The inspection was unannounced and took place on 6 and 7 November 2018.

Cavendish Court is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Cavendish Court is registered to provide accommodation with personal care for up to 43 people. The accommodation is located over three floors and there are lounges and dining rooms on each floor. On the day of our inspection there were 34 people living in the home.

At our last inspection we rated the home as good overall. At this inspection, we found that there were three breaches in regulations. There were breaches in Regulation 9: person centred care; Regulation 17: good governance and documentation and Regulation 18: staffing. The service was rated requires improvement overall and this is the first time that the service has received this rating. You can see what action we have taken at the back of this report.

Cavendish Court did not have a registered manager in post. There was a peripatetic manager in place at the time of our inspection and the new manager started the day prior to our inspection. 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.

There were not sufficient skilled and experienced staff to meet the needs of the people living in the home. Agency staff utilised in the home had not received sufficient induction to familiarise them with the home and the people living there.

Risks assessments were not consistently being reviewed and updated where there were changes.

People and their relatives were positive about the permanent staff working in the home. However, there were high levels of agency staff employed and people felt that they did not know their needs and preferences.

Staff had completed safeguarding training and safeguarding incidents were appropriately raised by staff. However, we found the provider was not recording the outcomes of safeguarding incidents so the opportunity for learning lessons was being missed.

People’s privacy and dignity was not respected by all staff members. We saw instances where staff were not caring in their approach.

Staff members did not receive regular supervision in line with the provider’s policy.

We received some negative comments about the food in the home. A new chef had recently been employed and improvements were being implemented.

Most of the care plans reflected people’s life history and their needs and were person centred. People and their relatives told us that the care they received was responsive to their needs. However, we found care plans were not consistently being evaluated and additional monitoring charts where risks were identified were not always being completed comprehensively.

The registered provider did not have effective systems in place to monitor and improve the quality and safety of the service. The issues we identified had been picked up by the provider’s audits, however they had not been effective at improving and sustaining that improvement within the service.

Medication was being stored and administered safely. Regular medication audits were being conducted and any issues identified were addressed.

Registered providers are required to send notifications in relation to events or changes which occur in the home. We found that the service was sending appropriate notifications.

Staff recruitment was safe and appropriate checks were completed to ensure that staff were safe to work with vulnerable people. Staff training was up to date.

People and their relatives felt confident that issues raised would be addresse

The inspection was unannounced and took place on 27 and 28 September 2016.

Cavendish Court is a modern purpose built care home which opened in 2008. It provides personal and nursing care for up to 43 people. The home is built on three floors, with the third level being the dedicated nursing floor and accommodating 15 people. Each floor has bedrooms, lounges and dining rooms. A quiet lounge is also available and there is a patio area outside. The home is located close to Alderley Edge village in Cheshire and is within walking distance of the local facilities.

The service was last inspected in January 2014 when we found that the service was compliant with all the areas that we looked at.

The home has a registered manager. 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. At the time of our inspection there were 42 people living in the home.

We found that people were provided with care that was safe, person centred, sensitive and compassionate. The home was managed and staffed by a consistent team of care assistants who were well supported.

We saw that the service had a safeguarding policy in place. This was designed to ensure that any safeguarding concerns that arose were dealt with openly and people were protected from possible harm. All the staff we spoke to confirmed that they were aware of the need to report any safeguarding concerns.

We looked at recruitment files for the most recently appointed staff members to check that effective recruitment procedures had been completed. We found that appropriate checks had been made to ensure that they were suitable to work with vulnerable adults.

We found that there were sufficient staff deployed to meet the needs of the people living in the home. The manager had identified the need to increase the staffing numbers and had recently increased staffing numbers the day prior to our visit. There were a number of additional staff waiting to start work and this would mean that the home was fully staffed and there would be no further need for agency staff.

The provider had their own induction training programme which was designed to ensure that any new staff members had the skills they needed to do their jobs effectively and competently. This resulted in staff having the skills and knowledge to carry out their jobs well and provide safe and effective care.

We asked staff members about training and they all confirmed that they received regular training throughout the year and that this was up to date and provided them with knowledge and skills to do their jobs effectively.

People had care plans which were personalised to their needs and wishes. Each care plan contained detailed information to assist support workers to provide care in a manner that respected the relevant person’s individual needs, promoting their personal preferences’.

People living in the home told us that the standard of care they received was good. Comments included, “It’s brilliant, I’m lucky to find this place”, “They look after me well and if I ask them to do something they will do it for me” and “Judging by the way I am taken care of, I would say this place is very well run and the staff who deal with me are nice, caring and have a good sense of humour”. Relatives spoken with praised the staff team for the quality of care provided. They told us that they were confident that their relatives were safe and well cared for.

The service had a range of policies and procedures which helped staff refer to good practice and included guidance on the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. This meant that staff were able to help and support people who had difficulty in making decisions and ensured t

During this inspection we spoke with five people who lived at the home who said they were happy with the care and support provided and how they were looked after. They told us that staff respected their rights, privacy and dignity. All five people we spoke with were complimentary of the staff. Comments included; "I’m fond of the staff they are very likeable.”; "I get help when I need it"; “They are more like family than staff.” And “The staff here are lovely.”

We also spoke with the peripatetic manager, the quality assurance manager and people who worked at the home.

We spoke with two family members who regularly visit the home. Both relatives said that they considered the care to be good. Comments included;" The care is lovely, stunning care." and "I really do believe that everything here is very, very good. I can’t fault the care or the staff at all."

We saw that there was a system in place to ensure that the quality of the service was monitored and that a complaints process was in place to enable people to raise any concerns that they had.

We spent time in all areas of the home and saw that people were supported to select food of their choice from a varied menu and that people were supported to eat and drink sufficient amounts to meet their needs.

We found that there were arrangements in place to ensure that the risk and spread of infection was minimised and that staffing was planned appropriately to ensure people’s needs were met.

We spoke to four people who live in the home, they all said they knew they needed full time support. They told us that although it was a difficult decision to make they were settling in quite well.

One person told us the decision to live at the home was made with their family and initially stayed at the home for respite.

Two people we spoke to said the staff were very good.

One person said “I can’t fault the care the staff are lovely”, another person said “I’m quite happy”.

The four people we spoke to spoke highly of the staff and the care they received. One person said staff were easy to talk to and always listened to them. They told us what they liked to do during the day and that they liked to join in the activities when possible.

We asked people about their meals and they told us they were given choices, as there was always an alternative if they didn’t want what was on the menu. One person said “I really like the food and I can have something different if I want”. Another person said “the food is very good”.

We spoke to four people visiting their friends and relatives at the home. They all told us they were always informed and consulted about their friend or relatives care and treatment.

During our visit to the home we spoke with seven people who live there. They told us they are looked after well and treated in a caring way with dignity and respect. They said they are able to do the things they want to do and gave examples of the things they did during the day. These included watching television, painting, reading, socialising with other people and taking part in activities organised by the activity coordinator.

All the people we spoke to said they are happy living at the home. They told us staff work hard and there are enough staff to meet their care and welfare needs. None had any concerns about their care. Three said if they have had concerns in the past they have spoken with staff or the manager who were approachable, listened to them and sorted things out.

The majority said they liked and enjoyed eating the food provided by the home and all said alternative options are offered if they do not like the choices available.