Cherington

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last inspection we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people’s needs were not always met. We found a breach of legal regulation in relation to person-centred care.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not make sure people were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Staffing levels, including the deployment of staff, meant people did not receive the high standard of person-centred care they were entitled to.

There was a lack of meaningful activities available for people. We were shown an activities planner for November and December. This included some external entertainers who visited, but mainly focused on things like art and craft, board games and chair exercises. There was no evidence to show how people were involved in planning what they would like to do. A relative said, “There used to be someone doing the activities, but she left 3 or 4 months ago. She tried to involve people, but they didn’t all want to take part. Now there’s nothing. It’s a mixture of there not being enough staff and staff not wanting to do it. They don’t try to engage with the clients. They do organise events occasionally; someone does chair exercises and they have music.”

In the middle of the morning, we observed 14 people were sat in the communal lounge, and 3 relatives were also present. The television was playing country music and a drinks trolley was positioned in the centre of the room. One person was walking around the room. A carer was engaged in serving drinks and biscuits but did not initiate any conversations with people. Many people had fallen asleep. In the afternoon, a singer entertained people and the atmosphere in the communal lounge changed to one of engagement and interactions.

The communal lounge could not have accommodated everyone who lived at the home. Some people chose to stay in their rooms, and some were cared for in bed. We observed that staff did not have time to chat with people in their bedrooms. For some, this did not matter, but for others, the lack of mental stimulation had a negative effect. We met with 1 person who was in bed and was clearly distraught. They said, “Staff don’t have time. I want to die. I just lay here hoping that I die.” The registered nurse tried to provide some comfort and suggested the person go downstairs to join others in the lounge, but the person was too upset to engage with this proposal.

After our inspection visit, the provider contacted us and said they had increased the number of care staff by 1 and another registered nurse to work in a supernumerary capacity. At night, 1 additional carer was on duty. There were plans to recruit an activities co-ordinator and to organise outings.

The provider understood the diverse health and care needs of people, so care was joined-up, flexible and supported choice and continuity.

People had access to a range of healthcare professionals such as GPs, speech and language therapists and podiatrists. The registered manager explained that before people came to live at Cherington, they and their families were consulted about their care needs, choices and preferences.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

In the dining area we saw there were instructions about safety on the stairs. If this was intended for people, it was not provided in an accessible format. There were notices, clearly aimed at staff, about the disposal of unwanted food in the dining room and protected mealtimes. This made the home feel institutional.

The registered manager told us that flash cards were sometimes used to aid people’s communication, although we did not see these in use. Meals were placed in front of people without them knowing in advance what the menu choices were. Staff did not give people a choice of meal by showing them a plated-up meal in advance. People were asked for their food choices the day before, but for many people living with dementia, they would not have remembered what they had chosen. There was a new board to show the day’s menu in the dining room, but this had not yet been put into use. People were either given a plate of fishfingers, chips and beans or, for people on a pureed diet, they were given chicken for lunch which we were told was leftover from the day before.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

Relatives told us meetings took place at which they could make suggestions and provide feedback. A relative said, “There was one in September, and they said they’d put the minutes on the notice board and make the owners aware of what we said. I don’t know if that happened. I don’t know if they told the owners, but they didn’t put the minutes up.” One person told us, “Up to a point it’s good, but they could improve it. The food’s good, everything’s washed down, and the laundry is picked up every day.”

The provider had a complaints policy, but this was not written in an accessible format for people. We asked to see the complaints log and were shown a record which evidenced just 1 complaint for the year relating to a broken bed rail which was fixed. There was no evidence to show whether there were more complaints than just this 1, how they were addressed, what actions were taken and how lessons were learned.

The provider made sure that people could access the care, support and treatment they needed when they needed it. However, the physical environment was not dementia-friendly.

A dementia-friendly environment is designed to feel safe and supportive for people living with dementia, reducing confusion and distress while promoting independence through clear signage, good lighting, uncluttered spaces and sensory cues. Whilst the physical environment provided clear signage and uncluttered spaces, there was nothing to balance stimulation with calm or provision of familiar objects that might aid memory or aid orientation to enable people with dementia to live well.

People’s care and treatment was accessible, timely and in line with best practice and legal requirements. They had access to the registered nurses on duty at the home and to a range of healthcare professionals.

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

The provider’s website states, ‘We believe it is important to remember that our residents are individuals. Therefore, our approach to care is driven through recognition that our residents have their own experiences of life, their own needs and feelings, likes and dislikes.’ We found no evidence at inspection to show how this approach was put into practice. Staff provided care that was task-driven rather than personalised to meet people’s choices and preferences. Several relatives made similar comments about the home and suggestions for improvements. One relative said, “I know she’s okay if I go away for a couple of days. I’m thankful for what they do, but it could be better. To improve they should have more regular staff who have the same high expectations of care and cleanliness. They should ask themselves how they would want their loved ones treated.”

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Relatives were consulted on how their loved ones would wish to be cared for. One relative said, “They know my wishes. They were very supportive some time ago. They said they’d ask questions then, rather than at a later time when it would be more difficult. It’s all in place as far as I know.”

Care plans included people’s future wishes with many choosing to be at Cherington rather than go into hospital for end-of-life care. Care plans included Recommended Summary Plans for Emergency Care and Treatment (ReSPECT). These focus on people’s individual needs and preferences and included advice in an emergency situation when a person may be unable to communicate, such as during a cardiac arrest.