Background to this inspection
Updated
3 December 2019
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was carried out by one inspector.
Service and service type
Cedar House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We used information the registered persons sent us in their Provider Information Return. This is information we require registered persons to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. This information helps support our inspections.
We reviewed other information we held about the service. This included notifications of incidents that the registered persons had sent us since our inspection in December 2016. These are events that happened in the service that the registered persons are required to tell us about.
We invited feedback from the commissioning bodies who contributed to purchasing some of the care provided by the service. We did this so that they could tell us their views about how well the service was meeting people's needs and wishes. We used all this information to plan our inspection.
During the inspection
During the inspection, we spoke with nine people, three relatives, three care staff, the deputy and the registered manager as well as the provider.
We reviewed a range of records, these included four people's care and medicines records as well as some risk assessments for other people. We checked that all staff were appropriately trained. We reviewed records about the management of the service, quality assurance records and a variety of policies and procedures. We also looked at other records such as minutes of resident and staff meetings where they had shared their views.
We displayed a poster letting people and visitors know about our inspection and invited feedback about the service. We did not receive any additional feedback following the inspection.
Updated
3 December 2019
About the service
Cedar House is a care home providing accommodation and personal care for up to 29 adults in one adapted property. At the time of the inspection, there were 18 people living at the service and two further people, registered at the service, but receiving care in hospital. People using the service were older people with varying needs.
People’s experience of using this service and what we found
People told us they felt safe and were happy living at Cedar House. However, we found processes were not consistent to ensure the effective management of some medicines and some records.
An incompatibility between a pressure mat and the alarm call system meant the system could not be used to alert staff of the risk of a person falling when they mobilised independently.
Although the shortfalls we found were addressed during our inspection, audits and quality assurance processes had not identified or acted on these issues as was their intended purpose. This was because monitoring procedures were not always effective to allow enough management oversight, which could compromise the quality and safety of the service people received.
Individual risk assessments provided the detail needed to keep people safe. People and their relatives told us they felt safe and staff knew how to keep them safe. There were enough staff to provide the support and flexibility people needed. Only suitable staff had been employed to support them, the provider had used robust recruitment practices.
The registered manager and the staff understood their responsibility about safeguarding people from abuse, staff had been appropriately trained and knew how to recognise and raise safeguarding concerns.
People were met with before they moved into the service to complete an initial assessment. This enabled the provider to make sure staff had the skills to provide people’s support. Staff received the training, support and supervision they needed to carry out their role and achieve personal development goals. People received a balanced diet.
People’s support was individual, planned and provided in a way that they preferred. People were encouraged to take part in activities they enjoyed. Staff knew people well, their likes, dislikes and what and who was important to them.
People were supported to have maximum choice and control of their lives 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.
When people were unwell or needed extra support, they were referred to health care professionals and other external agencies. People’s end of life wishes were recorded and people were supported at the end of their lives to be comfortable and pain free.
People knew how to complain or make comments and suggestions. People were asked their views about the service at meetings and by completing surveys, suggestions had been acted upon.
There was an open culture, led by the registered manager and provider. People, relatives and staff described them as approachable and supportive. People knew the provider well and were relaxed and enjoyed their company. The provider had oversight of the service, often visiting daily.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 24 January 2017).
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified a breach in relation to quality monitoring at this inspection. However, we found no evidence during this inspection that people were at risk of harm from this concern.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.