Cedarwood Care Centre

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 63 (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.

There was a positive learning culture within the service and systems were in place to identify, review and learn from incidents, accidents and concerns. The provider had implemented an action plan and made significant improvements to governance systems and auditing processes since the previous inspection.

Accidents and incidents were reviewed in a timely manner. Records demonstrated these were analysed to identify themes and trends, including falls, and actions were taken to reduce the risk of recurrence. We saw evidence that people's care plans and risk assessments were reviewed following incidents to ensure care remained appropriate and reflected their current needs.

Staff were able to describe how they would recognise and report concerns, accidents and safeguarding incidents. One member of staff told us, "If I have any concerns, I can go to the office, and they will follow this up." Another staff member said, "I do not always feel the manager listens when I raise concerns." Whilst this indicated some inconsistency in staff confidence, most staff told us they felt able to speak up and believed concerns would be acted upon.

There were clear systems for sharing learning with staff. Records of team meetings demonstrated lessons learned from incidents and service issues were discussed. Daily handover meetings supported effective communication between staff and management and helped ensure oversight of people's wellbeing, risks and any significant events within the service.

People and their relatives were positive about how concerns were managed. One relative told us, "If I have any concerns the office deal with it. They are lovely and always do their best." A complaints procedure was in place, and records showed concerns were investigated and responded to appropriately. Where required, the provider considered their responsibilities under the Duty of Candour and communicated outcomes openly with relatives when things had gone wrong.
 

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 before they moved into the service to help ensure the home could meet their needs safely and effectively. We reviewed pre-admission assessments, care plans and hospital discharge information, which demonstrated the service gathered information from a range of sources before people were moved in.
A person told us, “They came to see me before I came here. I had to move here quickly, and they really helped me settle and be relaxed.”

The service worked proactively with a range of healthcare professionals to support people's care and wellbeing. Records showed timely referrals were made to relevant services, including mental health teams, occupational therapists and continence services when additional support was required. People had access to hospital passports, which provided important information to support consistent care during admissions to hospital or attendance at healthcare appointments.

The service offered both permanent and respite placements, providing flexibility for people who required short-term support. People and their relatives were provided with information about the service through a service user guide to help them understand what support was available and what they could expect from their stay.

Where people's needs changed and could no longer be met safely within the service, the provider worked with relevant professionals and agencies to ensure appropriate referrals were made and alternative support arrangements explored. This helped promote continuity of care and supported safe transitions between services.

Healthcare professionals were positive about the way staff worked alongside external agencies. One professional told us, “The staff are very good here and know people well. They always let us know if there is a problem.” Staff demonstrated a good understanding of people's needs and were able to explain the support people required.

There was scope to further strengthen the provider's assessment processes. We found the home manager did not always undertake a physical assessment in person before admission. This had contributed to one person moving into the service whose needs could not be consistently met. The provider recognised this shortfall and had identified this as an area for improvement. They described actions being taken to enhance the admission process, particularly for people with more complex needs, to ensure all relevant risks and support requirements were fully understood before admission.
 

The provider did not always work effectively with people and healthcare partners to understand and support safety. They did not always recognise and report safeguarding concerns promptly with the appropriate agencies. There was no evidence of bullying, harassment or discrimination; however, people were not always fully protected from avoidable harm, abuse and neglect.

Systems and processes were in place designed to protect people from the risk of abuse and avoidable harm. Staff had completed safeguarding training and demonstrated a good understanding of their responsibilities, including recognising signs of abuse, reporting concerns and escalating issues appropriately. Staff were also aware of the provider's whistleblowing procedures and most told us they felt confident concerns would be acted upon by management.

Most safeguarding concerns had been identified, reported and investigated appropriately. However, the relevant agencies had not consistently been notified of safeguarding concerns. Records demonstrated that action had been taken to minimise risks, improve outcomes for people and reduce the likelihood of similar incidents occurring in the future. Safeguarding concerns, incidents and lessons learned were regularly discussed through team meetings and training sessions, helping to promote a culture of learning and continuous improvement.

Although safeguarding arrangements were generally effective, we identified occasions where incidents involving a person whose needs could not consistently be met by the service had not always been managed effectively.

The provider had recognised the issues, demonstrated learning from these events and implemented measures to reduce the likelihood of recurrence.
Systems were in place to monitor safeguarding concerns. Management maintained oversight of safeguarding activity and were able to demonstrate how concerns were investigated and followed up.
People and relatives told us they felt safe living at the service and knew who to speak to if they had concerns.
Where people lacked capacity to make specific decisions, appropriate assessments had been completed in line with the Mental Capacity Act 2005. Best interests decisions had been undertaken where required and records demonstrated how people were supported in the least restrictive way possible whilst maintaining their safety and wellbeing.
 

