Cedar Court Care Home

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

We identified two breaches of regulations. The service was not working within the principles of the Mental Capacity Act 2005 (MCA). People were not being supported appropriately with their nutritional and hydration needs. People’s needs were assessed; however support was not always being provided in line with the outcomes of these assessments. Robust systems were not in place to help keep all staff informed of people’s needs. People were supported to access healthcare services when required. People and relatives spoke positively about their care and treatment.

This service scored 33 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s needs were assessed. A person told us “The carers know what my needs are so I can’t ask for more from them.” A relative told us “They understand [person] and are very professional when supporting them.” Another relative told us “I’m extremely happy with the home. I am well informed, and they will discuss things like when they felt [person] needed more fluids. Everything I ask, they do. They are really ‘on it’.”

However, records showed a lack of involvement from people and relatives in the assessments and review of people’s health and care needs which was mainly completed by staff. Therefore, we could not be assured that positive outcomes were achieved for people’s care, treatment and support in accordance to their specific needs and requirements.

The registered manager told us assessments were carried out before people started using the service to ensure their needs could be met appropriately. However, these were not accessible at the time of this assessment due to the change of care provider and IT systems used by the service.

Care plans showed people’s needs were assessed monthly and expected outcomes identified, however this was ineffective. For example, although the care plans detailed people’s needs, there were areas such as diabetes, dementia and epilepsy, where appropriate guidance on how to support people with these needs was not in place

The provider used recognised assessment tools such as waterlow score and Malnutrition Universal Screening Tool (MUST) which are used to identify and manage pressure ulcer and malnutrition risk. However, we found instances where support was not being provided in line with the outcomes of assessments. For example, some people were required to be repositioned after 2-3 hours, however records showed one person was repositioned after 4 hours and on another instance, the person was repositioned after 3 hours 53 minutes. Another person was repositioned after 6 hours 15 minutes, for the next four days there was instances the person was repositioned after 4 hours. We also noted these instances were all during 4pm and 10.30pm, however the service failed to identify this as a risk to the person who experienced a negative outcome with their care.

We received mixed feedback about the food at the service. One person told us “The food is okay. There’s always something I like.” A relative told us “[Person] has a small appetite now and they try to find something they will like. If [person] can’t be persuaded to eat, they will even let them have a bowl of cornflakes.” Another relative told us “[Person] eats soft food, and the carers feed them at a nice pace. They are very patient.”

However, some people and relatives told us the food at times would be cold. A person told us “I have complained about being given cold chips. The food seems to have cooled down so fast.” A relative told us “[Person] is not happy with the food, the warmth and taste.” Another relative told us “The food looks a bit ‘instant’ rather than hand prepared. I have noticed the food is kept on the worktop, therefore cooling down, it needs to be kept on some kind of larger heated unit as it is served.”

We observed some positive interactions at lunchtimes. For example, as people arrived, staff would engage and helped them to settle. A person was singing and staff acknowledged them with a ‘thumbs up’ and a smile. However, some staff tended to be task focused with little interaction with people. Staff would speak loudly to each other across the dining room whilst supporting people to eat instead of meaningful engagement with the people they were supporting, therefore a negative experience for people.

We observed trays of food moved from the heated trolley to a worktop. From 12.10pm this is where the food sat, and people were still being served food from 1pm onwards which meant the food would have cooled down. There was no indication as to what was being served, no menu board or menus on tables. There was no background music. People were not provided with choice. No show plates were used. Some staff did not verbally offer a choice of meals and would just say ‘Do you want Shepherd’s Pie’ and not offer an alternative.

Lunchtimes was disorganised as staff were not deployed effectively. There were instances of a lack of consideration and dignity shown to people by staff.

For example, at 1.06pm, one person had fallen asleep in front of their lunch. The person had woken at 1.16pm but not eaten their food. A staff member did not acknowledge this and asked the person if they were enjoying their food and did not ask if they needed any support. No drink was provided for the person who eventually asked staff for a drink. At 1.30pm, the person fell asleep again and no staff member provided any support or assistance to ensure the person finished their meal

One person who is at risk of choking and required their food to be cut up, we observed they were given fish and chips which was not cut up. The person tried to spear vegetables onto a fork but could not manage this, so they used their fingers to eat. Different staff members would come over and start to feed the person whilst standing over them but left them after a couple of minutes. The person remained sat in front of their food and eventually pushed the food away which was taken away by staff without any further interaction with the person

One staff member sat with two people; we observed one person started coughing but the staff member did not get them a drink. A staff member supporting another person had got up and gave the person a drink.

We observed instances where staff were supporting people two or three people at a time and having to walk from one side of the table to the other. Eventually, one person got up and walked away, the staff member also left the dining room leaving the second person on their own. We observed different staff members would ask the second person if they were okay, but no one supported the person with their meal.

A person was given macaroni cheese; however they burnt their mouth as the cheese was too hot. The temperature of the food had not been taken before serving it to people.

Care plans contained some information on people’s dietary needs and individual preferences however, people were at risk of not receiving the appropriate support in accordance with their individual needs.

For example, one person’s care plan stated the person was at risk of choking and drank better with a straw and adult sippy cups. However during the onsite visit, we observed the person struggling to drink tea from a small cup, there was no sippy cup and or straws available for them to use. Care records had not been updated to reflect whether the person had been provided with these and if they would be useful for them to use to drink safely.

