Cedardale Residential Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question as inadequate. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 72 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The registered manager had established a robust safety culture within the service. Staff actively listened to safety concerns, thoroughly investigated incidents, and reported them appropriately. Staff completed timely accident and incident forms which were reviewed by the management team to ensure immediate actions were taken as needed.

Lessons were continuously learnt to identify and embed good practice. For example, when one person had fallen unexpectedly, staff took time to discuss and agree with the person and their family more support around personal care and introduce the precaution of a sensor alert mat by their bedside. This was quickly put in place, and additional staff checks were completed day and night until the new mat had been installed and connected. A relative told us, “Since the last inspection, communication is a lot better. If I have any problem, they sort it quickly.”

The registered manager regularly analysed accidents and incidents to identify patterns and trends. For example, when a number of unwitnessed falls had taken place, staff were remindedof the importance to check that people’s footwear was being worn correctly, to ensure that all residents had their mobility equipment beside them, and that all incidents were reported with full information including where the fall happened and whether they were in possession of their mobility aid at the time. All staff received regular supervision which focussed on accidents, prevention strategies, and reflected on lessons learned.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People’s needs were assessed prior to moving to Cedardale Residential Care home. People had the opportunity to visit the home prior to moving in to ensure they were happy with their decision. The registered manager told us, “We visit the person where they are, for example, the hospital or their home. Wherever possible we invite the resident into the home, find out what’s important to them, ask them open-ended questions. We want to engage with them and understand all their needs, including their communication, medications and any religious or cultural needs. We have face to face contact and if the person’s capacity is poor, we speak with the family, the nurse or GP.” One relative told us, “Dad was in a different care home before coming here. He was settled and it was a bit tough for him to move, but once he arrived, it seemed as if he’d been here the whole time. It was a smooth transition.”

People, their relatives, and other professionals were involved in planning people’s care and support needs. We saw records of multi-disciplinary meetings, held to discuss safe care and treatment pathways for people, and staff knew when to refer to specialist services to support and manage people’s care safely.

When people attended health appointments, they were supported by a member of staff. One relative told us, “When [person] needed to have their cataracts done, the staff supported them.” Another relative told us, “Since [person] has been here, they have had new glasses, seen the dentist, and had their hip and knee replaced. The staff are very good at getting people the right help when needed.” A health care professional told us, “There are no barriers for residents toaccess our service; I have always found Cedardale to be responsive to the needs of their residents.”

People and their families had access and input into their care plans. The registered manager told us, “This is their home, and we want to make them as comfortable as possible.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People told us they felt safe. One person told us, “I feel safe. It’s nice here. If you want anything, they get it for you.” Another person told us, “I’m very fortunate; I’m safe and they do look after me here.” A relative told us, “I know [person] is safe because she is treated well and seems happy in herself.”

The manager understood their role and responsibilities to safeguard people from abuse and had taken appropriate actions to address allegations of abuse. This included raising safeguarding alerts to the local authority, undertaking investigations, and notifying the CQC. The Deputy Manager told us, “Safeguarding is discussed in staff supervision and in our monthly team meetings. We also discuss safeguarding concerns every Friday with senior staff during our governance meeting. We hold daily flash meetings and our daily walk through the home, done at different times of the day, allows us to pick up any safeguarding issues quickly, reducing delays in a response to any concerns.”

Staff had a good understanding of how to identify abuse, were confident that actions would be taken if concerns were raised and would take further action to escalate their concerns if thesewere not addressed in a timely manner. One staff member told us, “I would inform the local authority and CQC if I had to, but I know the managers would definitely deal with any concern because they all listen and act straight away. They get things sorted quickly.”

The Mental Capacity Act 2005 (MCA) provides a legal framework for making 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 capacity to make specific decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. All staff had received training on the MCA and understood their role and responsibility in promoting the principles of the MCA, and people’s rights and freedoms were promoted by the provider.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

The registered manager and staff worked with people to understand and manage risks by thinking holistically. There was a proactive approach to involving people to manage risks to their health and in enabling positive risk taking. The deputy manager told us, “When one person joined us, we did a risk assessment to support them to continue to access their property which helped them to settle in.” A relative told us, “[Person] is at risk of falling; they have always dealt with this well. For example, they notify me straight away with any change and call the GP. They have got him a special mat, and he has a chair he can recline in, so he is not sliding out. They do all the risk assessments and work out what he needs to stay safe.”

The registered manager told us, “We have implemented a falls protocol, completed by the staff team, and review people’s risk assessments monthly to ensure they are accurate.”

