Cedar Court Care Home

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 inspection we rated this key question inadequate. At this inspection the rating has changed to requires improvement. This meant some aspects of the service was not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

At the last inspection, the service was in breach of safe care and treatment in regulation for not having effective risk assessments for people living with diabetes, epilepsy and risk of choking.

While improvements had been made, the service was still in breach of safe care and treatment.

At the last inspection, the service was in breach of regulation in relation to premises and equipment, staffing, infection, prevention and control, and the management of medicine. At this inspection, we found enough improvement has been made and they are no longer in breach for these reasons.

This service scored 50 (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 always have a proactive and positive culture of safety. Staff did not always listen to concerns and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

Concerns were raised about people’s personal items going missing. Relatives told us they did not think staff or management took these concerns seriously. Relatives gave us examples about personal items going missing. We raised this concern with the management team who told us it would be investigated, and that the issue with a watch had been resolved.

The service kept a log of falls, accidents and incidents. While CQC do not need to be notified of every accident or incident within the service, we saw incidents recorded of which CQC should have been notified of and were not. We raised this with the management team, highlighting which incidents should have been notified to CQC. While the log had a section to record lessons learned, causes of accidents, preventive measures put in place and learning from accidents and incidents were not documented. This left people risk of experiencing the same accidents and incidents and put people at the risk of avoidable harm.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

At the time of the inspection no people were transitioning between services. People told us they were supported to attend appointments as required. A healthcare professional told us they thought the management and staff were, “Approachable, collaborative and demonstrated a clear commitment to the well-being of their residents.” People and their relatives told us they thought the service worked well with healthcare professionals. They told us they had access to the GP associated with the service. They also told us they had access to a chiropodist and an optician who visited the service regularly.

Staff did not always work well with people to ensure they were not at risk of avoidable harm. We observed 2 separate instances of staff supporting people with meals while not giving people sufficient time to chew and/or swallow the content in their mouths before giving the person another spoonful of food. In one instance, a inspector intervened and asked the staff member to slow down. This behaviour put people at the risk of unavoidable harm by way of increasing the risk of choking. The management team advised us that mealtime observations and spot checks to ensure people were being supported safely at mealtimes. Choking competencies were updated and due to be completed and reviewed twice a year.

A relative fed back that they were not assured they were notified of instances of falls experienced at the service. The service did have a falls risk assessment in place, and falls were recorded when noted.

Some people and their relatives told us they felt safe at the service. We received comments like, “I think [relative] is protected from harm.” and “[Relative] is safe there, I think things are fine, I’ve never seen anything of any concern.”

The service had a safeguarding policy in place. The service worked with the local authority and health professionals, to put measures in place to best support people.

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

Some care plans did not contain enough information to ensure all risks to people’s safety and wellbeing were identified, and information on how staff should manage risks was not robust. For example, risk assessments for people living with diabetes did not specify how blood sugar levels should be managed. Some risk assessments were not personalised and contained generic information, which detailed the condition people had, but not how the condition should be managed individually for people. This put people at the risk of being supported by staff who were not adequately informed on how to manage their care needs, putting people at the risk of avoidable harm. We discussed these concerns with the management team who told us assessments would be reviewed.

Despite our findings, some people and their relatives told us they felt they were involved with managing risks. We received comments like, “We did a plan, and put everything down and used [relative’s] doctor’s records to plan”, and “Yes, they did a plan, my [relative] and I were involved. They changed things as [relative] deteriorated, they had several meetings about changes that needed to be made.”

The provider did not ensure the environment was dementia friendly. There were examples of poor maintenance and cleanliness that needed to be addressed.

While improvement has been made since the last inspection, the decor of the service was tired and needed to be updated. The décor of the service did not have contrasting or bright colours which might be an advantage to people living with dementia. There was a lack of dementia friendly signage around the service. This left people living with dementia at risk of becoming lost or confused in the building.

The walls in some bedrooms were damaged by deep markings beside the beds. The manager explained the damage was caused by the movement of bed furniture scraping along the walls when in operation.

On inspection, we noted an odour coming from 2 of the shower rooms. The manager explained that this might have been caused due to the extractor fans not being in operation once people had left the shower room after use. We were told this issue would be investigated with the intention to rectify. We saw a loose tap in 1 of the shower rooms. This was brought to the attention of the manager, who organised for maintenance to look at it straight away.