The provider worked with people to understand and manage risks in a way that reflected their individual needs and wishes. Staff provided safe and supportive care that enabled people to do the things that mattered to them.

People were supported to manage risks in ways that promoted their independence, choice and control. People had personalised risk assessments which provided clear guidance for staff on how to safely support them in areas such as falls prevention, nutrition, mobility and skin integrity. Risks were reviewed regularly and updated when people's needs changed to ensure care remained appropriate and reflected people's current circumstances.

Staff demonstrated a good understanding of people's individual risks and the measures required to reduce the likelihood of harm. Care records contained information about people's needs, preferences and how they wished to be supported, helping staff to balance safety with people's rights and freedom of choice.

During our inspection, we observed people being offered choices and encouraged to make decisions about their care and daily lives. Staff supported people in a manner which promoted their involvement and respected their wishes. We also observed staff supporting a person who was experiencing distress. Staff responded calmly and appropriately, using the least restrictive approach and following guidance within the person's support plan. This enabled the person to remain included in the activities and routines of the service while maintaining their safety and wellbeing.

Most people and relatives we spoke with told us they were involved in discussions about their care and how risks were managed. People's views and preferences were reflected within care plans and risk assessments, demonstrating a person-centred approach to risk management.
We reviewed behaviour support plans for people who may display distress when expressing their emotions. These contained personalised information about triggers, communication needs and strategies staff should use to provide support whilst maintaining people's dignity, choice and independence.

Overall, people were supported to manage risks in a way that balanced their safety with their rights, choice and independence. Staff understood the risks associated with people's care and were generally able to respond appropriately to changing needs. Care plans and risk assessments reflected people's individual circumstances and preferences and people were involved in decisions about their care wherever possible.
 

The provider did not always maintain a clean and safe environment. Governance and audit systems were not always effective in identifying and addressing environmental issues, which meant standards were not always consistently maintained.

People were supported in an environment where systems were in place to promote their safety and wellbeing. Fire safety systems were maintained and monitored, and records showed routine checks of fire alarms, emergency lighting and firefighting equipment were completed as required. Personal Emergency Evacuation Plans (PEEPs) were in place for people living at the service and had been reviewed regularly to ensure they reflected people's current needs. Records demonstrated that servicing and certification relating to the safety of the premises and equipment were up to date.

The provider had arrangements in place to monitor the safety of the environment. Maintenance records, health and safety checks, monthly quality audits and daily management walkarounds were completed to identify and address environmental risks. Staff understood emergency procedures and were able to describe the actions they would take in the event of a fire or other emergency.

People and relatives told us they felt comfortable and safe living at the service. During our inspection, we observed people moving freely around communal areas and accessing different parts of the home.

However, we identified some areas of the environment that required improvement. During our inspection of communal areas, bathrooms and the cellar, we found a maintenance room containing excessive storage, including some flammable materials. This had not been identified through the provider's existing quality assurance processes and presented a potential fire risk. We also identified concerns relating to some communal areas and bathrooms which required additional cleaning, maintenance and repair to ensure people were consistently supported in a safe, clean and well-maintained environment.

These issues had not been identified through existing audit and oversight arrangements, indicating that environmental monitoring systems had not always been effective in identifying and responding to risks in a timely manner. We discussed our findings with the provider during the assessment. The provider responded positively and took immediate action to address the concerns raised. Evidence was provided to demonstrate the identified issues had been addressed before the completion of the assessment which demonstrated a commitment to improving the safety and quality of the environment for people living at the service.
 

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.

People received support from enough staff who had the skills, knowledge and experience required to meet their needs. Robust recruitment processes were in place to help ensure suitable staff were employed. Recruitment records demonstrated appropriate pre-employment checks had been completed before staff commenced work at the service.

Staff completed a structured induction programme alongside mandatory and role-specific training. The provider used additional measures, including quizzes, competency assessments and observational checks, to assess staff understanding and application of learning in practice. This helped to ensure staff were competent to carry out their roles and support people safely.

Staffing levels were determined using a dependency assessment tool which considered people's needs and levels of support required. Rotas demonstrated planned staffing levels were consistently met or exceeded. During our inspection, staff were visible throughout the service and responded promptly to people's requests for support. We observed call bells being answered in a timely manner and people did not experience unnecessary delays when requiring assistance.

The service benefitted from a stable staff team, with many staff having worked at the home for a significant period of time. This meant staff knew people well, understood their preferences and routines, and were able to provide consistent support. People told us staff were available when needed and spoke positively about the care and support they received.
Most staff described the management team as approachable and supportive.

