7 February 2022, 8 February 2022, 9 February 2022
During a routine inspection
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability autistic people and providers must have regard to it.
About the service
Cedar Vale is an independent hospital managed by Cygnet (OE) Limited. Cygnet Cedar Vale is registered with the Care Quality Commission for the following regulated activities:
Treatment of disease, disorder or injury
Assessment or medical treatment for persons detained under the Mental Health Act 1983.
The hospital provides mental health services for up to 14 men with a learning disability and autistic men. Since January 2022, the provider had limited the number of people admitted to 10 due to staffing challenges.
People’s experience of using this service and what we found
Right Support
Staff supported people to have the maximum possible choice, control and independence and they had control over their own lives.
Staff focused on people’s strengths and promoted what they could do. However, people did not always have a fulfilling and meaningful everyday life. People did not take part in regular activities which were part of their planned care and support. Some relatives were concerned that their relative had gained weight since being at Cedar Vale and thought lack of physical activity had contributed to this. However, relatives said activities were arranged at Cedar Vale such as swimming, bowling and visits to a local farm. One relative said they would like their son to go out more often. People said they went swimming, bowling, out for walks and to visit their family with staff.
Staff worked with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative. Relatives told us that staff used distraction techniques to help their relative when they were distressed, and this helped to calm them down. They said staff only used medication when everything else like going for a drive or a walk had not relieved their relatives’ distress.
Staff did everything they could to avoid restraining people. The service recorded when staff restrained people, and staff learned from those incidents and how they might be avoided or reduced. People told us they felt safe at Cedar Vale and that staff didn’t shout which helped them to feel safe. Relatives said that staff helped to keep their relative safe and staff knew their relative well.
The hospital is in an isolated location on the edge of a small village. People were reliant on staff to transport them in vehicles to access the community.
The service did not always provide care and support to people in a well-equipped and well-furnished environment that met their sensory and physical needs. Some parts of the hospital could not be adapted to meet the needs of people with a physical disability and sensory needs. However, the environment was safe, clean and well-maintained. People said they liked Cedar Vale although one person said they would like to move into their own house and another person asked when they were going to move to a home.
People were able to personalise their rooms. Two people said they liked their bedroom, another person said they did not like their bedroom and wanted to paint it.
Staff enabled people to access specialist health care support in the community. Staff supported people to play an active role in maintaining their own health and wellbeing. Relatives said that staff updated them about their relative’s health needs and kept them informed.
Staff supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs.
Staff did not always manage the administration of medicines safely. Records showed staff had found tablets on the floor in a person’s bedroom, the kitchen, the clinic room, and corridor. This posed a risk to people's safety.
Right Care
Staff promoted equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate care.
People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs.
Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
The service had enough appropriately skilled staff to meet people’s needs and keep them safe.
People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs.
People who had individual ways of communicating, using body language, sounds, Makaton (a form of sign language), pictures and symbols could interact comfortably with staff and others involved in their treatment and care because staff had the necessary skills to understand them.
People’s care, treatment and support plans reflected their range of needs. People received care that supported their needs and followed best practice.
People did not take part in regular activities and interests that were tailored to them. The service had started to give people opportunities to try new activities to enhance and enrich their lives.
Right Culture
Staff placed people's wishes, needs and rights at the heart of everything they did. The registered manager and staff understood the importance of family to the people and made communication a priority. Relatives were concerned that their relative were so far away from their family although staff did bring their relative to see them or they could visit the hospital. They had regular phone calls with staff to keep them updated and could always email. Some relatives said they had video calls with their relatives and virtual tours of the hospital however, one relative said these did not happen even though they had requested it.
People and those important to them, including advocates, were involved in planning their care.
Relatives said they were fully involved in their relatives’ care and invited to review and best interest meetings. They were involved in discharge planning for their relative.
Staff knew and understood people well and were responsive.
People were supported to have choice 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 needs of people formed the basis of the culture at the service. Staff understood their role on making sure that people were always put first. They provided care that was genuinely person centred. Relatives told us that regular staff were very good with their relative and had got to know them well, they said “I can’t fault the staff, they work well as a team.”
Staff felt valued and empowered to suggest improvements and question poor practice. There was a transparent and open and honest culture between people, those important to them, staff and leaders. They all felt confident to raise concerns and complaints.