Cedar Court Residential and Nursing Home

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

People received safe care and support. Improvements had been made to the assessment and ongoing review systems and processes of people’s individual care and treatment needs. Additional monitoring of quality and safety had increased, and management oversight and leadership had improved risk management.

Overall, positive feedback was received from relatives about the care and treatment of their family members. Relatives reflected on improvements made at the service in relation to better communication, management, and leadership.

People received their prescribed medicines safely and when required. The provider’s medicines management and monitoring procedures had been reviewed and improvements made.

Improvements had been made to the guidance provided for staff about how to meet people’s needs. Where we identified minor shortfalls in relation to some inconsistencies in information, the management team took immediate action.

People were protected as far as possible, from avoidable harm and abuse. Staff had received safeguarding training and understood their responsibilities to protect people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way. Improvements were ongoing in relation to the assessment process of people’s mental capacity.

Staff deployment was based on people’s dependency needs and was regularly reviewed. Staff recruitment had increased, resulting in a reduction in the use of agency staff. This promoted increased consistency and continuity in care and treatment.

Staff had been safely recruited and had received refresher training and their competency assessed. Staff were found to be knowledgeable about people’s individual care and treatment needs. Staff spoke positively about the improvements made at the service and how they felt well supported.

Observations of staff engagement with people was positive. There was a calm, organised and relaxed atmosphere at the service.

The service was overall clean and hygienic. Some shortfalls with storage of equipment and products were identified. This was discussed with the management team.

The provider had developed their procedures in reviewing and learning from accidents and incidents. Incident analysis identified learning opportunities, and this was shared with staff to support their learning and understanding.

Internal audits, checks, systems, and processes had been strengthened. Actions identified from monitoring procedures were added to an ongoing improvement plan. This supported the service to continually develop.

The management team were open and honest and had worked well at making the required improvements. The management team acknowledged further time was required for improvements to become fully embedded and sustained.

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 rated inspection for this service was inadequate (published 17 November 2022). Breaches in regulations relating to safety and governance were identified, and warning notices issued.

At this inspection, we found enough improvements had been made and the service was no longer in breach of regulation.

This service has been in Special Measures since the last inspection. During this inspection, the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

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.

Please see the safe and well-led sections of this full report. You can read the report from our last inspection, by selecting the 'all reports' link for Cedar Court Residential and Nursing Home on our website at www.cqc.org.uk.

Follow up

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

The care home is split into three floors. On the last day of the inspection there were 19 people receiving nursing care on the first floor and 20 people receiving residential care on the middle floor.

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

There were widespread failings of the leadership and governance of the service. Quality assurance systems and processes were ineffective as they failed to identify the concerns we found during the inspection. The service failed to learn from incidents or to respond to and manage risks, increasing the risk of harm to people.

People did not always receive their medicines as prescribed and medicines were not always stored safely.

There were not always enough staff recruited or deployed to provide safe care to people. Where agency staff were used, these were not regular staff that knew people well.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way. However, whilst we observed staff offer people choices, mental capacity assessments and best interest decisions for people that were unable to make choices had not always been undertaken.

Staff were observed to wear personal protective equipment (PPE) in line with current government guidance. The service was clean and free from any malodours. Visits to the service were promoted and managed safely.

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 rated inspection for this service was good (published 17 October 2019).

Why we inspected

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

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 inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cedar Court Residential and Nursing Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment and the leadership and governance of the service.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Some areas of the service were not well maintained. Some of the flooring in corridors, sluices and the laundry was perforated or missing. There were areas of unpainted wood and areas where wall tiles were missing, cracked or had poor grouting. Pull chord switches were not a type that could be disinfected. These issues compromised infection control measures and the effectiveness of cleaning. This could contribute to the spread of infection to people and staff.

Quality assurance audits undertaken by the provider, were not effective in identifying the shortfalls found during the inspection.

We found the following examples of good practice.

¿ The provider ensured continual supplies of personal protective equipment (PPE)for all staff working in the service. This included face masks and aprons and we saw staff used these appropriately. Staff were encouraged to change their PPE regularly.

¿ Used PPE was disposed of in foot operated pedal bins situated throughout the home. This reduced the potential for transfer of infection.

¿ Staff encouraged people to wash their hands frequently throughout the day. Where this was not possible, hand sanitiser was offered as a means to reduce the transfer of infection.

¿ The provider participated in regular COVID-19 testing of people living in the service and staff. That ensured action could be taken swiftly to reduce the potential spread of infection if a positive test was returned.

