The Cedars is a ‘care home’ in Baildon, Bradford. People in care homes receive accommodation and 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. The care home accommodates 12 people in one adapted building. The inspection took place on 30 January 2018 and was unannounced. At the previous inspection in January 2016 we identified one breach of regulations relating to ‘Good Governance. “Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to ensure compliance with the regulations.
At this inspection we found issues remained with the organisation, presence and relevance of documentation. Although we did not identify any significant risks to people, if appropriate and robust documentation is not maintained there is the risk of unsafe of inconsistent care delivery.
A registered manager was in place. 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.
The registered manager and provider were very ‘hands on’ and provided highly person centred care. There was a dedication to ensuring people had fulfilling lives and the best possible care and support experience. However the ‘hands on’ nature of the registered manager was at the detriment to maintaining appropriate documentation, with a lack of administration support to carry out these duties. This lack of robust documentation meant the service could not consistently evidence safe, effective care and a well led service, despite some really positive feedback about the service from people, relatives and staff and positive interactions observed during the inspection.
People were safe from abuse living in the home. People said they felt safe and safeguarding procedures were in place to help protect people. Whilst the staff we spoke with had a good understanding of each person and the risks they presented, this was not always underpinned by robust and up-to-date risk assessments which increased the risk of inconsistent or appropriate care.
The premises was maintained to a high standard with very pleasant fixtures and fittings and a warm and homely feel. Key maintenance checks were undertaken in most areas, although we identified some concerns relating to fire safety which we referred to the Fire Service.
Medicines were managed safely and people received their medicines as prescribed. However protocols were required to support the safe and consistent use of “as required medicines”
There were enough staff deployed to ensure people received prompt care and support. Staff had time to spend with people as well as completing care and support tasks. Recruitment procedures were in place but documentation did not always evidence some of the recruitment decisions made.
Staff knew people well and were knowledgeable about the topics and questions we asked them about. However staff training was not well organised and we were unable to evidence staff had received training in a number of areas.
The service was compliant with the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity, decisions were made in their best interest. There was a culture of seeking consent before any care and support interventions.
The service worked effectively with a range of health professionals to meet people’s individual needs. Technology was utilised to help ensure care needs were met.
People had access to home cooked food which they said was of high quality. People had a range of choices which were adapted to people’s individual needs.
Staff were extremely kind and caring and treated people with a high level of dignity and respect. There was a pleasant , family like atmosphere within the home. Staff knew people very well and chatted to them throughout the day.
People’s views and opinions were respected and acted on. People had a say in what went on within the home, including the food, activities and décor. People’s independence was promoted and several people helped out around the home in order to achieve this.
People’s care needs were assessed and a range of plans of care put in place. Whilst we saw appropriate care was provided to people, care plans did not always reflect people’s current needs. People received kind and compassionate end of life care.
People had access to a range of activities and social opportunities. The service supported people to go out into the community and access events and community gatherings.
People and relatives displayed a high level of satisfaction with the service. They said the management team were approachable and listened to any issues or concerns they had.
There was a positive and visibly person centred culture within the home with people, relatives and staff all saying they would recommending the home to others.
Improvements were needed to governance systems to ensure the service achieved compliance with the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Audits ,checks and improvements plans needed putting in place to help achieve this.
We found two breaches of the health and social care act 2008 (Regulated Activities) 2014 Regulations. You can see what action was asked the provider to take at the back of the full version of this report.