Cedar Grange

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 changed to good. This meant people were safe and protected from avoidable harm.

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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff were encouraged to report incidents and understood the process for follow-up. Accident forms were completed, and investigations included staff statements. Lessons were shared during daily huddles and handovers. A staff member told us, “We have to fill out accident forms and if an investigation is needed, each person gives a statement.”

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.

People moved into and out of the service safely, with appropriate documentation in place. ‘Hospital passports’ were available for most people.

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.

Staff were knowledgeable about signs of abuse and confident concerns would be addressed. Safeguarding logs were maintained, and incidents were reported to external agencies when required. A staff member confirmed, “There are people you can go to when you have issues or concerns to raise and speak to.”

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risk assessments were in place for epilepsy, falls, choking, and skin integrity, but involvement of people and relatives was variable. A relative commented, “Some things I didn’t get to know until the end of the day but staff knew.”People accessed health professionals promptly.

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.

Checks on the environment took place. However, we identified 2 pieces of equipment did not have the appropriate checks in place. We brought this to the attention of the registered manager who took immediate action to rectify this. Signage throughout the home did not always support people who lived with dementia. For example, toilet facilities were not consistently signed, and the signage for people’s rooms could be improved by including more personal details to help individuals navigate the home.

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,

supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

We observed care which was unhurried. However, all the feedback we received suggested staffing levels were low, and concerns were raised about consistent deployment of staff across the 2 sites. Staff had not always received training within the required timeframes. This meant that in some instances there were no staff on shift who had received recent training in some of the specialised care areas people required. The provider was working to address this.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

The home was clean and odour-free, and there were good stocks of personal protective equipment (PPE), which staff used appropriately. Infection prevention and control (IPC) practices were followed. However, some areas of the home required attention, to ensure their cleanliness, following our inspection visit the registered manager confirmed these had been actioned and would be maintained.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

The service had appropriate systems in place to safely store, administer and record the use of medicines. Thickeners, which are used to thicken fluids for people with swallowing difficulties, were recorded when they had been used. Instructions for medicines which should be given at specific times were available. Patch application records were fully completed to show rotation in line with manufacturers guidance to prevent side effects. There was a process in place to indicate the site of the patch application to prevent the patch being placed on the same site too frequently. Detailed guidance specific to each person on how to administer medicines prescribed as and when people required them, (known as PRN) was available to staff. Some people were prescribed medicines with a variable dose i.e. 1 or 2 tablets to be given when required at regular intervals. The quantity administered had been recorded, meaning that records accurately reflected the treatment people had received. The use of topical creams and ointments were recorded on the medicines administration records and body maps were in place to show staff the site of application.