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The Cedar Gardens Care Limited Good

Reports


Inspection carried out on 24 April 2019

During a routine inspection

About the service:

The Cedar Gardens Care Limited is a care home registered to provide nursing and personal care for up to 45 people. At the time of the inspection, there were 41 people living at the home.

People’s experience of using this service:

The home continues to provide a good level of care and support to people. People were treated with dignity and respect.

People told us they felt safe living at the home. Staff had a good understanding of abuse and the safeguarding procedures that should be followed to report abuse and incidents of concern.

Risk assessments were in place to manage potential risks to people, whilst also promoting their independence.

People were supported with their medicines in a safe way.

People were supported to have enough to eat and drink. Dietary preferences and support needs were accommodated.

People had access to health care professionals for routine appointments, or if they felt unwell.

People were involved in making decisions about their care and support. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Adequate staffing levels were in place. We observed that staff were responsive to the needs of people living in the home.

Appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service.

Staff received regular refresher training to ensure they had the skills and knowledge to perform their roles. Specialist training was provided to make sure that people's needs were met and they were supported effectively.

A complaints procedure was in place and people knew what to do if they had a concern.

The management team was open and transparent throughout the inspection process and demonstrated a commitment to the ongoing development of the service.

There were systems in place to monitor the quality and safety of the service being provided.

The home was clean, and the risk of spreading of infections was well managed.

Rating at last inspection:

Good (Report published 28 October 2016.)

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Inspection carried out on 31 August 2016

During a routine inspection

The inspection took place on 31 August and 2 September 2016 and was an unannounced inspection. The inspection prior to this on 10 July 2013 found the standards inspected were met.

The Cedar Gardens Care Limited is a nursing home registered to provide accommodation for a maximum of 45 people requiring nursing or personal care. The home provides a service to adults of all ages who may have a range of disabilities including dementia, learning disability and autistic spectrum disorder, mental health, eating disorder and misuse drugs and alcohol.

There was a registered manager at the service. 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.

We received good overall feedback about the service. There was particular praise for how people’s health needs were addressed. The staff supported people well with healthcare matters and people had access to the nursing staff and were supported to access appropriate medical care. The service had an excellent record of pressure ulcer care utilizing the provider’s tissue viability nurse support. In addition the staff were friendly and caring towards people, and welcoming to their visitors. Nurses were knowledgeable about people’s medicines and medicines administration and storage was undertaken in an appropriate manner.

We found that the service had systems in place to recognise and report safeguarding adult concerns. There was a robust recruitment procedure and staffing was assessed on an ongoing basis to ensure the changing needs of people using the service were met. People and the environment were risk assessed and reviewed to reflect any changes in circumstances.

The service was clean and well maintained. Staff had received infection control training and understood good practice in preventing cross infection.

The service was working to the Mental Capacity Act 2005 and the management team understood their responsibilities under the Deprivation of Liberty Safeguards to ensure that people’s legal rights were being upheld.

Staff received regular supervision and training and were well supported by a proactive and accessible management team.

People were supported to eat a healthy diet and remain well hydrated and although some people liked the meals provided others were not so complimentary. We brought this to the attention of the manager who was in the process of compiling new menus to trial. She undertook to continue the work to ensure all people were happy with the selection of meals.

People had person centred plans that reflected their likes and dislikes and told staff how they wished to be supported. Care plans told staff about people’s histories and named activities that people enjoyed. There was care taken to ensure activities were varied and involved people with different cognitive functioning.

The service was well- led by a strong management team who were visible and accessible to both staff and people using the service. The registered manager and deputy manager were both passionate about their role in ensuring good care and were well supported by the nursing staff and the provider management team. People and visitors told us they could raise concerns and any issue raised was addressed immediately by the registered manager.

The views of people, their visitors and staff were sought by the management team who responded to the outcomes of surveys and initiated changes suggested.

Inspection carried out on 10 July 2013

During a routine inspection

During our last inspection in April 2013 we found that the recording of supervision meetings did not demonstrate that supervisions were held as frequently as stated in the provider's policy. During our July 2013 inspection we found that the provider had focused on increasing the number of supervisions and improving how they were recorded and planned. Records of supervision and appraisal meetings included discussion of staff's strengths and development needs and we found that teamwork and person-centred care had been emphasised. This meant that people were supported by appropriately trained and supervised staff.

A new system to record training required and undertaken was in place and linked with the development needs identified in supervision and appraisal meetings. This included professional nursing courses. The home had been selected to participate in a pilot training programme offered by the London Borough of Barnet which would enable them to further develop staff and offer training to other providers. This meant that people were cared for in an environment which was striving for clinical excellence.

Inspection carried out on 10 April 2013

During a routine inspection

People were provided with a choice of suitable and nutritious food and drink and one person told us �the food is good here,� The home had systems in place to ensure people received adequate nutrition and hydration.

People who use the service were protected from the risk of abuse. Staff were guided by training and documents available and people told us they felt safe in the home.

The provider had made several improvements to the premises in accordance with our last inspection.

Staff providing care to people were subject to a number of checks before starting work and received regular training. Supervision meetings took place but the provider accepted the recording of these did not demonstrate that supervisions were held as frequently as stated in the provider's policy.

Inspection carried out on 8 January 2013

During a routine inspection

A person we spoke with who lived in the home said �I�m perfectly happy here�. People were spoken to respectfully. A varied person-centred activities programme was enjoyed by people living at the home. People said they were involved and respected.

Care plans were individualized, comprehensive and reviewed regularly. We saw relatives� signatures to confirm their involvement. People were receiving the care and treatment they needed.

There were ongoing problems with a number of issues relating to the premises. The home�s own audit procedures identified them but they had not been resolved promptly. The lift had broken down more than once in the year and there had been no communal bathroom in working order on the first floor since October 2012. The home was not meeting its own policy which stated its premises must be fit for purpose and safe.

There were enough qualified, skilled and experienced staff to meet people�s needs. One person said �staff come when I ring the bell.�

The provider had an effective system to regularly assess and monitor the quality of service received. We were shown a large number of audits carried out in the home on an ongoing basis. Aside from the delays outlined regarding the premises, we could see that action had been as a result of these audits.

Reports under our old system of regulation (including those from before CQC was created)