Archived: Cedar House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question requires improvement.

At this assessment the rating has changed to inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

The service was previously in breach of regulation in relation to person centred care plans and improvements were not found in this assessment. The provider remained in breach of this regulation and still needs to make improvements.
 

This service scored 29 (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 consistently assess and understand people’s needs to ensure they received personalised and effective support.
Inspectors were not assured that people, most of whom did not communicate verbally with words, were supported to communicate effectively. While some staff demonstrated person-specific communication approaches, others were unable to describe how people preferred to be supported. Care plans did not consistently reflect people’s communication needs or show how they had been involved in the care planning process.
Assessments were not carried out to identify how people expressed distress or pain. Communication tools were generic and service-led, focusing on menus and activities, with no visual aids to help people express emotions or satisfaction. One staff member described interpreting pain based on mood changes, rather than using structured tools or guidance.
Documentation showed people were consulted every month about activities they might enjoy from a set of pictures of existing activities, so choice was limited to what the provider offered. Staff sometimes made decisions based on convenience rather than the person’s best interests.
There was little evidence that people or their advocates were involved in care planning and most people did not have an advocate. However, inspectors did see that people had annual health checks with healthcare professionals.

The provider did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards.
Inspectors found staff did not clearly or accurately document people’s care and support needs. Care plans and risk assessments lacked learning and failed to reduce risks to people and others.
Hydration charts showed people were not meeting target volumes and there was no indication that action had been taken. Seizure monitoring charts were unclear and did not consistently show whether medication had been administered in line with care plans. However peoples MAR charts showed that people were administered the correct medication in line with medical guidance.
Although people’s eating and drinking needs had been assessed externally, staff were not always seen to prepare or serve food in accordance with that guidance. Inspectors observed unsafe practices including people being served modified food which did not meet required texture levels, increasing the risk of choking.
Personal care was not always delivered in accordance with care plans, including catheter care which was found to be unsafe. Staff were not assessed to ensure they understood training, and inspectors observed people left unmonitored despite being at risk of epileptic seizures.

The provider did not work well across teams and services to support people.
Inspectors found that shift handovers, led by senior support workers, were hindered by documentation that lacked space for clear and detailed notes. We observed verbal handovers were conducted in people’s bedrooms while they slept, requiring staff to whisper, which compromised both communication and dignity.
Care records and staff guidance were inconsistent. Instructions such as “flush the PEG ” lacked detail on method, frequency, or volume. Eating and drinking assessments failed to specify IDDSI levels, instead directing staff to other documents, which created confusion, delay and risk.
Inspectors observed staff did not always understand procedures, delaying breakfast unnecessarily, checking the temperature of a cold cheese sandwich, but failing to test other food temperatures when appropriate.
Some staff expressed that care plans did not accurately reflect the needs of people, particularly those requiring support from 2 staff members. Inspectors found that people were not always referred to health professionals for advice, and decisions were sometimes made without clinical input, raising concerns about the safety and quality of care.
Senior managers acknowledged these issues and confirmed that care plans were under review. However, inspectors noted an urgent need for clearer, more practical systems to guide staff in delivering safe and effective care.

The provider did not support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not support people to live healthier lives, or where possible, reduce their future needs for care and support.

Inspectors found no documented appropriate exercise-based activities and very few that meaningfully involved or supported people. Although the service had appointed an activities champion, they had not received specialised training and were responsible for other duties. This limited their ability to focus on activities, resulting in people not being consistently supported to engage in routines that were stimulating, beneficial, or tailored to their needs.

An activities schedule was displayed in the kitchen but listed activities that were not suitable for people with mobility issues, visual impairments or learning disabilities. Several activities were repetitive and mundane, such as watching television or listening to music.
On the first day of the inspection , we saw that most people were not engaged in any activities and some were observed sitting unattended in lounges or the kitchen.

We saw staff were always busy and had little time to engage with people who lived there but the engagement we did see was mostly caring and indicated that some staff knew people well.

We saw an audit that requested that people be supported to achieve goals as part of their care plan. We saw evidence of one such goal for a person who wanted to make a sandwich, however no action had been shown that this had been supported or actioned.

These findings indicated that the service did not consistently promote meaningful engagement or support people to live healthier, more fulfilling lives
However, we did observe 1 person playing chess with a member of staff. We did see that some people individually attended day centres and sometimes the activity champion had organised trips.
 

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.
Inspectors found that the service failed to monitor care and treatment effectively, resulting in missed opportunities to improve outcomes and ensure safety. Hydration charts showed people were regularly under their fluid targets by up to 500ml, with no oversight or action taken, placing people at risk of dehydration.
Night-time monitoring for people with epilepsy was inconsistent; although care plans stated that some people required monitoring during the night, this was not always carried out as staff were occupied with other tasks.
Behaviour monitoring charts lacked outcomes, meaning care plans and risk assessments did not reflect learning needed to reduce harm. Staff did not always manage risks effectively, with some people left unsupervised in lounges or seated at tables for extended periods while staff prepared food.
Overall, the lack of effective documentation, clinical oversight, and responsive care planning showed that the service did not meet clinical standards or the expectations of the people it supported.

The provider did not tell people about their rights around consent and did not respect their rights when delivering care and treatment.
While staff could explain consent and the principles of the Mental Capacity Act 2005 (MCA), care plans and people’s care and treatment did not reflect this knowledge in practice. Where a person cannot consent to all aspects of their own care and treatment, mental capacity assessments should be carried out to check whether they can make specific decisions. If the person is found not to have capacity to consent, a decision should be made in their best interests, involving relatives and advocates where possible. We saw 1 mental capacity assessment which showed someone had capacity to make decisions yet the same document included a best interest decision which denied the person control over a form of restraint.
Staff practice was institutionalised and we raised concerns about the lack of choice and control people had over their own lives. There was no proactive plan to reduce restrictive practice and we found issues relating to unauthorised covert medication where medication was introduced into peoples’ food.