The Cedar Grange Nursing 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. This is the first assessment for this newly registered provider. However, the new provider inherited the previous rating of requires improvement. This key question has remained rated 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 provider was in breach of the legal regulation relating to safe care and treatment. Risks were not always identified and health diagnosis’s requiring monitoring required improvement.

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 and registered manager evidenced a learning culture in the care provided. A system and process was in place for reporting and recording accidents and incidents. The registered manager completed a trend analysis and monthly audit of accidents and incidents, these would then be discussed with the team and actions to mitigate further incidents were recorded and completed. We saw where a serious incident or safeguarding concern had been present, the staff team were provided with a debrief and a team meeting would be held. One staff member told us, “All incidents are reported and shared, very open and honest”. The provider had in place a business continuity plan. This covered all aspects of what to do in the event of an emergency.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. For example, the care plans of people who were diagnosed with Chronic Obstructive Pulmonary Disease (COPD), had no information about safe oxygen saturation levels (SATs) to guide staff to identify and provide appropriate support to people at times when their oxygen levels become too low. When we highlighted this missing information, the registered manager contacted a medical professional to request the information required around people’s COPD needs. The staff did however work well with external professionals to provide effective rehabilitation for people to support with progression into independent living. One person told us how they had moved to the home and the service provided such a high level of care, they were able to move back into their own home and live independently. The person told us, “The staff were excellent and ensured they invested time into me, can’t thank the home and the manager enough”.

The provider did not always effectively keep people safe and understand the best way to achieve safety. For example, where a person required support during times of emotional distress, the provider had identified on a risk assessment a person’s distressed care need. However, we observed this was not followed to mitigate the risks or impact of the persons distress on others. During our visit we observed 1 person in distress, this impacted on the person they were sat with and resulted in both having a food substance thrown over them. Whilst people and relatives told us they felt safe and protected from harm and abuse, we identified concerns that required the service to improve. For example, where people are at risk of self-neglect, no plans were in place to mitigate this. One staff member did not always respond to service users distressed emotions and this caused impact on other service users. However, the registered manager responded to safeguarding concerns and reported safeguarding’s that were present in the home. Staff had completed safeguarding training and told us how they identified any forms of abuse and the channels they would follow to report this. One staff member told us, “We report safeguarding to the registered manager, they report this and if were not happy they have reported correctly we would contact CQC”.

The provider did not always work well with people to understand and manage risks. Risk assessments relating to the health, safety and welfare of people using the service were not always completed. For example, where a person required support during times of emotional distress, the provider had not identified or mitigated the risks or impact of the person’s distress on others. In response to our feedback, the registered manager reviewed the person’s care plan and updated the risk assessment to include the risk to others. We also found that where risk assessments and plans were in place, these were not always followed to keep people safe. For example, where people had been identified as at risk of dehydration, fluid charts were not completed effectively as planned. This meant we found some people had not met their fluid intake targets for periods of up to 8 days and action had not been taken to address this in accordance with the care plan or the provider’s policy. We raised this with the local safeguarding authority and registered manager who took immediate action and introduced a system where nurses would check fluid charts and include this in their daily handover. We will check this system has been effective at our next inspection.

The provider did not always make sure the facilities supported safe care. For example, clear, dementia friendly signage was not in place to support people living with dementia to mobilise independently around the building. The provider did not always control potential risks in the care environment. For example, radiator covers did not always cover the full length of the radiator and appropriate risk assessments identifying and mitigating the risks that this posed to people were not in place. Whilst no incidents of burns had been reported at the time of this assessment, due to the needs of people the potential risks were high. The provider and registered manager took immediate action to resolve this. We will check this action has been effective at our next inspection. The provider did however have good oversight around fire safety. Fire checks were completed regularly, this included fire equipment checks ensuring fire alarms were working and keeping people safe in the event of a fire happening. The provider completed monthly environmental audits. We saw the registered manager completed daily environmental checks during their walkaround. A discussion of the environment would be discussed during daily flash meetings where heads of departments would meet to discuss the homes practices.

The provider had not always ensured staff were skilled and knowledgeable to provide safe care and support. For example, where people had needs that required monitoring, such as, diabetes management, staff had received online training, however, were not clear on how to manage this condition safely. This placed people at increased risk of harm. However, the provider did ensure there were enough staff working at the service, 1 person told us, “There’s enough staff. [relative] used to need 1 now they need 2. There are always enough to hoist [relative]. It’s never been a problem”. Staff received effective support, supervision and development in other areas of their role. The registered manager took immediate action in response to our feedback and booked staff onto the required specialist training.

The provider had systems in place to support infection prevention, however, systems were not always robust in identifying shortfalls in the daily running of the home. Personal protective equipment stations were positioned around the home. However, not all stations had the required PPE present for staff to use. The registered manager completed daily walkarounds, however these were not effective in identifying that the PPE stations throughout the home were not stocked appropriately. However, the home was clean and tidy. Cleaners followed cleaning schedules, and these were signed off daily once completed. The provider had a home improvement plan in place which included how and when they were going to redecorate and replace flooring.

The provider did not always ensure that medicines were stored and managed safely. We found discrepancies with medicine stock levels. For example, paracetamol had been incorrectly counted, and staff had recorded the incorrect amount for 2 consecutive days. This medication was then sent back to the pharmacy, however, there was a discrepancy not identified of 4 missing tablets. Some people were prescribed ‘as required’ (PRN) medications. Where people were having these on a regular basis, no reason or medication review had taken place to monitor this. Prescribed creams were left on side units in people’s bedrooms. This was a risk to people who walked independently around the home as these medicines could cause harm if they were accessed unsupervised. The registered manager and provider was responsive to our feedback and took immediate action to resolve the concerns we raised. We will check this action has been effective at our next inspection.