Cedar Court is registered to provide care and accommodation for up to thirteen people. At the time of the inspection there were eleven people living there. People living at Cedar Court were young adults who may have a learning disability or autistic spectrum disorder.
This inspection took place on 24 July 2017 and was unannounced.
The service had a registered manager. 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.
At the last inspection of the service in May 2016 the service was rated as ‘requires improvement’. On this inspection we saw improvements had been made. For example on the last inspection the governance systems at the service were not robust, and quality assurance systems were not well developed. On this inspection we found improved systems had been put in place to assess, monitor and improve the quality and safety of the services provided. This included more robust auditing systems and regular assessments and reports being undertaken to highlight any concerns, trends or areas needing attention. Feedback was being obtained from people living at the service, relatives, staff and healthcare professionals in order to improve the service, and improvements had been made as a result.
On the last inspection we had identified concerns over the support planning systems in use. On this inspection we saw improvements had been made. People’s care plans contained information about any health concerns and support needed, for example with managing long term health conditions. Positive support plans and communication strategies helped identify potential signs and causes of anxiety or distress and how to support the person to reduce this. Some plans to do this had been drawn up with the support of specialist professionals, and covered any risks from or to the person.
People were protected from the risk of abuse as staff understood the signs of abuse and how to report any concerns. Staff spoke very positively of people, and were enthusiastic about supporting people at the service, including celebrating any advances people made towards greater independence. People’s rights were respected, and staff had received training and had a clear understanding of the Mental Capacity Act 2005 in practice. Where people lacked capacity to make an informed decision, staff acted in their best interests, and with significant decisions had involved other parties such as relatives or medical teams to assist with decision making. Appropriate applications had been made to deprive people of their liberty under the Deprivation of Liberty Safeguards (DoLS), and systems were in place to manage any concerns or complaints.
There were enough staff employed by the service to meet people’s needs. Many people had defined staffing levels, such as one to one staffing, or more in specific circumstances. The service had access to a flexible group of bank staff who were familiar with people, so they were always supported by someone who knew them well and understood their needs. This helped to reduce people’s anxiety. Since the last inspection improvements had been made to the staff recruitment process, with improved risk assessment processes. This helped to ensure people were supported by suitable staff.
Staff had the skills and support they needed to carry out their role effectively. There was a programme of training in place, and staff told us they were well supported both by their team colleagues and the service’s management. Staff training updates were booked and new staff were completing the care certificate, which is a set of standards that should be covered as a part of induction training for staff new to care.
People received their medicines safely as prescribed. Staff had received training in medicines management, systems were audited and actions taken to reduce any risk of errors.
People’s health was promoted because they were supported to have enough to eat and drink. Some people were involved in shopping for and preparing their own meals, and the service aimed to offer advice on healthy eating and choices. Where one person needed additional support we saw this was given with gentleness and time to enjoy their food.
Accommodation had been adapted to meet individual people’s needs and was subject to an ongoing programme of refurbishment and improvement. Cedar Court comprised two semi-detached properties, linked internally. One side of the property provided flatlets for people, while the other provided more traditional residential rooms with shared spaces, such as the kitchen. Accommodation had been adapted to meet individual’s needs and wishes. For example one person was involved in making decisions about a refurbishment of their flat.
People were treated with dignity and respect. They were encouraged to participate in activities of their choice and on the day of the inspection we saw the service was busy and active, with people going out with relatives, shopping, visiting a local carnival, going out for coffee to a local beauty spot, playing computer games and undertaking service tasks such as laundry. People’s independence was encouraged and people were supported to develop this at their own pace, with small steps, based on their own “Pathway to independence” documents.
There was a clear philosophy for the service which was well understood by staff. The registered manager and directors were well respected and demonstrated the values in practice. Staff understood their roles and were positive about the experience of working at the service. Systems were in place to ensure effective communication.
Records were well maintained and kept securely. The service had notified the CQC of incidents at the service as required by law.