Some people and their relatives told us they were not happy with the environment. One relative said, 'The home is tatty, the rooms aren't fancy, and the furniture isn't good.'

The doors to people's rooms appeared new and were fire safety approved. Doors had people's pictures on them. There was also information about staff who supports them; however, the writing was small and situated above head height on the door. This meant important information might not have been legible to people with the capacity to read it. We brought this to the attention of the leadership team.All the bathrooms, ensuites and toilets have been refurbished to a good standard and were clean and presentable. People were happy with the refurbishment that was underway. Staff toilets clearly labelled and separate from those people used in the service.

The stairways were wide and had emergency lighting installed in the event of a power cut.

Some people’s bedrooms were newly decorated, nicely presented, and had people's personal effects present.Some people’s bedrooms were newly decorated, nicely presented, and had people's personal effects present.

The provider did not always ensure staffing was safe and effective. People told us they thought the service did not have enough staff to care for people. One person said, “They need more staff, they are not managing with the type of people.” Another person said in relation to staff numbers, “It depends on the day, sometimes they seem to have less staff particularly at the weekend where [relative] can be a little dirty.” A health professional told us they find it difficult to get someone to assist them if they visit the service early. This put people at risk of not receiving support in a timely manner. However, some people did think the service had enough staff. One person said, “Yes, every time I go there, there is at least 3 or 4 of them[staff].”

During the inspection, we saw the service had enough people on duty to support people safely with their care and treatment.

The provider had measures in place to ensure recruitment was safe. Right to work in the UK checks, while present were not fully completed. We raised these concerns with the management team. They quickly gathered the missing information to update the recruitment files. We saw a staff file which had inappropriate references for background checks. We raised this with the leadership team and were informed this member of staff was employed by the previous provider and they did not complete this staff members recruitment process.

New staff employed received an induction. They shadowed experienced staff before they were able to care for people independently. The provider ensured staff had access to a wide range of training including Safeguarding Adults, Dementia Care and Health and Safety Awareness. Training was delivered both online and face to face. The manager completed themed supervisions to check staff competencies. One staff member told us, “I can go to my manager and say if I want to do training. They listen.”

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly. Several people and their relatives raised their concerns over a bedbug infestation. The service was working with the pest control team to resolve this issue. The latest pest control report we reviewed showed the infestation had greatly reduced and activity was present in 1 room in the home only. We are continuing to monitor the progression of this.

One person told us they observed their relative to have dirty hands when they visited and thought there was a hygiene issue at the service. They said, “I worry about [relative] eating like that.”

We observed not all people were given the option to wash or clean their hands before or after mealtime. For example, at lunchtime, 10 people were seated within the dining room on the first floor, only 1 person was offered an antibacterial wipe to clean their hands and face. The issues found at inspection put people at the risk of avoidable harm by not doing all reasonably possible to reduce the risk of infection being spread.

People told us staff wore PPE, and they saw staff washing their hands when going between different residents to support them. All staff wore uniforms which were in a clean and presentable manner. All the kitchen staff were in clean uniforms, and had their hair covered while working in the kitchen.

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. Staff were observed to administer people’s medicines appropriately and in line with current guidance. The medicine rounds were evenly spaced out throughout the day to ensure people received their medicines at appropriate times. Observation of staff practice showed staff undertook this task with dignity and respect for the people being supported.

We viewed the Medicine Administration Records [MAR] for 10 people and found they were maintained at a good standard. This demonstrated people received their medicines required in line with the prescriber’s instructions.

The service ensured people's behaviour when anxious and distressed was not controlled by excessive and inappropriate use of medicines. A register to record the receipt, administration, disposal and transfer of controlled medicines held by the service, were maintained to a good standard.

Where people had their medicines administered in a disguised format, the need for covert administration was recorded, including evidence of GP and pharmaceutical advice and authorisation. However, 1 person’s medicines care plan had conflicting information, stating they were compliant and required their medicine to be administered covertly on occasions. We discussed this with the management team who confirmed the person was not receiving medicines covertly. We were advised the care plan would be updated quickly.