¿ Areas were cleaned and disinfected with cleaning products approved to reduce the potential transfer of infection.

¿ Risk assessments had been completed to protect people and any staff who may be at a higher risk if they contracted COVID-19. Measures were in place to support them.

¿ Staff worked in set teams and usually on a set floor of the two story home. That lessened the potential of cross infection within shift members.

Further information is in the detailed findings below.

Cedar Court Residential and Nursing Home is a care home providing personal care and accommodation for up to 52 people. There were 40 people using the service at the time of our inspection

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

People felt safe living at Cedar Court Residential and Nursing Home and risks to people had been identified, assessed and managed. People’s medicines were handled safely and provided in line with GP’s instructions. The registered manager and staff team understood their responsibilities for keeping people safe from abuse and avoidable harm. New staff were appropriately recruited into the service and there were overall, enough suitably trained staff to meet people’s needs. The staff team followed the providers infection control procedures and lessons were learned when things went wrong to improve the service moving forward.

People’s needs had been assessed to make sure the staff team could meet them. Plans of care had been developed and the staff team knew the needs of the people well. People were supported with their nutritional needs and supported to eat and drink well. People were supported to access the relevant healthcare professional when they required it.

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. Whilst major refurbishment was under way at the service, there were still places available for people to meet with others or to be alone.

The staff team were kind and caring and treated people with dignity and respect. People were involved in making decisions about their care and their consent to care was always obtained.

People’s care was centred on them and plans of care had been monitored regularly. Issues identified on day one of our visit regarding catheter care had been addressed by day two. This included the development of new documentation and supervision with staff. People’s complaints had been handled in line with the providers complaints policy. People’s wishes at end of life had been explored.

The staff team felt supported by the registered manager and management team. People, their relatives and staff were involved in how the service was run through meetings, the use of surveys and day to day conversations with the registered manager and the staff team. The registered manager worked in partnership with others to make sure people received safe care and support.

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 requires improvement (published 9 July 2018).

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.

The inspection took place on 18 and 21 May 2018. The first day of the inspection was unannounced.

Cedar Court Residential and Nursing Home provides personal and nursing care and accommodation for up to 48 people. On the day of the inspection the registered manager informed us that 46 people were living at the home.

At our last inspection we rated the service as Requires Improvement. At this inspection we found the service had improved but was still rated as Requires Improvement.

People's risk assessments provided staff with information on how to support people safely, though some assessments were not fully in place. Staff had been trained in safeguarding (protecting people from abuse) and understood their responsibilities in this area, although they were not aware of all the relevant outside agencies they could report any concerns to.

People told us they liked the staff and got on well with them. We saw many examples of staff working with people in a friendly and caring way, though the registered manager agreed that some staff were not always friendly and caring. Confidentiality of people’s information had not always been protected.

Care plans were individual to the people using the service and covered their health and social care needs. However, care staff had not read all of care plans to equip them to meet all the needs of people. Care did not always meet people's needs and . Activities were organised to provide stimulation for people and they had opportunities to take part in activities in the community if they chose.

A registered manager was in post. This is a condition of the registration of the service. 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 and associated Regulations about how the service is run.

Lessons to prevent incidents occurring had been learnt from past events. Staffing levels were sufficient to ensure people's safety.

Staff were subject to checks to ensure they were appropriate to work with the people who used the service. People were protected from the risks of infection.

People using the service and relatives we spoke with said they thought the home was safe. They thought their medicines were supplied to them safely and on time, and this had been the case when we checked.

Staff had been trained to ensure they had the skills and knowledge to meet people's needs. Staff understood their main responsibility under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) to allow, as much as possible, people to have an effective choice about how they lived their lives.

People had plenty to eat and drink and everyone told us they liked the food served.

People's health care needs had been protected by referral to health care professionals when necessary.

People and their representatives were involved in making decisions about their care, treatment and support.

People and their relatives told us they would tell staff if they had any concerns and were confident these would be followed up.

Cedar Court Residential and Nursing Home is located in Wigston, Leicester. The service provides accommodation for up to 48 people who require nursing or personal care. There were 44 people using the service at the time of our inspection.

The service had a registered manager. 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 people using the service, relatives and members of staff told us that there were not always sufficient numbers of staff deployed to meet the needs of the people using the service. This was observed during our visit.

The records kept in relation to peoples medicines did not always correspond with the medicines held at the service. People received their medicines in a safe way.

People told us they felt safe living at Cedar Court Residential and Nursing Home. The staff team were aware of their responsibilities for keeping people safe from avoidable harm and knew to report any concerns to the management team.

