Cedar Lawn 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 inspection for this service. This key question has been 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.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff told us they knew how to raise concerns with the registered manager and felt confident they would be treated with compassion and understanding. A staff member gave us an example of when they raised a concern with the registered manager and that changes were made as a result of it. Relatives told us they knew how to raise concerns and were confident they would be listened to. A relative told us, “Staff are very on the ball and always happy to support me or hear our suggestions.” The service held meetings for relatives which they found useful.

The service worked with people and health and social care partners to establish and maintain safe systems of care. They made sure there was continuity of care, including when people moved between different services.The service had a process in place to ensure people’s information was available if the person was admitted to hospital.People and relatives told us they were supported to attend health appointments with staff who knew them well. Staff we spoke with said they had access to information about people to know how to support them.

Health and social care professionals we spoke with were complimentary about the service. A health and social care professional said, “There are no issues with flexibility and continuity of care. Staff will email us if they have any concerns or require advice.”

The service worked with people and health and social care professionals to understand what being safe meant to them and the best way to achieve that. The service shared concerns quickly and appropriately and had established safeguarding procedures in place.

People and relatives felt the service was safe.One relative told us, “[Family member] has settled in nicely and is very happy [at the service].” Another relative said, “I can see that all of the residents are kept safe by the actions the staff are taking when I am visiting.”

Staff received training in safeguarding and the provider had an up-to-date safeguarding policy in place. Staff were also aware they could report any concerns they had externally to the local authority or CQC.The service had posters displayed in communal areas on how to contact relevant agencies if required. One staff member told us, “I have not seen any colleague who is not kind and caring. If I did, I would be raising this with them and the registered manager.” Another staff member said, “People are safe, there is always someone who is constantly checking on them.”

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.

Staff knew people well and communicated changes to people’s care needs to the relevant health and social care professionals.

Staff were aware of people’s risks. Staff confirmed they had time to read people’s care plans, however we found the care plans were not always reflective of the support needed and were not person centred. For example, some care plans contained conflicting information relating to people’s frequency repositioning in their records. In response to our feedback the registered manager started the process of reviewing and amending people’s care plans.

The service 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. We observed air flow mattresses were not consistently checked to ensure they were set at the right level for the person using them. The provider had a system to monitor the settings for air flow mattresses. However, this was not always used effectively to identify incorrect settings. We found mattress settings were not always set correctly, in line with people’s assessed needs. The registered manager responded to shortfalls identified and implemented a new system to ensure compliance to mitigate the risks.

Some equipment, including wheelchairs and hoists, was stored in the hallways due to lack of space. Some of the bathrooms were not being used for their intended purpose and instead were used as storage.

All the equipment seen during the inspection was checked by qualified professionals and well maintained. The service used external contractors to undertake some of the environmental checks such as gas, electrical and water hygiene. This meant they had been carried out by qualified individuals.

People’s rooms were clean, and personalised.

We received mixed feedback from people and relatives regarding staffing levels at the service. Some people felt they were not given as many options in the afternoons to do what they wanted due to the number of staff on duty. Comments included, “Staff don't have time to do [an activity] and I miss that they haven't got time," "Staff come in and then have to go. They are hounded," and “Finding time for the staff can be hard as everyone is pushed but I get the support I need."

Comments from relatives included, “When I have visited mid-morning, on occasions [family member’s] breakfast is still on the bed tray where staff have not been able to support [my family member]. I think that the morning staff are busy and maybe there is not enough of them”, “I have not had any issues when needing help [from staff]”, and “We could always do with more staff, but we have never struggled to have assistance if needed. Staff work hard but are always available and friendly.” The service had a system to determine the number of staff required in relation to people’s needs. The system indicated that staffing levels were sufficient. The registered manager was in the process of reviewing the staffing needs for the service.

Recruitment procedures were in place, however we found some gaps in staff’s documentation. The registered manager responded to our feedback and assured us all files have now been checked and any gaps addressed.

Staff received appropriate training to ensure their competence was maintained. A staff member told us, “Training is good if I need something I can speak with the registered manager.”

The service assessed and managed the risk of infection. We observed the service to be clean and cleaning staff maintained a constant presence within the service.

The service had an up-to-date infection control policy in place. Staff were aware of the importance of cleanliness and hygiene.

Staff received training in infection control techniques and were observed to use Personal Protective Equipment during our onsite inspection.

People received personalised support with their medicines. The service worked with health care professionals to ensure medicines were given in a safe way, for example when tablets had to be crushed and not taken whole. Creams were dated when opened and stored safely. Some people were prescribed ‘as required’ medicines and had up-to-date guidance in place to help staff administer these medicines safely.

We found some gaps in temperature monitoring records for the medicines’ rooms. Additionally, there was no guidance for staff on what the process was for reporting or acting on temperatures that were outside of those deemed as safe. In response to our feedback the registered manager introduced updated temperature checks. The documents included guidance for staff about actions they should take if temperatures exceeded safe ranges.