Cavendish Residential Care Homes Limited

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last inspection we rated this key question good. At this inspection the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 58 (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 always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them. People received an assessment when they joined the service, to support the development of care plans. However, this did not always translate into good quality care planning, as these records were not always accurate or up to date. Relatives told us they took part in initial assessments but had limited involvement in the care planning process in terms of ongoing reviews. A relative said, “I was involved in putting a care plan together when [person] was first admitted, but I can’t recall a review.” However, other care plans did record information about people’s specific needs in a more personalised way. The provider was aware care planning required attention to ensure consistency and told us they planned to review and revise all care planning records.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. They did not always do this in line with legislation and current evidence-based good practice and standards. Best practice in dementia care was not fully demonstrated as staff did not always recognise potential issues and concerns. We received mixed feedback in this area, with some positive comments, but others suggesting more timely intervention was required. For 1 person, a professional told us, “The home has had involvement from the dementia team and that’s been working really well for [person].” However, another person’s relative said, "[Staff] seem to have a good understanding of [person’s] needs, however sometimes I felt they didn’t acknowledge [person’s] mood swings. For example, I had asked for the dementia team to be contacted to discuss these, but this did not happen until there was an incident.” People had access to nutritious home cooked meals and were offered enough to eat and drink. Whilst we saw there was a lack of meaningful variety available on the menu, people were satisfied with the quality of meals. A person told us, “The food is lovely, no complaints at all.” Another person said there was a “very good kitchen” but when asked about whether they were offered choice, told us, “Not really no, but it’s nice.” We asked another person about choice, who told us, “It’s usually an A or B to decide.” The provider told us the chef offered people different options daily, and they were continuing to work on the menus and seeking people’s views and input.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services. We saw instances where staff had worked together with healthcare professionals and relatives to support them to access the equipment they needed, to support independence, mobility and reduce the risk of social isolation. This had led to positive outcomes such as ensuring people did not have to remain in bed unnecessarily, as observed during our visits to the care home. A relative said, “[Person] has been visited by an occupational therapist and with the assistance of staff, they managed to get [person] sitting upright and eating independently.” Another person’s relative told us, “When [person] experienced a fall the home contacted me straight away.” This practice needed to be reinforced through good care planning documentation.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support. Records showed most people had access to support such as dentists, opticians and healthcare professionals as required, to promote good physical health. A relative said, “[Staff] seem to have a quick response from the GP surgery. The home always rings me if there are any issues and tell me what has happened and what they have done.” We also received feedback people felt able to share their concerns with staff, promoting wellbeing and good mental health. When asked who they could speak with if something was upsetting them, 1 person told us, “I would tell the staff. They’re brilliant.” Another person said of the staff team, “They’re lovely. Always available to have a chat with if I’m feeling down.”

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves. Although monitoring was carried out in relation to people’s clinical needs, this was not effective due to shortfalls in care planning. For example, monitoring records showed 1 person frequently refused fluids, but there was no information in the care plan for staff on how or when to escalate this, or associated risks related to dehydration such as urinary tract infections (UTIs). Another person had records kept where staff had supported them to reposition when cared for in bed, to ensure good skin integrity and reduce the risk of pressure damage. However, the care plan did not have any information to confirm this practice was in place and the frequency of repositioning support required. The service approach to monitoring also needed to be expanded to ensure it showed quality of life measures and the impact on outcomes for people.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment. Whilst some people told us they were offered choice and control, this was inconsistent. A relative told us, “[Staff] always come in and ask what [person] wants before providing any care. They are very good.” Mental Capacity Assessments (MCAs) were in place where people did not have the ability to consent to all aspects of their own care. However, we found MCAs were brief and lacked detail about how decision making was promoted, and action taken was not always the least restrictive option. For example, 1 person’s medicines were being given covertly, without their knowledge or agreement. However, we found the reason for this was because the tablets were too large to swallow, rather than being refused by the person. There was CCTV in shared spaces of the care home, to help with reviewing incidents such as falls or other accidents. Whilst the footage was securely stored, and signage on display, the provider had not completed any MCAs where people could not consent to this practice. A Deprivation of Liberty Safeguards log was in place to ensure oversight of applications and renewal dates. However, care plans did not clearly show how staff complied with any conditions on people’s DoLS. The provider told us they would act on our feedback.