Archived: The Cedars and Larches

The Cedars and Larches is a residential care home providing personal and nursing care to up to 69 people in 2 adapted buildings. The service provides support to older people. Each building is over 2 floors with communal spaces for dining and relaxation. At the time of our inspection there were 54 people using the service.

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

Systems in place to monitor the quality of the service did not always identify gaps in recording of monitoring charts and investigation of accidents and incidents.

The registered manager was focused on developing a positive culture by strengthening the staff team and providing specific competency-based training for people to achieve better outcomes. People were regularly consulted to give feedback on the service; this was used to drive improvements.

Systems were in place to protect people from abuse. Risks to people were regularly assessed and appropriate measures were in place to minimise risk. Staff understood the principles of safeguarding people from the risk of abuse and were aware of how to raise a concern.

There were enough staff to meet people’s care needs. Staff were recruited safely and appropriate checks were completed prior to employment. People received their prescribed medicines safely and staff followed correct infection control procedures.

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.

People told us they were happy with the support provided to people and staff were professional and friendly. The provider worked alongside other healthcare professionals to support people's care needs.

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 16 October 2019).

Why we inspected

We received concerns in relation to care and treatment. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

We found no evidence during this inspection that people were at risk of harm from this concern.

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 good to requires improvement based on the findings of this inspection.

Follow up

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

The Cedars and Larches is a residential care home providing personal and nursing care to 39 people aged 65 and over at the time of the inspection. The service can support up to 61 people in two adapted buildings. Each building is over two floors and provides communal spaces for dinning and relaxing. There are supported bathing facilities and personalised bedrooms.

We found the following examples of good practice.

The home has had an outbreak of COVID-19. The provider had obtained the required support from health care professionals to protect people and staff to reduce the risk of spreading the infection.

The provider followed the required guidance for testing of staff and people living in the service for COVID-19 symptoms. We saw additional testing had been implemented as part of the outbreak measures.

The two buildings had dedicated domestic staff who ensure areas of the home were cleaned and disinfected with approved products to reduce the potential of transfer of infection. There were cleaning schedules in place, and these were monitored. Some areas required intensive cleans and we saw these were completed.

Staff had received training in the use of personal protective equipment (PPE) and managing the infection. This training had been revisited following the outbreak to ensure these measures were followed. We saw PPE was accessible throughout the buildings and staff used it in accordance with the training and guidance.

Staffing numbers had been reviewed to support the needs of people using the service and recruitment was ongoing to maintain consistent staffing levels.

The provider had a COVID 19 policy which was updated to reflect the most recent guidance, and this was shared with staff.

We found the following examples of good practice.

¿ The home has had an outbreak of COVID-19, which has affected both people in the home and staff. The provider has been supported by health care professionals to review their infection control practices. These had been implemented to drive improvements and to reduce the potential for spread of the infection.

¿ There was a detailed entry system into the home, with temperature testing, contact questionnaire and hand disinfection on entry.

¿ The provider had ensured there were plentiful supplies of personal protective equipment and we saw staff used this appropriately.

¿ The provider participated in regular testing of staff and people living in the service for COVID-19 symptoms. People living in the home are tested in line with government guidance.

¿ Areas were thoroughly cleaned and disinfected with approved products to reduce the potential of transfer of infection. The provider had produced detailed cleaning and disinfection information and introduced this through all residential and nursing homes.

¿ Risk assessments had been completed to protect people and any people and staff who may be at higher risk of being infected with COVID-19 and measures were in place to support them.

¿ Staff worked on a regular shift pattern and due to a short-term shortage of staff used additional agency staff. These were allocated to one of the two buildings on the site, to reduce the potential for cross contamination.

¿ Staff had received training in the use of personal protective equipment (PPE) and ensured these measures were followed putting on, taking off and disposing of PPE.

The Cedars and Larches is a residential care home providing personal and nursing care to 53 people aged 65 and over at the time of the inspection. The service can support up to 61 people in two adapted buildings. One building is known as The Cedars and the other building is known as The Larches. Both buildings support people over two floors and are located next to each other.