Risks associated with people's care and support had been assessed to enable the staff team to provide the safest possible support. Where risks had been identified these had, wherever possible, been minimised to better protect people's health and welfare.

Appropriate checks had been carried out before new members of staff commenced work. This was to make sure that they were suitable and safe to work at the service.

People received support from a staff team that had the necessary skills and knowledge. New members of staff had received a comprehensive induction into the service when they were first employed and training relevant to their role had been provided.

People's food and drink requirements had been assessed and a balanced diet was being provided. Records kept for people assessed as being at risk of not getting the food and drinks they needed to keep them well were not always accurate.

People were supported to maintain good health. They had access to relevant healthcare services such as doctors and community nurses and they received on-going healthcare support.

People's privacy and dignity was respected and promoted by the staff team.

People had been involved in making day to day decisions about their care and support. Where people lacked the capacity to make their own decisions, evidence was seen to demonstrate that decisions had been made for them in their best interest and in consultation with others.

People had plans of care that reflected their care and support needs. These provided the staff team with the information they needed in order to properly support the people using the service.

Relatives and friends were encouraged to visit and they told us that they were made welcome at all times by the staff team.

People were supported to follow their interests and take part in social activities. An activities coordinator was employed and they supported the people using the service with both one to one and group activities.

There was a complaints procedure in place and the people using the service and their relatives and friends knew what to do if they had a concern of any kind.

Staff meetings and meetings for the people using the service and their relatives had been held. These meetings provided people with the opportunity to be involved in how the service was run.

The service was in breach of one regulation of the Health and Social Care Act 2008 (Regulated Activities Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

Below is a summary of what we found. The summary describes what we observed, the records we looked at, and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People said they felt safe at Cedar Court and would speak out if they had any concerns. One person told us, 'The staff look after us very well and are always kind, but if that ever changed I would tell the manager.' Relatives also said they would report any concerns to staff. One relative commented, 'If I was upset about something here I'd tell the carers, but I know I could tell the management too if I needed to.'

Staff had been trained in safeguarding (protecting vulnerable people from abuse) and knew what to do if they were concerned about the well-being of any of the people who used the service. They also knew how to escalate a concern if they felt it had not been properly addressed.

Staff had been safely recruited with background checks done to help ensure they were fit to work with the people who used the service.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

At our last pharmacy inspection the home was given a warning notice for safe management of medicines. Our pharmacist found this had been met and people were being given their medicines when they needed them, and in a safe way.

Is the service effective?

Since we last inspected care plans had been re-written to make them more person-centred, setting out people's likes, dislikes and preferences. For example, one person's specified they liked jelly babies, mint imperials, and chocolate and stated 'ensure X has a good supply of their favourite sweets'. We met this person in their room and found this was the case.

At our last two inspections of Cedar Court people raised concerns about the quality of mouth care in the home and we told the provider to address this. At this inspection some improvements had been made. New care plans and risk assessments were in place for people who needed mouth care, for example those who were 'nil by mouth' and/or receiving palliative care.

We talked to the people who used the service and their relatives about mouth care. Some said it had improved and they were now satisfied. Other felt there was still room for improvement. One person said, 'It's still a bit hit and miss.' One care plan and risk assessment had not been updated to show the level of assistance one person needed with their mouth care. We reported this to the management team who agreed to update the care plan.

Is the service caring?

People told us they were pleased with the current staff team. One person who used the service said, 'The care staff are very bubbly, I like that and it makes for a good atmosphere.' A relative commented, 'The staff treat all the residents with respect and look after them brilliantly.'

People said the staff coped well when the home was busy. One person said, 'I've no complaints about the staff. Sometimes there's a lot to do and the home is a bit hectic but the staff deal with it well and are all very helpful.'

All the staff we met were positive, caring and friendly. We saw evidence of team working across all the staff groups. For example one of the cleaning staff comforted a person who used the service when they spilt a drink, and went to get a care worker to assist them in changing.

The home had recruited some new permanent staff and were keeping the use of agency staff to a minimum. This meant the people who used the service and their relatives had the opportunity to get to know individual staff members, build up relationships with them, and experience continuity of care.

Is the service responsive?

People told us they were happy with the care provided. One person said, 'Everything's good, I like it here.' Another person commented, 'The girls bring my tea to my room, they're fantastic.' Relatives also said they were satisfied with the care. One relative told us, 'Through all the changes the care has always been good.' Another said, 'The staff here know how to care for the residents properly.'

