We carried out a review of the data available to us about Cedar Tree Care Home Limited on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Cedar Tree Care Home Limited, you can give feedback on this service.
We found the following examples of good practice.
¿ The home was closed to visitors and there was clean signage to inform visitors. While the home was closed the service kept people in touch with their families using video calls or phone calls.
¿ When the home was open to visitors, the registered manager ensured relatives were booked in, and policies were followed to minimize the risk of infection.
¿ People living at the service who were COVID-19 positive were in isolation, one person who was not able to isolate in their room was isolated in a communal area alone to minimize risk.
¿ Chairs and couches in communal areas could be easily cleaned and had been spaced to prevent cross infection when in use.
¿ All rooms were ensuite and had televisions and Internet so people were easily isolated.
¿ The building was designed so rooms were in bubbles of four and staff were allocated to these bubbles to reduce the risk of cross infection.
¿ People living at the service and staff had all been risk assessed to identify if shielding was required.
¿ People had their temperatures and oxygen saturation checked twice a day to identify any change in their condition quickly.
¿ The service was spacious and staff had rooms on each floor to take socially distanced breaks. Rooms had been allocated with showers for staff to change uniforms to prevent cross infection.
¿ The registered manager had set up a COVID-19 testing room with bathroom facilities and staff were tested three times a week.
¿ Signage to remind staff of the correct personal protective equipment (PPE) and handwashing procedures were visible throughout the home to promote current guidelines.
¿ The main kitchen distributed meals which were served out by staff in dining areas. This meant kitchen staff minimized contact with staff and people to prevent cross infection, there were signs on the kitchen door reminding staff not to enter.
¿ Laundry facilities were spacious, tidy and well organized to prevent cross infection.
¿ The registered manager had ensured staff had been given additional training in infection control procedures, PPE, handwashing and how to perform COVID-19 tests.
¿ Extra domestic staff had been employed to ensure cleaning was enhanced and extra cleaning of frequent touch points was in place. The service had a sanitizer that was used at night to clean communal areas.
¿ People had their own equipment and wheelchairs. Any equipment that needed to be shared like hoists were cleaned immediately after use.
¿ When staff were self-isolating, staff on duty had pulled together and worked extra shifts to cover to avoid using agency staff.
¿ The registered manager performed regular walks round the service to ensure safety and compliance with current guidance and PPE.
¿ The registered manager told us that directors were very supportive and had been in the home to help and increased staffing when required to support people.
About the service
Cedar Tree Care Home is a care home that provided nursing and personal care to 38 people at the time of the inspection. The service can support up to 40 people.
People’s experience of using this service and what we found
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 exceptional end of life care from a meticulously trained and informed staff group. Staff went out of their way to find out about people’s previous life history, linked this to in house activities, special days and events both in and out of the home.
People told us they felt safe living at Cedar Tree Care Home. The risks to people had been assessed, and where appropriate some relatives had been involved in compiling and reviewing care plans. Staff had a detailed knowledge about the range of people’s needs. People were supported with their medicines in a safe way. People accessed healthcare services when they needed them, and they were supported to eat and drink enough to remain healthy. Specialist medical appointments were arranged where needed.
People were involved in making decisions about their care and support and their consent about the care and services offered was obtained. People were supported by a staff team who were kind and caring and treated them in a considerate and respectful manner.
Recruitment checks had been carried out to ensure staff were suitable to work at the service. Training relevant to people’s support needs had been undertaken by staff. The staff team felt involved in the running of the home and were supported by the registered manager and management team.
There were systems in place to monitor the quality and safety of the service being provided. People’s views of the service were sought through meetings, surveys and informal chats. A complaints procedure was in place and people knew what to do if they had a concern of any kind.
The registered manager understood their roles and responsibilities as a registered person. They worked in partnership with other agencies to ensure people received care and support that was consistent with their assessed needs.
More information can be found in the detailed findings below.
Rating at last inspection
The last rating for this service was Good. The last report was published July 2017.
Why we inspected
This was a planned inspection based on the previous rating.
The overall rating for the service has remained at Good. This is based on the findings at this inspection.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Cedar Tree Care Home Limited is a care home with nursing for older people, many of whom are living with dementia. People in care homes receive accommodation, nursing and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, both of which were looked at during this inspection.
