We carried out a review of the data available to us about The Cedars on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about The Cedars, you can give feedback on this service.
We found the following examples of good practice.
Individual COVID-19 risk assessments were in place for people who lived at the home. These looked at identified risk for people and considered their health needs, visiting and going out into the community.
There was a visiting process in place to support people and relatives to conduct safe visits as and when required. This explained the use of personal protective equipment (PPE) to people and relatives to ensure the correct guidance is followed.
There had been regular contact with families using video calls throughout the pandemic. As staff knew people really well, they were able to monitor the best times for relatives to make contact which meant a call could be set up at short notice or whenever the person wanted to make a call to their relatives.
External visitors went through a robust procedure prior to entering the home. This included a health questionnaire, PPE, hand washing, temperature checks and lateral flow test.
The provider had a detailed infection prevention and control policy in place. This gave guidance around what actions to take if there was a positive COVID-19 result. How people can be kept safe by zoning off the bungalows to prevent any spread of infection.
People who lived at the service had been supported by staff throughout the pandemic to learn and understand the changes this had made to their lives. How best to keep themselves and other people safe and why PPE was now being used within the service.
Staff had spent time developing understanding by using sensory based games or activities which they adapted to people’s needs and level of understanding.
The provider had access to PPE and maintained a regular level of stock to be prepared for any potential outbreak. The provider also had a regular COVID-19 testing programme in place for people and staff that ensured they were kept safe.
The provider had robust cleaning schedules in place. Each bungalow had its own rota and high touch point cleaning which was audited daily. Equipment located in each bungalow was included within the regular cleaning.
The provider had supported people to obtain the first dose of the vaccination. Consent had been obtained from people and where people had been unable to consent, best interest decisions were recorded after liaising with appropriate relatives and healthcare professionals.
People's experience of using this service:
People were supported by consistent staff who knew them and their needs well. Staff communicated effectively with one another about people's needs. Staff treated people with respect and maintained their dignity when supporting them. Staff encouraged people to make choices about their care and respected their decisions. 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 practice.
People were provided with a variety of opportunities to go out and take part in activities. This included the on site day centre, in-house activities and trips out to visit places.
The management of the service was effectively run. The registered manager knew people and staff well and had a positive attitude towards making improvements in people’s life's.
The principles and values of Registering the Right Support and other best practice guidance ensure people with a learning disability and or autism who use a service can live as full a life as possible and achieve the best outcomes that include control, choice and independence. At this inspection the provider had ensured they were applied.
The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.
There were enough staff on each shift to meet people's needs and keep them safe. The provider's recruitment procedures helped ensure only suitable staff were employed. Staff had the induction, training and support they needed to carry out their roles. They understood their roles in keeping people safe from abuse and felt able to speak up about any concerns they had.
Potential risks to people had been assessed and measures put in place to mitigate these. If accidents or incidents occurred, staff took action to reduce the risk of similar incidents happening again. Medicines were managed safely and staff maintained appropriate standards of hygiene and infection control. Staff supported people to maintain good health and worked effectively with any professionals involved in their care.
Staff were kind treated people with respect. 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 practice.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
At the last inspection the service was rated Good. The report of this inspection was published on 14 January 2017.
Why we inspected:
This was a planned inspection based on the previous rating.
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 we receive any concerning information we may inspect sooner.
This inspection took place on the 29 November 2016 and was unannounced.
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.
The Cedars provides accommodation and personal care for up to 14 people who have multiple and complex learning and physical needs. People are accommodated in three bungalows on one site. On the day of our visit there were 14 people at the service.
During our inspection of May 2015 the provider was found to be in breach of two Regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. We found that effective infection control systems were not in place and the quality audits undertaken were not robust.
We carried out this fully comprehensive inspection to see what action the provider had taken in response to the shortfalls we had previously identified. We found during this inspection that the provider had made the improvements needed and was now meeting the regulations.
People’s relatives told us they felt the service was safe. Relatives told us that staff were very kind and they had no concerns in relation to the safety of their family member. Staff understood their responsibilities in relation to keeping people safe and they had received training in relation to safeguarding. Staff were able to describe the types of abuse and the processes to be followed when reporting suspected or actual abuse.
There were enough staff to ensure that people’s assessed needs could be met. It was clear that staff had a good understanding of how to attend to people’s needs.
