Cedar Lodge Nursing Home

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 good. At this assessment the rating has changed to requires improvement.

This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 58 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

People reported their individual needs were assessed and support was provided where needed. People and their loved ones confirmed they had been involved in the development of their care plans.

Staff told us they were provided with the information they required to meet people’s needs when people were first admitted to the service.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

A combination of electronic and paper records being used was not effective to store people’s care records and what was important to them. The introduction of an electronic care planning system had not been fully implemented resulting in a combination of information relating to people’s healthcare needs being kept electronically and on paper.

A number of care plans failed to hold clear and accessible clinical records relating to people’s healthcare needs. For example, where a care plan stated a person was diabetic, there was no information to be found to identify the risks and symptoms to look out for if the person became unwell and ultimately what actions to take.

The provider took on board our concerns and in consultation with the acting manager, an action plan was put in place to ensure staff were provided with complete and accurate information regarding people’s care needs and how to meet them.

Staff were aware of people’s dietary needs and information was accessible to all staff alerting them to this. However, we observed over two days, some people’s mealtime experience had not been positive. Whilst some people enjoyed their lunch, we noted two individuals wait up to 50 minutes to be served whilst watching others around them eat. We also noted staff had failed to observe that one person was unable to eat by themselves and this was bought to their attention by the inspector. One person told us, “The food is alright. We get choices. They ask us on a morning what we want. They don’t just give it to you. They ask you.”

Despite there being a lack of clinical paperwork in place we received positive comments from people and their loved ones regarding their health care needs being met. One relative described in detail a number of health issues their loved one suffered with and how the service had responded positively to them to ensure they received the appropriate medical care. They told us, “When there is a problem, they let us know straight away. They are always so gentle with [person]. [Person] is a completely different person now to what they were when they moved in here. We see all the staff being lovely and kind to them and to others.”

Other relatives told us, “The care there is absolutely outstanding. How they look after [person] is brilliant. We leave them and don’t worry about them. They are in good hands” and “[Person] lost weight in their previous care home. They have gained it all back again here. They are definitely safe here and they eat well."

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff reported they were provided with the information they needed to support people and if there were any changes in people’s needs. Information was shared at handover. We observed appropriate healthcare services were sourced to meet people’s needs.

A member of staff was responsible for allocating care and nursing staff to the rota to ensure the skill mix was right on each shift.

Staff reported they worked alongside a number of healthcare professionals in order to meet people’s needs.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People and their loved ones told us they were supported to access a variety of healthcare services. For example, we noted referrals to the Falls team and to Speech and Language Therapy [SALT] where appropriate. The service was being closely supported by Commissioners to ensure people had access to healthcare services.

Relatives described improvements in people’ health and wellbeing since moving to the service, noting gains in weight, healing of pressure injuries, and overall enhanced comfort and safety.

Activities were being introduced and developed by a small group of staff with a view to supporting people’s physical and mental health.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and

consistent, or that they met both clinical expectations and the expectations of people themselves.

People were supported by staff who were aware of their care needs, but records had failed to provide accurate and accessible information. A resident of the day review system was in place but had not taken into account a number of incidents involving a service user the previous month. This meant opportunities to learn lessons and potentially improve outcomes for that person, were lost.

The current systems in place were not robust and there was no analysis of events to establish any trends and identify areas of action. Where accidents, incidents, safeguarding events took place, individual actions were taken but there was no overall analysis of events to identify any potential trends.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

We observed staff treat people with respect and obtain their consent prior to offering support. People told us their privacy and dignity was always observed. Records of best interests meetings were seen, but there was no evidence of the paperwork relating to this on the electronic recording system. The system in place to monitor DoLS applications was not robust and CQC had not been notified in a timely manner regarding a number of DoLS authorisations.

A relative told us, “Even the nurses ask before giving people their medicine, even though [person] doesn’t have capacity. They ask them everything. They don’t tell them. It’s just all amazing."