Cedar Lodge

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 71 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

People’s needs were assessed prior to moving into the home. These processes helped the service to meet people’s individual expectations to support positive outcomes. People and relatives were confident the support they received met their needs right from the beginning. One relative said, “We looked around (the home), the process was very easy, [Registered manager] said ‘we’ll make this happen’ which was such a relief.”

People’s assessments were completed by staff who focused on giving people the best opportunity to maximise their input into the assessment process. Staff invested time prior to initial assessments to determine the best way for people to contribute. This helped to ensure people's needs, wishes, and preferences, were fully identified and they could make informed decisions about moving to the home. One staff member told us, “We are always asked if we can do the care [people] want.” The staff member explained there was a positive approach to meeting the needs of people from a diverse background and said, “We have a ‘can do’ approach and it needs to be a fair game all the way. The approach is getting to know the individual, it means we can help them when others can’t.”

Staff told us they were supported to understand what mattered to people when they first moved into the home through prompt information sharing. One staff member showed us they were provided with key information about people's needs and care preferences on staff’s handheld electronic devices. This help to ensure staff were able to support people as they wished as soon as they moved into the home.

People’s care plans reflected their needs and preferences. These were regularly reviewed, and staff keep clear, detailed, person-centred records which demonstrated appropriate communication and action when changes to people’s needs, health or wellbeing were identified. People’s care plans were reviewed monthly however we found examples of recently reviewed care plans that required further input to ensure their accuracy. The registered manager assured us care plans would be reviewed to ensure people continued to receive the care they needed.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Recognised tools to monitor and evaluate people’s health conditions were used to determine the support and risk strategies people needed to support good care outcomes. Where people required regular assessing to monitor those who were malnourished, or at risk of malnutrition, or people’s likelihood of developing pressure areas, we observed pressure relieving equipment in place for those who needed it. This helped make sure, people received the right support to maintain their overall health and wellbeing.

Staff understood the national recognised tool used to determine a person’s food and fluid consistency so people could eat and drink in a safe way based on their individual needs. Staff described to us those people who needed thickener in their drinks, to reduce the risk of choking. The person’s care plan confirmed this. Staff completed individual food and fluid charts; however, we recommended staff also recorded the specific food that was given. The registered manager agreed to take action to address this. Staff conversations showed they knew the correct consistency of people’s food and drinks, so we were confident people received the right support.

People were provided with a range of meal choices to meet their nutritional needs. Staff showed people plated meal options, so they could make informed choices about what they would like to eat, especially those with limited memory function. This encouraged people to eat enough to remain well. Where staff had any concerns people may not be eating or drinking enough, staff promptly escalated their concerns to specialist health providers.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved

The registered manager, nursing staff and care staff all worked with external professionals to ensure people’s needs were met. Relevant agencies had been involved with adapting people’s care plans, so any advice or additional support needs that had been offered, were followed. People’s needs were reviewed and discussed with those health professionals to make sure people’s care remained effective. The registered manager told us the whole staff team worked well together. Communication was clear, strong and effective. Daily handovers, huddle meetings and clinical meetings were used to share important information to help staff be aware of any changing needs.

Staff worked with people and together to ensure people had the care they wanted. One staff member explained if there were any concerns for people’s well-being, “We tell the nurse and they will come and check on the [person]. You have to look with the [person] and seniors.” Nurses told us they could rely on care staff escalating any concerns about people’s health and well-being to them. Staff knew what actions to take in the event of people wanting care from the emergency services and gave examples showing how people had been supported to access both emergency and routine care from other health professionals. Staff were supported to make the right decision regarding future treatment by their underpinning knowledge about people and the impact of the medicines they were administered. For example, one staff member told us, “You need to be careful with blood thinners. You always contact 111 or 999.”

People were either accompanied by staff or relatives when attending hospital. Staff were positive about the relationship built with people’s GPs and where any external nursing advice was required to ensure people were appropriately supported, this was in place.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and wherepossible, reduce their future needs for care and support.

People were supported by staff to have access to other health services to promote their health and wellbeing. These included GPs, district nurses, speech and language therapist and music therapists. People and relatives said people saw external professionals that supported them to live a healthy life as possible. People and relatives were all in agreement from those we spoke with, they were in a home that provided good outcomes. One relative said, “[Relative] was in another home before this one, if she was still there now, we couldn’t have left her, we have peace of mind that she is being cared for here, it is a big relief.” A senior staff member explained if they had concerns for people’s health or wellbeing, “It’s escalated to their GP, so we can rule out any minor infections. We tell [people] if their health has changed.” The staff member advised us they would sometimes need to obtain more specialist help, for example, from speech and language therapists, so people would be supported to achieve the best outcomes possible.