Accidents and incidents were recorded and monitored by staff at the service to help minimise the risk of repeated events.
Staff had received training, supervisions and annual appraisals that helped them to perform their duties
Medicines were managed in a safe way and recording of medicines was completed to show people had received the medicines they required.
Staff understood the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure decisions were made for people in the least restrictive way; however, the registered manager, whilst being knowledgeable about the MCA, had not followed the guidance and recommendations of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards. DoLS applications had been sent for approval, but the MCA assessments for specific decisions had not been undertaken for all applications before they were sent. We have made a good practice recommendation in relation to this.
People were not prevented from doing things they enjoyed as staff had identified and assessed individual risks for people.
The provider ensured that full recruitment checks had been carried out to help ensure that only suitable staff worked with people at The Cedars.
People lived in a homely environment that had been adapted to the needs of people. People’s bedrooms were personalised with family photographs and their personal belongings.
People were encouraged and supported by staff to be as independent as they were able. Staff supported people to eat a good range of foods. Those with a specific dietary requirement were provided with appropriate food.
People had access to external health services and professional involvement was sought by staff when appropriate to help maintain good health.
Staff showed kindness and compassion and people’s privacy and dignity were upheld. People were able to spend time on their own in their bedrooms and their personal care needs were attended to in private. People took part in a variety of activities that interested them.
Documentation that enabled staff to support people and to record the care they had received was up to date and regularly reviewed. People’s preferences, likes and dislikes were recorded.
If an emergency occurred or the service had to close for a period of time, people’s care would not be interrupted as there were procedures in place to minimise the disruption to people.
A complaints procedure was available for any concerns. This was displayed in a format that was easy for people to understand.
Staff and the provider undertook quality assurance audits to ensure the care provided was of a standard people should expect. Any areas identified as needing improvement were attended to by staff.
Relatives and associated professionals had been asked for their views about the care provided and how the service was run. Regular staff meetings took place.
This inspection took place on 28 May 2015 and was an unannounced inspection. This was the first inspection since the registration of the provider Voyage 1Limited on 18 June 2014.
The Cedars is a care home which comprises of three separate bungalows. The Cedars provides accommodation and care for 14 adults who have multiple and complex learning and physical disabilities.
A new manager was in post and they told us they had submitted an application to register with the Care Quality Commission (CQC). 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.
People were at risk because there were inconsistencies in the systems and arrangements to protect people from the spread of infection. Appropriate standards of cleanliness were not being maintained. Infection control policies and procedures were in place; however, these had not always been followed.
During this inspection we found that staff had not always been recruited safely. This put people at risk of receiving care from staff who may not be suitable to work with people in a caring environment. Documents required to ensure people are safe to work in a care role had not been completed or acquired from prospective employees. Documents required were not in place for all staff. This put people at risk of receiving care from staff that may not be suitable to work with people in a caring environment.
People had care plans in place that told staff how people preferred their assessed needs to be met, however, care plans not been updated since the registration of the new provider in June 2014 so may not be meeting peoples’ current needs.
A complaints procedure was available for any concerns and relatives and people were encouraged to feedback their views and ideas into the running of the home. However, the complaints procedure required to be updated.
Staff carried out appropriate checks to make sure that any risks to people were identified and appropriate risk assessments had been put in place to minimise risks to people.
Staff had followed legal requirements where there were restrictions in place on people’s care to make sure this was done in the person’s best interests. Staff understood the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) to ensure decisions were made for people in the least restrictive way.
Staff were aware of their responsibilities in relation to safeguarding people from abuse and they knew the processes to be followed in such an event. People’s care would not be interrupted in the event of an emergency and people needed to be evacuated from the home as staff had guidance to follow.
Staff were provided with training; specific to the needs of people. This helped them to carry out their role in an effective way. It was evident staff had a good understanding of the individual care and communication needs of people.
People received their medicines in a safe way. People were encouraged to eat a healthy and varied diet and were involved in choosing the food they ate.
People were supported to keep healthy and had access to all health care services. Professional involvement was sought by staff when appropriate.
Staff supported people in an individualised way. They planned activities that meant something to people.
Staff felt supported by the manager and the provider and had the opportunity to have regular team meetings and one to one supervisions with their line managers.
During the inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.