Cavendish Residential Care Homes Limited

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect. At our last inspection we rated this key question good. At this inspection the rating has changed to requires improvement. This meant people did not always feel well-supported, cared for or treated with dignity and respect.

The service was in breach of legal regulation in relation to dignity and respect.

This service scored 55 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff did not always treat people with kindness, empathy and compassion, or respect their privacy and dignity. However, staff and leaders did treat colleagues from other organisations with kindness and respect. Although we saw positive interactions between staff and people living at the service, there were some institutionalised staff practice issues which meant people were not always treated in a dignified way. For example, although not unkind, staff spoke audibly about people who needed to go to the toilet throughout the day in shared spaces, or talked across the room to one another about the support people needed. Staff had also previously operated a ‘toileting round’, rather than consider individual needs, and we observed staff waking someone who was soundly asleep to use the toilet, without giving them time to wake up fully or process the information. This led to the person becoming confused and upset. The provider told us they had raised this issue in a recent staff meeting to ensure discussions about continence care were discreet and people’s privacy respected. Despite this, we received positive feedback from people and their relatives. Staff also told us they were committed to treating people kindly. A staff member told me, “We always honour requests for female only care, and we are extra mindful during personal care or district nurse visits to keep curtains and doors closed so residents never feel exposed.” More work was required to ensure this was embedded in everyday interactions.

The provider did not always treat people as individuals and made sure people’s care, support and treatment met people’s needs and preferences. They did not always take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics. Care plans contained basic information about people’s protected characteristics, but there was limited information about people’s life histories to support personalised care. Some people’s care plans used the incorrect pronouns to describe them, suggesting information had been ‘copy and pasted’ rather than personalised to each individual. Although staff knew people well as individuals and had a good rapport, people tended to be cared for as a group with a task-orientated focus. This included people having tables placed in front of them to discourage them from getting up in the lounge, and recent examples of people being woken very early to meet the needs of staff. Whilst some action had been taken to address these concerns, changes were not yet embedded in day-to-day staff practice. The Nominated Individual was aware of this and working to change the culture of the service to promote fully personalised care. Despite this, people were positive about staff support, and relatives felt improvements had already been made. A person’s relative said, “One person used to be sat behind a table to stop them [getting up] and to keep them safe but now they are in an easy chair.” A person told us, “I love it here, we’re all together and it’s all very nice.”

The provider did not always promote people’s independence, so people knew their rights and had choice and control over their own care, treatment and wellbeing. Although staff gave people choices in day-to-day interactions, which were positive and warm, there were still systemic issues which needed to be fully resolved. For example, as part of everyday practice we saw staff supporting people in a respectful way at lunchtime, offering different cutlery, explaining what was on the plate and not rushing people when they were eating. However, at leadership level, all mealtime visiting had been restricted by the previous management, which meant some people were having visitors at unsociable hours without clear rationale. The Nominated Individual told us mealtime visits had been reintroduced, stating, “The home has become more open, with no restrictions on resident’s family visiting when it is mealtime, and [relatives] not left outside waiting.” This was confirmed by the feedback we received. A relative said, “We (family members) can now visit at mealtimes which is nice. I have stayed at mealtimes and the meals look good. When I stayed [person] ate well and enjoyed the food.” Another person’s relative said, “I feel I can go in as often as I want without inconveniencing anyone. Staff are always polite and greet me when I visit.” These positive changes needed to be embedded and sustained.

The provider did not always listen to and understand people’s needs, views and wishes. Staff were caring, but did not always respond to people’s needs in the moment or act to minimise any discomfort, concern or distress. We saw staff acted kindly to reassure people when they were upset. However, Positive Behaviour Support (PBS) plans lacked detail about triggers which meant staff did not always have the information needed to reduce the risk of potential incidents where people became distressed. Records where people had become distressed lacked detail, inhibiting learning. However, we received positive feedback that staff answered nurse call bells in a timely way and checked in on people regularly if unable to ask for help. A relative said, “[Staff] check [person] regularly because [person] cannot use the call bell.” Relatives told us they were satisfied staff acted promptly to support people, and there had been recent improvements in this area. A person’s relative said, “[Person’s] care needs are met.” And, "In the past I have had concerns when there have been 15-18 residents in the lounge and only 1 care worker available. I have seen care staff ask the chef to keep an eye on people whilst they assisted a resident, but this seems to be very rare now and there are usually 4-5 staff available.” Staff told us they were committed to caring for people with compassion, including when upset or communicating an unmet need. A staff member told us, “I offer reassurance, give [people] time and space, and I will offer them drinks or redirect their attention to something they enjoy. If needed, I will inform the senior staff and document the incident according to the care home policy.”

The provider cared about and promoted the wellbeing of their staff. However, due to shortfalls in care planning, the provider had not fully supported and enabled staff to always deliver person-centred care. This was being addressed by the provider at the time of inspection. Although there had been some recent changes to leadership, staff told us they felt supported and able to raise any issues freely with the new management team, to support their wellbeing. Staff were offered the opportunity for promotion and qualifications. The provider also completed ‘exit interviews’ to check the reason for staff leaving the role, so this could be addressed to make improvements to the workplace. A staff member told us, “The current management team has created a more supportive and positive working environment, and communication with staff has improved. Staff feel listened to and supported in their roles.” And, “Previously, communication and support from senior staff was sometimes more difficult, but the current management approach has made a noticeable improvement in teamwork and morale.” A relative said, “It is far freer and easy now. The home feels lighter in atmosphere.”