Cedarwood Care Centre

Cederwood Care Centre is a residential care home providing personal care for up to 38 older people and/or people with dementia. At the time of inspection 22 people were living in the home with 16 vacancies.

Cederwood Care Centre accommodates up to 38 people in one adapted building. The accommodation is over two floors with a lift connecting the ground floor to the first floor. There is a dedicated managers office located on the ground floor and a staff room located in the converted loft area. There are usually five staff on day shifts including a senior carer as well as the registered manager. Nights are covered by three staff with managers available ‘on-call’ as required.

People’s experience of using this service and what we found

The quality assurance checks in place to drive improvement were not robust. They had not ensured the safety of care was sufficiently monitored. The provider told us that they had not completed audits since June 2021.

People told us staff were kind and caring and treated them with dignity and respect and we observed some examples of staff working in a caring way. However, there was a lack of systems in place to ensure the home was consistently caring and people were fully involved in their care.

People did not always receive person centred care and there were not always enough activities available for people to enjoy. People and relatives were not always consulted about their wishes about the end of their life and were not involved in reviews of their care. People, relatives and staff were not always given the opportunity to provide feedback.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests.

People, staff and relatives knew how to complain. The nominated individual understood their responsibilities under the duty of candour.

From 11 November 2021 registered persons must make sure all care home workers and other professionals visiting the service are fully vaccinated against COVID-19, unless they have an exemption or there is an emergency. We checked to make sure the service was meeting this requirement. We found the service had effective measures in place to make sure this requirement was being met.

Rating at last inspection

The last rating for this service was good (published 08 June 2021).

The service was registered on 14 February 2014.

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

The inspection was prompted in part by notification of a specific incident. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Safe and Well-Led sections of this full report.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-Led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cederwood Care Centre on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to regulation 12, safe care and treatment and regulation 17, governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Cedarwood Care Centre is a residential care home providing personal care to 31 younger and older people with dementia at the time of the inspection. The service can support up to 38 people.

People’s experience of using this service and what we found

There had been concerns received by CQC about people being neglected and the environment being in a poor state of repair. We did not find any concerns of this nature. People felt the staff kept them safe. People received their medicines safely. Staff practice in relation to COVID-19 measures were safe.

There were some improvements required in relation to how feedback was gathered to ensure people were able to share their opinions and concerns to enable them to be addressed. Interactions between staff and people were positive but there were some missed opportunities.

There were mixed opinions from people about whether there was enough for them to do and the cultural appropriateness of the food. The registered manager had not been made aware of these concerns and acted on them once alerted. People accessed the community if they chose to. Peoples communication needs were met.

Systems were in place to monitor the service and actions addressed. People and relatives fed back the home had a positive culture. The staff team worked with external professionals to ensure good outcomes for people.

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 8 May 2019).

Why we inspected

The inspection was prompted in part due to concerns received about people being neglected and the environment being in a poor state of repair. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from this concern or that the environment was in a poor state of repair. Please see the safe section of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

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

People's experience of using this service:

People felt safe living at the home and were very complimentary about the manager and staff in the way they cared for them. Improvements had been made to the deployment of staff since our last inspection. We saw people who were cared for in their bedrooms had regular checks on their safety and well-being.

Staff understood how to keep people safe without restricting their liberty and promoted positive risk taking . There had been a decrease in the number of safeguarding and whistle blowing notifications since the last inspection indicating people received safe care in line with their needs.

Safe systems were in place to manage people’s medicines. The home was kept clean and odour free and staff followed infection control measures.

People were supported in line with the Mental Capacity Act 2005 and their consent to care was obtained. Staff understood how to support people whose liberty was restricted for their safety. Staff received training and support to develop their skills and care for people effectively. People were supported to maintain a healthy diet with additional specialist support from professionals where needed.

People were consistently complementary about the caring nature of the staff. People had been involved in developing their care plan and their independence was promoted with age appropriate opportunities to pursue. People had access to activities and regular stimulation with plans in place to further develop people’s hobbies and interests.

People, relatives and staff all commented that the home was well managed and improvements had been made to benefit people. The manager had promoted a positive culture so that people were treated with care and compassion. The provider’s audits and checks were consistently carried out and had been effective in identifying areas and making improvements.

More information is in the detailed findings below.

Rating at last inspection: Requires improvement (report published 29 January 2018).

