Archived: The Cedars Nursing Home

Updated 24 November 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection was carried out by one inspector on the 27, 30 April and 02 June 2021 and two inspectors and one assistant inspector on 14 June 2021.

Service and service type

The Cedars Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager however this person was not registered with the Care Quality Commission. On 14 June 2021 the manager was not in post and an interim manager had taken on this role. A registered manager and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all this information to plan our inspection.

During the inspection

We spoke with six people who used the service and one relative about their experience of the care provided. We spoke with 18 members of staff including the interim manager, the regional manager, the manager, deputy manager, head of care, agency nurses, agency care staff, senior care staff and care staff, a domestic assistant, an administrator and the maintenance person. The provider had appointed the manager as their nominated individual although this arrangement changed during the course of the inspection. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We spoke with the nominated individual during our inspection process. We observed care taking place in communal areas to help us understand the experience of people.

We reviewed a range of records. This included aspects of 14 people’s care records and medication records. We looked at agency staff induction to the service and staff handover. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at information forwarded to us including staff rotas and training as well as quality assurance records.

Updated 24 November 2021

About the service

The Cedars Nursing Home is a care home providing personal and nursing care to for up to 40 people. At the start of the inspection 28 people aged both under and 65 years old were living at the home at the end of the inspection 26 people lived in the home. The home consists of an adapted building with a purpose-built extension.

People’s experience of using this service and what we found

Risks to people’s safety were not always monitored or reviewed. People told us their care needs were not met in a timely way. People were not always supported by staff who had the skills and knowledge to do so. People who needed support to eat and drink were at risk of dehydration and malnutrition as records did not clearly demonstrate that people had sufficient amounts to eat and drink. People’s medicines were not always managed in a safe way. People were not protected from the risk of cross infection. Staff did not always recognise different types of abuse and how to report it. The provider could not be assured the staff group had sufficient knowledge and skills to support people.

The provider had inadequate systems in place to monitor and review the service provision. The provider had failed to sustain improvements of the service. This is the second time in two years the service has been placed into special measures. The leadership at provider level and management level within the home was unstable and lacked consistency. Staff morale was low and staff did not feel supported by the provider to fulfil their role to provide good quality care for people. The provider had hired an interim manager to oversee the service and ensure people’s safety, until a permanent manager could be recruited.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (19 March 2020).

Why we inspected

We received concerns in relation to standards of care and staffing levels. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-Led sections of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to people’s safety and the leadership of the service at this inspection. You can see what enforcement action we have taken at the end of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Cedars Nursing Home on our website at www.cqc.org.uk.