Cedar Court Care Home

Cedar Court Care Home is a purpose-built nursing care home providing personal and nursing care for up to 63 people. At the time of the inspection the service was supporting 46 people.

People’s experience of using this service and what we found

Staff understood their responsibilities to protect people from harm. Staff were encouraged and supported to raise any concerns they may have. Incidents and accidents were recorded and checked by the provider to see what steps could be taken to prevent these from happening again.

Medication administration records (MAR) confirmed people had received their medicines as prescribed. We received mixed but mainly positive feedback regarding staffing levels from people, their relatives and staff. Robust recruitment processes aimed to ensure only suitable staff were selected to work with people.

There was no registered manager in post. The service provider told us they had recruited new manager who was awaiting their starting date. The service was run by an experienced deputy manager with the help of an operations manager and a regional director. The provider carried out regular checks on the quality of care and services to identify any areas that required improvement. Policies, procedures and other documentation were reviewed regularly to ensure staff were provided with up-to-date information.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 28 March 2020).

Why we inspected

We received concerns in relation to poor infection prevention control, medication errors, low staffing numbers and unlawful restraint. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions, and therefore we did not inspect them. Ratings from the previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained good. This is based on the findings obtained at this inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information, we may inspect sooner.

Cedar Court Care Home is a purpose-built nursing care home providing personal and nursing care for up to 63 people. At the time of the inspection the service was supporting 52 people.

People’s experience of using this service and what we found

People had a range of individualised risk assessments in place to keep them safe and to help them maintain their independence. Medicines were stored and administered safely. Accidents and incidents were recorded and thoroughly investigated to enable the service to learn from incidents and mistakes. There were appropriate arrangements in place to prevent and control the pandemic.

Each staff member had received induction and training to enable them to meet people’s needs effectively.

The service involved other professionals in people’s care in order to achieve best outcomes for people.

There was no one receiving end of life care. However, we saw that people’s wishes were assessed and some people who had been assessed by health care professionals as needing end of life care had made a recovery so this was no longer needed.

People, their relatives and staff spoke highly of the management. There were systems in place that monitored the quality of the service, resolved issues and strived for continuous improvement.

Rating at last inspection The last rating for this service was good (published 28 March 2020).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about end of life care and administration of medicines. The overall rating for the service has not changed following this targeted inspection and remains good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Cedar Court Care home is a purpose-built nursing care home providing personal and nursing care for up to 63 people. At the time of the inspection the service was supporting 58 people.

People’s experience of using this service and what we found

Improvements had been made in all areas since the last inspection. People felt safe and were supported by staff who knew how to protect them from avoidable harm. Individual risks to people were assessed and monitored to minimise accidents and injury. People received their medication at intervals as it had been prescribed. There were sufficient staff to meet people's needs. Recruitment processes aimed to ensure staff were safe and suitable to work. The home was clean. Staff had received infection control training and protective clothing including gloves and aprons was available to them.

People's needs were assessed before their admission to the service. People and their relatives, where appropriate, had been involved in the care planning process. Staff received support, induction and training to ensure they had the skills to carry out their role. Staff were complimentary about the provider and felt they were very supported in their role. People were assisted to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service promoted this practice. People were supported to maintain a balanced diet. Health and social care professionals were regularly involved in people's care to ensure people received the care and treatment which was suitable for them.

We observed staff interacting with people in a positive way. People told us they enjoyed living at the service. We received positive feedback from people who used the service and their relatives. Staff understood the importance of ensuring people's dignity was upheld. Relatives and other visitors were welcomed into the home at any time.

Reviews of people's care and support needs were undertaken regularly. People enjoyed a range of social activities which were meaningful. People who used the service had access to a complaints procedure and were encouraged to make complaints where required. Complaints were followed up and responded to in line with the providers policy.

