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

The service was in breach of legal regulation in relation to accurate record keeping to ensure safe care and treatment.

This service scored 59 (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 based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.
At our last assessment, the provider had not always informed CQC of the incidents we should have been notified of. A process for learning lessons following accidents and incidents was not in place. At this inspection we found some improvement but there continued to be further improvement needed in this area. Staff recorded incidents when they happened. However, the process for monitoring accidents and incidents and ensuring all staff learnt lessons from incidents to prevent a re-occurrence still needed a more robust and effective approach. The manager recorded lessons learnt during their monthly monitoring. These were general lessons and did not support learning around individual people’s incidents to enhance their future safety. A consistent process was not in place to cascade learning and check that all staff had read and understood their responsibilities to keep people safe from preventable incidents.

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.
Although no people from Cedar Court Care Home were in the process of moving between services, we found people’s care plans and risk assessments provided sufficient information to be able to share with others when necessary. This meant information needing to be passed to other agencies such as hospitals and other care homes were up to date and generally reflected the needs of the person. Staff who were unfamiliar with people would have the information to provide care and support if needed as their needs and risks were adequately recorded.
People had been referred to healthcare agencies such as GP, dietician, speech and language therapy and community mental health team. People and their relatives confirmed this when we spoke with them. A relative commented, “They keep her well and healthy.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.
At our last assessment, inspector’s observations at mealtimes led them to have concerns for people’s safety. At this assessment we did not have any concerns when staff were supporting people to eat their meal. Staff made sure people ate at their own pace and did not rush them.
Incidents were appropriately referred to the local authority safeguarding team and CQC were notified as required. Staff were aware of their responsibilities to report incidents in order to safeguard people.
People and their relatives told us they felt safe. Comments included, "I feel safe. They are nice here” and “She has a good relationship with the staff. They make everyone feel comfortable and safe.”

Where relevant, a Deprivation of Liberty Safeguards (DoLS) application had been made when people had been assessed as lacking the capacity to consent to their care and treatment.

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 safe, supportive and enabled people to do the things that mattered to them.
At our last assessment, we found some care plans did not contain enough information to ensure all risks to people’s safety and wellbeing were identified. Information on how staff should manage risks was not robust. At this assessment we found this generally continued to be the case. Although risk assessments were in place, risks in relation to some people’s medical conditions had not been assessed and mitigated against. For example, a person had a specific medical condition that could impact their everyday life. There was no information about this in either their care plans or risk assessments to make sure staff were aware of any potential risks. Some people had seizures and were prescribed medicines to control seizure activity. They had risk assessments in place in relation to seizure management however, the guidance was general, not individual to the person and their circumstances. There was inconsistency in the quality of information and guidance for staff. One person’s epilepsy risk assessment recorded what may trigger a seizure while another person’s assessment did not. Epilepsy risk assessments did not include the risks associated with bathing or using a wheelchair and the action to take to mitigate risks should a person have a seizure in either of these scenarios. A person became anxious and distressed, resulting in reactions such as shouting and occasionally showing some physical aggression. A risk assessment was not in place to ensure staff had the appropriate guidance to provide consistent safe support at these times.
Further work was required to ensure all risk documentation contained the guidance staff needed to keep people safe, was accurate and consistently linked to people’s conditions and care needs.
People and relatives told us they felt safe. Comments included, "I feel safe. I have been here a long time" and “She is safe, I am more than happy with her safety.”

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.
At our last assessment, the premises and furniture were tired and in need of refurbishment, there was an odour that needed investigating. The provider had not considered ensuring a dementia friendly environment including contrasting colours and signage. At this assessment, some improvement had been made, no odours were present throughout the service. Some redecorating had taken place, however, refurbishment was required throughout the service so this was an ongoing task to provide a more pleasant and homely environment for people. Many people were living with dementia, however, there continued to be a need to provide a more dementia friendly environment as described in best practice guidance. We found 2 rooms unlocked, housing boiler equipment and hot pipes as well as providing storage space, creating a risk to people’s safety. We told the manager about this who took action to add locks to the doors. Some people’s relatives told us they felt more effort needed to be put into improving the environment. Relatives’ comments included, “I think it could do with decorating and upgrading. It is clean though. Her room is small but clean” and “There are more modern ones, but they are improving. It needs a freshen up as it’s dated in certain places.”
Equipment such as hoists and wheelchairs were stored safely. The provider ensured all servicing of equipment and systems was completed appropriately.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support and development. They did not always work together well to provide safe care that met people’s individual needs.
Staff thought there were insufficient care staff on duty to provide the care people needed. We had received a significant number of anonymous whistleblowing concerns in relation to this. Although we found there were in theory sufficient numbers of staff on duty for the numbers of people living at the service at the time of the assessment, feedback from staff, leaders and relatives highlighted there was room for improvement in staff deployment. There was a culture of senior care staff not providing people’s day to day personal care as they were considered ‘office based’. The numbers of people living in the service had reduced and therefore staffing numbers had reduced. This meant when care staff were providing personal care to people in their room who required 2 staff to support them, there were potentially no other staff available to support other people during that time. Care staff told us some senior care staff did help put but others did not. The manager told us they were tackling the situation as senior care staff were expected to provide hands on care, however, this required more time to embed. The culture within the service meant people may not always receive the care they needed when they needed it. Relatives had mixed views about staffing levels. Comments included, “There always appears to be staff around and they are busy doing stuff. They are very visible” and “Sometimes there’s not enough staff but he does get all the care he needs. Sometimes it just feels like there’s a skeleton staff, it feels different. They do eventually get round to doing everything though.” The provider made the decision to increase staffing levels by 1 care staff on each floor following the assessment.
New staff were not always recruited safely. The provider had checked the disclosure and barring service to make sure staff did not have a criminal record, and had checked their identity and right to work in the UK. However, they had not always checked staff employment references carefully to make sure they were suitable and genuine.
 

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.
At our last assessment people were not always protected from the risk of infection. There had been a bed bug infestation that had not been controlled in a timely way, people were not given the opportunity to clean their hands before eating, and a relative reported their loved one had unclean hands. At this assessment, the prevention and control of infection had improved. The service was clean and odour free. The bed bug infestation was now under control, and a pest control company visited each month to check this continued. We saw people being given the opportunity to clean their hands before eating. A relative also told us they had seen this when visiting. Staff had access to personal protective equipment when needed and we saw staff using aprons and gloves appropriately.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.
Medicines were not always managed in a safe way. We found the numbers of medicines in stock did not always match the numbers that should be left in stock according to people’s medicine administration records (MAR). Staff checked the numbers left after giving people their medicines to make sure they tallied and recorded the numbers left in stock at the end of the day’s record. However, mistakes had been made in recording by some staff and other staff had followed the erroneous record without counting the medicines and realising the mistakes. This created a risk that people may not receive their medicines as prescribed and errors would not be picked up quickly. Most staff had a competency assessment to check they continued to be safe to administer people’s medicines. However, a member of staff on the list to administer medicines had not had a competency assessment. This meant people could not be assured all staff were fully competent to give them their prescribed medicines. We were assured the member of staff had their competency checked after the assessment.
Other areas of medicines management were safe. Where people were prescribed medicines to take as and when they needed, such as painkillers, guidance was in place to make sure they were given safely. For example, the reasons for the medicine, the safe intervals between doses and what side effects staff needed to be aware of. There were photographs of people on the MAR, a record of any allergies and how people liked to take their medicines.