Cedar Lodge

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 69 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The registered manager gave us examples in how they learned from events to improve staff practice and outcomes for people. The registered manager told us of an example when they became registered manager before the COVID-19 pandemic. They told us how working through that, keeping people, staff and visitors safe helped them become more alert to risks. They also said they had reflected upon those times and took learning from this, such as explaining to staff how as a management team, all of the changes and managing at pace with changing guidelines had impacted on them all. The registered manager said by doing this it helped staff have an understanding, that despite job titles, everyone was impacted. The learning from this was taken to improve the culture at the service to be more open, inclusive and accepting.

Staff told us there was an expectation to explore how any incidents occurred. One staff member said if people experienced a fall, “Senior [staff] always ask what has happened.” Staff gave us examples showing how learning had been communicated across the team, so the likelihood of people experiencing burns from drinks was reduced. The staff member said, “Our nurses tell us in handover, and all staff attend handover.” Another staff member gave us an example of lessons learnt shared with staff, such as a person who missed their breakfast, as they had not been asked at their preferred time. Staff were reminded about allocating this task and this was resolved. Another staff member told us department heads and seniors met each day, to review any safety incidents. The staff member said, “We always look at the way the fall occurred, and ask is the equipment right for the [person].”

Accidents, incidents were recorded and the provider’s audit identifies trends and themes, so action could be taken to prevent similar incidents from reoccurring. Trends and themes were also identified by the providers internal quality teams. The clinical assessor told us they had shared with the provider learnings from this inspection.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Relatives felt very engaged in the process to assess family member’s needs and whether the home was right for them. One relative said they moved from one of the provider’s other homes when it closed. About Cedar Lodge, they said, “Staff are brilliant, very proactive. Every time there is a problem (minor), they tell me.”

A senior staff member explained a hospital pack was created from the provider’s IT care system, so essential information was available to accompany any routine or emergency admissions to hospital. People’s medicines were also taken by care staff, who accompanied people to hospital.

The provider’s systems captured personalised information about people’s histories, risks to people’s health, their medication and wishes for future care. This information was shared with other healthcare professionals where necessary.

The provider did concentrate on improving people’s lives to protect their rights for making decisions in people’s best interests. People did live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did work well with people and healthcare partners to understand what being safe meant to them and how to achieve that.

People felt safe and relatives said, they felt their family members safety needs were met as they were now living at Cedar Lodge. One relative said, “We can have meetings, we can visit anytime, I know [Relative] is safe because the staff are excellent.” A person said, “I have been here for 1 year. I feel very safe.” People said they felt safe because staff looked after them well and were attentive when they needed help. Nobody had experienced any unsafe practice from anyone at the service.

Staff conversations showed they knew what safeguarding meant and their responsibility to report any concerns through poor practice. Information about the local safeguarding processes was accessible for staff. Staff knew how to identify any potential safeguarding issues, including self-harm. One staff member told us, “You have to consider safeguarding. Are [people] tense? You encourage them to ask for help, but you don’t ignore it.” Another staff member told us, “You document it. It must be facts, not word of mouth. You are [people’s] advocates.” Staff described how they escalated any concerns to senior staff, recorded their concerns, and were confident senior staff would take action to support people. Staff also understood which external organisations had responsibilities for keeping people safe.

We were not confident some staff fully understood people who may have a deprivation of liberty safeguard (DoLS). A staff member said she was not sure if anyone in the dementia unit had a DoLS in place and said senior staff would deal with this. A senior staff member said most people on the dementia unit had a DoLS in place, and advised us the deputy manager completed the DoLS, however, communication back to nurses was not always prompt when DoLS were approved.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Some care plans required information to ensure people continued to receive consistent care whilst minimising risks. We looked at examples of people’s catheter care plans. We saw plans informed staff about risks relating to urinary blockage and risks and history of urinary infections. People had a catheter passport that showed when their catheters required changing every 3 months. In some cases, the date of the next expected/planned change was blank. In 1 example, the catheter should have been changed but had not been. In another 2 examples, we saw it was recorded as changed in some documents, but not on the catheter passport. This had not been identified for improvement. Some medicine risks around the application of pain patch medicines had not been identified.

However, staff assessed risks to people’s health, safety and welfare and care plans described the action to be taken to manage those risks. Some risk management plans reflected the support people needed. For example, people’s care plans recorded their risks and what actions staff need to take to support them, such as risks associated with the medicines they were administered, when moving about the home, and risks associated with their health and well-being diagnosis. These included risk of falls, skin breakdown and weight loss. One staff member gave us an example showing how staff had identified a person was at risk of skin damage. The staff member had escalated their concerns and nurses had ensured additional equipment was obtained, to reduce risks to the person.

