Archived: Cedar Grange

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 requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 69 (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.Accidents and incidents were reported by staff and action was taken to mitigate risk of events happening again. The registered manager had a good overview of accidents and events. Staff told us there was a robust process for sharing information and a learning culture was embedded. Feedback from staff included, “We have staff meetings, and all information is shared” and “If there is an investigation it’s shared in handover”.

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. Continuity of care was maintained by ensuring staff had access to records. People’s needs were assessed before they started using the service. Feedback from staff included, “We have the information of their needs, and then we’re updated soon after the new resident has moved in” and “There is a new resident this morning. We’ve had the assessment sent over for the new person before they arrive". Care plans were reviewed regularly and when people's needs changes this was recorded effectively. Leaders shared all relevant information with staff to ensure care was delivered safely in line with best practice.

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.Systems and processes were in place to ensure people were safeguarded from the risk of abuse. Staff received safeguarding training and understood how to recognise and report poor care and abuse. Comments included, “There’s been no safety concerns” and “I’m quite happy about [Name’s] care, I’d say [Name] is definitely safe because if there’s any stumbles or falls, they ring me”.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homesthis can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found that the provider was able to identify when people were potentially being deprived of their liberty, complied with the basic principles of the Act, and made applications or/and urgent authorisations in a timely manner.

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.Risks to people’s health, safety and well-being were assessed and regularly reviewed. Staff told us they were kept up to date about any changes in people’s needs through good communication and handovers. We observed care being delivered in line with people’s care plans, which promoted their independence and choice. Where people required support with moving and handling there were clear risk assessments in place. We observed staff following care plans and using equipment safely. Staff told us care plans were discussed and regularly reviewed. Comments included, “Relatives can come in and look through the care plans, and any changes will be updated by [the registered manager]” and “[Name] wanted a hotter plate at mealtimes, we discussed this with management and completed a risk assessment and updated the care plan”.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. The home was tidy, well maintained and safe. Systems were in place to ensure the required health and safety checks were completed. There was a dedicated maintenance worker on site which meant shortfalls could be addressed promptly. Staff comments included, “I have only once had to raise a concern regarding a wheelchair, and it was fixed” and “It’s clean and tidy at all times”. One relative told us, “The lift was broken, but it was fixed within the day”.

The provider did not always make sure there were enough qualified, skilled and experienced staff. Recruitment was managed safely. Staff had and induction, support and training to carry out their role. Staff comments included, “There is in house training, I have had a lot of training, the help is there” and “Yes we do have supervisions, and we can raise concerns if we have anything”. We observed staff were attentive and responded to people promptly when they needed care and support. However, feedback from staff was mixed. Most staff told us there was a shortage of staff on an evening and the varying needs of people could not always be met without delay. Comments from staff included, “It depends on what’s going on that day”, “On an evening you need 1 more person” and “I think there is enough but every shift is different, evenings we have 2 and on the dependency of the residents, it’s best if there was 3”. Relative’s comments included, “I’m really happy with the day staff because they give good attention” and “The staff, yes there are enough of them, or there seems to be”.

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.Processes were in place to ensure people were protected from the risk of infection. The service was clean and tidy. People and relatives complimented the cleanliness of the home. Comments included, “Yes, we like it, there’s no issue with the place. It’s clean and fresh, and fine” and “[Names] bedroom’s a very nice one, is immaculate and they like that”.

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. Medicines were stored securely and areas used to store medicines had the temperature monitored. When staff had recorded that the temperature had exceeded the manufacturers recommendation, they had not documented what action had been taken to ensure medicines were stored correctly. For people who had their medicines crushed prior to administration there were not always written instructions available to staff to ensure these medicines were administered in an appropriate and safe way. For people prescribed medicine patches there was a patch chart in place for staff to document where this had been applied to the body, however this showed staff did not always follow manufacturer’s directions on where to apply.

Instructions for medicines that were given when required were available and contained person-centred information. Staff documented the time of administration of medicines given when required and the dose given when a variable dose was prescribed, however we found that staff did not document the outcome or effectiveness of these medicines when they had been administered. People were supported to self-administer their own medicines if it was appropriate, however care plans did not always reflect that people managed their own medicines, and the service did not complete risk assessments with people to ensure they were safe to do so. Although the service was carrying out audits of medicines management these had not always picked up on some of the issues found during the inspection. Following the inspection the provider sent a report of actions taken to address these concerns. We did not identify any evidence of impact or harm.