The Cedars Care Home

We found the following examples of good practice.

People were supported to remain in contact with their families in line with government guidance. This was accomplished through safe visiting arrangements at the service and video calling facilities. The provider sent regular emails to keep families updated on any changes to the guidance.

The service had robust checks in place for visitors to check whether they had any COVID-19 symptoms or had tested positive. Guidance related to COVID-19 was visible on arrival at the home. Visitors were asked to complete a lateral flow test for COVID-19 before they were allowed to enter the building. They signed a disclaimer stating they had not been in contact with anyone who had was symptomatic or who had tested positive. Hand hygiene was promoted and a personal protective equipment (PPE) station was available at the door. The home provided visitors with PPE which had to be worn at all times.

The management team had worked closely with colleagues across health and social care, such as the local infection control team, to ensure they were following the most up to date guidance. The local clinical commissioning group and ambulance service provided training in infection control and the correct use of PPE. The registered manager did frequent spot checks to ensure staff were following good IPC practice.

Robust risk assessments were completed, making it clear how staff could reduce the risk of transmission of COVID-19. Where risks had been identified, measures to support staff had been recorded. There were risk assessments in place for those staff who were in high risk groups or who were clinically vulnerable which enabled them to adapt their working practices.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained good.

Safeguarding procedures were in place and staff knew how to report abuse, People told us they felt safe and there were a sufficient number of staff to meet people’s needs. Risks to people were identified and appropriately managed. Medicine administration and recording was safe, as were infection control practices. Accidents and incidents were recorded and monitored for trends.

Thorough pre-assessments were completed to ensure that people’s needs could be met. 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 support this practice. Staff were aware of the principles of the Mental Capacity Act 2005 and people’s rights were protected. Staff had received training relevant to their roles which was up to date and had regular supervision with their line manager. People were supported to maintain the health, nutritional and hydration needs.

People were treated with kindness and respect, and staff were knowledgeable about people’s needs. People’s independence and privacy was respected and promoted. Staff were aware of how to support people to express their opinions.

People received personalised care and activities, and were able to decorate their rooms in any way they pleased. People were supported to express their religion, culture and sexuality, and to raise complaints. End of life care plans were detailed and expressed people’s individual last wishes.

There was a warm and friendly culture within the service amongst staff and people. People and relatives said that the registered manager and staff were approachable and the service had a family feel which they valued. The provider had plans to improve the service and actively sought feedback from people, relatives and staff. There were robust quality governance systems in place to identify any issues which were resolved in a timely manner. There was strong engagement with a range of external stakeholders.

Further information is in the detailed findings below.

The Cedars Care Home is registered to provide accommodation with nursing care for up to 16 people. At the time of our visit, there were 14 people living at the home. The majority of the people who live at the home are living with dementia, as well as having complex needs. The home also provides end of life care. The accommodation is provided over two floors that were accessible by stairs with a stair lift and a lift.

There was a registered manager 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.

People and relative told us they were safe at The Cedars Care Home. Staff had a good understanding about the signs of abuse and were aware of what to do if they suspected abuse was taking place. There were systems and processes in place to protect people from harm.

There was sufficient numbers of staff deployed who had the necessary skills and knowledge to meet people’s needs. Recruitment practices were safe and relevant checks had been completed before staff started work.

Medicines were managed, stored and disposed of safely. Any changes to people’s medicines were prescribed by the person’s GP and administered appropriately.

Fire safety arrangements and risk assessments for the environment were in place to help keep people safe. The service had a business contingency plan that identified how the home would function in the event of an emergency such as fire, adverse weather conditions, flooding or power cuts.

Staff were up to date with current guidance to support people to make decisions. Where people had restrictions placed on them these were done in their best interests using appropriate safeguards. Staff had a clear understanding of Deprivation of Liberty Safeguards (DoLS) and the Mental Capacity Act (MCA) as well as their responsibilities in respect of this.

The registered manager ensured staff had the skills and experience which were necessary to carry out their role. Staff had received appropriate support that promoted their development. The staff team were knowledgeable about people’s care needs. People told us they felt supported and staff knew what they were doing.

People had enough to eat and drink and there were arrangements in place to identify and support people who were nutritionally at risk. People were supported to have access to healthcare services and were involved in the regular monitoring of their health. The provider worked effectively with healthcare professionals and was pro-active in referring people for assessment or treatment.

Staff treated people with compassion, kindness, dignity and respect. People’s preferences, likes and dislikes had been taken into consideration and support was provided in accordance with people’s wishes. People’s privacy and dignity were respected and promoted when personal care was undertaken.

People’s needs were assessed when they entered the home and on a continuous basis to reflect changes in their needs.

People were encouraged to voice their concerns or complaints about the service and there were different ways for their voice to be heard. Suggestions, concerns and complaints were used as an opportunity to learn and improve the service people received.

People had access to activities that were important and relevant to them. People were protected from social isolation through systems the service had in place. There were a range of activities available within the home and community.

People’s care and welfare was monitored regularly to ensure their needs were met. The provider had systems in place to regularly assess and monitor the quality of the care provided.

People told us the staff were friendly and management were always approachable. Staff were encouraged to contribute to the improvement of the home. Staff told us they would report any concerns to their manager and said they felt that management were very supportive.

We saw that most people were mobile, however needed support or supervision due to physical frailty and dementia related impairment. We observed three people walking independently and freely around the home environment. People readily interacted with us and we saw staff knew people well and paid attention to their needs.

Not all people had the capacity to readily express their views verbally. We observed people's behaviour and well being. People appeared comfortable and relaxed.

One person told us ' The food is quite good, I want to be home. They (the staff) are all quite kind.'

Another person we spoke with told us ' I wouldn't want to leave here now , I've just got used to everyone.'

A relative we spoke with told us that they were happy with the service as ' they have been fantastic at communication'.

A member of staff told us ' each person has their own routine , not all people always know they are in a care home - they feel part of the house'.

We found that staff felt supported; one member of staff told us ' I feel supported here , there is always someone to ask'.

Staff received supervision and training. The service had sought the views of people and relatives. We found the home had systems to monitor quality and safety.

However we observed some of the care and support provided to people. This showed that staff treated people with respect, and worked with people at their own pace.

On the day of inspection the hairdresser was there and the people told us how much they enjoyed having their hair done. We were told by one person 'It makes you feel so much better to have your hair done.'

We listened to another person who had a conversation about where they danced when they were younger. One person told us the music, which played in the background, reminded them of those days they said. 'I wish my legs would work properly to let me dance again.'

We observed some of the lunch service and found that people were enjoying their soup. Choices were given to them regarding the main meal and a menu was displayed in the dining room.