Archived: Cedarwood

During our inspection there were three people there for a short-stay at Cedarwood following their discharge from Good Hope Hospital. We spoke with all of the people and relatives. We asked them about their experiences of the service.

Since our last inspection a new manager has commenced employment with the provider. They told us that they were in the process of applying to become registered with us; the Care Quality Commission. We spoke with a senior manager. They told us that they were now operationally responsible for Cedarwood and providing support to the new manager. We also spoke with six staff members during our inspection.

Below is a summary of what we found.

The detailed evidence supporting our summary can be read in our full report.

We looked to see if staff acted in accordance with people's wishes and gained their consent to care and treatment.

We observed that staff respected people's choices. Staff told us that they explained how support would be given to people, for example with personal care.

The manager and some staff demonstrated to us their understanding and responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

We looked to see if the care and welfare needs of people who used the service were met.

All of the people told us that they were satisfied with the care and support that they received at Cedarwood. One person told us, 'I'd stay here if I could.' Another person told us, 'I feel very well supported here.'

We saw that people's individual needs were met in a timely way by staff.

We found that people's welfare and safety were protected and risk assessments were in place to reduce the risk of harm to people.

Some staff demonstrated to us that they were able to deal with emergencies that might arise from time to time. A few staff were new to Cedarwood and the manager told us plans were in place to provide further training, such as first aid, so that they would be able to deal with emergencies that might arise.

We looked at cleanliness and infection control.

We saw that all areas of the home were visibly clean and tidy.

One relative told us, 'It is always clean when I visit.'

We saw that appropriate arrangements were in place to ensure appropriate standards of cleanliness and hygiene were maintained.

We looked at the management of medicines.

We looked at three sets of people's medication records and saw that appropriate information was recorded about their medicines.

We found that people were protected against the risks associated with the unsafe use and management of medicines.

We looked at the safety and suitability of premises.

All of the people that we spoke with told us that they felt Cedarwood was suitable for them. One person told us, 'I have my own bedroom and use the lounge and dining area.'

We saw that actions had been implemented to ensure that the home was suitable for the people having short stays there.

We looked at staffing.

All of the staff that we spoke with told us that they felt there were enough staff on shift to meet people's identified needs. One staff member told us, 'Things have improved a lot. Shifts are now more structured and we are also more supported.'

All of the people that we spoke with told us they felt their needs were met by staff and that staff had the skills for their job roles.

We looked at assessing and monitoring the quality of service provision.

All of the people told us that they were asked for their feedback on the quality of the service. One person told us, 'Staff asks me if everything is alright.'

We saw that effective systems of audit were in place to monitor the quality of the service provided.

We looked at records.

We saw that accurate and appropriate records were kept about people's care and support and that these were kept securely.

During our last inspection in February 2014 we had found that the registered provider was not meeting all of the regulations inspected. During this inspection we looked to see if improvement had been made and found that it had not.

We saw that there had been a change of manager since our last inspection. The new manager told us, "I started about three months ago and have submitted an application to become the registered manager."

We spoke with the manager, operations manager and with eight staff on duty. We also spoke with a few healthcare professionals that were based at Good Hope Hospital but were involved with people's care at Cedarwood. We spoke with 15 people or their relative and asked them about their experiences of the service. We observed staff interactions with people in the home. Our conversations with people helped us to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? and, Is the service well led?

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

We found that some risks were assessed but these lacked detail.

We found that the poor management of medicines created a risk of harm to people.

We found that cleaning and infection control and prevention did not always take place in an effective way. This meant that there was a risk of cross infection that could cause illness to people.

We found that the premises were on one level and had individual bedrooms with shared communal bathroom, dining and lounge facilities.

All of the people that we spoke with were happy with their bedrooms but found the bedroom doors too heavy to open. One person told us, 'The bedroom doors and too heavy for me.' This resulted in bedroom doors (which were fire doors) being propped open which meant that the bedroom doors were not suitable for people that had short stays on Cedarwood.

