needs and concerns which we discussed with the registered manager.

We found that record-keeping was still inconsistent and not robust. Together with care and treatment which was not always safe, this put people at risk. When people were at risk of pressure sores, required wound care or were at risk of malnutrition, the management and recording of this was not always robust. The registered manager and provider had taken steps to improve this, through easier to use daily recording charts additional training, meetings and specially appointed support staff.

Staff, managers and the provider had identified issues, improvement needed and actions to take, but these at times needed to be responded to more quickly. This included ensuring more robustly that people’s health and wellbeing was promoted and protected. We heard comments that while care overall had improved, person-centred knowledge varied. This needed to be supported through clearer and consistent care planning, which was still an area for improvement. However, new documents had been introduced to help.

Although there were signs of improvement, we considered these changes had yet to be embedded fully to provide consistently safe, effective and high-quality personalised care. The service’s rating therefore has not changed overall. We highlight however that while there continued to be issues, we also heard and recognised that there had been progress.

A person who lived at the service told us, “I feel safe and well looked after. I could not cope at home. This is better than home.” People, relatives and staff told us the new registered manager had helped to improve the staff culture, atmosphere and morale in the service. A relative said, “The current manager is first class and seems to be trying to improve things. I feel my [relative] is looked after well and is in a safe place.”

We heard particularly positive comments about the more consistent staffing and reduced use of agency workers, as well as improvement of the food at the service. Staff we spoke with felt more supported. People, relatives and staff had been involved in the service through regular meetings and felt that communication had much improved.

People were overall 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, with a few areas for development.

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

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 9 January 2019) and there were three breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider had rectified two of the breaches. However, we found one continued and one additional breach of regulations. The service remains rated Requires Improvement and has been rated Requires Improvement for the last two consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about different areas of concern, which included pressure ulcer prevention, medicines and infection control. A decision was made for us to inspect and examine those risks. This inspection also followed up on action we told the provider to take at the last inspection.

We have found evidence that the provider needed to make further improvements. Please see the safe, effective, responsive 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. During the inspection, the registered manager and provider evidenced steps they had already taken to make improvements and reduce risk for people going forward.

Enforcement

We have identified breaches in relation to the safe care and treatment of people, as well as robust record keeping in relation to the safety and quality of people’s care at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. 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 with the 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.

Cavendish Court is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Cavendish Court is registered to provide accommodation with personal care for up to 43 people. The accommodation is located over three floors and there are lounges and dining rooms on each floor. On the day of our inspection there were 34 people living in the home.

At our last inspection we rated the home as good overall. At this inspection, we found that there were three breaches in regulations. There were breaches in Regulation 9: person centred care; Regulation 17: good governance and documentation and Regulation 18: staffing. The service was rated requires improvement overall and this is the first time that the service has received this rating. You can see what action we have taken at the back of this report.

Cavendish Court did not have a registered manager in post. There was a peripatetic manager in place at the time of our inspection and the new manager started the day prior to our inspection. 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.

There were not sufficient skilled and experienced staff to meet the needs of the people living in the home. Agency staff utilised in the home had not received sufficient induction to familiarise them with the home and the people living there.

Risks assessments were not consistently being reviewed and updated where there were changes.

People and their relatives were positive about the permanent staff working in the home. However, there were high levels of agency staff employed and people felt that they did not know their needs and preferences.

Staff had completed safeguarding training and safeguarding incidents were appropriately raised by staff. However, we found the provider was not recording the outcomes of safeguarding incidents so the opportunity for learning lessons was being missed.

People’s privacy and dignity was not respected by all staff members. We saw instances where staff were not caring in their approach.

Staff members did not receive regular supervision in line with the provider’s policy.

We received some negative comments about the food in the home. A new chef had recently been employed and improvements were being implemented.

Most of the care plans reflected people’s life history and their needs and were person centred. People and their relatives told us that the care they received was responsive to their needs. However, we found care plans were not consistently being evaluated and additional monitoring charts where risks were identified were not always being completed comprehensively.

The registered provider did not have effective systems in place to monitor and improve the quality and safety of the service. The issues we identified had been picked up by the provider’s audits, however they had not been effective at improving and sustaining that improvement within the service.

Medication was being stored and administered safely. Regular medication audits were being conducted and any issues identified were addressed.

Registered providers are required to send notifications in relation to events or changes which occur in the home. We found that the service was sending appropriate notifications.

Staff recruitment was safe and appropriate checks were completed to ensure that staff were safe to work with vulnerable people. Staff training was up to date.

People and their relatives felt confident that issues raised would be addressed. Complaints were recorded and dealt with in accordance with the provider’s complaints policy.

The provider was acting in accordance with the Mental Capacity Act 2005 to ensure that people were receiving the right level of support with their decision making. People were involved in the care plans and had signed their consent to care where able. Where people lacked capacity, appropriate paperwork was in place to ensure that decisions were made in their best interests.

We saw regular checks on the property were undertaken and the premises were safe without restricting people’s ability to move about freely.

