Cedarwood House

Cedarwood House is a residential care home providing accommodation and personal care for up to 20 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 17 people using the service.

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

Risks to people had not always been safely managed. Improvements were needed to ensure that people with diabetes were supported safely by staff. Care plans and risk assessments were not up to date and did not always reflect people’s needs. Medicine processes were not always robust. Systems were not in place for checking that staff had given people their medicines as prescribed and medicines had not always been stored correctly.

The management team and most staff were new to the home. More time was needed for this new team to be able to identify issues at the service and take action to make improvements. Audit systems were in place but had not been completed recently. Improvements were needed to documents to ensure that staff were accurately recording the support people received.

There were enough staff to support people and staff were recruited safely. Staff followed infection, prevention and control procedures and the home was clean and hygienic. Staff spoke to people with kindness and respect and people seemed comfortable around staff.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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 good (Published 26 March 2021).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

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 monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment and governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The home was clean and tidy throughout. There was a cleaning schedule and this included regular cleaning of high touch areas. Windows were opened, where possible, to improve ventilation around the home. Staff had access to personal protective equipment (PPE) and were seen to be using and disposing of this appropriately. Staff had received specific Covid-19 training, and this included guidance for staff about how to put on and take off PPE safely. Regular testing for people and staff was taking place.

When people had tested positive for Covid-19, were unwell or self-isolating they were cared for in their own rooms to minimise the risk of spreading the virus. Before people were admitted to the home, they were required to have a negative Covid-19 test and remain in their rooms for 14 days on arrival. At the time of the inspection the isolation period had passed and people were able to move around the home freely. Furniture had been positioned to help people maintain social distancing.

People were supported to maintain regular contact with their friends and families. This was through phone and video calls and window visits. The provider was currently reviewing their visiting policy to reflect the latest government guidance of one named visitor. There was also a ‘pod’ being built which would allow people to meet safely with friends and family. The registered manager maintained regular contact with people’s families to inform them of their loved ones welfare and update them about visiting procedures.

The registered manager acknowledged the impact Covid-19 had on people and staff and was aware it would take time for them to fully recover. Support was in place to help them through this difficult time. A small memorial service had taken place to support people through the loss of their friends.

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

People’s experience of using this service:

¿ We found improvements were needed to people’s records to ensure they contained all the information about people and fully reflected their care and support needs.

¿ People received support that was person-centred and met their individual needs, choices and preferences. People’s engaged in a range of activities that they enjoyed and were meaningful.

¿ People were supported by staff who treated them with kindness, respect and compassion. Staff understood people’s needs, choices and histories and knew what was important to each person. People were enabled to make their own decisions and choices about what they did each day.

¿ People's health and well-being needs were met. They were supported to have access to healthcare services when they needed them. Staff received training that enabled them to deliver the support that people needed. Staff received support from the registered manager and their colleagues.

¿ Staff had a good understanding of the risks associated with the people they supported. Risk assessments provided further information for staff about individual and environmental risks. People were protected from the risks of harm, abuse or discrimination because staff knew what actions to take if they identified concerns.

¿ People were supported to receive their medicines when they needed them. There were enough staff working to provide the support people needed, at times of their choice. Recruitment procedures ensured only suitable staff worked at the service.

¿ People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this.

¿ People's dietary needs were assessed and people received the support they needed with their meals. People's needs were met by the design and adaptation of the building. Complaints had been recorded, investigated and responded to appropriately.

¿ The quality assurance system helped the provider to identify areas were improvement and development were needed. People, relatives and staff were encouraged to be involved and given opportunities to provide feedback and put forward their ideas for the service.

Rating at last inspection:

¿ Good. (Report published 23 September 2016).

Why we inspected:

¿ This was a planned inspection based on the rating at the last inspection.

Follow up:

¿ We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

We inspected on the 16 and 17 August 2016 to follow up on whether the required actions had been taken. We found the provider was now meeting the legal requirements.

