Cavendish Care Home is a residential care home for up to 24 people living with dementia. At the time of the inspection there were 18 people living there and three people were staying for respite care. Two double sized rooms provide accommodation for people who have agreed to share accommodation. Privacy screens are provided. Four bedrooms have en-suite facilities. People share two lounges/dining areas. The grounds to the front and rear of the home are accessible to people providing pleasant areas to sit or walk around.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

People’s care was individualised reflecting their personal wishes, likes and dislikes and any routines important to them. Staff understood people’s needs well and treated them with dignity and respect. Staff were passionate about the care they provided. People were respected and their diversity and individuality was celebrated. Staff sang along with people, laughing and sharing jokes. Music was used as a means to communicate with people encouraging them to walk and participate in activities. People were able to join in with a variety of meaningful activities provided by an activities co-ordinator and external providers. A dementia friendly environment was provided and dementia friendly resources available for people to engage with. People’s nutritional needs had been assessed. A choice of meals and snacks were provided which reflected their cultural diversity.

People were kept safe from the risk of harm and abuse. Their medicines were safely administered. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People benefited from staff who had access to training and support to develop professionally. They said they felt supported and communication within the team was good. They said the staff team worked effectively together and they felt that their opinions mattered. There were enough staff, scheduled to work flexibly to meet people's needs. Four staff had received awards from a local care awards scheme recognising their skills. Staff said the registered manager was open and accessible. The registered manager worked alongside staff promoting best practice. The registered manager and staff worked closely with health care professionals to support people to stay healthy and well. People’s views and those of their relatives and staff were sought to make improvements to the service. A range of quality assurance processes were in place to monitor the quality of care provided. The registered manager had plans to make further improvements to the environment and care records.

Further information is in the detailed findings below.

Two adult social care inspectors carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with one relative, seven staff and the provider's representative. We spoke to two people who use the service who were able to comment on the food they were eating. We met and spoke to many more people who use the service but their comments did not relate to the standards we were inspecting. This was due to their complex needs in relation to their dementia. We observed the interactions between staff and the people who use the service and observed some of the support provided to people. We reviewed records relating to people's care as well as records relating to the management of the service. For example, quality monitoring records and cleaning records.

In this report the name of a registered manager appears who was not in post and not managing the regulated activities at this location at the time of this inspection. Their name appears because they were still the registered manager on our register at the time of this inspection. We have advised the provider of what they need to do to remove the individual’s name from our register.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

People were safe because there were enough staff to meet people's needs and staff had been given relevant information about people's. For example care plans gave detailed information about people's needs, abilities and the care they required. People were assessed and their identified risks were managed. For example, specialised equipment had been introduced to reduce people's risks of developing pressure ulcers. Other risks had been identified however the management of some of these risks had not always been clearly recorded to give staff guidance.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications needed to be submitted proper policies and procedures were in place. Relevant staff understood when an application should be made and how to submit one.

Is the service effective?

The service was effective because people received care that met their individual needs. Care plans gave good detail about people's individual likes, dislikes and preferences and staff were aware of these. We observed people's particular needs and choices being met. Staff were aware of what people’s individual reactions would be to certain situations and interventions and they adapted to meet these. Where people could not give consent for the care and treatment planned staff delivered this in people's best interests.

Is the service caring?

The service was caring because we observed people being treated with respect and their dignity was maintained. Arrangements were in place to preserve people's privacy. Staff responded to people in a manner that showed they cared. Staff demonstrated kindness, warmth, empathy and a sense of fun when providing people's support. Staff reassured people in a respectful way when they were distressed or confused. Staff were kind and showed understanding towards a relative when their relative was nearing the end of their life. People who use the service were given support to make choices about what they ate, drank and wore even though they required repeated support to do this. Staff wanted to improve people’s quality of life however there were limited opportunities to partake in social activities due to limited access to available activities. Staff recognised, when able, it was important for people to be independent. Examples of this were seen during mealtimes and during activities and in the opportunities given to people to make simple choices.

Is the service responsive?

The service was responsive because it responded to people’s care needs and acted when people's needs altered. Staff provided individualised care and support recognising people’s diversity. Staff sought additional support or intervention when needed. Referrals were made to health care professionals when needed and their advice followed.

Is the service well led?

The service was well led because the interim manager had provided strong but supportive leadership during a period where the service had been taking actions to improve standards of care and services to people. The interim manager had been approachable and had empowered staff to use their skills effectively. There was a system that recorded people's falls and accidents, managed the associated risks to people and then looked at ways of avoiding repeated occurrences. In managing people's risks their dignity was considered and actions were taken to maintain this. Management staff were aware of the day to day culture in the service. They took action to help staff improve their performance and addressed identified shortfalls in people's care. There were arrangements in place to monitor and improve the services provided. The provider's representative was actively involved in monitoring the service's performance and received information that enabled them to take action where required.

People in this service had a diagnosis of dementia and were unable to tell us about their experiences. Some also had physical care needs and were generally frail. Some people had not received appropriate care in relation to their incontinence (lack of bladder and bowel control) and damage to their skin resulting from this. Although the service had taken advice relating to this from visiting professionals. When people's needs were not being met as a result of this advice, staff had not question the advice. Staff did not have adequate knowledge or skills to do this or meet these people's needs.