We found that one entrance to Cedarwood was secure and offered appropriate security. However, we saw that a further two entrances did not offer the same level of security.

Is the service effective?

We found that staff were not always familiar with people's needs and care records did not always contain the information that they needed.

Most of the people that we spoke with told us that they felt shifts were short-staffed. Most people told us that they felt this impacted upon how effective staff were in meeting their care needs in a timely way or at all. One person told us, 'I would like to have a shower every morning but cannot manage on my own. There are not enough staff to help me. I've only had two showers in three weeks here.' Another person told us, 'Staff do their best. It's not their fault. There are just not enough of them.'

All of the staff spoken with told us that they felt that Cedarwood was very busy and that shifts would benefit from extra staffing. One staff member told us, "It is hard to give one hundred per cent to people. We do our best but really need extra staff."

We found that communication was not always effective. Some people's needs, such as a referral to a health care specialist, had been identified but were not completed in a timely way.

One healthcare professional told us that they felt Cedarwood 'bridged the gap' in meeting people's needs but that individual needs were not always met in an effective way.

As part of our inspection we looked to see how the registered provider implemented the Mental Capacity Act 2005. We saw that one person may have required a mental capacity assessment and referral under the Deprivation of Liberty Safeguards. This had not been completed. This meant that the manager had not given consideration to, or acted upon, their responsibilities under the Mental Capacity Act and the Deprivation of Liberty Safeguards.

Is the service caring?

All of the people spoken with told us that they felt that most staff were kind and caring. One person told us, 'The staff are great.' However, most people also told us that they felt that there were not enough staff on duty to fully meet their care and support needs.

We found that people's experience of being asked for feedback about the quality of the service provided was when they were discharged from Cedarwood. People told us and the manager confirmed that feedback was not sought from people during their short stay on Cedarwood.

Is the service responsive?

All of the people and relatives that we spoke with told us that they were grateful for the service. One person told us, 'I could not stay in hospital any longer as I was ready to be discharged. But, I could not return home because I needed some equipment. So, it is useful that I can be here until I go home.'

People told us that they knew how to make a complaint if they needed to. However, one person told us, 'I would not complain. I would not want to make things worse for myself or others.'

Is the service well led?

We found that the manager was confused about the type of service Cedarwood was registered to provide.

We found that the medication policy did not reflect the service offered. We also found that some practices required by the regulated service were not being followed, such as those to promote infection prevention and control, were not being followed as a result of the managers and operations managers confusion about the type of service that Cedarwood was registered to provide.

Some people and their relatives that we spoke with did not feel that the service was well led. One relative told us, 'Communication could improve.'

There were some systems of checks and audit in place but we found that these were not effective.

Staff felt supported in their job roles by the manager. One staff member told us, 'Most of the team started at the same time. We are a good team. I feel supported.'

Some records were not easily located and some that we asked for such as one person's daily care logs were not located during our inspection. The manager told us they did not know where they were. We found that some care records such as 'enablement plans' were either not competed or did not contain the information needed by staff. We found that some risk assessments had not been completed or were not detailed.

At the time of our inspection there were 24 people who used the service. The registered manager as detailed in this report was on leave at the time of our inspection. We spoke with the operational manager, four members of staff and three health care professionals. We spoke with eleven people who used the service and four of their relatives. We also looked at four people's care records and medication records.

A lack of detail and gaps in care plans and risk assessments meant that care was not always planned and delivered in a way that was intended to ensure people's safety and welfare.

Safeguarding procedures were in place so that staff would recognise and report any allegations of abuse to protect vulnerable people from the risk of harm. One person told us, "I have no concerns I am very pleased with the care".

People were not fully protected against the risks associated with medicines because the provider did not have an effective system in place to manage medicines.

People were cared for by staff that were trained and supported to deliver care to an appropriate standard. One person told us, "Staff are wonderful and always helpful"

The provider did not have an effective system to regularly assess and monitor the quality of service that people received.