Cedar Tree Care Home Limited

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 54 (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 make sure people’s care and treatment was effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

Assessments did not always show how risk was identified and calculated. For example, one person’s ‘Getting to know me – personal hygiene’ assessment stated the person was very reluctant, disliked washing and dressing and detailed they were at risk of harm to themselves or others. Despite these risks being identified, all scores remained zero.

We found multiple inaccuracies within people’s care plans and risk assessments. We found care plans and risk assessments were not always updated and reviewed following incidents. Transfer methods for people had not always been updated when they had changed or did not provide sufficient detail such as what sling loops had been assessed as safe to use when a person was hoisted. Another person’s nutritional care plan stated they were on a pureed diet when they were on a normal diet and required staff to assist them to eat when they were able to eat independently. A person’s pressure sore records had not been updated to reflect their current wounds. It was not clear what dressing routines staff were to follow. For another person it wasnot clear what frequency staff were to monitor their weight. There was limited information on how people and their relatives when appropriate, had been given the chance to review and check people’s care plans and risk assessments. Some relatives told us they had been involved with care planning while other relatives said they had not seen a care plan.

However, people’s communication needs were known, and staff were able to meet these. For example, staff were able to communicate with people in languages other than English.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. People’s care and treatment was not always informed by the most current legislation and evidence-based good practice and standards.

The provider’s policies were not always up to date or in line with current guidance. We were therefore not assured people’s care and treatment was planned in line with the most recent evidence based good practice and standards.

However, people’s nutritional and hydration needs were met. Most people told us they enjoyed their meals, and the service had been awarded the highest 5 star food hygiene rating. One relative told us, “The food is excellent; I have eaten here.” Drinks were readily available for visitors, and we saw staff provided drinks to people throughout the day.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

People had access to other healthcare services if they needed these. For example, speech and language therapists. Staff told us they liaised with people’s GPs if any advice was needed and one person told us they saw their chiropodist. Staff told us if people needed a stay in hospital, then important information about their care needs went with them. This helped people experience continuity of care.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff were able to tell us what actions they would take if they thought a person was unwell. This involved raising their concerns directly with the Nursing team and the registered manager so appropriate healthcare could be arranged. People were supported to access optician and audiology services when needed. This helped to support people to live healthier lives.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive andconsistent, or that they met both clinical expectations and the expectations of people themselves.

One person had been identified as being at high risk of malnutrition. Their care plan stated their weight should be monitored on a fortnightly basis and be audited monthly. The weight records for this person showed there were gaps of nearly 3 months between some of the weights recorded. Records for pressure sores did not show the healing or deterioration of wounds had been regularly monitored with photographic evidence and evaluated. Therefore, the provider would not always be able to quickly identify changes and take any action to maintain their safety and well-being.

The provider had not always told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff provided examples of how they checked people consented to their care. For example, one staff member told us, “I speak to them to make them comfortable, and communicate each step, and let them know why I am there to help them.” Staff told us when people declined help from one person they would attempt to ask them again later, or a different member of staff would try and assist them.” Staff understood how to seek consent from people when providing care.

However, not all staff understood how the principles of the Mental Capacity Act 2005 related to people’s care. When people needed the protections of the Mental Capacity Act 2005 to help protect their rights when making decisions, these had not always been recorded in line with this guidance.