Cedar Grange

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 good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

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.

The provider made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

People’s needs were assessed comprehensively, and care plans reflected health conditions and risks. Assessments included communication needs, continence, mobility, and nutrition. For example, 1 care plan detailed dysphasia (language difficulties) and provided clear guidance for staff on how to support communication. Staff confirmed they received detailed handovers and used the new electronic system to access up-to-date information. A staff member explained, “The handheld system makes us work faster and more efficiently. You have all the information you need instantly so it helps a lot when taking care of residents.” However, some care plans lacked detail in personal history and preferences. The registered manager told us there was a process in place to update these as care plans were moved to the electronic care planning system.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Care was delivered in line with best practice for nutrition, hydration, and pressure area care. The cook demonstrated a good knowledge of how to fortify diets, to support people who were vulnerable to weight loss, and the different types of textured diets people required. They told us, “I like to fortify food, put spinach in quiche and thicken soups with mash.” However, clear guidance and information about the slings people had and used to support them when moving were not included in care plans. The registered manager rectified this during our inspection visit.

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.

Staff worked collaboratively and held daily ‘huddles’ involving all departments. A staff member explained, “At 10:45am [the registered manager] comes with the senior, we do a huddle so all daily information you may have missed is discussed.” Electronic records supported efficient communication, and staff described strong teamwork. Agency staff were integrated but staff told us they sometimes lacked engagement with residents, which impacted the social atmosphere. Staff consistently demonstrated a commitment to supporting each other and maintaining continuity of care. Staff ensured guidance from health professionals was followed.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People were supported to maintain health through routine monitoring and timely referrals. The service supported and encouraged people’s access to a wide range of health professionals. Care plans showed involvement and how staff had followed their instructions. For example, diabetes management had contributed to the improved stability of the health of a person.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Outcomes were monitored through monthly reviews and audits. The electronic system enabled real-time updates, and staff understood the importance of accurate documentation. Improvements were made promptly when concerns were raised, and staff were proactive in suggesting, for example, changes to how staff were deployed to support better care for people.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

Consent processes were inconsistent. Whilst general consent forms were in place, they were not specific to individual decisions. Mental Capacity Act (MCA) assessments lacked detail about questions asked and had not always been reviewed. Best interest decisions were recorded, but involvement of all relevant parties was not consistent, and conditions about some people’s deprivation of liberty safeguarding (DoLS) applications were not reflected in care plans. Staff demonstrated awareness of the need for least restrictive options, but documentation did not fully meet legal requirements. The registered manager took action to improve this following the inspection visit.