Cedarwood House provides accommodation and care for up to 20 people. At the time of our inspection 18 older people were living at the home aged between 77 and 96. All people at Cedarwood House were living with early stages to severe dementia. People had various long term health care needs including diabetes and other conditions which impacted on mobility putting people at risk from falls.

Cedarwood House was on two floors with five bedrooms on the first floor accessed by a lift in the dining room and 15 bedrooms on the ground floor. The ground floor also included a kitchen, a staff room, the dining room, the communal lounge, an office and a recently decorated garden or sensory room.

There was a registered manager at the home. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Throughout our inspection, people spoke positively about the home. Comments included, “No complaints whatsoever, it’s lovely here” and, “I’m well looked after.” Although staff knew people well and had a good understanding of their individual needs and choices there was a lack of consistent written information which could leave people at risk of receiving care that was inappropriate or inconsistent. This had not been identified through the quality assurance system. We have made a recommendation about improving the quality assurance process.

People told us they felt safe living at Cedarwood House. There were sufficient levels of staff to protect people’s health, safety and welfare. The provider had improved staffing levels based on the dependency of people’s needs.

Medicines were managed safely including covert and PRN medication. The provider had put in place clear guidance for staff on the covert administration of medicines.

People were provided with a choice of healthy food and drink ensuring their nutritional needs were met. Staff encouraged and supported people to eat and drink well. One person said, “The food is good, we get choices.”

Staff knew the individual personalities of people they supported. We saw staff were kind, compassionate and patient and promoted people’s privacy, dignity and choice. People were encouraged to be as independent as possible and we saw friendly and genuine relationships had developed between people and staff. One person said, “The staff are helpful and cheerful and treat me well.” A staff member told us, “I would put one of my loved ones here because the carers are compassionate.”

Training schedules confirmed staff had received training in safeguarding adults at risk. Staff knew how to identify if people were at risk of abuse or harm and knew what to do to ensure they were protected. Staff had received quarterly supervisions with their manager to discuss additional training needs and development. Staff were encouraged to attend further training, with a number having achieved National Vocational (NVQ) in health and social care.

Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work and staff received a range of training that enabled them to support people living at Cedarwood House.

People’s health and wellbeing was monitored and staff regularly liaised with healthcare professionals for advice and guidance. A visiting healthcare professional told us, “If staff have any concerns they will call straight away.”

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found appropriate policies and procedures were in place. The registered manager was familiar with the processes involved in the application for a DoLS, and had made the necessary applications to the authorising authority. Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure decisions were made in the person’s best interests.

People’s friends and family were made welcome and relatives spoke positively about the welcome they received. One told us, “I visit every day. If I could I’d give it 11 out of 10.”

We observed staff speaking with people who use the service in polite and simple language, showing them choices such as with clothes or food and giving the person time to think about their answer. We saw that care plans were detailed and focused on the person's needs. They set out clearly how the staff assisted people on a daily basis with basic personal care to stimulating activities.

We observed some of the morning medication being administered. The staff member was seen to follow the home's policy. They informed the person that it was time for their medication and answered their questions calmly and politely. The staff member was able to describe the purpose of some basic medications in addition to their side effects. We noted that they waited to ensure that the medication had been swallowed safely before returning to sign the medication chart.

We saw the training records for all staff which included all mandatory training and dementia awareness. Attendance was confirmed by certificates in the personnel files

We used a number of different methods to help us understand the experiences of people using the service, as they had complex needs. This meant they were not always able to tell us their experiences. We spent time with people using the service and observed their interaction with each other and the staff. We saw that interaction between people in the home was positive and constructive.

We saw staff asked for people's consent before they provided any care or treatment. People who were able to, told us they were asked for their consent before any care and support was provided. They told us they were happy living at the home and with the care and support provided. All feedback received about the home was positive. One relative called the home 'marvellous.'

We looked at the systems and processes that the home had in place to ensure the people using the service were protected from abuse. These processes ensured that staff knew what constituted abuse and what to do if it was suspected.

We saw there were enough appropriately trained staff in place to meet the needs of the people living in the home.

We looked at the systems and processes the home had in place to respond to complaints. These processes ensured complaints could be raised and resolved to people's satisfaction.