Archived: Cedar House

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question requires improvement.
At this assessment the rating has changed to inadequate. This meant services were not planned or delivered in ways that met people’s needs.

The service was in breach of legal regulation in relation to person centred care, good governance, dignity and respect safe care and treatment.
 

This service scored 32 (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 make sure people were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs.
Care plans did not show that people were consistently consulted to set personal goals. Where goals were documented, they did not always show goals for people but how staff should provide care for them and there was no evidence of action taken or opportunities provided to help individuals achieve them.
Inspectors observed that many staff interactions were task-focused rather than person-centred. This should be considered in the context of the volume of work expected from staff, which limited their ability to engage meaningfully with people.

The service had not explored different ways to communicate with people to understand what made them happy. Communication tools were generic and service-led, and there was limited evidence of tailored approaches to support individual preferences.

Although staff stated that people were offered food choices, this was not reflected in practice. At breakfast and lunch, individuals were given the same meal without any communication to confirm their preferences. People who were blind or deaf were not supported to choose their meals in accessible ways.

A senior leader audit had previously documented that some staff actions were task focused. Inspectors observed similar patterns during the visit, including a case where a person’s breakfast was delayed until nearly midday causing unnecessary distress.

However, people’s rooms were personalised with photos and accessories, and bedding was appropriate for the warm weather at the time of inspection. Some staff were seen engaging in informal activities with individuals, although these were not documented on the activity chart. Despite this, the fundamental approach of the service was institutionalised, and did not reflect holistic, meaningfully person-centred care.
 

There were significant shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not joined-up, flexible or supportive of choice and continuity.

People who lived at the service had a wide range of learning and physical disabilities that required specialist training to support them. We were not assured that staff were sufficiently trained, assessed or supported to meet those needs and due to the workload, the staff approach was task focussed.

The service did not always refer to other health providers to ensure that people were provided safe support with health conditions.

We were not assured that the service made efforts to communicate in ways that people could understand or supported people with their physical or spiritual needs. Although a senior leader had raised that people were not supported to attend places of worship, this was not facilitated due to the inflexibility of staff provision and skills.

Although we did see some people were supported to access transport to a to day service, most people remained at the care home throughout the day which meant they did not generally interact with people other than staff at the care home. This limited their ability for meaningful conversation and interactions to enrich their lives.

The provider did not supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Inspectors were not assured that the provider communicated in ways that respected and matched people’s individual needs and preferences . Evidence showed that decisions were often made for people rather than with them. Personal plans included cartoon imagery that appeared to infantilise individuals, undermining their dignity and autonomy. We saw no communication tools such as PECS, Easy read, Makaton or Large print in use.

Signage within the home was inaccurate, such as the registration certificate for the registered manager which remained on display in the hallway, despite the manager no longer working at the service.

A survey was carried out with staff, healthcare professionals and family members, but it did not produce meaningful outcomes. The findings were selective and focused more on the process than the feedback. There was no clear summary of views or areas for improvement.
 

We were not assured the service provided ways for people to communicate and contribute to how they were cared for.

Inspectors were not assured the service provided meaningful ways for people to communicate or contribute to decisions about their care. Most individuals had learning disabilities and required additional support, yet the only communication aids observed were basic pictorial displays of activities and menus. There was little evidence of approaches that would enable people to express their views, preferences, or concerns effectively.

Some individuals lacked advocates and in most cases the provider could only offer contact details for a social worker, raising concerns about how people were represented in decision-making.

Although some concerns were noted in the complaints and compliments book, the service’s response lacked clear specific action. A complaint about clinical continence waste was mentioned in a staff meeting, but the issue was only addressed with a vague reminder of keeping rooms tidy rather than direct feedback. This approach missed an opportunity for meaningful learning and reduced accountability. Compliments and thank-you cards were recorded, there was no evidence to show that these acknowledgements had been shared with staff.

The 2025 satisfaction survey included input from staff, families, health professionals, and people who lived at the service, but the responses appeared selective and lacked meaningful analysis or a balanced overview of feedback.

“You said, we did” poster in the hallway suggesting a disconnect between stated actions and actual practice. Similarly, staff meetings were held, but when staff raised matters, their comments were not recorded.

Overall, the service did not demonstrate equity in access in respect of communication or decision-making. People were not consistently supported to express themselves, and feedback mechanisms lacked inclusiveness, particularly for those with complex needs or without advocate support.
 

The premises were accessible to people who lived there with corridors that had capacity for free passage. The environment was calm and people could personalise their rooms.

However, other than in the sensory room we saw no items that people could independently interact with such as games or sensory items. We did not see that people were always supported to use comfortable furniture when it was available in lounges or seating areas. Although water was available in jugs on the tables people these were not easily accessible to people.
 

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

The service did not adequately support the communication, safety, or wellbeing of the people who lived there, many of whom were unable to express themselves verbally with words or lacked advocates.

Although staff had received training in equality and diversity, there was no assurance that people were consistently treated in line with their individual needs.

Due to insufficient staffing levels, people did not always receive the care they needed. Inspectors observed individuals left alone in rooms while staff attended to other duties such as food preparation or personal care for others.

There was a lack of innovative or tailored communication methods for people who did not communicate verbally with words, were blind, or deaf, only basic pictorial aids were used and these were not personalised. Those who could communicate effectively were not consistently engaged or supported in ways that would promote their mental health and emotional wellbeing. These findings highlight gaps in person-centred care and inclusive communication practices, which failed to address potential barriers to care.
 

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life and funeral arrangements.

Inspectors found that while care plans included details about how individuals wished to be supported at the end of life and how they wanted to be remembered, there was a lack of meaningful advocacy for those without people to support them externally. For many people who lived there, the only advocates identified were social workers, who had limited contact with people. Family members reported that the service did not always communicate with them promptly during emergency situations, which raised concerns about transparency and responsiveness.

The service had recently introduced personal goals for people and while some were documented in care plans, inspectors saw no evidence of action taken to help individuals work towards those goals. Some goals recorded for some people were care instructions for staff supporting them such as “safe management of catheter, good recording and carry out action if required” and therefore no goals had been identified to support them. This suggested a disconnect between planning and implementation, undermining the potential for person-centred progress .