Cedar Lodge Care Home

Cedar Lodge Care Home is registered to provide accommodation and personal care for up to 19 people, including people living with dementia. At the time of our inspection visit there were 18 people living at the home, with one person in hospital. Care is provided across two floors. A communal lounge and dining area are located on the ground floor. People’s bedrooms are ensuite and there are further communal bathroom facilities located on each floor.

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

At our last inspection, we found improvements were required. Some people’s health and physical risks were not always assessed and risks around safe medicines management were not managed effectively. Environmental and fire safety risks were also not managed safely. The provider’s systems of audits and checks had not always identified where improvements were needed.

Following the last inspection, we formally requested the provider to send us a monthly action plan telling us what they had improved and where improvements continued to be made at the service, with timescales.

At this inspection, we found the provider’s action plan had driven some improvements and risks associated with people’s care were managed safely. Known risks relating to people’s health and welfare and environmental risks were better managed.

The provider’s quality assurance systems were improved and had begun to highlight where further improvements were needed. Management restructuring and reviewing their own audit systems through a critical eye had begun to identify improvement. With increased adaptations and improvements, the audit processes now need to become embedded into everyday practice to ensure its true effectiveness. This meant the provider was no longer in breach.

People received their medicines from trained and competent staff. We found improvements had been made in the management of ‘patch medicines’ and body maps were now in place to show where those medicines had been applied. However, we recommended the registered manager sought advice to ensure patch medicines were applied as directed when increased rotational administration to the body was required.

People who required ‘as and when’ medicines had a protocol in place to tell staff, when, how and at what dose, these medicines should be given safely.

Risks for some people were updated, reviewed and reflected the support people needed. Staff knew how to manage those risks. The provider told us they had spent time since the last inspection, updating people’s care plans and they were more confident records supported positive outcomes for people.

People were pleased with the support and the quality of care they received. People were complimentary of staff and the management of the home and told us they felt safe receiving care and support from staff.

The provider had sufficiently trained and suitable staff on shift to meet people’s needs. People told us they felt there were enough staff on duty to meet their needs. Where people had used their call bell to request a staff member, people said they did not wait long for assistance. The provider continued to follow safe recruitment processes.

During our visit, the home was in a COVID-19 outbreak which had impacted on staff availability. The management team stepped in to cover gaps in shifts to ensure people’s needs continued to be met.

People were supported 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 supported this practice.

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 12 May 2022) and there were breaches of regulations. Following this visit, the provider sent us an action plan telling us how they would improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced inspection of this service on 7 April 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve in safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well Led which contain those requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cedar Lodge on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Cedar Lodge Care Home is registered to provide accommodation and personal care for up to 19 people, including people living with dementia. At the time of our inspection visit there were 15 people living at the home, with an additional two people currently in hospital. Care is provided across two floors. A communal lounge and dining area were located on the ground floor. People’s bedrooms were ensuite and there were further communal bathroom facilities located on each floor.

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

At our last inspection, we found concerns related to the management of risks, management of staff recruitment, systems to monitor deprivation of liberty safeguards and effective oversight of the service which did not meet the regulations. At this visit, we found some improvements had been made but further improvement was still needed.

In response to our last inspection the provider told us additional staff were trained in fire safety checks and systems to monitor fire check completion was improved. They also said the management team had created a new checklist to audit monthly as well as reminders to ensure checks were completed which included better oversight of staff recruitment files.

However, we found a continued lack of oversight to ensure standards were maintained. Some areas previously identified as a concern, remained.

Audits such as medicine management, identifying environmental and health risks were either not completed or they were ineffective in identifying where improvement was needed. Several improvement actions we found during our visit had not been identified through any provider checks at the service. The provider’s response to our last inspection and action plans had not always been implemented or effectively followed through.

Not all medicine records lacked detailed information to confirm safe management, especially around pain patch medicine application and PRN protocols. Systems to monitor safe medicine storage in refrigerators was not effective.

Environmental risks such as fire safety required improvement. Some fire doors did not close at all, while others closed at varying speeds. Staff who completed fire safety checks had not received sufficient training to identify and rectify potential issues.

People were involved in consenting to day to day life choices, however consent for the provider to use CCTV in communal areas had not been considered, consented too or reviewed. On the second day of our visit, the registered manager turned the CCTV system off to consider its ongoing use and consent from people.

People spoke positively about their experiences living at Cedar Lodge Care Home and the quality of their care that was provided by a consistent staff team. People’s feedback was sought through meetings and surveys as well as through conversation when care was provided.

People were supported 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 supported this practice.

Staff told us face masks were worn when providing personal care and staff wore masks when they supported people around the home. The home was clean and tidy and good infection control practices were followed.

Staff understood their responsibility to report any concerns to protect people from the risk of abuse. There were enough staff on duty to support people, and people told us they felt safe living at the home.

Staffing levels met people’s needs. People told us staff supported them in an unrushed manner and staff were able to respond to requests for support without minimal delay. People felt staff were trained because they knew what to do when supporting them.

Staff completed an induction process and were confident in their role. The registered manager promoted staff development and encouraged staff to attend additional training to enhance their skills and knowledge.

