Cedar Court Care Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We identified one breach of regulation. There was a lack of involvement from people and relatives in relation to their care. People’s care plans did not fully reflect people’s needs and how people should be supported safely. Information was not always provided to people in an accessible way. Staff did not have training in using different communication methods specific to peoples’ needs. Procedures were in place to respond to complaints. People and relatives contributed their views about the service; however, feedback was not always followed up. There was limited information in relation to supporting people with their equality and diversity needs.

This service scored 36 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives told us they were informed of any changes with people’s care; however they were not aware and had a lack of involvement with people’s care plans and care reviews. A relative told us “I believe there is a care plan. I think we did one when [person] came here, but I’ve never sat and read it since. They do tell me if there have been any changes to [person’s] needs, like changes to meds.” Another relative told us “I am the main [relative] who deals with [person], but no I have no idea about a care plan.” A third relative told us “I really don’t know much about [person’s] care plan, and I would have thought it would have been reviewed before, but maybe social services are involved with that.” A fourth relative told us “I don’t think the care plan needs changing; I guess that’s why it’s not been reviewed for a long time.”

People and relatives told us they have not been asked by the service specifically about their care. One person told us “I’ve never been asked if I’m happy with my care.” Another person told us “I’ve never been asked if I’m happy with my care. I’m sure they would notice if I was unhappy and listen to me then.” A relative told us “No one asks me if I’m happy with [person’s] care.” Another relative told us “I’m not asked if I’m happy with [person’s] care. I guess they are too busy to reflect on that.”

People’s care plans did not fully reflect people’s health needs and conditions and how people should be supported safely.

People using the service had specific needs such as epilepsy, diabetes, stroke, dementia and behaviours that challenged, however care plans contained limited guidance for staff on how to support people appropriately and safely. For example, one person had type 2 diabetes, however in their care plan it stated staff will offer diabetic meal choices and support, to have a healthy diet and for staff to support the person, however there was no further information detailing what their diabetic diet included, how staff were to support the person and actions to take should there any changes in the person’s blood sugar levels.

Another person who had epilepsy, their care plan stated they had suffered from seizures and staff to support the person with taking their medication for a risk of seizure to be reduced as possible. However, there was no further information about the person’s seizures and the support the person should receive should they suffer a seizure.

We found there were no formal care review meetings with people and relatives in which people’s care was discussed and reviewed, and they were involved in making decisions about their care to ensure people’s needs were being met appropriately.

People were supported to access services when needed.

Staff were aware of how to access services to ensure people’s care needs were met.

The service worked with other health and social care professionals to ensure people were supported with their needs. A healthcare professional told us “We have a good working relationship with the service, we meet monthly and discuss any resident that they are concerned about, follow up and give advice. The management team email or call with any query or question and respond in a timely manner when we require responses. They always take on board any suggestion or actions we make.”

We found information within the service was not always provided to people in a way that was accessible. For example, people’s care plans and policies were not available in accessible formats, there were no pictorial menus and use of signs or pictures being used to support people to understand information. This limited the choice and control people had in their day to day lives on accessing information about them and that could support them to make decisions.

People’s communication needs had been assessed and recorded, however there was not always detailed guidance for staff on how to best communicate with people. For example, a person’s care records stated they had autistic traits and has delayed speech or does not speak. The person’s eyesight and hearing deteriorated which makes communication very difficult and the person now screams and swears to make themselves known to staff. However, there was limited information detailing alternative communication methods for staff to support people with profound needs and impairments.

Care records for another person stated they were able to communicate verbally but at times can become confused. The person struggles with word placement when trying to speak longer sentences can become confused so staff to give him reassurance, however there was no further information detailing what this meant and how and what reassurance staff should be providing to the person.

Since 2016 onwards all organisations that provide publicly funded adult social care are legally required to follow the Accessible Information Standard (AIS). The standard was introduced to make sure people are given information in a way they can understand. The standard applies to all people with a disability, impairment or sensory loss and in some circumstances to their carers.

Staff we spoke with did not know what the accessible information standard was and were unable to tell us how they provided information to people in different formats. Staff told us that no other communication methods apart from looking at hand, facial and body language was used to aid communication.

Training records showed staff had received effective communication training, however, did not have training in using different communication methods specific to people with needs such dementia and where English was not their first language.

There was a lack of reasonable adjustments made to ensure people were supported with accessible information to understand, to be able to express themselves and enable them to communicate their wishes effectively.

