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Inspection Summary


Overall summary & rating

Requires improvement

Updated 10 April 2019

About the service: About the service:

• Cedar House offers accommodation and personal or nursing care for up to 42 older people, some of whom are living with the experience of dementia. The accommodation is provided on the ground and first floor of a purpose-built building. There were 40 people using the service at the time of our inspection.

• Cedar House is part of HC-One Oval Limited, a large organisation which owns over 300 care homes across the United Kingdom.

People’s experience of using the service:

• We found that, although there were processes for auditing and monitoring the quality and safety of services people received, these had failed to identify the issues we had found in a timely manner so the provider could make the necessary improvements.

• Although some improvements had been made, some people stated there were not always enough permanent staff on duty, especially at weekends and during school holidays to provide continuity of care. The staff rota indicated all shifts were covered, although many by agency staff.

• People who required the use of hoists to mobilise did not have their own allocated slings. This meant there was a risk of cross contamination. There was a malodour in the downstairs unit which persisted throughout the day of our inspection.

• People who used the service did not always get the support they needed to eat, in line with their care plans. Therefore there was a risk some people did not receive enough food and drink to meet their nutritional needs.

• There were times when staff did not meet people’s needs in a person-centred way and were focused on the task they were required to complete. Some supported people without speaking with them or explaining what they were doing.

• The provider had processes for the recording and investigation of incidents and accidents. However, not all included actions taken to prevent reoccurrence and the lessons learned.

• People were supported by staff who were suitably trained, supervised and appraised

• There was evidence that people were offered a range of activities and an activity plan was displayed. The provider employed an activity officer who was planning to improve the provision of activities for people who used the service.

• Care plans were comprehensive and detailed. They contained all the necessary information about the person and how they wanted their care provided.

• Risk assessments were in place. These identified the risks that people faced and included guidelines for staff to follow to help ensure people were safe from harm.

• People’s healthcare needs were met because staff took appropriate action when concerns were identified.

• Medicines were safely managed. There were systems for ordering, administering and monitoring medicines. Staff received training in the administration of medicines and had their competencies checked.

• People’s end of life wishes were recorded in their care plans. These included their religious and cultural needs and where they wanted to receive care when they reached the end of their life.

• Recruitment checks were carried out before staff started working for the service and included checks to ensure staff had the relevant previous experience and qualifications.

• The environment was comfortable and homely and suited to the individual needs of people, such as people living with the experience of dementia.

• The provider acted in accordance with the Mental Capacity Act 2005 (MCA). Where people lacked the capacity to make particular decisions about their care, their mental capacity was assessed. Where necessary, people were being deprived of their liberty lawfully.

• Rating at last inspection: At the last inspection on 15 and 16 January 2018 the service was rated requires improvement in the key questions of ‘safe’, ‘caring’, ‘responsive’ and ‘well led’ and overall. Previously to this, we also rated the service requires improvement for two consecutive years. During this inspection we found the

Inspection areas

Safe

Requires improvement

Updated 10 April 2019

The service was not always safe

Details are in our Safe findings below.

Effective

Requires improvement

Updated 10 April 2019

The service was not always effective

Details are in our Effective findings below.

Caring

Requires improvement

Updated 10 April 2019

The service was not always caring

Details are in our Caring findings below.

Responsive

Requires improvement

Updated 10 April 2019

The service was not always responsive.

Details are in our Responsive findings below.

Well-led

Requires improvement

Updated 10 April 2019

The service was not always well led.

Details are in our Well led findings below.