The provider and the registered manager followed governance systems which provided effective oversight and monitoring of the service. The registered manager kept themselves up to date with changes in legislation and practice. The registered manager and staff were motivated to provide the best service they could for people and their relatives.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 7 March 2019) and there were four breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. Following the inspection we imposed restrictive conditions on the provider’s registration to keep people safe and support them to improve. At this inspection, we found improvements had been made and the provider was no longer in breach of regulations. The restrictive conditions will be removed from the provider’s registration.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information, we may inspect sooner.

Cedar Court Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Cedar Court is a purpose-built nursing home, able to provide care and support for up to 63 people whose care needs are associated with physical needs, mental frailty and/or dementia. At the time of our visit 47 people were using the service.

There was no registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. In the absence of a registered manager the service was operated by operational relief support manager.

We found the staffing levels to be inadequate to support the high number of people who required two staff to support them. As a result, staff spent most of their time carrying out care-related tasks in people's bedrooms, which meant they were not able to spend sufficient time engaging with people. With staff being busy caring out their tasks, some people were deprived of the care and support they needed for periods of time. This was evident from our observations and discussions with staff and people’s relatives.

Infection control monitoring within the service was in need of improvement. We found that bathrooms and some communal areas were not always clean.

The ‘grab bag’ that was supposed to be used in case of evacuation from the building contained a list of the residents that was up to date. However, the ‘grab bag’ first aid kit contained bandages that had expired in 2016.

Risks to people's health, safety and well-being had been assessed and were included in people's care plans. Records included guidance for staff to follow to protect people from the risk of harm. However, risks were not always managed appropriately in practice.

Some people told us they liked the food, but others found it was not to their taste. The menus displayed in the dining rooms was not always up to date. The dining experience was not positive for people who lived in the home.

Health care professionals told us that the service had not always sought medical advice in a timely manner.

Whilst some staff treated people in a kind and compassionate manner, this was not always demonstrated by all staff. People could not be assured their confidentiality of information was protected.

People were not always provided with opportunities to engage in meaningful activities, which depended on the availability of staff.

The provider had a complaints procedures, however, there was no evidence of all complaints being investigated and provided with a response.

Quality assurance systems were not always effective and did not identify the shortfalls we found during this inspection

People were supported to receive their prescribed medicines safely.

Appropriate arrangements were in place for reporting and reviewing accidents and incidents. This included auditing all incidents to identify any trends or lessons to be learned.

Safety checks for gas, emergency lighting and hoists had been completed and PAT testing was up-to-date.

Staff employed by the service had been subject to pre-employment checks to make sure they were suitable to work at the service and people felt cared for safely.

Staff completed induction when they started work, which included mandatory training and shadowing experienced colleagues. Staff told us they received one-to-one supervision and this was demonstrated by the records we checked.

Staff ensured people's rights and best interest by working within the principles of the Mental Capacity Act (MCA) 2005. People were supported to make choices and decisions about their care.

People's care was reviewed and care plans updated to ensure they reflected people's current needs.

Staff felt supported by the operational relief support manager and they were able to approach them for advice and guidance when they needed. People and their relatives spoke highly of the operational relief support manager and the way they ran the home.

We recorded four breaches of our regulations. You can see what action we have told the registered persons to take at the end of the full version of this report.

Cedar Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

We inspected Cedar Court on 12 June 2018. This was an unannounced inspection.

Cedar Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care home accommodates up to 63 people. At the time of the inspection there were 38 people living at the service.

At our last inspection on 25 October and 1 November 2017, the overall rating was Inadequate and the service was placed into special measures by the Care Quality Commission (CQC). Five breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified. Following the inspection, we received regular action plans which set out what actions were being taken to bring the service up to standard.

We undertook this inspection on 12 June 2018 in line with our special measures guidance to see if improvements had been made. At this inspection we found significant improvements in the service. We could see that action had been taken to improve people’s safety, ensure there was enough staff, provide care that met people’s needs, ensure consent was sought in line with legislation and had effective systems and processes to monitor and improve care. However, improvements were still required in some areas which the provider was already working towards.