Cedar Tree Care Homes accommodates up to 40 older people in one purpose built building, fully accessible throughout. At the time of our inspection there were 39 people using the service.
The service had 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.
Staff understood how to recognise the signs and the many different types of abuse. They knew how to report any concerns they may have and were knowledgeable about how to contact external agencies with their concerns.
Potential risks people were exposed to were identified and regularly reviewed. Records included detailed information and guidance to support staff to carry out their role. Accidents and incidents were analysed, reviewed and actions taken to improve safety across the service.
There were robust recruitment processes in place. These helped to ensure staff were suitable to provide care and support. There were enough staff available to meet people's needs as assessed in their care plans.
People received their medicines safely and as prescribed.
Staff followed infection control procedures to control and reduce the risk of infection for people.
The management and leadership within the service had a clear structure and the registered manager was knowledgeable about people's needs and key issues and challenges within the service. Staff felt supported and enabled in their role. Diversity was recognised and supported within the service.
People and their relatives were supported to share their views about the service and these were respected and used to drive improvements and develop the service.
The registered manager and the provider had systems in place to monitor the quality of care and ensure the values, aims and objectives of the service were met. This included audits and checks of key aspects of the service, Outcomes were used to ensure people received good, safe care.
The service is a residential service and is registered to care for up to 40 older people. On the day of inspection it was caring for 39 people.
There was a registered manager in post and they were present throughout the 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.
People were safe at Cedar Tree Care Home. Staff received training on how to keep people safe, and there were policies in place to support them if they had any concerns regarding a person’s safety. Equipment was checked and serviced as required and staff were trained on how to use it. Risks to people were identified and plans put in place to reduce the risk of harm. Medicines were managed safely and there was enough skilled and knowledgeable staff available to care for people.
Staff received the relevant training and support to meet the needs of people. Information was shared appropriately between staff and relevant health professionals to ensure people had consistent care. People had access to community healthcare services, as required. People enjoyed their food and were able to choose from a nutritious and varied menu. Special diets and preferences were catered for and recommendations from dieticians were followed.
People were cared for by staff who were kind, caring and compassionate. People were encouraged to share their views and their choices and preferences were respected. Staff cared for people with dignity and respect and promoted people’s independence and individuality.
Staff understood people’s needs and preferences, and took time to ‘get to know’ people, their lives, as well as who and what was important to them. There was a varied and inclusive activities programme which met people’s aspirations and was designed around people’s interests, special occasions and cultural needs. The registered manager proactively sought feedback and responded positively to comments and suggestions. Relatives praised the personalised care their loved ones received and described it as exceptional; they told us they had no complaints with the service.
The management team were praised by people, relatives and staff for their open and inclusive style of management, and for the support they offered them. The service was developed and managed with care and compassion, ‘from the top’ and responded to individual needs by developing a personalised service for people and their families. The quality assurance systems in place enabled effective monitoring of performance and led to good quality care for people.
The service, located on Rowley Lane, Derby is registered for 40 older people, including those living with dementia. There was a registered manager in post. 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 our last inspection on 29 July 2013, we found examples of poor management of medicines which meant the provider had not always protected people from unsafe administration of medicines. We also found that staff were not always supported by the manager, as supervisions were not always conducted at the frequency described in the provider’s policy. These were in breach of Regulations 13 and 23 of the Health & Social Care Act (2008) Regulated Activities Regulations (2010) which following the legislative changes in April 2015, corresponds to regulation 12 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following that inspection the provider sent us an action plan, detailing how they would address these concerns. At this inspection we found that improvements had taken place to the management of medicines and the provider was now meeting the requirements of Regulation 12.
However, we still had concerns regarding supervisions at this inspection, and we have made a recommendation regarding the frequency and quality of supervisions in this report.
We found that risk assessments and care plans were not always updated following incidents. Therefore we could not be assured that people always received the most appropriate care to meet their needs. We also found that information about people was not always shared where there was a legal duty to do so, for instance safeguarding incidents. Therefore people were not always protected from the risk of harm or abuse. We have made a recommendation regarding the reporting of incidents and sharing information, in order to keep people safe.
