Archived: Cedar Lodge

Cedar Lodge cares for people with a learning disability and is registered for 10 people. There was a 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.

People were cared for by staff who understood their responsibilities to keep people safe from harm. There were risk assessments in place which were reviewed regularly and helped ensure people were protected from identified risks. There were sufficient numbers of staff on duty to meet the needs of people using the service. Staff who administered medicines were suitably trained and their competency checked, to ensure they had the knowledge and skills to manage medicines safely.

Staff received relevant training for their job role and had frequent supervisions and appraisals with the managers. Training was arranged in response to the particular needs of people using the service; and ensured that staff had the knowledge and skills to fulfil their responsibilities to people. Staff gained consent from people before offering care and explained what they were doing in ways that people understood. People were involved in planning their meals, which included shopping and preparing meals or setting tables. People were supported to access community healthcare services to manage their overall health.

People were cared for by caring and compassionate staff who enjoyed their work. Staff spent time getting to know people and their personal characteristics. They developed positive and supportive relationships with people whilst promoting independence and dignity. People contributed to their care plans and made decisions about their daily activities. The provider welcomed feedback and comments from people who used the service along with their family and health and social care practitioners who were involved with the care of people. The service had not received any formal complaints but had systems in place to respond to comments and suggestions and provided examples of how this had improved the service.

The service was well led and managed by the registered manager; who was supported by a senior management team and the provider. There was an open and inclusive culture within the organisation where people and staff felt supported and heard. People and staff were involved in the development of the service and the registered manager used feedback when developing the improvement plan.

We last inspected this service on 6 December 2013. At that time we found that care plans did not always contain information which was relevant and up to date. At this inspection we found that the manager had reviewed the care plans, removing much of the historical information which was no longer relevant to the person's care. However, we found care plans did not always contain the information needed to ensure people's welfare and safety, for example, medical information about a person's medicines. A summary of what we found is set out below. We used the evidence we collected during our inspection to answer five questions.

Is the service safe?

We spoke with three care staff who understood the systems in place to protect people, who received care, from abuse or neglect. They told us they received training in how to protect people and knew how to report concerns, for example, to the local authority safeguarding team.

We saw individual evacuation plans were in place for each person. These identified the level of support the person needed to evacuate the building in an emergency for example, a fire.

There were no Deprivation of Liberty Safeguards (DoLS) in place at the time of our inspection. The manager was considering the need to apply for a DoLS authorisation for one person. The manager told us they were in the process of obtaining advice from a healthcare professional before proceeding further. The Deprivation of Liberty Safeguards are a legal framework designed to ensure that the care people receive does not unlawfully deprive someone of their liberty. Some people were not able to make decisions because of their condition. The service had policies in place for managing medicines safely. Care staff followed these and they were audited and checked.

Is the service effective?

People's needs were assessed and we saw support plans had been reviewed and updated. The manager told us they had reviewed the content of the plans since our last visit to remove any unnecessary information.

Care staff we spoke with were familiar with the content of people's support plans and ensured the care delivered was consistent with the person's assessed needs. Risk assessments had been carried out. Care staff told us each person had a key worker whose role was to check and update the person's support needs. Support plans described people's personal care needs and how these should be met. Plans to support people's behaviour were also in place.

Care staff had the appropriate training and experience to enable them to carry out their role effectively. Care staff told us they received regular supervision and appraisal. They told us they felt supported by their manager to carry out their role.

Is the service caring?

One person we spoke with was shortly to go on holiday. The manager told us care staff had suggested a trip to a theme park because of the person's interests. The person told us how much they were looking forward to the trip and their birthday party which was due to take place around the same time. One member of the care staff told us people who used the service were like, 'An extended family."

We observed care staff providing support at lunchtime and in the afternoon when people were playing board games and appeared to be enjoying themselves. Care staff we spoke with told us that they knew people well and were able to respond to their needs. They also told us it was important to protect people from harm and explained how they supported them to engage in activities in the community.

Is the service responsive?

One person told us they had an hour each day when they received one to one support from care staff. They told us this was helping them to deal with some of their emotions. They said they were finding this support very helpful.

We saw examples of care staff obtaining professional advice for people, for example, from a dietician for one person who had lost weight. The service had also arranged for the person to receive care when they needed it from local health services which supported people with a long term condition. When we spoke with the cook they told us they would like to carry out further training to understand how they could better support people.

Is the service well-led?

Care staff told us the manager was supportive and approachable. The manager and one of the company directors carried out regular checks to identify things which could be improved. The service also obtained the views of people who use the service and used these to discuss improvements. There were regular meetings with people who used the service to discuss improvements to the service, for example, the menus and activities.

Staff we spoke with were generally knowledgeable about people's care needs and described appropriate ways of supporting them. However, people's care files contained some conflicting information and did not always provide the right guidance for staff. We saw that staff working at Cedar Lodge were recruited through proper procedures and were given suitable training and support to provide care for people living at Cedar Lodge.