Cavendish Residential Care Homes Limited

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 inspection the rating has changed to requires improvement. This meant people’s needs were not always met.

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 always make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs. Although staff sought to provide personalised care, shortfalls in care planning and oversight processes made this difficult to achieve in practice. Care plans did not always accurately set out how to meet individual needs and preferences. A staff member told us, “Every day, we come into their home to do our best and the goal of keeping Cavendish a jolly, safe, and loving place. We aren't just doing a job; we are making sure our residents are truly home.” The provider was in the process of updating care records to support the staff team to achieve their aim of providing fully personalised care.

The provider did not always fully understand the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity. We found the service worked with external professionals to support continuity of care, and to ensure familiar staff were available to meet people’s needs. This included referrals to the District Nursing team, Speech and Language Therapy (SALT) and to the Dementia Intensive Support Team (DIST). However, whilst staff understood how to escalate concerns to external professionals, this did not always translate into consistently effective outcomes. This was due to issues with care planning, which in turn impacted on monitoring and identifying root causes to ensure a full picture of care, reducing the effectiveness of joined‑up working. Professionals gave positive feedback about the service.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs. Whilst the service had acted to ensure some information was provided in an accessible way, this was not consistently the case. People’s communication needs were recorded in care plans, and an Accessible Information Standard policy was in place. Some documents were available in an Easy Read format, such as the complaints procedure. Easy Read is text written in a short and simple format, with accompanying pictures to support understanding. However, other information was not clear, for example the menu on display had writing which was too small for people with a visual impairment and did not accurately reflect the food being served that day. There was also a lack of dementia-friendly signage, to help people orientate themselves in the home. The new manager confirmed they had identified this and would be taking action to ensure this was addressed.

The provider sought to make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. However, as there were limited action plans arising from mechanisms such as surveys, this meant the provider could not demonstrate they had fully involved people in decisions or told them what had changed as a result, even where they had acted on that feedback. A complaints policy was in place for people to follow if required, and we saw responses were given in line with this policy. A person’s relative said, “I know who to go to if I have any concerns.” The service had received a number of compliments and positive reviews, including good feedback about recent changes at the service. One relative wrote, ‘The changes the care home have taken are very positive.’ Surveys with family members generally showed satisfaction with the service provided. The provider also sought the views of staff. This would benefit from more detailed analysis and action plans to show the action taken in response to suggestions made.

The provider made sure that people could access the care, support and treatment they needed when they needed it. The building was accessible for people’s mobility needs, promoting equity of access. Some care planning showed positive consideration about removing barriers in the environment, including for those living with dementia. For example, 1 person’s care plan said, ‘If [person] appears to be trying to join in with others encourage [person]’, and ‘If [person] prefers to be in certain places in the home, by the windows for example, it will be easiest for [staff] to both predict where [person] will be and perhaps find ways to make the space more available or more comfortable for [person].’ We were told people often used the garden in warmer months. A staff member said, “When the weather is nice, we have 3 or 4 big tables with umbrellas, benches and chairs, and have impromptu parties and barbeques. People do what they want to do. [Person] will sit in the garden, reading their book.”

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes to tailor their care, support and treatment in response to this. Although there were some leisure activities, these were not always fully personalised to ensure everyone had a tailored approach in line with their interests and to meet their specific needs. This was because people spent most of the day sitting in a shared lounge space, and so leisure activities were largely provided to a group. We received some feedback leisure activities had recently improved as there was now an activity coordinator. There were also some external entertainers invited into the home. A staff member said, ‘We organise singers, choir, therapy dogs. Residents like it and it is stuff that they’ve asked for.” A person told us they enjoyed activities, visiting singers and staff dancing in the lounge, telling us, “When I see them (staff) dancing like that it makes me smile.” However, 1 relative said, “Some of the activities are not always dementia friendly such as number bingo.” More work needed to be done to ensure leisure activities met everybody’s individual needs and could be adapted as required.

People were not always 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. Information was recorded as to whether people had a Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) in place, as well as their preferred place of care when very unwell. Staff received training in end-of-life care, and the service worked with other professionals such as the hospice. However, end-of-life care plans were brief and generic, and did not fully set out how people would like to be cared for holistically when very unwell. We raised this with the provider for review as part of their wider care planning improvement works.