Cedar Lodge

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s needs were met through good organisation and delivery.

This service scored 79 (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 were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

People’s care plans demonstrated staff had considered people’s individual preferences and used this information to complete a personalised care plan for staff to follow. Staff understood what was important to people and how they individually liked to be supported. Staff explained how they used their knowledge of what mattered to people when caring for them. One staff member told us about the history of one person they supported, who used to run their own business. The staff member explained how they supported the person to continue to wear the clothes they liked to wear so they felt smart and prepared for the day. The staff member told us how they supported other people so their identify was maintained. The staff member said, “You know which ladies like a bit of lippy, [lipstick], and which handbag they will want to use.”

One staff member told us how they supported one person who was sometimes anxious. The staff member said, “You offer [person’s name] a cuppa, it picks up their mood.” Staff were mindful of people’s differing religious needs and took action to adapt how they provided care, so their needs were met. For example, one staff member explained they had adapted when they provided nutritional support to one person, whose faith meant they needed to eat at a specific time.

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

Relatives felt supported and involved to continue playing an important role in caring for their family members. People and relatives described staff as being very kind, supportive and understanding of their relationships. One person said, “The staff are very kind and thoughtful when I want them, always quite respectful. I’m left alone, it’s how I like it but if I ask them to get something special, they do.” One relative told us, “I have never been aware of staff rushing people or anyone else here and they do help when she needs it.” Staff told us they knew people well, worked well with their colleagues and because they worked across both floors, knew people which helped if they had to cover other staff in the home at short notice.

The management and staff team had built effective partnership working with external healthcare professionals and commissioners of services so people could be confident of receiving the care they needed at the right time. Staff had a good understanding of people’s social care and health needs and people were supported to have a regular staff team caring for them. This included when they wanted support from other health and social care professionals, with staff accompanying people to appointments and advocating for them. Relatives were kept informed of their family member’s well-being and sometimes accompanied staff when they supported people to extend external health appointments. Systems were in place to ensure key information was appropriately communicated to other health and social care professionals, so people benefited from continuity of care.

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Relatives said they were involved and if there were any changes, they were consulted with and informed. Staff gave us examples showing how they had supported people, so their communication and sensory needs were met. One staff member told us they had used a whiteboard to communicate with one person with sensory needs, so they could be sure they were making their own decisions. The staff member said, “You can offer choices this way if people cannot lip read.” Another staff member told us although they had not needed to support people with specific communication needs, they were confident senior staff would provide large font or translations of documents, should this be required.

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their day to day care.

People were asked what care they wanted. People and relatives saw the registered manager regularly so had opportunity to speak with them about anything. Staff understood how to support people and others to raise any concerns or complaints they may have. One staff member told us any concerns were treated seriously. They said, “It should be sorted first time, not happen a second time.” Our observations showed people were involved, asked and their wishes followed.

The provider ensured people could access the care, support and treatment they needed when they needed it.

People with protected characteristics were supported to achieve good outcomes. For example, staff identified and fully responded to people’s needs, checking and adapting their practice as people’s care journeys progressed. Staff gave us an example showing how one person’s disability protected characteristic needs had been met over many weeks. This had increased the person’s well-being, and they were now less anxious and more able and confident to accept support from staff. One staff member told us after an extended period of 1:1 care, “[Person’s name] started holding staff’s hands, it was brilliant.” Staff had also supported the person regaining their independence when eating and drinking. As part of this, staff had carefully considered what aids and adaptations the person needed to do this safely and ensured these were put in place.

Staff and leaders were innovative in how they listened to information about people who are most likely to experience inequality in experience or outcomes. Staff and leaders actively used this information to provide exceptionally tailored care, support and treatment in response to this.