We were welcomed by the registered manager, the regional director and staff who were happy to see us and keen to show their caring nature and share the positive changes they had made in the last six months.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found the provider had made significant improvements to ensure people’s safety. Staffing numbers had been increased to ensure there were sufficient numbers of suitable staff to meet people's needs. The provider continuously recruited staff. The home had staff vacancies which were covered by regular agency staff to meet people's needs. Same agency staff were used to maintain continuity. The management team were doing all they could to ensure safety and maintain staffing levels. The home had robust recruitment procedures and conducted background checks to ensure staff were suitable for their roles.

People told us they were safe living at Cedar Court. Staff demonstrated they understood how to keep people safe and we saw that risks to people's safety and well-being were managed through a risk management process. There were systems in place to manage safe administration and storage of medicines. People received their medicines as prescribed. However, records relating to application of topical creams were not always completed. We also found people’s records in relation to activities and repositioning were not always up to date.

People had their needs assessed prior to living at Cedar Court to ensure staff were able to meet people’s needs. Staff worked with various local social and health care professionals. Referrals for specialist advice were submitted in a timely manner.

People were supported by staff that had the right skills and knowledge to fulfil their roles effectively. Staff told us they were well supported by the management team. Staff support was through regular supervisions (one to one meetings with their line manager), appraisals and team meetings to help them meet the needs of the people they cared for.

People living at Cedar Court were supported to meet their nutritional needs and maintain an enjoyable and varied diet. Meal times were considered social events. We observed a pleasant dining experience during our inspection.

People told us they were treated with respect and their dignity was maintained. People were supported to maintain their independency. The provider had an equality and diversity policy which stated their commitment to equal opportunities and diversity. Staff knew how to support people without breaching their rights.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and report on what we find. The registered manager and staff had a good understanding of the MCA and applied its principles in their work. Where people were thought to lack capacity to make certain decisions, assessments had been completed in line with the principles of MCA. The registered manager and staff understood their responsibilities under the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be deprived of their liberty for their own safety.

People knew how to complain and complaints were dealt with in line with the provider’s complaints policy. People’s input was valued and they were encouraged to feedback on the quality of the service and make suggestions for improvements. Where people had received end of life care, staff had taken actions to ensure people would have as dignified and comfortable death as possible.

People, their relatives and staff told us they felt Cedar Court was well run. The registered manager and management team promoted a positive, transparent and open culture. Staff told us they worked well as a team and felt valued. The provider had effective quality assurance systems in place which were used to drive improvement. The registered manager had a clear plan to develop and further improve the home. The home had established links with the local communities which allowed people to maintain their relationships.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Cedar Court is a care home registered to provide accommodation for people who require personal or nursing care. It is located in a purpose-built facility and can accommodate up to 63 people whose care needs are associated with physical needs, mental frailty and/or dementia. At the time of our visit 43 people were using the service, most of whom lived with dementia. Prior to our inspection, we had received concerns about staffing levels, people’s safety and lack of social interaction between staff and people.

There was a registered manager in post at the time of our inspection. However, the registered manager resigned from their post after the first day of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

There was a high number of people at the service who needed two staff members to assist them with their personal care and when mobilizing using a hoist. However, the staffing levels were insufficient to meet the needs of people. As a result, staff were occupied with providing care in people's bedrooms without being able to spend enough time engaging with people. This meant that when staff provided care to some individuals, other people were left without the care and support they needed for significant periods of time. This was evident from our observations and discussions with staff and relatives. Some relatives were concerned that they could not locate staff when they visited the home.

We could not be sure that people received assistance from staff when they needed it, because call bells were not available to some people. There was no alternative system in place for people to call for assistance.

Risk assessments and care plans were in place for each person. Although risks to people had been identified, the steps to be taken to deal with those risks were not always clear. Care plans did not always give enough detail to staff to enable them to manage those risks. People did not receive appropriate monitoring which placed them at increased risk of harm. For example, people were not always supported to eat and drink.