During this inspection evidence showed that staff could not always adequately supervise people at night time. Due to some people's particular needs and behaviours this meant some people had been at risk of harm during this time.

Insufficient cleaning/laundry hours had resulted in care staff carrying out these tasks instead of attending to the additional needs of people with dementia.

Arrangements for monitoring the services provided had not been robust enough to identify shortfalls and effect required improvement.

People were at risk of receiving unsafe or inappropriate care due to a lack of clear guidance for staff to follow. Care records were not always well maintained.

During our inspection on 2, 3 and 4 June 2013, we found the provider was not compliant in this outcome. People's care needs and risks had not been assessed, reviewed or planned for appropriately. Some care practices were inconsistent and at times had not addressed people's needs. The provider sent us an action plan which detailed what changes needed to be made to achieve compliance. The provider confirmed to us that they would be compliant by the 15 November 2013. This visit was a follow up inspection to check compliance against this action plan.

We looked at the care files for six people who used the service. We found up to date care plans and risk assessments. These had been reviewed regularly ensuring people were receiving up to date care. Nutritional and fluid intake was being monitored in accordance with people's individual care plans. Where concerns had been identified we saw that the staff took the appropriate action and recorded this in the care files.

As a result of concerns being raised about the service, we brought forward our planned inspection.

We were not able to speak to people to ask them directly about living in the home because the people using the service had a diagnosis of dementia which meant they were not able to tell us their experiences.

We gathered evidence of people's experience of the service by speaking with relatives, looking at feedback received by the service and observing staff. Five comment cards received by the home showed that most people considered that home and the services it provided were either good or excellent. One relative we spoke with told us "Very caring, very good home. My mother is walking better now that I have ever seen her".

Staff were observed interacting with people in a respectful manner that showed that they understood each individual’s needs and how to communicate with them.

People who live at Cavendish Care Home have a diagnosis of dementia and therefore we did not ask them direct questions about their care. We did not speak to people as this visit was undertaken in the early hours of one morning and people were in bed and mostly asleep.

People who live at Cavendish Care Home have a diagnosis of dementia and therefore we did not ask them direct questions about their care. We spoke to people about the food provision and we received the following comments; one person said the food was “ok”, another person said “alright”. We asked people if they receive enough food and they all said “yes”.

The inspection took place on 13 and 14 April 2015 and was unannounced.

At the last inspection on 10 September 2014 we asked the provider to improve the records used to give staff guidance on managing people’s risks. In particular risks associated with the management of behaviour that could be perceived as challenging. The registered provider told us they would meet this legal requirement by 30 January 2015. We found these actions had been met.

The service predominantly cared for older people who live with dementia and could accommodate up to 24 people. At the time of the inspection 19 people in total were cared for.

A new manager had started in post in November 2014. They were not yet the registered manager of the service however, they had applied to us to be the registered manager and were waiting completion of this process. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found the service had generally improved since the last inspection in September 2014. People were safe because risks relating to their health and care had been identified and were appropriately managed. This included the improved guidance for staff in relation to managing behaviours that could be perceived as challenging. People were protected from abuse and their human rights were upheld. Environmental risks were managed and any shortfalls were addressed. Accidents and incidents were monitored and a more focused approach to addressing these had resulted in a decline in reoccurrences. There were enough staff to meet people’s needs and staff recruitment practices protected people from those who may not be suitable to care for them. People’s medicines were managed correctly.

Staff received training and support in order to meet people’s needs. Some improvements had been made to the support staff were receiving. Staff knew what was expected of them and appropriate action was taken if staff did not perform appropriately. Best practice was promoted and advice was sought from other professionals when needed. People had access to health and social care professionals in order for their needs to be met. People who required support with their eating and drinking were provided with this. People who lacked mental capacity were protected against discrimination and poor practice because the service adhered to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). Adaptions to the environment had been made to improve the well-being of those who lived there.

People were cared for by staff who were kind and compassionate. Staff demonstrated a real passion for improving the lives of those who lived with dementia. They were patient and understanding of people’s individual needs. People were treated with respect, dignity and afforded the privacy they were entitled to. Staff gave explanations and guidance to people in a way that they could understand. People who mattered to those who were receiving care were also supported and made to feel included. Those who did not have family support and who lacked mental capacity were provided with independent advocacy when significant decisions needed to be made. People’s independence was supported where possible.

Care was delivered in a personalised way meaning staff saw the person as an individual. People’s care plans reflected this approach and were maintained well so that staff received up to date information about people’s needs. People’s needs were reviewed and the care delivery altered accordingly. Opportunities for activities that were meaningful to the individual taking part had improved. All staff understood the importance of engaging people and providing them with the appropriate level of stimulation. People’s life histories, wishes and choices were listened to and incorporated into people’s plan of care. There were opportunities for people to express their concerns or make a complaint, although the new manager had not received any since being in post.

People lived in a service that was well-led. The culture had improved and staff were happier, generally more supported and included in how the service was run. This came with additional responsibilities which included supporting the manager’s visions and values and performing in a way that was expected of them. People’s representatives were also included and their views were sought on how to improve the service further. The quality of the services provided were monitored by both the manager and the provider. Actions were taken to address any shortfalls, promote further improvement as well as best practice.