There was a whole team commitment to ensuring all people were treated fairly and their protected characteristics were celebrated and their lives enriched. The registered manager had a passion to promote and educate everyone about the importance of equality, diversity and inclusion. Positive consideration to this started before people moved into Cedar Lodge. The registered manager told us about 1 person who through their specific health conditions, did not want to enter the home for a pre assessment of needs. Recognising their anxieties and potential barriers, the registered manager with the persons permission, completed the pre assessment outside. In a short period of the time, the person felt confident to enter the home and was happy to stay. In another example, the registered manager said they assessed a person who had come from a different part of the country who had previous addiction and complex behaviours. Understanding their individuality and encouraging the person to be confident with a staff team who understood and wanted to help, this person moved into the home. We were told most of their anxieties had disappeared because they received the right levels of support and involvement. This was because people’s individual characteristics were embedded throughout the initial assessment and by ensuring people were fully supported by staff to access specialist clinical advice when they wanted this.

Staff supported people who may often be marginalised owing to their existing physical health diagnosis, anxiety or addictions. They did this by embracing people’s unique needs and by adapting and tailoring initial assessment processes, so people had the best opportunity to make key decisions about their lives. This included if they wished to move into the home, and what care they wished to receive. This enhanced people’s wellbeing and provided fair access to accommodation, care and support. This approach was made possible as senior staff were open and transparent about the support people wanted to meet their protected characteristics. Senior staff worked closely with care staff, so they were empowered to provide exceptional support to people. This fostered an environment where staff’s confidence grew and their own protected characteristics were understood and promoted.

People were supported to plan in enough detail for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life. At the time of our inspection, some people were on an end-of-life care pathway.

People and relatives felt supported by staff when end of life care pathways needed to be considered. One relative said, “We did discuss end of life, and they have been very professional. I have no criticisms, they (staff) have been very good, very caring.” Another person felt involved in end of life choices, one person said, “The end of life plans have been discussed and they know my views. We have discussed my preferences – opted for DNR (do not resuscitate) and I don’t want a religious service.” Another relative told us, “Staff really seem to know what they are doing, even now [Relative] is nearing the end of their life. They (staff) are so gentle and understanding.”

We saw relatives were treated compassionately, sensitively, honestly, and supported as their family members entered the last days of their lives and were treated as partners in their care. Relatives were supported to stay with their family members for extended periods, as they wished, at the end of their family member’s lives.

Staff understood how people’s needs changed as they moved to the end of their lives. This included people’s dietary and respiratory and pain management support needs. One staff member said, “We feel we want to be there. It’s having the compassion and empathy and doing the enhanced checks.” Another staff member said, “You make them comfortable, make them priority and offer to wash them, get them a meal. Some have lived with us a long time, so we get to attend the funeral and say our own goodbyes.” Staff provided care to people that were approaching end of life. Staff knew what to do, how to provide their care and support as well as keeping relatives fully informed. In some cases, external health professionals and organisations were involved.

The registered manager said they had recently been in contact with a local hospice to provide additional learning and information to guide staff around end-of-life care. During our visit, the registered manager told us a person had passed away. When the funeral directors attended the home, staff were invited to gather and pay tribute to celebrate a person’s life as they left their home.

People’s care plans reflected their basic preferences for where they wished to receive end of life care. We saw some care records that contained basic information about end-of-life care. In some cases, not everyone wanted to provide full details now about what they wanted to do at the time end of life care was needed. However, in examples we saw, those records would benefit from important information about people’s spiritual or holistic wishes being known. We discussed this with the area manager who acknowledged this was an area for continued development.

The registered manager told us they worked collaboratively with the previous Chaplain, by developing an ‘End-of-Life booklet’ for Cedar Lodge. This booklet was available to people, relatives, and staff, and clearly outlined the end-of-life practices alongside helpful and supportive information. This provided reassurance to families. The registered manager introduced a respectful practice whereby staff accompany residents when funeral directors attend the home. The registered manager said, “This has become an embedded part of our culture and continues consistently even in my absence. Staff have shared how meaningful this practice feels, expressing pride and gratitude for the opportunity to say a final goodbye to residents they have cared for.” This approach has been positively recognised externally; a funeral director had recently, specifically complimented Cedar Lodge on this practice, noting the personal and dignified touch it brings to the end-of-life process.