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

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.
At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 58 (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 make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.
There were some inconsistencies between assessments and the information in other parts of the care record. A person’s nutrition assessment recorded they were on a modified diet but the profile on the front page of their electronic record recorded they were on a normal diet. A person’s relative told us they had a condition that impaired their vision, however, this was not recorded in any of their assessments and therefore not included in their care plan and risk assessments. Another person’s assessment recorded they had a medical condition that may affect their life and life expectancy. However, no further information about the condition and how it affected them and may affect them in the future was included in any of their care plans or risk assessments. There was a risk staff may not provide the most appropriate and safe care in relation to the condition, including recognising symptoms and deterioration in the person’s condition. This could lead to poorer outcomes for the person.
Initial assessments were undertaken with people before they moved into the service to make sure their needs could be met by staff. However, the provider had admitted people who had a learning disability when the service was not equipped to provide the specific care and support people with a learning disability may need. This meant people may not have access to specialist support, appropriate staffing levels or an environment that suits their needs.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.
People’s care plans had been reviewed regularly. Staff used nationally recognised tools to assess risks to people such as malnutrition and skin integrity which were accurate and generally contained up to date information. Care records generally provided guidance for staff on how to respond to most identified risks, and how care should be delivered in line with best practice. Staff knew people well, and together with appropriate guidance, most people could be supported consistently. A relative said, “She doesn’t walk alone she always walks arm in arm with staff. They have said she can’t walk alone. They do use a wheelchair if needed.”

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.
The provider worked well with other teams such as healthcare providers and safeguarding teams, seeking advice to support people. Records demonstrated involvement from GPs, district nurses, dietitians, mental health professionals and other specialist services when required. There was nobody moving between services at the time of the assessment however, processes were in place to support people in transition if they did. A relative told us, "She has a district nurse who comes to see her. I am told every time the GP is involved, and they keep me updated on her progress."

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.
Care plans generally included nutritional monitoring, hydration support, bowel management, skin integrity management and falls prevention. People’s health needs were usually recognised to support people with their health and well-being. However, people who had a learning disability were living at the service and although they had an annual health check which is good practice, their social and well-being needs were not always fully considered or met. People who have a learning disability usually respond better in a specialist service, in a smaller home sharing with people with similar needs and supported by staff who are focused on those needs. This way of living promotes a holistic approach to supporting people’s independence, choice and control.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.
At our last assessment, care plans for people who required additional behaviour support did not have sufficient information about how staff should support them documented. At this inspection improvements had not taken place or been maintained. Monitoring systems were not always in place to improve care and drive improvement. Where they were in place, they were not always effective in assessing risk and improving outcomes. For example, a person’s oral health plan recorded they had their own teeth. However, the record also stated the person does not see a dentist without any explanation why or what was being done to support them to see a dentist. The lack of dental care input may lead to poor outcomes for the person in relation to pain or losing their teeth.
Some people who were known to get anxious and distressed had care plans in place describing this and recorded an action to take that may help to support the person to calm. However, the records also stated that the action described should only be taken to ‘reward good behaviour’ rather than when they have ‘not been good’. This could lead to action by staff that creates poorer outcomes for people if they are misunderstood, rather than a positive approach to intervention and support.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.
At our last assessment, staff did not always seek consent from people relating to their care and treatment. At this assessment, we found improvements were still needed in relation to people’s rights around capacity and consent. There were inconsistencies in some people’s care records in relation to their capacity to consent to specific decisions. One person’s care plan recorded contradictory information about their ability to consent. Some care records described the person as having poor retention, cognitive impairment, inability to recognise risk and inability to manage safety independently. However, no mental capacity assessments had been undertaken to determine their capacity to make specific decisions in relation to their care. Other people did have mental capacity assessments in place where they were deemed to not have the ability to make the relevant specific decisions. However, some were not individual to the person or did not record evidence of how the assessor determined the person lacked capacity. For example, the record did not contain information about how the assessor knew whether the person understood what they were being asked and could retain and understand the information. It was also not documented what steps had been taken by the assessor to try to support the person to understand. This could include if they used prompts or pictures or tried a time of day that might suit the person better, to give them the best possible opportunity to make decisions. This meant people’s rights may not be upheld within the guidance of the MCA 2005.
We saw staff offering people choices, for example at mealtimes, and seeking consent before placing protective covers over their clothes before eating. The staff we spoke with were able to describe the principles of choice and consent.