People had access to activities within the home and told us that they were happy with the activities on offer.

Cavendish Court is a modern purpose built care home which opened in 2008. It provides personal and nursing care for up to 43 people. The home is built on three floors, with the third level being the dedicated nursing floor and accommodating 15 people. Each floor has bedrooms, lounges and dining rooms. A quiet lounge is also available and there is a patio area outside. The home is located close to Alderley Edge village in Cheshire and is within walking distance of the local facilities.

The service was last inspected in January 2014 when we found that the service was compliant with all the areas that we looked at.

The home has a registered manager. 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. At the time of our inspection there were 42 people living in the home.

We found that people were provided with care that was safe, person centred, sensitive and compassionate. The home was managed and staffed by a consistent team of care assistants who were well supported.

We saw that the service had a safeguarding policy in place. This was designed to ensure that any safeguarding concerns that arose were dealt with openly and people were protected from possible harm. All the staff we spoke to confirmed that they were aware of the need to report any safeguarding concerns.

We looked at recruitment files for the most recently appointed staff members to check that effective recruitment procedures had been completed. We found that appropriate checks had been made to ensure that they were suitable to work with vulnerable adults.

We found that there were sufficient staff deployed to meet the needs of the people living in the home. The manager had identified the need to increase the staffing numbers and had recently increased staffing numbers the day prior to our visit. There were a number of additional staff waiting to start work and this would mean that the home was fully staffed and there would be no further need for agency staff.

The provider had their own induction training programme which was designed to ensure that any new staff members had the skills they needed to do their jobs effectively and competently. This resulted in staff having the skills and knowledge to carry out their jobs well and provide safe and effective care.

We asked staff members about training and they all confirmed that they received regular training throughout the year and that this was up to date and provided them with knowledge and skills to do their jobs effectively.

People had care plans which were personalised to their needs and wishes. Each care plan contained detailed information to assist support workers to provide care in a manner that respected the relevant person’s individual needs, promoting their personal preferences’.

People living in the home told us that the standard of care they received was good. Comments included, “It’s brilliant, I’m lucky to find this place”, “They look after me well and if I ask them to do something they will do it for me” and “Judging by the way I am taken care of, I would say this place is very well run and the staff who deal with me are nice, caring and have a good sense of humour”. Relatives spoken with praised the staff team for the quality of care provided. They told us that they were confident that their relatives were safe and well cared for.

The service had a range of policies and procedures which helped staff refer to good practice and included guidance on the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. This meant that staff were able to help and support people who had difficulty in making decisions and ensured that plans were put in place in the person’s best interests. We saw that whilst applications had been made appropriately, consent to care had not always been recorded appropriately and best interest decisions were not present on the care file. This had been identified as an area for improvement by the provider’s quality assurance system and the manager was working to address this.

There was a flexible menu in place which provided a good variety of food to people using the service. People living there told us that the food was good and they had a wide variety of food choices as well as where they could eat their meal. There was scope for improvement in the presentation of pureed food which had been discussed at recent relatives and staff meetings.

Staff members, relatives and people living in the home were positive about how the home was being managed and felt that the manager was supportive and approachable.

There was an internal quality assurance system in place to review systems and help to ensure compliance with the regulations and to promote the welfare of the people who lived at the home. This included audits on care plans, medication and accidents. The areas for improvement that we identified during our inspection had been picked up by their own audit processes and plans were in plans to improve these areas.

The home was well-maintained and clean and provided a calm, relaxing atmosphere. There were a number of maintenance checks being carried out weekly and monthly. These included water temperatures as well as safety checks on the fire alarm system and emergency lighting. These were audited regularly.

We also spoke with the peripatetic manager, the quality assurance manager and people who worked at the home.

We spoke with two family members who regularly visit the home. Both relatives said that they considered the care to be good. Comments included;" The care is lovely, stunning care." and "I really do believe that everything here is very, very good. I can't fault the care or the staff at all."

We saw that there was a system in place to ensure that the quality of the service was monitored and that a complaints process was in place to enable people to raise any concerns that they had.

We spent time in all areas of the home and saw that people were supported to select food of their choice from a varied menu and that people were supported to eat and drink sufficient amounts to meet their needs.

We found that there were arrangements in place to ensure that the risk and spread of infection was minimised and that staffing was planned appropriately to ensure people's needs were met.

One person told us the decision to live at the home was made with their family and initially stayed at the home for respite.

Two people we spoke to said the staff were very good.

One person said 'I can't fault the care the staff are lovely', another person said 'I'm quite happy'.

The four people we spoke to spoke highly of the staff and the care they received. One person said staff were easy to talk to and always listened to them. They told us what they liked to do during the day and that they liked to join in the activities when possible.

We asked people about their meals and they told us they were given choices, as there was always an alternative if they didn't want what was on the menu. One person said 'I really like the food and I can have something different if I want'. Another person said 'the food is very good'.

We spoke to four people visiting their friends and relatives at the home. They all told us they were always informed and consulted about their friend or relatives care and treatment.