The registered manager and provider welcomed the inspection and following our visit, had begun to take steps to address some of the issues identified. This included seeking support from an external consultant and they were awaiting a fire authority visit planned for end April 2022.

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 11 September 2019) and there were breaches of regulation. The provider completed an action plan after the last inspection to show us how they would improve and by when. At this inspection we found some improvements had been made, however, the provider remained in breach of regulation.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has not changed. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cedar Lodge Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so. We have identified a breach in relation to safe care and treatment and a breach related to good governance. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

People enjoyed window visits with their family. The window remained closed for safety and they spoke to each other on the phone during the visit.

The provider had divided the home into 3 zones following the outbreak to restrict the movement of people within the building and minimise the spread of infection.

Personal Protective Equipment (PPE) stations with clinical waste bins had been placed at key points throughout the home so staff could don and doff their PPE regularly and maintain good hand hygiene.

The provider established a COVID-19 Committee comprising of staff and managers. The focus of the committee was to discuss the homes response to the pandemic and develop procedures to reduce the risk of infection.

The registered manager moved into a lodge in the garden so they could support residents who had tested positive for COVID-19. This provided additional support to people and the staff team whenever it was needed.

Further information is in the detailed findings below.

Cedar Lodge is a care home providing personal care for up to 19 people. At the time of the inspection 17 people were receiving care in one adapted building. Bedrooms and communal facilities were provided on the ground and first floor.

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

Although people felt safe living at the home and their relatives believed their family member to be safe we found areas of concern within the environment which posed potential risks to people and their safety.

Testing of the fire alarm system was not routinely taking place and actions taken following a fire door not fully closing was not recorded. We identified shortfalls with some fire fighting equipment. The access to one extinguisher was blocked while the location of another had moved from its allocated place in the kitchen and was free standing in the dining room.

We found references were not always obtained in relation to new members of staff to ensure they were of good character and suitable to provide care to people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. However, systems did not always support this practice. Authorised Deprivation of Liberty Safeguards (DoL’S) had expired and therefore were no longer active.

The registered manager took action during and after our inspection to make improvements in these areas.

The provider’s current quality rating was not displayed on the provider’s website.

People received their medicines as prescribed although improvement was found to be needed in relation to recording the date when boxed medicines were opened.

Care plans and risk assessments were in place and regularly reviewed. Information about a medical need giving details for staff to follow was not included within people’s plans.

People had access to healthcare professionals to meet their needs and ensure wellbeing. Sufficient staff were on duty to meet people’s needs.

People liked the food provided and were able to request alternatives from the menu. Suggestions regarding the menu were acted upon.

People told us the home was a comfortable place to live and were able to personalise their own bedrooms. People were able to participate in fun and interesting things to do. People found the staff to be kind and caring and upheld their privacy and dignity while encouraging independence. Staff received training to ensure they were able to meet people’s needs.

People found the management to be open and approachable and believed they would be listened to in the event of having any concerns.

Rating at last inspection

The last rating for this service was Good (published 25 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvement. Please see the safe, effective and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cedar Lodge Care Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safety in the home around environmental safety, recruitment of staff and management checks to ensure people were in receipt of safe and effective care and support.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. 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.

The inspection took place on the 28 December 2016 and was unannounced.

There was a registered manager at this home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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.

Staff we spoke with were aware of how to recognise signs of abuse, and systems were in place to guide them in reporting these. They were knowledgeable about how to manage people’s individual risks, and were able to respond to people’s needs. People told us they were supported in a safe way and had their medicines as prescribed. The registered manager had identified medicines records were not always completed and was taking steps to support staff to improve this.

People told us staff knew how to support them. Relatives said staff were well trained. Staff had up to date knowledge and training to support people. Staff respected people's rights to make their own decisions and choices about their support. People's permission was sought by staff before they helped them with anything. Staff made sure people understood what was being said to them by using appropriate communication methods. When people did not have the capacity to make their own specific decisions these were made in their best interests by people who knew them well and were authorised to do this.

People had food and drink they enjoyed and had choices available to them, to maintain a healthy diet. People said they had access to health professionals when they needed to. Relatives were confident their family member was supported to maintain their well-being and had access to the health professionals they needed.

People said they were happy living at the home and supported by patient and kind staff. Relatives told us they were happy with the service their family member received. They told us staff were patient and promoted independence. People living at the home were able to see their friends and relatives as they wanted. We saw staff treated people with dignity and respect and had a good knowledge of people’s rights. They knew people well, and took people’s preferences into account and respected them.

People and their relatives were included in how care was provided. They knew how to raise complaints and felt confident that they would be listened to and action taken to resolve any concerns. The registered manager had arrangements in place to ensure people were listened to and action could be taken if required.

The registered manager promoted an inclusive approach to providing care for people living at the home. For example people and their relatives were encouraged to attend regular meetings, and to complete questionnaires to share their views about the quality of the service. The management team had actioned suggestions made by people, their families and staff where possible, and took a proactive approach making improvements.

The provider had systems in place to monitor the quality of care and treatment people living at the home received. The registered manager had identified where improvements were needed and had a plan in place to ensure these were made in a timely way.