The Cedars

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 good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately. A relative told us, “The staff are faultless, I am never concerned about [my family member’s] safety.” Another relative told us, “Everything is as you would expect, there are no secrets.”

There were effective systems and processes in place to keep people safe. The registered manager understood their responsibility to protect people from the risk of harm and ensured when required, they worked with other agencies to safeguard people from further risk.

There was a clear understanding of the Deprivation of Liberty Safeguards (DoLS) and this was only used in people’s best interests. Staff had a good understanding of the Mental Capacity Act 2005 and explained how they supported people to understand decisions and the importance of consent. A staff member told us, “We try and make sure whatever we do for our residents is the least restrictive.”

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People and their relatives were involved in discussions about how to understand and manage any risks. For example, a relative told us options were discussed after their family member had a fall to reduce the risk of it happening again. They told us their family member was referred to an occupational therapist and now had a walking frame to support them to safely mobilise around the home. Another relative told us the service had developed strategies for caring for their family member who could be regularly distressed. They told us, “It’s a two-way process, the registered manager listens and works with us. It gives me peace of mind.”

Staff explained strategies they used when supporting people when they were distressed. However, we found care plans often lacked guidance on how to support people and manage any risks. We have reported on this more in medicines optimisation.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

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.

Staff were recruited through robust processes which ensured staff were suitable to work in this type of service. Records showed staff had completed training in line with their roles which was up to date. However, only some staff had completed training on learning disabilities and autism awareness, which is a legal requirement. Following our feedback, the registered manager ensured all staff completed this training.

Most people and their relatives felt there were enough staff to safely support people. A relative told us, “I visit at different times, daytimes and weekends, and I have never seen a shortage of staff.” There was a low staff turnover, which meant people were supported by a consistent staff team. A person told us, “The staff are really good, many have been here for a while, so it must be good.” A relative told us, “[My family member] has a terrific relationship with the staff and there’s not a high turnover.” People and their relative’s felt staff were well trained and told us they used equipment safely.

Staff told us they felt well supported. A staff member told us, “The management team are so open and welcoming. It feels like a family.”

Processes were in place to ensure staff received support which included regular supervision Supervisions offer a structured way to provide support, address any performance issues and facilitate continuous learning. Communication between different departments was effective and the management team held regular staff meetings where staff were encouraged to share feedback and ideas.

Staff were respected and appreciated by the management team. There were several awards and initiatives to show appreciation and acknowledge achievements. This supported a positive working environment and contributed to a more effective and committed staff team.

The service had people who volunteered which enhanced and enriched people’s experiences. Volunteers were safely recruited.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

People were protected as much as possible from the risk of infection because premises and equipment were clean and hygienic. People and their relatives were happy with the cleanliness and told us the home was kept spotlessly clean and tidy. A relative told us, “I have never had any concerns about the cleanliness of the home. [Staff] always wear gloves and aprons for personal care.” Staff were well trained and understood their roles in ensuring a high standard of cleanliness and hygiene. Domestic staff were knowledgeable about the providers infection prevention and control policies and could clearly explain measures in place to manage any outbreaks of infection.

The service carried out their own internal infection prevention and control audits which helped maintain a safe environment and helped to identify areas for improvement.

Information about the risks of infection or outbreaks was shared appropriately with relevant agencies, people and visitors. A relative told us, “They had an outbreak a while ago and took appropriate action. We were notified by email and requested not to visit. It didn’t last long.”

The provider did not always make sure that medicines and treatments were safe and met people’s needs. Staff proactively asked people if they required pain relief and used recognised pain scales to assess pain for those unable to communicate verbally. However, care plans often lacked clear guidance for staff supporting people who became distressed. We raised this with the service and staff started reviewing care plans following our feedback. When ‘as required’ (PRN) medicines were given for distress, records did not mention the person had been distressed, the triggers or what actions had been taken by staff prior to administering the medicines. This made it difficult to assess future needs, the effectiveness of support and the outcomes of medicines given.

Staff did not consistently record bowel movements relying on verbal handovers, which put people at risk of not receiving appropriate treatment for constipation. Following the inspectors feedback the registered manager stated they were reassessing each person individually to see who required regular monitoring. For people prescribed transdermal patches (a medicated adhesive patch) the site of application was not rotated according to manufacturer’s recommendations. This posed a risk of skin irritation and increased the amount of medicine delivered to the bloodstream.

Staff interacted with people kindly and provided support when medicines were administered. People were empowered to take their own medicines when they had been assessed as safe to do so. Care plans for people with diabetes were detailed and provided sufficient information for staff to safely support people.

Medicines including controlled drugs (medicines requiring additional security measures due to their risk of misuse) were stored securely. Staff felt supported in administering medicines and they received regular medicines training and competency checks.

Staff followed processes to report medicines-related errors. These were investigated and lessons learned were shared in staff meetings.