Cedar Tree Care Home Limited

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to people’s safe care and treatment.

This service scored 53 (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 proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

We found risk assessments and care plans were generally more up to date and more accurately reflected when people could act in ways that placed themselves and others at risk of harm. However, this had not yet been consistently applied. For example, one person did not have a relevant risk assessment in place, and other people’s relevant care plans did not reflect people could demonstrate behaviours that placed themselves and others at risk, and effective strategies for staff to use in these circumstances.

Where staff had recorded incidents of behaviours that could place the person and others at potential risk of harm, these had not resulted in updates and changes to people’s care plans and risk assessments. For example, where people had repeated behaviours that could place themselves and others at risk. Evidence was not in place to demonstrate incidents were used as opportunities to learn and improve people’s care.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

Staff were now able to explain the principles of the MCA and had completed recent training in this area. Assessments of people’s capacity to understand decisions had now been completed however, these recorded discussions for multiple decisions in one assessment, where they should be distinct and specific assessments for each decision. Additionally, mental capacity assessments and best interest decisions had not always been completed for every relevant decision. The registered manager told us they would arrange for these to be completed. Where specific best interest decision making records were in place, these included the views of relevant professionals and next of kin as appropriate.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS).The provider had a system to track and monitor when people required a Deprivation of Liberty Safeguard to be in place.

The provider did not work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Care plans for managing behaviours that could place people or others at risk still needed further improvement. For example, one person did not have a risk assessment in place for when they could show their distress in ways that could harm themselves or others. For another person, who could show distress during personal care and act in a way that could cause harm to themselves as well as others, there were no details included in their relevant care plans for these areas to advise staff of this and what they should do should this occur. Whilst the registered manager told us incidents were reviewed by staff who had regular reviews with involved external healthcare professionals, there was a lack of evidence to show how incidents had been reviewed and relevant actions taken. For example, care planning different strategies to see if they were more effective.

Improvements were needed to the policy to guide people’s care when they had behaviours that could place themselves or others at risk of harm. The current policy was not appropriate to guide the care for people living with dementia, for example it did not set out the processes for the ‘Antecedent, Behaviour and Consequence’ (ABC) monitoring records staff made to record any behaviours that placed people or others at risk of harm and how they should be used to help improve people’s care. The policy referred to restraint and staff being trained in breakaway techniques however, the registered manager told us staff had not received training in breakaway techniques and physical restraint was not used. They told us the policy meant restraints such as lap belts when people were in their wheelchairs. However, this was not clear from the policy, and it lacked detail on person-centred care approaches to managing dementia.

Details of how people transferred when they used equipment to do so had now been included in people’s care plans.

Care plans in general, were now more accurate. This included care plans for pressure sores which had improved and now recorded more clearly people’s dressing regimes and photographs and measurements of wounds to show healing or any deterioration. However, we found one person’s care plan for their skin integrity required further information to be added.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

Staff told us they now had sufficient equipment such as hoists, to help people transfer. Records showed these had been serviced and maintained in line with guidance.

There had been an external health and safety audit completed, and the Registered Manager told us they were working through the action plan to ensure the home was compliant at the time of the inspection. The audit had identified the fire risk assessment needed to be updated due to the building work underway. The registered manager told us this would be completed in approximately one month’s time. However, there had been no interim update made to the fire risk assessment to identify any areas where fire safety was compromised whilst the building work was on-going.

Some relatives commented that parts of the home that required maintenance and upkeep were not always responded to quickly. For example, one relative told us, “Just look at the scuff marks here on this paintwork, they’ve been here ages.”

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Staff recruitment checks were now all in place. This included obtaining Disclosure and Barring Service (DBS) checks. These provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

Staff had now completed the training identified by the provider as required for their job role. Staff were able to tell us about their training and how it helped them understand people’s care needs.

All staff now attended ‘handover’ meetings at shift change. This helped to ensure information about people’s care needs was effectively communicated to new staff starting their shift. However, staff told us improvements could still be made to how the care and nursing teams worked together.

Most people felt there were enough staff to meet their needs in a timely manner however, one person told us they had to wait. We observed staff were able to respond to people quickly on the day of our inspection.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading.

The downstairs carpet areas had now been professionally cleaned however, armchairs in lounges and some dining chairs remained stained. The provider had completed an action plan that stated the armchairs would be replaced after our last inspection, however, this had not been completed. As a result, measures to prevent and control infection were still not effective as chairs were still visibly soiled.

The provider was replacing the other carpeted areas of the home however, there was no specific timescales set for this work.

Records of what cleaning had been undertaken had improved and staff were observed to follow infection prevention and control guidelines.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Prescribed topical skin creams were now stored in locked cupboards and records of their administration had been completed.

Other medicines were kept securely and regularly audited to ensure the correct amount of medicines remained in stock. We checked a sample of medicines and found these were all accounted for accurately. Records showed people had been offered their medicines to take as prescribed.