For one person, there was a booklet with photos and descriptive narrative in their native language and flash cards. However staff relied on the person to bring the flash cards to them when they wanted staff to understand what they were saying rather than staff being actively engaged with the person. We did not see these tools being used by staff during the site visit. The person used body language, facial expressions and hand gestures to make their needs known, however there was no information or guidance for staff as to what these were.

There was contradictory information about the language they used to communicate. Some parts of the care plan stated they did not speak English, other parts stated they had limited English. Due to the person’s dementia, the person can become confused and often mixed English words with their native language, however there was no information detailing how staff were to communicate with them. The care plan also states staff to offer opportunities to participate in activities, but did not provide any guidance as to how to do this in accordance with their individual communication needs.

Care records for one person showed their communication ability was declining and was not able to verbally converse. The person was no longer able to say full words and will communicate with hand gestures and thumbs up signals, however there was no information on what these gestures were. Records also stated due to poor communication, the person struggled to interact with others, but enjoys 1:1 with staff, however there were no records to show this was regularly taking place. The care plan stated that the person needed staff to anticipate their needs but there was no information detailing how staff should anticipate the person’s needs.

People and relatives were supported and encouraged to contribute their views about the service. A relative told us “I have attended relatives’ meetings.” Another relative told us “ I have been to a meeting held for relatives. We just talked generally about things. There is a Facebook page, but we don’t get personal emails. I would like more communication with how things are going. We are told if there are major events happening.” However, feedback was not always acted upon.

People and relatives were able to approach staff and the registered manager if they had any concerns.

Feedback from people and relatives was obtained through resident and relatives’ meetings. Minutes of meetings showed people and relatives spoke positively about the service and were able to share any feedback and raise any concerns. Records showed complimentary thank you cards and comments received about the service.

Surveys were also sent to people and relatives to obtain feedback. We reviewed the surveys from January, April and August 2024. Although the overall feedback about the service was positive, there were some concerns raised about the décor, activities, the laundry service to prevent clothing being lost or misplaced and not having seen the complaints procedure. However, there were no records which showed any of these areas had been followed up and actioned.

Procedures were in place for receiving, handling and responding to complaints. The registered manager told us no complaints had been received about the service.

People were supported to access healthcare services when needed.

Staff were aware of how to access the necessary support for people.

The service made sure that people could access healthcare services.

People told us they received visits from members of their local church. A person told us “There’s a couple of ladies from the church who talk to us” and a family member told us “The vicar comes in at times.” However, not all cultural needs for people were being met by the service.

Not all staff were able to tell us about people’s cultural and religious needs. Three staff members told us no one at the service had cultural needs even though there were two people who needed support with this.

Care records for people contained limited information on their equality and diversity needs. Care records listed people’s religion, however there was limited information detailing how people were supported with their cultural and religious beliefs; this included cultural diets. Two people liked to eat traditional foods which family members would bring the food in for them. However, there was no information in their care records to show that staff had asked the family about people’s traditional foods so they could be supported with this appropriately.

No one at the service currently received end of life care.

It was unclear how staff supported people to plan for important life changes and future care, so they can have the time and support so informed decisions can be made about their future, including at the end of their life. Care records contained limited information about this and there was no clear process for this to be done and that people and relatives were involved with this process. .

There was a lack of information in relation to people’s end of life care and wishes to help ensure these could be met and managed in sensitive manner. There was no information showing how the service would work with relevant healthcare professionals including GPs and local hospices to ensure people’s end of life needs were met with dignity.

One person’s care plan stated for them to pass away peacefully and pain free. The person has relatives involved with their care, however there was no information showing their involvement to explore whether the person had any particular wishes and how their end of life care should be given.

Another person’s care plan stated for them to be comfortable, pain free, during their end of life and have their privacy and dignity respected. Staff to act in person’s best interests involving person’s family in all end of life decisions. However, there was no information detailing whether this had been discussed with the family.

It was not clear how people who lacked capacity were supported and best interests decisions were conducted to ensure people received the appropriate care and support as needed. For example, one person’s care plan who lacked capacity, stated they had no next of kin, however, does have an advocate who will be kept informed of any changes to [persons] end of life care. [Person] to be comfortable and pain free at their end of life. However there was no further information detailing the advocates involvement to ensure decisions were made in the person’s best interest and measures they would be in place to ensure the person was comfortable and pain free.

For another person who had no next of kin, their care plan stated for them to pass away with dignity and pain free. However, there was no further information detailing how the service would ensure this and how decisions will made in the person’s best interests in relation to their end of life care wishes and ensure these were met with dignity.