Cedarwood House Care Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement.

This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care. The provider was previously in breach of the legal regulation in relation to governance. Improvements were found at this assessment and the provider was no longer in breach of this regulation.

This service scored 61 (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 did not have a clear shared vision, strategy and culture which was based on transparency, equity, inclusion, and engagement. The service had been without a registered manager for 3 and a half years at the time of this assessment. The service was being overseen by the manager of the service’s sister home, and they split their time across the 2 homes. The operations manager told us that the manager would soon register for this service and make running the two services a permanent arrangement. The manager did have a plan for the development of the service and this centered around creating a positive and calm environment for people to live in, to increase the availability of daily activities and to increase the use of social media to promote the home. A deputy manager was in place which helped with the ongoing oversight and management of the service however this role and the responsibilities that came with it needed time to fully embed so that the holder of that deputy role would be confident to oversee the service in the manager’s absence. A service contingency plan was in place and had been recently reviewed and updated.

Leaders did not always have the skills, knowledge, experience and credibility, or the time to lead effectively. There was a concern however about the resilience of the current management structure. The manager told us that they were on call constantly, 24 hours every day. This coupled with their responsibilities to manage the sister home meant there was little support in place for the manager. A deputy had been appointed who was capable but still needed time to fully take on some of the managerial tasks and although they shared some of the on-call responsibility they usually had to refer to the manager for advice. The manager told us that the staff team were young but keen and capable but acknowledged that the new management structure needed time to embed. This situation had also been noticed by relatives one of whom said, “Running 2 places is a concern. He (manager) and the deputy are great, but I feel it’s a lot to take on and I’m not sure it’s a wise move. It’s a small home but it needs to be properly managed.” The manager had been in post for a few months and had made an impact on the home. Staff told us they were approachable and supportive. A staff member said, “He’s a good manager, supportive to us.” The manager had introduced some face-to-face training which had been well received as this also helped the team to bond. The manager told us that they had worked a variety of shifts, including night shifts, to get to see all staff as quickly as possible.

The provider fostered a positive culture where people felt they could speak up, and their voice would be heard. Staff had a voice at the home. Staff were able to raise issues, concerns, celebrate and highlight best practice to their peers and to managers. Staff told us there were various forums they could use to achieve making themselves heard. For example, regular supervision meetings, handover meetings, team meetings or by speaking directly to managers when at work. The managers operated an open-door policy and encouraged staff to come forward and speak with them. Some staff told us they had been asked to fill in a questionnaire asking them for their views on the service and inviting suggestions for improvements. A staff member told us, “Yes I am able to give my opinions and I feel I can speak freely in the home and that my concerns will be listened to.” Regarding team meetings another said, “It is difficult sometimes to get everyone together so we have had ‘google’ meetings. Online meetings where staff can join remotely.”

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them. Staff told us they felt valued by the management team and that the environment they worked in fostered a positive relationship between staff from different cultures, religions and backgrounds. A staff member told us, “It’s a welcoming environment for people (staff).” Equality and diversity policies were in place and regularly reviewed. The manager described the importance of creating a working environment for staff where everyone felt comfortable to come to work. Different faiths were acknowledged and celebrated with staff being able to work flexibly on special days according to their faith.

The provider did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate. Auditing processes were in place and the responsibility was shared between the managers at the service. Some auditing processes were efficient for example the oversight and management of training. A colour coded spreadsheet was used to identify completed, due and overdue training. A recent environmental audit had shown a largely positive overview of the home’s equipment and general décor. Similarly, medicines reviews were regularly carried out with MAR charts, storage areas and staff competencies all being audited. Some areas however lacked details. For example, reviews or auditing of daily tasks had failed to highlight people’s oral hygiene concerns. Care plans audits had not identified the lack of detail in some areas for example, personal histories and preferred means of communication. It was acknowledged by the manager that more detailed auditing was required in some areas.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement. Positive working relationships had developed between the home and other professionals. Professionals noted the improvements in the home and the communication with them since the new manager had been in place. One professional told us, “District Nursing referrals are being received. Recently there have been palliative care patients and I would commend the team of carers for their care for these patients and the working relationship between the carers of the home and District Nursing Team was excellent.” The result of partners working well together and receiving timely referrals and requests for support resulted in the best care and support being provided for people. Relatives also told us that their loved ones received the support they needed, one highlighted a recent podiatry appointment that was made quickly and efficiently and with a prompt attendance preventing a larger issue from arising.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research. The current manager of the home was experienced, knowledgeable and dedicated to improving the service. However, the lack of consistency in managers in recent years had impacted on the service moving forward and having the opportunity to embed learning among the staff. The manager attended a safeguarding meeting shortly after being moved to the home. An incident which involved a serious fall had occurred and there were lessons to be learned and shared with staff. An action from that meeting was to share learning at the next team meeting. Although staff told us that a mobile phone application was used for sharing some information and shift handovers were thorough, we could find no reference or debriefing discussion held with staff from the subsequent team meetings minutes. The manager did meet regularly with the local authority, the medicines team and pharmacists to share and gain information with, and from close professional partners.