Another person’s care plan stated they could no longer use cutlery independently and struggled with their coordination. Food is to be cut up and placed on their fork and needed lots of encouragement to eat. However, during lunch times, we observed the person was not supported as required and did not eat much at all due to the lack of support from staff.

For a third person, the care plan stated they should have a diabetic friendly diet but did not provide any further information detailing what this meant and the types of food the person would require in accordance with their diabetic needs.

Relatives told us they were able to speak to staff about people’s care and treatment. A relative told us “The carers are very friendly, and they know my name. They’ll tell me how [person] is doing. They are very respectful of the residents.” Another relative told us “[The registered manager] will always do his best to respond to any need. We have regular discussions with him and the senior carers about [person]. There’s a consistency between the manager and the seniors and maybe it all accounts for a relatively low turnover of staff. It’s lovely seeing the same faces.”

Staff told us they did not always have access to the information they needed to appropriately deliver people’s care and support. Two staff members told us they did not look at the care plans and only completed the room folders which were daily checks for people. Staff also told us if there were any changes in people’s needs, they would be more reliant on observations with people than people’s care records.

Robust systems were not in place to help keep all staff informed of people’s needs and changes in their care and treatment to help ensure people received effective continuity of their care from all staff.

Information in relation to people’s needs and any changes with their care were shared through daily handovers with staff. However, when we spoke to staff, we found care plans were only completed by senior staff and any updates or changes were reported to staff on a WhatsApp group on their personal phones which is neither effective nor appropriate. We raised this with the registered manager and provider who told us they would issue work mobiles to staff in the near future.

People were supported to access healthcare services when required. A person told us “I’m sure if I needed a doctor, they would get me one.” A relative told us “If there’s any concerns, they will get the doctor for [person]” and “[Person] has a lot of 1:1 help because of their condition. I feel that they are adaptable to their needs, so that I am satisfied with the quality of care [person] receives. I don’t need to tell them of any concerns, because they seem to be ‘on it’ first and will call the doctor if they are concerned.”

Records showed staff communicated with other organisations when there were issues or concerns about people’s health and wellbeing.

The service worked in partnership with other services and a range of health and social care professionals to ensure people’s health was maintained, including the GP, chiropodist, district nurses, the local pharmacy and local authorities that commissioned the service.

People and relatives spoke positively about their care and treatment. A person told us “The carers know my capabilities, so that means they support me well.” Another person told us “The carers know me and support me when I need help. They speak to me and ask how I am, so it’s not just a case of helping me and moving off straight away.” A relative told us “I get confidence from the way the carers act. They are friendly and good natured and really understand [person’s] issues. [Person] hallucinates and can be a challenge, but they calm them down.” Another relative told us “They support [person] very well. They are very person focused and will guide them and chat to them. They really know [person] so well.”

Care records did not always detail, and staff were not always aware of people’s needs and the appropriate support people required with all aspects of their care and treatment.

Despite positive feedback we could not see how people were being supported to identify and work towards long-term goals as there was a lack of involvement from people and relatives recorded when people’s needs were assessed, reviewed and monitored. This was done by senior staff members.

People told us staff sought their consent before supporting them with their care and treatment. A person told us “They knock on my door before coming in and ask permission before helping me.” A relative told us “I feel [person] is in a good place here, it’s great. It’s a second home for [person]. They have [person’s] best interests at heart.”

There were Mental Capacity Act 2005 (MCA) policies and procedures in place and staff had received MCA training. However, the service was not following the correct procedures to ensure decisions were being made in people’s best interests.

Records showed Do not attempt cardiopulmonary resuscitation (DNACPR) conversations had been conducted by staff with people that lacked capacity. DNACPR decisions and conversations should be undertaken by staff that are appropriately trained, competent and experienced. Training records showed staff had not received any specific training in advance care planning and DNACPR decision making.

Where people were deemed to lack capacity, there was a lack of evidence to show the service acted in accordance with the MCA and the correct process was followed to ensure decisions were made in people’s best interests. For example, for one person, the MCA forms were fully completed by staff with references made such as ‘discussed with [persons] sister’ and ‘Next of kin (NOK) informed. [Relative] supports decision.’ However, there were no information showing what had been discussed and agreed with family representatives, therefore we could not be assured that the DNACPR decision was appropriately made in the person’s best interests.

For another person who lacked capacity, records showed a ‘friend’ was their representative. It was unclear what the role of the ‘friend’ was and whether they had legal authorisation to be the person’s representative. The MCA forms were completed and the decision made for the DNACPR for this person was done by staff and the GP only.

For another person, the DNACPR form stated was ‘based on a previous discussion with a NOK in hospital.’ This form was completed by the GP and the review date was left blank. There was no further information to show the DNACPR had been reviewed after hospital treatment to ensure the DNACPR was appropriate and took into account any changes in the person’s circumstances.

Decisions about CPR should be reviewed at appropriate frequent intervals. However, there appeared to be a ‘blanket approach’ adopted to DNACPR at the service. For example, records showed DNACPR forms in place had no review dates. DNACPR forms were signed off by the GP as ‘indefinite.’ There was no information detailing the reasons why DNACPR decisions would not be reviewed and that the appropriate best interest’s decision making process had been robustly implemented to ensure this decision was appropriate and lawful.