This unannounced inspection was conducted on 16 and 17 January 2017.
Cedar Grange is a residential care home that provides accommodation and personal care to a maximum of 26 people living with dementia. The home is situated in Southport near to the town centre. The facilities are provided over two floors with a passenger lift for easy access to the upper floor. All communal areas are on the ground floor including lounges, an activities room and toilets. There is a large conservatory at the back of the home which serves as the dining room. At the time of the inspection 24 people were living at the service.
A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
During a previous inspection in November 2015 concerns were identified relating to the Mental capacity Act 2005 (MCA) and in particular to the assessment of people’s capacity to make decisions. We made a recommendation. At this inspection we checked people’s care records for evidence that capacity was being assessed on a decision-specific basis in accordance with the MCA. We saw that improvements had been made to capacity assessments and they were no longer generic.
At the previous inspection we identified concerns relating to the submission of notifications to the Commission and the display of the ratings from an earlier inspection. At this inspection we looked at recent incidents and spoke with the registered manager regarding these matters. We saw that notifications had been submitted as required and that the ratings from the previous inspection were displayed.
People and their relatives told us that they felt the service provided at Cedar Grange was safe. We saw that staff were vigilant in monitoring safety and acting to protect people from harm.
Risk was appropriately assessed and recorded in care files. We saw examples of risk being regularly reviewed in conjunction with care plans and with the involvement of people, relatives and care staff.
Because of the design and layout of the building and the vulnerability of the people living at Cedar Grange, we were concerned about the effectiveness of emergency evacuation procedures. The instructions were clear, but did not indicate exactly where it was safe to move people to within the building in the event of a fire. We spoke with the registered manager and maintenance manager about this and they provided an updated set of instructions with greater detail within 24 hours.
Staff were recruited following safe procedures and deployed in sufficient numbers to provide safe, effective care.
Medicines were stored and administered in accordance with best practice guidance. Where issues had been identified through audits, they had been addressed appropriately.
The staff that we spoke with were positive about the training that was made available to them. We saw from the training matrix that staff had access to a wide range of training course which gave them the skills and knowledge to meet people’s needs.
We observed the lunchtime experience, looked at the menus and spoke with a chef at the service. Lunch was served in a well presented dining room and consisted of two sittings. People who required assistance were seated first so that staff could attend to their needs.
People were supported to maintain their health through regular contact with community-based healthcare professionals. The service had daily input from district nurses and GP’s and made use of a ‘Telemed’ service which gave access to healthcare professionals for consultation over a secure internet connection.
Cedar Grange had been adapted to meet the needs of people living with dementia. The service had a reminiscence room, music room and other dementia-friendly facilities. However, some areas of the building were better suited to meeting the needs of people living with dementia than others.
People told us that the staff were caring and attentive and over the course of the inspection we saw that this was the case. We saw and heard that staff knew people well and spoke to them in a gentle and caring manner.
For the majority of the inspection we saw that the provision of care was not task-led, but it was clear that at certain times of the day, for example, meal-times, staff had less time to sit and talk to people or engage with them.
People’s right to privacy and dignity were respected by staff through the provision of care and the choices that they were offered. Personal care was given discretely in locked bathrooms or bedrooms.
The majority of people at Cedar Grange were living with dementia which made it more difficult to involve them in the assessment and planning of care. To ensure that their views and preferences were considered, the service met with each person and their relative on a regular basis to review care needs. Staff also completed monthly reviews of care to ensure that people’s needs were being met.
People were supported to stay active and follow interests through a programme of structured activities. Social events were open to relatives and sometimes used as an opportunity to gather feedback. Posters were used in conjunction with an activities board to promote events and photographs were displayed to aid memory and discussion.
The procedure for making a complaint was displayed in the service and the people that we spoke with were clear about who they should speak to.
The service had good links to the local community and was part of networks which helped improve quality. For example, the service was represented at the Dementia Provider Forum where developments in practice and issues of concern were debated.
The service had an extensive set of policies and procedures containing important information and guidance for staff. We noted that the review of these policies was not consistent and that some contained out of date information.
The quality and safety audits that we saw were comprehensive and demonstrated honesty and transparency when mistakes were identified. Audit processes were completed on a regular basis by managers at a local and national level and coordinated through a dedicated quality team.
The staff that we spoke with were motivated to provide safe, effective care. They told us that they understood what was expected of them and enjoyed their jobs.