People who were identified at risk of falling had alarm mats in front of where they sat, or for people at risk of falling from their bed, people were in beds set to their lowest position to minimise risk of injury from falling. Environmental risks such as water quality, fire safety and health and safety were completed at regular intervals.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Health and safety and environmental checks on water quality, water temperature equipment, the environment and maintenance issues were completed. We were told vacant rooms had regular water checks to ensure water quality remained safe. One relative whose family member had limited mobility and could not use the bathroom facilities that frequently said, “Maintenance issues are dealt with quickly; they even pop in to flush the toilet and run the taps occasionally”

People raised no concerns with us about their environment. People could access the communal areas and corridors without restriction and corridors were wide enough that made it easier for people using mobility equipment to navigate to areas of the home. A lift meant people could access other floors. There was an outside space people could use and this could be accessed by people with limited mobility.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Our observations showed there were enough staff to meet people’s needs. People and relatives felt staffing levels were sufficient. One person said, “Oh I think there’s plenty, I’ve never had a problem finding someone if I need to ask a question.” Another person said, “I’ve got a button to press, or there’s always people going past. They always come quickly.” Some people felt staff did not always arrive to them promptly, but they did say staff always supported them.

Staff told us there were sufficient staff to care for people. One staff member said there was a consistent staff team supporting people. The staff member told us, “[People] are comfortable, because they get to know our faces.” The registered manager was confident they had enough staff on duty to meet people’s needs. The registered manager used a dependency tool so staffing levels were based upon people’s assessed needs. The registered manager and area manager were confident people’s assessed level of risks were accurate and that there were enough suitably trained staff to meet people’s needs.

Staff were supported to understand how to care for people through induction, which included repositioning, continence care, safeguarding and Mental Capacity Act training. One staff member said, “You can’t do care until you have done it.” Staff had an induction when they started working at Cedar Lodge and worked alongside more experienced staff to get to know people and their preferred routines. The registered manager told us training was regularly refreshed and spoke positively about their training opportunities. The provider completed necessary recruitment checks prior to staff starting work to ensure the suitability of staff before they commenced employment. Recruitment checks included references and Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. This helps providers make safe recruitment decisions. Where some checks identified a potential risk, appropriate measures were put in place to keep people safe and protected. Staff we spoke with felt they had the right training that was relevant and necessary for their role.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. The provider assessed and managed the risk of infection.

People and relatives raised no concerns. One relative said, “I can’t believe how clean it is.”Throughout the home, we saw personal protective equipment (PPE) such as gloves, aprons and masks were available, if required. Our observations showed staff wore PPE at the appropriate times and there was information to remind staff how to apply and remove PPE safely, to minimise the risk of cross infection. A relative was confident staff followed safe infection control practices, they told us, “I’ve seen them (staff) wear gloves and aprons.”

Housekeeping staff maintained the home and used relevant mops to reduce the cross-infection risks. Signage was displayed in communal bathrooms to inform and remind people and visitors about good hygiene practice. Foot-operated bins helped reduce contact points to limit risk of cross infection. Whilst we saw infection control measures were in place, we found some people who required their fluids to be thickened, their drinks were pre-made and left out in their room for up to 12 hours before being changed or consumed. We recommended those people’s drinks were made when needed rather than left out, which would help to reduce any risk of infection.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

We found some improvements were required in the way some people’s medicines were administered and recorded. For those people, we found people had not come to harm. The providers systems to check and staff’s knowledge, did not give us confidence those people received their medicines safely and as prescribed. For example, we found some patch medicines for pain management were not applied correctly to the skin. When a medicated pain patch is not applied as directed, it may not deliver the right dose of medication, potentially leading to a loss of pain relief or, in some cases, an overdose. Speaking with staff, they were not aware they had to rotate where certain patch medicines where applied on the person’s body. During our second day, the area manager and clinical assessor confirmed they had taken steps improve this.

Processes to make sure people received their medicines were completed, such as regular audits and actions to address medicine errors at the earliest opportunity. However, these were not always effective in identifying the issues we found. The area manager told us they would reconsider the scope of the checks to ensure issues were identified more quickly, so actions could be taken to keep people safe.

Medicines were stored safely. Medicines that required storage in a refrigerator were stored within safe temperature range. Where people received medicines on as an and when basis, protocols gave staff the right information to administer these medicines safely. People told us they received their medicines and relatives were satisfied their family member’s received medicines from staff at the times needed. Staff were confident if they raised any concerns regarding medicines or pain relief senior staff would address them. Some staff had responsibility for administering medicinal creams. Staff described an appropriate process for managing such medicines safely. This included checking the date people’s creams were opened, so they could be sure the creams they were applying had maintained their therapeutic values.

Staff told us they had medicines training and their competency to administer medicines safely was checked. During our visit, a clinical assessor was assessing the registered managers medicines competency.