Cedar Lodge

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement: This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always check people’s care and wellbeing needs with them.

Systems were in place to capture information as part of the assessment process to determine if the service could support people safely. Within The Limes we were told this also included the person visiting and completing compatibility assessments before they moved to the service.

Following the assessment process, care plans and risk assessments were developed. However, we found not all information from the assessment was transferred into these, risks were not always assessed, and care plans and risk assessments did not always contain enough detail. For example, there was no risk assessment in place for 1 person who had shown a specific behaviour that was detailed within their assessment. For another person, who was at risk of choking, there was no details regarding the actions staff should take should this person choke, and for another person their records did not provide sufficient information to guide staff on how to manage their health condition. This meant staff did not always have clear guidance on how to meet people’s needs safely and consistently. We discussed the concerns with the management team who rectified them during the assessment.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

We received mixed feedback from people and relatives regarding how people’s personal belongings were looked after. Comments included, "The laundry is the problem, 3-4 cardigans, the state of them, discoloured, stained and misshaped, sometimes they are wearing another person’s clothes", "The laundry keeps losing my stuff" and "The laundry, the whites, I am not happy, their underwear is an awful colour."

Staff had access to training which helped to make sure the care and support they provided was in accordance with up-to-date best practice guidelines and legislation. However, records did not always evidence care was delivered in line with best practice guidance. For example, for 1 person who required repositioning in bed, records showed this had not been consistently completed. Whilst systems were in place to support evidence-based care, further work was needed to ensure guidance was consistently embedded into day-to-day practice.

People and relatives were complimentary about the food within the home. Comments included, "[Relative] loves the food and says that it is nice food" and "The food is alright, I would like more salad."

The provider did not always work well across teams and services to support people.

Although the managers and staff described how they worked with external professionals, including GPs and district nurses, we received mixed feedback from professionals regarding this. One professional told us, “We advise and create a plan. They are pretty good here at following the plans.” However, another professional told us about a time when their recommendation was not followed. The manager confirmed they had discussed the concerns with the professional who told them some concerns may have been due to miscommunication. The provider told us they valued positive and constructive relationships with professionals and recognised the importance of effective partnership working.

People told us they were supported to access healthcare services when needed. Comments included, “The doctor visits 1-2 times a week” and “I can arrange to see a doctor if I need to.”

Staff told us they worked well together as a team. Comments included, “We have flash meetings and someone’s here every day just to discuss things”, “I’ve not had a problem, communications good” and “It’s a lovely place to work. I’ve been here for so many years. The staff and the residents, it’s like a big family.”

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control.

At the time of the assessment the garden within 1 part of the home was not accessible to people unless supported by staff. This meant people could not independently enjoy outdoor space. One relative told us their loved one liked pottering outside in the garden, and it would enhance their quality of life when they could access it. We discussed the concerns with the management team who rectified them during the assessment.

The activity schedule included regular activities for mental and physical wellbeing. This included exercise, music and movement, quizzes and animal therapy. One person told us, “I enjoy the activities, scrabble, word searches, they keep my mind in gear." A relative told us, "The activities bloke is great. [Relative] loves the activities, loves music, quizzes, making cakes, [relative] likes to go, even if [relative] doesn’t join in.” A staff member told us, “The activities are good here to keep their minds occupied.”

The provider did not always routinely monitor people’s care and treatment to continuously improve it.

Records did not always provide consistent assurance that all aspects of care were delivered and monitored as planned, to ensure outcomes for people improved. For example, a review of records for 1 person who required repositioning in bed found this had not been consistently completed. For 2 other people, we found welfare checks detailed within their care plan to keep them and others safe had not been completed. This meant monitoring and recording processes required improvement to ensure care was delivered consistently and outcomes reviewed effectively. We discussed the concerns with the management team who started to rectify them during the assessment.

However, we also saw evidence of positive outcomes. For 1 person, through collaboration and partnership working they had developed their independence, confidence, social skills, and overall wellbeing and achieved their goal of moving into a supported living environment. For other people, relatives told us, "[Relative] has been a different person since they have been in the home. They are clean, tidy, fed well, they give them lots of drinks, and they spend time talking to them. They are very safe. The care staff are amazing they give them time, they have greatly improved" and “Since the new manager has come, [relative] has improved greatly. They now get up and go into the lounges, first time ever they have wanted to be with other people.”

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. Improvements were needed to ensure decision specific mental capacity assessments and best interest decisions were in place. For example, 1 person’s mental capacity assessment and best interest decision covered 7 different decisions, where the MCA states they should be decision specific. We discussed the concerns with the management team who started to rectify them during the assessment.

Staff told us they sought consent before supporting people and people confirmed this. One person told us, "They do ask for my consent to do things.”