Cavendish Homecare Ltd

Cavendish Homecare Ltd is a domiciliary care service providing personal care to adults. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of our inspection there were 21 people receiving support.

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

People and relatives spoke positively about the staff. One relative told us, “They always seem to be happy and friendly. They are patient with [relative] and ask her what she wants.”

People were safeguarded against the risk of abuse. People told us they felt safe with the staff who supported them. One person said, “They can be trusted. I trust the carers and the firm. I would recommend them.”

Recruitment had been affected by COVID-19 and the current cost of living crisis. The provider had reduced the areas they covered to ensure they had enough staff to cover people’s needs. Most people and relatives told us that they saw the same staff and they stayed for the correct length of time. One relative said, “They are reliable, consistent and easy to access if you have concerns.”

There was a system in place to manage medicines safely. We identified several issues with the recording of medicines. The registered manager told us this would be addressed. We have made a recommendation about this.

People and relatives told us that staff wore PPE to help reduce the risk of infection.

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. The registered manager was strengthening their recording systems around the MCA, to ensure it was clear how staff were following the requirements of the MCA. We have made a recommendation about this.

Staff were suitably supported and trained to ensure they could carry out their roles safely and effectively. Most people told us staff knew what they were doing. Staff supported people to eat and drink enough, where this was part of their plan of care.

People and relatives confirmed that staff were responsive to people’s needs and planned and provided person-centred care. Comments from relatives included, “I think they are responsive. They are very accommodating. They have picked up on any little thing” and “They make sure [relative] is alive and go over and beyond.” Care plans were in place which contained information about people's care and preferences. Reviews were carried out to ensure the care provided, met people's needs. One relative said, “They do what’s asked and seem to follow the care plan.”

Audits were carried out to monitor the quality and safety of the service. The provider was strengthening their medicines recording system. People and relatives spoke positively about service. Comments included, “I would recommend Cavendish for the 100% attention you get” and ““They fit in with me I am happy with the carers.”

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

Rating at last inspection

The last rating for this service was requires improvement (published 2 September 2021) and there were breaches of regulation in relation to staff training and support, recruitment procedures and quality monitoring processes. 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

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report covers our findings in relation to the key questions safe, effective, responsive and well-led which contain those requirements.

We used the ratings awarded for the caring key question at the last comprehensive inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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

Recommendations

We have made recommendations in the safe and effective key questions in relation to the recording of medicines and the maintenance of records regarding the Mental Capacity Act (2005). Please see these sections for further details.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Cavendish Homecare Ltd is a domiciliary homecare service based in Ashington, Northumberland, supporting people in their own homes. The service provides help and personal care to both older and younger adults, including people who are living with a physical disability or mental health condition. At the time of the inspection the service supported 38 people.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

People were not always supported by staff who had been subject to a safe recruitment process. Where staff had received specialist training there was no evidence their competency to deliver this specialist care had been assessed. Robust quality monitoring processes were not always in place and had not identified the failings found at this inspection.

People were supported by a designated group of care staff, who knew their needs, although some people told us there could be some changes, they were not always aware of. Risks related to care delivery were assessed and staff understood the actions they needed to take to minimise risks. People were supported with their medicines safely and staff followed appropriate infection control practices when in people’s homes.

People’s individual needs were understood, and their choices reflected in care plans and care delivery. Staff training had improved, with the exception of specialist care procedures. Observations of staff competency for moving and handling and medicines were undertaken, although records were often limited in detail.

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 received good quality and caring support from staff. Comments included: “They are all lovely; very respectful” and “They put my hair in. They do anything I ask them.” Staff told us they enjoyed supporting people. One staff member told us, “What I really enjoy about my job is putting a smile on people’s faces.”

People’s care plans had improved and contained more personalised information. The response to formal complaints was appropriate, although concerns expressed to the main office were said to not always meet with an appropriate response.

People were asked their opinion about the care they received and were involved in reviews of care. Staff said they were well supported by the registered manager.

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

Rating at last inspection

The last rating for this service was requires improvement (published 2 February 2021) and there were multiple breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made in some areas and the provider was still in breach of regulations.

The last rating for this service was requires improvement (published 2 February 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We carried out an announced comprehensive inspection of this service on 6 January 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve; Safe care and treatment, Staffing, Fit and proper persons employed and Good governance.

We undertook this inspection to check they had followed their action plan and to confirm they now met legal requirements. This report covers our findings in relation to the Key Questions: Safe, Effective, Caring, Responsive and Well-led which contain those requirements.

Whilst we have noted improvements in some areas we have found evidence the provider needs to make further improvements in others. Please see the Safe, Effective 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. The provider has taken immediate action to minimise the risk to people who use the service and address the concerns found at this inspection.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the safe recruitment of staff, ensuring staff have appropriate training and robust oversight of the quality of care provided by the service.

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 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 Homecare Ltd is a domiciliary care service providing personal care to 33 people. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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

There were mixed views about the caring nature of the service. People said staff were kind and did their best. Concerns were shared about the lack of communication in relation to staffing. Specific concerns were shared about the lack of consistency of staff involved in people’s care and the impact this had on people’s dignity.

Risks had not always been assessed and incidents had not always been analysed for lessons learned. The provider had not always followed their own procedures in relation to the safe recruitment of staff. Probation meetings had not always been documented. Medicines were not always managed properly and safely. Steps had been taken to minimise the risk of infection, including Covid-19.

People’s needs were assessed although the quality and detail of information varied. Staff had not been appropriately trained or assessed as competent to deliver safe care that met people’s needs. People were supported with nutritional needs and staff worked with other professionals to meet people’s health care needs.

Quality assurance systems had not been effectively implemented to assess the quality of the service and drive improvements.

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.

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

Rating at last inspection

This service was registered with us on 19 March 2020 and this is the first inspection.

Why we inspected

This was the first inspection of the service. The inspection was prompted in part due to concerns received about the services. A decision was made for us to inspect and examine all domains.

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 see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to safe care and treatment, governance, staffing and recruitment practices. Please see the action we have told the provider to take at the end of this report.

Follow up

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 alongside the provider and local authority to monitor progress. We will meet with the provider following the report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.