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

The completion of regular health and safety checks was inconsistently recorded. A maintenance worker usually completed these checks, but this post had been vacant for several months, and although cover had been arranged to ensure the checks were completed, there were significant gaps in recording. Audits completed by the registered manager and regional manager identified this, but no plan was put in place to address the issue. We made a recommendation about this.

People were supported by a well-trained staff team who were available when they needed assistance. However, during an observation of a lunch time on The Laurels, we noted one member of staff was supporting eight people, and some people had to wait a short while to be assisted with their food. Whilst there were enough staff, they had not been deployed effectively to support the lunch time sitting. We discussed this with the registered manager who agreed to review the deployment of staff at lunch.

People said they were safe and happy living at the home, and that staff provided kind and caring support. Relatives also provided positive feedback about staff. People were supported to maintain their independence and were treated with dignity and respect.

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.

Medicines were managed safely. Risks to people were assessed and addressed. The provider ensured the service had safe staffing levels and had robust recruitment processes.

People were able to see healthcare professionals to assist their health and wellbeing. Staff supported people to eat healthy nutritious food and to drink sufficient fluids and were familiar with people's dietary needs.

People received personalised support based on their assessed needs and preferences. Staff supported people to access activities they enjoyed.

People's views were regularly sought through computers placed around the home. Feedback from people, relatives, professionals and staff was used to improve the quality of the service. There was also an effective complaints process which was clearly displayed for people to see.

Although the registered manager had only been in place for seven weeks prior to the inspection, we received positive feedback from people, relatives and staff about the leadership provided. Staff understood their role and had confidence in the registered manager. Staff told us they worked well together as a team, and there was good morale amongst them.

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 good (published 24 March 2017).

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.

This inspection visit was unannounced and took place on 7 March 2017. At our last inspection visit on June 2015 we asked the provider to make improvements to the staffing in the communal areas of the home. At this inspection, we found improvements had been made. The service was registered to provide accommodation for up to 61 people. People who used the service had physical health needs and/or were living with dementia. At the time of our inspection 58 people were using the service.

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.

The home had enough staff to support people’s needs and they were deployed to ensure people received support when they needed it. The staff - employed had received a range of checks to ensure they were suitable to work in the home. People were supported to make choices, and - assessments reflected the person’s level of understanding in different situations. The manager and provider had established a range of audits to monitor improvements within the home. We saw feedback was sought from people, relatives and professionals and any areas raised had been considered and responded to.

We found staff had established positive relationships with people. Staff showed respect for people’s choices- and supported them to maintain their privacy and dignity at all times. People were able to choose the meals they wished to eat and alternatives were provided. We saw that medicines were managed safely and administered in line with people’s prescriptions and preferences. Referrals had been made to health care professionals and any guidance provided had been followed.

Staff obtained information from the person and their relatives to support the completion of the care plan. People were encouraged and supported with activities or hobbies they wished to engage in.- c-Complaints had been addressed and resolved in a timely manner.

Staff felt supported by the manager and there was a clear process in place to cascade information to staff about the service and the needs of people. Staff had received training and the provider had invested time to expand the staff knowledge in end of life care which was provided in a dignified and respectful way.

We saw that the previous rating was displayed in the reception of the home - and on the provider’s website as required. The manager understood their responsibility of registration with us and notified us of important events that occurred at the service; this meant we could check appropriate action had been taken.

Some people told us that over recent weeks there had been a shortage of staff in the cedars unit, this had led to them having to wait longer than usual for staff support. The registered manager had taken action to cover gaps in shifts and additional staff were in the process of being recruited.

Care records demonstrated that people's support needs had been identified and information was in place regarding people's preferences and interests, including their life history, this supported staff in providing holistic care to each person. Staff spoken with had a good understanding of people's needs.

People's care plans included information about their ability to make day to day decisions regarding their life and their capacity to consent.

A variety of activities were available for people to participate in.

People spoken with had mixed views on the meals provided. The majority of people told us they enjoyed the meals, others thought there was not enough variety in the choices available.

Medicines were managed appropriately, this ensured people received their prescribed medication in a safe way.