Staff provided care to meet people’s needs that was safe, supportive and enabled people to do things that mattered to them. One person told us, “The carers are very attentive and kind. I am

happier in my room; they give me peace. I know they are there if I need them, and they check on me. Everything is alright.”

One relative told us, “[Person] sometimes forgets to use their walker, but it’s always to hand and they have a sensor mat, and [person] has a trolley with food and drink on it which is always accessible as well.”

Staff understood the health risks people faced and how to mitigate the risks to keep people safe. People’s care plans were detailed, and risk assessments were reviewed regularly and updated to reflect people’s changing needs, and staff followed the measures in place to support people safely, for example to reduce the risks associated with UTIs (urinary tract infections) and constipation. One relative told us, “When the NHS incontinence pads weren’t suitable for [person], the staff involved us in working with the district nurse. This has made things better for mum and as a family we know exactly what’s going on.” Another relative told us, “When [person] didn’t want to eat, they got the GP out and now they are back to their normal self again.”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. For example, the provider had ensured that all actions had been taken to safely evacuate people in the event of an emergency. Fire drills, to check that staff had the practical skills needed, had taken place with all staff, and the provider had ensured that people had the correct equipment in place to safely evacuate them in the event of a fire.

People benefitted from an environment that was kept clean, tidy and warm, and records showed that health and safety checks were carried out frequently. Care equipment, such as moving and handling aids were serviced and records of maintenance kept. One person told us, “When I ring my bell, it’s answered quickly.” One relative told us, “They’ve certainly improved things. The décor changes have been good and everyone seems happier.”

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The registered manager ensured there were enough staff on duty to provide safe care. People, their relatives and staff told us there were enough carers to support people in a safe, calm, and person-centred way, and people had key workers to ensure continuity of care. One person told us, “I am not rushed, and the carers are not pushy, they are all very kind. They know I prefer a wash in the morning and a shower in the evening, and they support me with this.”

A relative told us, “The staff are very kind with mum. They know her little ways. If she doesn’t respond to their encouragement first time, they return to her later.” Another relative told us, “When a person is by themself, I have noticed staff sit and chat with them. I don’t think people are left on their own unless this is something they have requested, and staff check on people in their rooms.”

The registered manager regularly carried out spot checks which included the scrutiny of staff deployment. Staff underwent a robust induction, training and shadowing programme prior to working on their own. All staff told us the induction and training provided was good and gave them the knowledge and skills they needed to be a competent member of staff.

Staff received support through formal and informal face to face meetings with their line manager. This gave them the opportunity to discuss their role, concerns and training needs as well as personal welfare.

Prospective staff went through a safe recruitment process which included their right to work in the UK and their fitness for the role. All staff had undergone a Disclosure and Barring Service (DBS) checklist to help ensure they were suitable to work for the company.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

People lived in a clean, comfortable and well adapted environment which met their needs, and staff worked hard to maintain a good standard of cleanliness.

Staff had access to appropriate personal protective equipment (PPE) when they needed it, such as gloves and aprons, and we saw them correctly wearing PPE at times throughout the day, such as when they were serving meals, administering medication or giving people drinks.

The registered manager carried out regular infection control audits while flash meetings and daily walks around the home included checks on the cleanliness of the environment.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

The provider had medicines policies and procedures in place and had invested in an electronic medicines system since the last inspection. However, staff were not fully aware of how to investigate the system when something was not right. For example, we found a couple of discrepancies in the stock count of some medicines. While no harm had been caused, audits had not identified this shortfall and medicine incidents had not been completed with staff.

We also found some incidences of medicines being given together with other medicines, when they were prescribed to be taken alone. The management were made aware of these issues at the time of the inspection and responded immediately with an action to plan to resolve these concerns that included additional training.

There was some good practice around medicines management. For example, there was a good level of information shared with staff in handovers, appropriate referrals were made to the GP when needed, and there were safe and correct processes in the reduction of some people’s medicines. Patch rotation charts were in place documenting position changes weekly, body maps were used well, and there was good staff adherence and knowledge of PRN (as and when required) medicine process and protocols. Medicine reviews were undertaken regularly and recorded on people’s medication profiles. Staff administering medicines to people wereobserved following IPC (infection prevention and control) procedures, had gained people’s consent, and ensured people had taken their medicine safety. One relative told us, “Staff always watch [person] to make sure they have taken their medicine properly.” Risk assessments were in place for flammable creams and staff had received appropriate medicines training and regular competency testing. Medicine audits were completed regularly, however, had not effectively picked up the concerns found during this inspection. This was an area for further training and improvement.