Archived: Cedar House

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question requires improvement.
At this assessment the rating has changed to inadequate. This meant people were not treated with compassion and there were breaches of dignity; staff caring attitudes had significant shortfalls.

The service was in breach of the legal regulations in relation to dignity and respect and person-centred care.
 

This service scored 30 (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 did not always treat people with kindness, empathy and compassion, or respect their privacy and dignity

During the first visit, inspectors observed staff treating people with kindness and respect. Staff were seen giving warmth through words and gestures, knocking and requesting consent before entering rooms, and adapting communication to meet individual needs. However, during a follow-up visit, inspectors witnessed several instances where people’s dignity was compromised.

A visual monitor was left on while a person received personal care in their bedroom, breaching their privacy, which was degrading for the person. In another case, a person receiving personal care was repeatedly exposed as another staff member entered and exited the bathroom, compromising their privacy.

Staff were observed conducting handovers by entering people’s bedrooms while they were asleep and discussing care information in their presence. This practice did not respect people’s right to privacy and highlighted inconsistencies in how respectful and person-centred care was delivered.

Some staff told inspectors that compassion and engagement were lacking among colleagues. They described seeing staff sit in lounges with drinks, ignoring people. Although this had been raised in team meetings, the behaviour continued, as the provider failed to take appropriate action.

Staff said they knew people well, including their preferences and signs of pain or distress, but this knowledge was not consistently reflected in care plans, nor staff practice.

The provider did not treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences. They did not take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

People were not treated as individuals in relation to their dietary needs and preferences. Inspectors observed that during mealtimes, everyone received the same food prepared in the same way, regardless of whether they required a specific International Dysphagia Diet Standardisation Initiative (IDDSI) diet .

Although the provider displayed a menu offering alternative meals, some options were unavailable because the service had not purchased the ingredients to make them.

One person who refused the main meal was not offered a suitable hot alternative. Instead, they were given a cold sandwich that did not meet their IDDSI requirements or align with their care plan, raising concerns about the service’s ability to deliver safe, person-centred care.

Care plans showed consultation with people about goals, such as 1 person wishing to prepare their own sandwiches. However, no efforts had been made to support this goal.

People’s spiritual needs were not always upheld. Although some individuals wished to attend places of worship, staffing levels and lack of appropriately skilled staff at weekends meant this could not be facilitated.

However, inspectors found that people’s rooms were personalised with pictures and items that reflected their interests and preferences.

The provider did not promote people’s independence, so people did not know their rights and have choice and control over their own care, treatment and wellbeing.
Care was delivered as part of a system and culture of institutionalised practices. People were woken at the same time each morning to fit staff routines, not personal preference.
Though kitchen menus displayed a choice of food, people were not offered the alternatives shown. We observed if people declined the main meal, they were offered fruit or a sandwich. Meal logs, fridge and freezer contents and receipts showed advertised meals were not always available. Breakfasts lacked variety and meals were not consistently adapted to individual dietary or texture needs.
Hydration support was inadequate. Jugs of water were placed on tables but were inaccessible to people with limited dexterity or communication ability and people were not routinely offered drinks. Inspectors did not observe people being routinely offered drinks though most people were monitored for hydration.
Staff functions were often task-led. Staff reported not having enough time to take breaks, which impacted their ability to provide person-centred care.
A monthly meeting showed people were shown images of activities they already did and asked to pick their preference. One person requested more “robust activities,” but there was no evidence that this feedback led to any changes. This meant people did not have choice and control over engagement with leisure activities meaningful to them.
These findings raised concerns about the service’s ability to uphold the principles of dignity, inclusion, and individualised care.

The provider did not listen to or understand people’s needs, views and wishes. Staff did not respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.

Peoples care plans did not always give staff enough information to recognise when people were in pain or distress and how to respond to keep them safe and comforted.

Inspectors observed that people’s care needs were not always addressed in a timely or appropriate manner, raising concerns about the responsiveness and safety of support provided. We saw a person that used a catheter bag was not provided prompt care putting their health and comfort at risk.

Although staff could outline how to care for people with dysphagia (swallowing difficulties), we saw a person with dysphagia coughing whilst being supported to eat by a staff member who did not follow guidance that would have reduced the risk of choking. We brought this to the attention of the provider to take immediate action.

We saw people who were visibly distressed because they were hungry after their breakfast was delayed due to staff misunderstanding instructions which highlighted gaps in communication and care planning that impacted the timely delivery of essential support.

Staff were seen not observing people with a diagnosis of epilepsy on several occasions whilst inspectors were present. This was observed at the start of the day when there were only 3 staff on duty and during the day shift when people were left in their room to rest. This was observed at a previous inspection. This put people at risk of harm if they were left unmonitored and had an epileptic seizure, contrary to their care plan.
 

The provider did not monitor or promote the wellbeing of their staff. They did not support or enable staff to deliver person-centred care.

Inspectors identified concerns regarding staff workload, shift patterns, and the adequacy of staffing arrangements to meet both care and operational demands. Rosters showed staff were often working excessive hours, including consecutive day and night shifts. Although some staff had opted out of the Working Time Directive (legislation which limits hours staff can work), there was no evidence of safeguards or support in place to protect their wellbeing. While agency staff were listed on the rota, there was no indication that they had been used to relieve pressure. Rosters showed that 2 staff members were scheduled to work 71 hours during the inspection week, raising concerns about fatigue, wellbeing, and the safety of care delivery.

The service used a staff dependency tool to calculate staffing levels based on people’s care needs. However, this tool did not account for time needed to complete domestic duties such as cleaning and food preparation. Staff reported struggling to complete all expected tasks, and we observed essential duties, such as monitoring food and fridge temperatures and catheter care, were not consistently carried out. Staff reported that although they were entitled to breaks during a 14.5-hour shift, they often could not take them due to workload demands.

Monthly staff meetings were held, but often only recorded the Chair’s comments, with little or no detail of staff contribution. Some staff expressed satisfaction with their roles and felt supported by management, whilst others reported feeling unfairly treated. All staff inspectors spoke to said the service should employ a dedicated cook and some said they had prepared food without receiving any formal training.

Overall, the findings indicated that staffing arrangements and workload distribution did not ensure safe, sustainable care delivery.