We found a lack of understanding from some staff, regarding the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DOLS). Particularly how this impacted on their ability to care for people lawfully; especially where people had their movements restricted. For example, there were some people receiving restrictive care to keep them safe, which had not yet been legally authorised. We have made a recommendation regarding how the MCA and DoLS are applied when caring for people.
Staff received an induction where they were supported by the senior staff team to complete all the necessary training; and develop a thorough knowledge of the service and the people using it. This was supported by on-going training and supervision of staff. This meant staff were able to update their skills and knowledge to care for people effectively.
We observed positive caring relationships between staff and people using the service and their families. Staff clearly knew people’s individual needs, preferences and interests and provided care, support and activities in response to these. For example in response to individual interests and requests, there was a model railway in the lounge for people to use. There were also pet guinea pigs and birds, an outdoor seating area and a varied programme of events and activities that included the local community. This meant people had access to a variety of activities to suit their individual interests and abilities and felt part of the wider community and neighbourhood.
People, families and staff spoke highly of the registered manager, who they said was always available and ‘a great support to all’. Relatives were reassured that their family member was ‘in safe hands’ and staff felt supported and motivated The registered manager told us they understood their responsibilities to ensure that people received high quality care and had appropriate systems in place to monitor this. However, we found they had not always recognised their duty to share information, in order to protect people from the risk of abuse or harm.
People told us they were very happy with the care that they received. One person told us 'The care is brilliant. The staff seem to know when I want something or need assistance before I ask and they are there to help'.
The provider had clear systems in place to obtain feedback from all persons involved in the service as well as auditing their own service. This showed that the provider monitored the quality of the service it provided.
People were not protected against the risks associated with medicines as issues were identified during the inspection relating to people not always receiving medication at the times it was prescribed. There were, no 'as required' protocols in place to give clear guidance when certain medicines should be administered and there were gaps identified in the medication records.
People were cared for by staff who received appropriate training however the staff were not always suitably supervised and appraised.
We carried out a review of staff training records, and the mental capacity assessments for those people who were unable to make decisions or lacked the capacity to do so.
Relatives were happy with the support provided. One relative said 'I am very happy with the care and the staff are very good.' Another said 'I wouldn't move my relative from here as both I and the person who lives here are very happy with the care. I can not speak highly enough of the clinical lead nurse.'
Relatives told us they were involved in decisions about the care, treatment and support their family member received. One person told us they knew about their relative's care plan and could ask to see the file at any time. They told us 'The staff tell me straight away if there are any changes with mum.' Another relative told us they had been involved in the care planning process.
We saw people were offered a choice of meal, and the menu was displayed near the dining tables. People told us they enjoyed the meals provided. We saw people joining in with organised activities, or sitting quietly reading the newspaper or a book. One person told us they happy with activities provided.
People told us they felt safe and had not seen any care practice that gave them cause for concern. Relatives told us they had no concerns about staff practice and felt able to raise any concerns with staff.
We observed staff speaking respectfully with individual people. There were some people whose first language was Punjabi and there were staff available who could communicate well with them.
Records showed that people had attention from professionals outside the home when needed. One person told us that hospital appointments were organised by staff at the home and that a member of the care staff helped them at appointments.
We found there was an effective care planning process, but there were no clear written plans about how people needed their medication. We did, though, see that nurses gave medication safely to people and people told us they always got their medication.
People told us the home was always clean and we saw that people had all the facilities and equipment they needed at Cedar Tree. One visitor said, 'Oh it's always clean here'. One person living there told us, 'I like my room. They clean it every day.'
During the morning of our visit there seemed to be sufficient staff to meet people's needs, but during the afternoon people were waiting for attention. There had been a shortage of staff due to sickness and no arrangements had been made for cover. The recruitment procedure for new staff was clear, but in practice this was not followed and staff were allowed to commence work before all checks on their fitness were completed. This meant that the providers could not be completely sure people in their care were protected. The staff we saw in the upper unit demonstrated their skills in working with people with needs relating to dementia. We saw people benefiting from staff speaking individually with them and occupying them. The staff there knew how to keep people safe. In the lower unit, staff showed they were skilled in moving people with a hoist when needed and they were working as rapidly as possible to meet people's care needs. There was written evidence that staff were appropriately trained to meet people's needs.