The provider had systems in place to support staff through supervision and appraisal arrangements. However, the registered manager had identified opportunities to further strengthen these processes by placing a greater emphasis on staff wellbeing, personal development and career progression. This would help ensure supervision sessions consistently supported staff to reflect on their practice and identify professional development goals.
 

The provider did not always identify and address infection prevention and control risks promptly. Standards of cleanliness were not consistently maintained, which heightened the risk of infection. However, concerns were shared with relevant agencies when needed.

The provider had arrangements in place to monitor cleanliness and infection prevention and control within the service. This included cleaning schedules, routine checks and environmental audits. Staff had received relevant training and understood their responsibilities for maintaining a clean and safe environment. Personal protective equipment (PPE) was readily available throughout the service, and we observed staff using PPE appropriately when providing care and support to people. We also saw information and signage displayed around the home to promote good infection prevention and control practices, including reminders for staff and visitors about effective hand hygiene.

However, we identified some areas of the home which included flooring in some communal bathrooms, radiator covers and areas in corridors which required some general maintenance and repair along with improved cleaning to ensure they were safe and would not harbour any bacteria. We also identified areas being used for storage of large amounts of unused equipment which could make effective cleaning more difficult. These issues had not been identified through the provider's existing quality assurance and monitoring systems.

We discussed our findings with the provider during the assessment. They responded promptly to the concerns raised and took immediate action to address the issues identified. Evidence reviewed during the assessment demonstrated that improvements had been made before the assessment concluded.

Overall, the provider had systems in place to support infection prevention and control, and staff demonstrated an understanding of good practice. PPE was available and used appropriately and information was displayed to promote effective hand hygiene.
 

The provider always made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff always involved people in planning, including when changes happened.

People received their medicines safely from staff who had the skills, knowledge and competence to undertake the task. The provider had established effective systems and processes to support the safe ordering, storage, administration and monitoring of medicines. Medicines were stored securely within a dedicated medication room which was organised and maintained in line with the provider's policies and procedures. Individual medicines were stored in clearly identified trays, helping to ensure medicines could be located and administered safely and efficiently.

Technology was used to enhance the safety of medicines administration. The electronic medicines management system required staff to undertake additional checks before medicines could be administered, reducing the risk of errors. Staff allocated to administer medicines wore tabards to minimise unnecessary interruptions and support safe practice. The service allocated two members of staff to undertake medication rounds, ensuring sufficient capacity was available to complete medicines administration safely and in a timely way.

The provider had developed effective systems to ensure people's individual medicines needs were recognised and prioritised. People prescribed time-critical medicines were clearly identified within the system and received their medications at the required times. We saw evidence that medicines administration was planned around people's individual needs and preferences rather than the operational needs of the service.

Medicines audits were completed regularly to maintain oversight of practice. Daily medicines audits were undertaken by team leaders and additional audits were completed by leaders and the supplying pharmacy. Staff also checked medication stocks following each medication round and completed timely ordering processes where required. These arrangements helped to ensure sufficient stocks of medicines were maintained, and any discrepancies were identified promptly.

Staff responsible for administering medicines had received additional training and competency assessments. The provider worked collaboratively with healthcare professionals, including the local pharmacist and nursing staff, to provide additional support and guidance in relation to specialist medication administration, such as eye drops. Staff demonstrated a good understanding of medicines management procedures and their responsibilities for safe administration.

Where people required medicines to be administered on an "as required" basis, clear protocols were in place to guide staff. Covert medication arrangements were appropriately authorised and documented. Records demonstrated that, even where covert administration plans were in place, staff first offered people their medicines in the usual way before implementing alternative arrangements. This demonstrated a commitment to promoting people's choice and independence wherever possible.

During our inspection, we observed medicines being administered in a person-centred way. Staff took time to explain medicines to people in a manner they understood and respected people's preferences regarding where and when they received their medicines. For example, 1 person chose to attend the medication room to receive their medicines as this formed part of their normal routine. We also observed a member of staff offering medicines to a person who was receiving personal care. When the person indicated they were not ready, the staff member respected their choice and reassured them they could receive their medication when they wished. This demonstrated how people's rights, preferences and dignity were promoted throughout the medicines administration process.

People told us they received their medicines when required and observations completed during the assessment confirmed medicines storage and administration processes were well organised and safe.
Overall, medicines were managed exceptionally well. Robust governance arrangements, regular auditing, competent staff and effective use of technology supported the safe administration of medicines. People received their medicines in a way that was safe, personalised and responsive to their individual needs and preferences. We found no concerns in relation to medicines management during this assessment.