Why we inspected:

This was a planned inspection based on the rating at the last inspection. At the last inspection on 24 and 26 October 2017, the key questions around Safe, Responsive and Well led were rated ‘requires improvement’. This was due to concerns around staff deployment, people’s involvement in the development and review of their care plans and checks and audits not being carried out effectively. At this inspection we found that there had been improvements and the overall rating has now improved to Good.

Enforcement:

No enforcement action was required.

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

Cedarwood Care Centre is registered to provide accommodation and support for up to 33 people with dementia and mental health needs. On the day of the inspection visit there were 33 people living at the home. There was an acting manager in place who was in the process of registering with us as a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 comprehensive inspection in February 2017, the provider was found to be ‘requires improvement’ under the key question of ‘Is the service safe’. At this inspection we found improvements had been made to the way people were supported with how their medicines were managed, however other areas had been identified as requiring improvement. We identified that there were insufficient numbers of staff to respond to people’s needs.

At the previous inspection, the provider was found to be ‘requires improvement’ under the key question of ‘Is the service effective’. At this inspection we found improvements had been made to ensure that people’s rights were protected to ensure they were not unlawfully restricted and that their dietary needs were now being assessed and monitored.

At the inspection in February 2017, the provider was found to be ‘requires improvement’ under the key question of ‘Is the service caring’. At this inspection we found improvements had been made to the way people’s confidentiality was protected and their independence was being encouraged..

During our previous inspection, the provider was found to be ‘requires improvement’ under the key question of ‘Is the service responsive’. At this inspection we identified that there had not been significant improvements in people having access to activities that were meaningful to them and people and their relatives were not always consulted on how care plans were developed.

At the last comprehensive inspection the provider was found to be ‘requires improvement’ under the key question of ‘Is the service well led’. At this inspection we found that the provider was progressing in developing systems to monitor safety and quality of the service, although improvement was still required. We also identified that the views pf people and their relatives was not always sought regarding how the service was managed.

People were kept safe and secure, and relatives believed their family members were safe from risk of harm. Potential risks to people had been assessed and managed appropriately by the provider.

People received their medicines safely and as prescribed.

Staff had been recruited appropriately and all pre-employment checks had been completed.

Staff sought people’s consent before providing care and support. The provider ensured that the legal requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) were being followed.

People’s rights to privacy and confidentiality were respected by the staff that supported them and their dignity was maintained.

People had a variety of food, drinks and snacks available throughout the day. They were able to choose the meals that they preferred to eat.

People were supported to stay healthy and had access to health care professionals as required. They were treated with kindness and compassion and there were positive interactions between staff and the people living at the location.

People’s choices and independence were respected and promoted. Staff responded appropriately to people’s support needs and people received care from staff that knew them well.

Relatives and staff were confident about approaching the manager if they needed to raise an issue or discuss their family members care and support needs.

Cedarwood Care Centre is a residential care home providing care and accommodation for people with a range of care needs including people living with dementia and people with mental health needs. The provider in recent years had extended the service and increased its registered numbers to 33. At the time of our inspection 23 people were living there.

The manager was registered with us as is required by law and was present on the day. 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.

There were processes in place to monitor the quality of the service although they had not been effective as these had not identified issues that needed improvement in a timely way.

People were not always supported to take their medicines as prescribed by their doctor. Staff had not always ensured that the processes in place to ensure that people received care in line with their best interests had been followed and understood. Activities for people were not always offered and encouraged.

Staff were recruited and inducted safely into their role. However, staff had not received all the training they needed to meet people’s needs and keep them safe.

Processes were in place to prevent people from the risks of accidents and injuries and to protect people from harm and abuse. There were enough staff available to meet people’s needs and to keep them safe.

Staff supported people to have sufficient diet and fluids to prevent them experiencing ill health due to malnutrition and dehydration. People had mixed views about the quality of the food. People received assessment and treatment when needed from a range of health care professionals which helped to promote their health and well-being.

People were supported and cared for by staff who were kind and caring. People were encouraged and supported to undertake daily tasks and attend to their own personal hygiene needs.

People were enabled to make some decisions about their care and were involved in how their care was planned and delivered. Staff supported people to keep in contact with their family as this was important to them. People and their families were asked to give their view on the service provided. Complaints processes were in place for people and their relatives to access if they were dissatisfied with any aspect of the service provision.