Nurses and staff communicated well, sharing information to ensure they knew how people were feeling each day. Handover meetings helped achieve this as well as sharing updates through clinical meetings and with external health care professionals if advice was sought.

A range of healthy and calorie dense snacks and drinks were available throughout the day for people to choose from. A staff member gave us an example of the impact of the care they provided, which had led to a person having increased control regarding their eating habits.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Records were kept for monitoring people’s food and fluid intake, catheter care and when people needed to be repositioned to prevent skin damage, as well as checks on any pressure relieving equipment they needed. We found gaps in some monitoring records. For example, staff did not always record an air flow setting at required intervals. In one example, staff record ‘Yes’ to a pressure relieving mattress being set to the required weight when it was not. In another example, staff should have checked the setting and wrote ‘n/a’. Other records for food and fluids did not consistently record what snacks or meals a person had. A lack of accurate records could make it difficult for staff or other health professionals to know, what the person ate more of to help keep maintain their nutritional intake. Improved oversight of daily records was required to ensure monitoring records were completed accurately and consistently. The registered manager assured us this would be addressed.

People told us said staff checked on them which they appreciated. One person said, “They check in on you during the night. If you agree to it, they will register the check on their device, so you know when they came. You can opt out if you wish, but I find it very reassuring.” A relative told us, “[Relative] has had falls and they are very good at getting them checked out, and they let us know what’s happening.” Where health professionals had input in people’s care, that advice was followed and recorded.

People's health and well-being needs started to be monitored as soon as they move to the home. One staff member explained this included checks on people skin integrity, so any concerns could be identified and further monitoring and care arranged. Another staff member told us people’s changing health needs were considered at each handover and during staff meetings, so consideration could be given to obtaining more support for them as people’s needs changed. Staff were well informed of people’s health needs. This helped them understand what care people wanted and to know what areas of people’s health to monitor. One staff member explained for some people hourly checks on their health and welfare were undertaken, so staff could be sure they were receiving the care they needed at key stages in their care. A senior staff member told us, “[People] have good food and skin outcomes because we monitor them and report changes to each other.” Senior staff gave us examples of positive improvements in people’s skin care as a result of the care provided across teams to people. This included improvements in skin integrity for people in receipt of end of life care. The staff member said, “The wound care is amazing here.”

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

Our observations showed staff sought people’s consent, before they did anything. Staff were seen asking people what they wanted to do, or where they wanted to go in the home.People’s capacity to make their own decisions had been considered, but people’s mental capacity assessments did not consistently evidence people had been given the best opportunity to make their own decisions. For example, there was limited information about how people had been supported to understand the decision to be made, including trying at different times of the day, or under different circumstances. Doing so may give people greater opportunity to understand the decision to be made.

Where best interest decisions had been taken, for example, for covert medication, best interest decisions were not always fully completed. Staff advised this was recorded on the person’s medicine administration record. It was evidenced as being recorded on the RESECT form. In some examples, staff were not able to find any best interests decisions for some people. However, some capacity assessments did show other appropriate people had been consulted, such as people’s relatives and GPs, when the care and accommodation people required was considered. Before we left, the area manager and clinical assessor had already identified further work with staff, through training and understanding, was required to improve this.

Staff understood people had the right to make their own decisions, such as what care they wanted, what time they wanted their care and where in the home they wished to spend their time. A staff member said, “[People] have a choice about if they want to say in bed or get out, what to wear, and if they would like a glass of wine with their meals.” Another staff member explained how people’s GPs were consulted where significant decisions may need to be made. The staff member advised the person’s GP was able to advocate for the person, if required.

Staff were mindful of the impact of people choosing to spend extended periods of time in their own on their and possible impacts on their physical health and wellbeing. One staff member told us if people initially declined care, they reoffered this at a later stage, so they could be sure people’s needs were met.

Staff gave examples showing how they checked people’s body language and explained options to them, so they could be sure people were consenting to the care offered. Staff did not make assumptions that people’s usual preferences would always be chosen, so checked this with people regularly. This helped to ensure people’s needs were continually met and their rights were continually promoted.