The Cedar Grange Nursing 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. This is the first assessment for this newly registered provider. However, the new provider inherited the previous rating of requires improvement. This key question remains rated requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent. The provider was in breach of the legal regulation relating to dignity and respect. Care was not always provided in the most dignified manner to meet peoples needs.

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 service did not always have effective systems in place to ensure people’s health needs were effectively planned and reviewed For example, where people had diabetes there was not a care plan in place to guide staff on the protocols to follow when peoples sugar levels were raised or too low. Staff told us they were not always involved in the planning and reviewing of their care. One staff member told us, “We’re not always included in the assessing of people or completing the care plan for people”. People’s communication methods were outlined within their care plans to enable them to receive care and treatment which worked for them. The registered manager had a process to assess new referrals, this provided an initial assessment plan that recorded people’s needs, likes and dislikes. The registered manager also worked with the local authority and people to include professionals’ assessments and care already in place.

The provider did not always ensure care and treatment met best practice guidance. For example, COPD care plans did not have therapeutic Oxygen levels, and we found 1 person had SATs levels that were clinically out of the safe range. This did not meet the National Institute for Health and Care Excellence (NICE) guidance which provides national guidance and advice to improve health and social care and refers to specific target ranges for people. The provider used a standardised malnutrition screening tool to ensure people’s need were suitably met however the hydration targets set for people were not realistic or based on best practice guidance to keep people healthy. For example, fluid levels were set at random numbers for people to achieve daily. We raised this with the registered manager, and it was identified to be a system error and the electronic care plan was generating levels without this being inputted manually. Following our inspection, the provider has investigated this and found it was down to a staff inputting error.However, where people had a specific specialised diet, the kitchen staff were aware of the consistency and how this needed to be prepared. The registered manager had regular supervisions with staff and a plan was present to complete supervisions and appraisals throughout the year. Staff told us this provided a chance for them to develop and deliver feedback on the service.

The staff worked well across teams and services to support people, this included when people moved between different services. One visitor told us their experience of the care they had from the service. This included the person moving into the home in a poor state of health, to becoming independent and well enough to return home independently. They told us, ‘I always feel welcome here, and now come and visit regularly’.

We were not assured that people were consistently supported to live healthier lives. Robust monitoring was not in place to keep effective oversight of the management of people’s diabetes. For example, records showed a person’s sugar levels were higher than the safe levels recorded in their care and no action had been taken in response to this. However, people were supported to access healthcare, at and away from the service. One person told us, “If ever I feel I need to see the doctor, the staff help me do this”. People told us they were happy with the quality of food provided and were always offered choice. One person told us, “Meals are very nice here”.

The service did not always evidence care and treatment was provided as planned. A new electronic care planning and daily note recording system had been developed and implemented into the service. The system needed further development, and staff were learning how to use and input information into the system. This meant there were missing details found in documents recording the care people had received each day. The provider and registered manager were responsive to our feedback and actioned a review of peoples care records and outcomes. The registered manager also contacted the electronic care planning team to discuss and make plans on how this would be inputted into the system.The provider has given assurances that further training was provided since the inspection

Where appropriate, people had best interests and mental capacity assessments in place. However, these lacked detail, did not always contain essential information or show when people’s representatives were involved. In response to our feedback, the provider took action to ensure this would be reflected in future capacity assessments and best interest decisions. The staff told people about their rights around consent and respected these when delivering person-centred care and treatment. A person told us, “They always ask how I would like things done”. Staff had completed mental capacity training and understood the principles of implementing this into the care they provided.