We saw staff were kind when they cared for people and did not rush them. One care worker brought a person into the lounge and spent time helping them decide where they wanted to sit. They brought them a jug of juice and a cup and made sure they were comfortable before they left. Another care worker reassured a person who was distressed and held their hand until them were calm.

At our previous inspection we found examples of care plans and risk assessments that were not fit for purpose. For example, some care plans and risk assessments did not give staff clear instructions on how to support people.

At this inspection care plans and risk assessments had been improved. The management team said staff had been reviewing and updating them and most were complete.

Is the service well-led?

Since we last inspected the leadership of the home had changed. A management team was in place and a new acting manager in post. She had applied to CQC to become the new registered manager. The management team and acting manager were working together to bring about improvements to the home.

People told us they were happy with the new management arrangements. One relative said, 'The new (acting) manager is a people-person. She was at the relatives meeting and she's on our wavelength. She's making it easier for staff to do their jobs. Morale had been low but staff seem much happier now.'

People were consulted about their care. The acting manager was holding monthly 'residents and relatives' meetings to explain what was being done to improve the home. This gave the people who used the service and their relatives the opportunity to comment on progress, make suggestions, and give feedback. The relatives we spoke with said they found these meetings useful and appreciated being involved in decisions about the home.

The home had a system to assure the quality of the service they provided. The way the service was run had been regularly reviewed. Records showed prompt action had been taken to improve the service or put right any shortfalls they had found.

When we visited all areas of the home were clean and tidy. Staff were motivated and got on well with the people who used the service. A range of activities were on offer from the home's activities co-ordinator.

At our last inspection people's mental health and other needs were not being fully recognised or met at Cedar Court. Since then some improvements had been made to how these needs were assessed and met via staff training, new more person centred care plans/risk assessments, and regular reviews. However some care plans/risk assessments were still not fit for purpose.

At our last inspection medicines were not being managed safely and the provider agreed to take action to improve the situation. At this inspection we conducted a sample audit of 12 people's medicines. We found three people did not have some of their prescribed medicines available. We noted gaps in some medicine administration records and also medicine errors which had not been identified by the service. This meant that we could not be assured people were being given their medicines as intended by prescribers.

People told us they were satisfied with the food provided. One person said, 'I can't knock the cooking. If you don't like what's on the menu the staff will put themselves out for you and go and get you something else.' Another person commented, 'They do some lovely meals. They do a nice salad with everything in it.'

People said they liked the staff at Cedar Court. One person told us, 'The staff are pretty good. They are always busy but they do find time for a quick chat.' Another person commented, 'I get on well with all the staff. They are very helpful, as is the manager. If something's wrong you can tell her. She's solved a few problems for me.'

People told us they were happy with how the home looked. One person said, "It's a very smart looking place and always lovely and clean.' Another commented, 'There's been lots of improvements and redecorating since I came here. It looks fantastic now.'

Some care plans for mental health were unsatisfactory and not all care plans/risk assessments had been regularly reviewed. Improvements were also needed to the way medication was managed and administered in the home. The manager has agreed to address these issues.

People told us they liked the staff team and got on well with them. One person said, 'The carers are wonderful ' they do everything with a smile.' Another person told us, 'They're not short of staff here. I'm always well-looked after. The staff are excellent.' We observed staff spending time with people, chatting to them and taking an interest in what they were doing.

People said they thought the home had improved in the last few months. One person told us, 'They've redecorated and it looks lovely.' A relative commented, 'The new manager seems really good and the home has definitely improved since she's been here. The new d'cor is fantastic ' I love visiting now.'

The people who used the service and relatives told us the new manager was approachable easy to talk to. A relative said, 'Nothing's too much trouble for the new manager ' I'm very impressed with her.'

Group activities were provided in one of the lounges but some people who tended to stay in their rooms did not know what activities were on or how they could take part. One person told us, 'There are no activities here as far as I'm aware.' Another person said, 'I can't do group activities, I'm not well enough to get to the lounge.'

People said they felt safe in the home and trusted the staff. One person told us, 'I'd speak to any of the staff if I had a complaint or there was anything else wrong. There's plenty who are easy to talk to.' Another person commented, 'I've never felt anything but safe here.'

People told us they thought the staff were well-trained and knew how to provide appropriate care. One person told us, 'The carers seem to know what they're doing and if they don't know they ask me or one of the nurses.' Another person commented, 'The nurses seem very knowledgeable and if I have any problems I always ask them for advice.'