The premises were not free from offensive odours. The odour of urine was noted in different places, such as people’s rooms and the communal areas, in the course of the inspection. The home was unclean, both people’s bedrooms and the communal areas were untidy.

Although staff had received training in relation to the Mental Capacity Act (MCA). However, this learning was not applied. Capacity assessments were not decision-specific or individualised for each person. Where people lacked capacity to make decisions, capacity assessments and best interest's decisions were not completed where they should have been, for example in relation to the use of bed rails.

We observed interactions between staff and people. We found the culture of the service to be task focused. Meeting the individual needs of people was not priority in this culture. End of life care plans were in place, however, due to the low staffing levels staff could not spend time with people in the last days of their lives.

People’s social needs were met on a group level, however, due to the staffing levels the service was unable to meet individual social needs of people.

The provider had a range of quality monitoring arrangements in place to monitor care and plan ongoing improvements. This included audits, surveys and regular health and safety checks. However, the systems in place had not identified the shortfalls found at our inspection.

People were protected by the provider's recruitment procedures. The provider made appropriate pre-employment checks to ensure that only suitable staff were employed. Staff understood their responsibilities in terms of safeguarding and knew how to report concerns if they suspected abuse.

Medicines were administered as prescribed.

Staff were provided with an induction when they started work, which included mandatory training and shadowing experienced colleagues. Staff told us they received one-to-one supervision and this was demonstrated by the records we checked.

The home had a robust complaints policy and records showed complaints were responded to in line with it. People and their relatives told us they knew how to make complaints.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

During this inspection we identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Cedar Court is a purpose-built nursing home caring for up to 63 people whose care needs are associated with physical needs, mental frailty and/or dementia. At the time of our visit 62 people were using the service, most of whom lived with dementia.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us they felt safe and staff were aware of their responsibility to keep people safe. Risks to people's safety were appropriately assessed and managed.

Systems were in place to make sure people received their medicines safely. Arrangements were in place for the recording of medicines received into the home and for their storage, administration and disposal.

Staff knew what action to take if they were concerned that someone was being abused or mistreated. The provider's whistleblowing policy protected staff to make disclosures about poor staff conduct or practice, and staff confirmed the manager would take responsive action if they reported such problems.

Staff had been recruited safely to ensure they were suitable to work with vulnerable people. There were sufficient numbers of suitable staff to meet people's needs and people received their medicines as prescribed.

We found the premises were clean and tidy. There was a record of essential inspections and maintenance carried out. The service had an infection control policy and measures were in place for infection control.

Staff had a good understanding of the Mental Capacity Act 2005 and we saw people’s consent was sought routinely. People were supported to make their own decisions wherever possible, and staff took steps to support people to do this. Where people were unable to make a decision, there was a best interest decision recorded within their support plan. We saw the person concerned and relevant people had been involved in making best interest decisions. This meant people were given the opportunity to participate in decision making and decisions were made in the person's best interests. The service had effectively implemented the Deprivation of Liberty Safeguards (DoLS) as required.

Records showed staff received the training they needed to keep people safe. The manager had taken action to ensure that training was kept up-to-date and future training was planned.

Staff told us they felt supported by the management and received supervision and appraisals, which helped to identify their training and development needs.

People had access to healthcare when they needed it and recommendations from healthcare professionals were implemented.

Staff prepared appropriate care plans to ensure people received safe and appropriate care and support. Each person had a personalised care plan containing information about their likes and dislikes as well as their care and support needs. The care plans were updated in line with changing needs and people and their relatives were involved in making decisions regarding their care.

People’s healthcare needs were closely monitored and responded to. Staff were considerate and caring. Their knowledge of the individual choices and preferences of people enabled them to provide people with relevant care and support.

The management appreciated and acted on people's and relatives’ opinions on the service, including complaints. Such information was used to implement changes and enhance the functioning of the service. People and staff had confidence in the manager as their leader and were complimentary about the positive culture within the service. There were systems and processes in place to help monitor the quality of the care people received.