We carried out a review of the data available to us about Cedar House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Cedar House, you can give feedback on this service.
Cedar House is a residential home that provides accommodation and personal care for adults with a range of care and support needs, including adults who are living with dementia. The service can accommodate up to 32 people in one adapted building over two floors. At the time of this inspection there were 21 people using the service.
People’s experience of using this service and what we found
People received safe care from staff who had been provided with safeguarding training. There were risk plans in place to protect and promote people’s safety. Staffing numbers were being maintained to keep people safe and the registered manager followed the established recruitment procedures to ensure staff employed were suitable for their role. Medicines were stored, managed and administered safely.
People's needs were assessed before they moved into the service to ensure they could receive the care they required. Staff received training and support to carry out their roles and responsibilities. People enjoyed a varied and nutritious diet. Staff worked with external professionals to promote people’s health and wellbeing. 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. We have made a recommendation about the environment for people living with dementia.
People were treated with dignity and respect and their independence was promoted. Privacy was encouraged and maintained.
Staff knew people well and encouraged people to take part in activities which were meaningful to them. There were policies and procedures in place to manage complaints appropriately. Effective systems were in place to monitor and improve the quality of the service provided through a range of internal checks and audits.
Rating at last inspection and update: The last rating for this service was requires improvement (published 18 September 2019) and there were three breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection.
We found no evidence during this inspection that people were at risk of harm.
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.
Cedar House is a residential care home providing personal and nursing care for 33 people aged 65 and over. At the time of the inspection there were 32 people living at Cedar House.
People’s experience of using this service and what we found
Although there were some areas of safe practice, people were not always safe. Not all medicines were securely stored to ensure people’s safety. Where medication audits highlighted discrepancies, action plans were not in place to show how these were addressed and lessons learned. Risks to people were recorded but not in enough detail to evidence how these risks were to be reduced. Suitable arrangements were in place to safeguard people from abuse and there were enough numbers of staff available to meet people’s needs. Recruitment practices were generally safe. The premises were clean and hygienic.
Staff did not receive training from an accredited trainer who had subject expertise. This meant there was a risk that the training provided would not be effective to make sure staff were knowledgeable and competent. Robust inductions were not in place for newly appointed staff. People were not always supported to have maximum choice and control of their lives. The dining experience was positive, and people were supported to eat and drink enough. The service worked together with other organisations and people were supported to access a range of healthcare services.
Though most people using the service and their relatives said staff were kind, our findings did not suggest a consistent caring service or a service that was always respectful and treated people with dignity. People were supported to express their views but where issues were raised, it was not always clear what had been done. However, people received good end of life care to ensure a comfortable and dignified death.
People did not always receive personalised care that met their needs. People were not routinely supported and enabled to follow their interests and take part in social activities. Improvements were required in relation to care planning. People’s concerns and complaints were listened to.
Quality assurance and governance arrangements at the service were not reliable or effective in identifying shortfalls in the service. There was a lack of understanding of the risks and issues and the potential impact on people using the service.
We have made a recommendation about staff training and induction.
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 good (published 11 February 2017).
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
At the last inspection, the service was rated Good. At this inspection we found the service remained Good.
The service was safe. The service’s recruitment process ensured that appropriate checks were carried out before staff commenced employment. There were sufficient staff on duty to meet the needs of people and keep them safe from potential harm or abuse. People’s health and wellbeing needs were assessed and reviewed to minimise risk to health. The service needed to improve management and record keeping of administered medication.
The service was effective. People were cared for and supported by staff who had received training to support people to meet their needs. The registered manager had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People were supported to eat and drink enough as to ensure they maintained a balanced diet and referrals to health and social care services was made when required.
The service was caring. Staff cared for people in a empathetic and kind manner. Staff had a good understanding of people’s preferences of care. Staff always worked hard to promote people’s independence through encouraging and supporting people to make informed decisions.
The service was responsive. People and their relatives were involved in the planning and review of their care. Care plans were reviewed on a regular basis and also when there was a change in care needs. People were supported to follow their interests and participate in social activities. The service responded to complaints received in a timely manner.
The service was well-led. Staff, people and their relatives spoke very highly of the manager and the provider who they informed to be very supportive and worked hard to provide an exceptional service. The service had systems in place to monitor and provide good care and these were reviewed on a regular basis. The registered manager acknowledged that some of the systems and processes needed to be improved.
Cedar House provides care and accommodation for up to 33 older people who may be living with dementia. This inspection took place on 20 October 2014 and was unannounced. The inspection team consisted of an inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.
The service has had a registered manager in post since it was first registered in October 2012. 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.
People told us that they felt safe living in Cedar House. They told us that they were treated with dignity and respect. We saw staff interacting with people and they did so in a kind, caring and sensitive manner. Staff showed a good knowledge of safeguarding procedures and were clear about the actions they would take to protect people.
Recruitment checks had been carried out before staff started work. There were sufficient numbers of skilled, well trained and qualified staff on duty. Staff told us that they felt well supported to carry out their work. We saw that staff had received regular supervision and training.
We found that detailed assessments had been carried out and that the care plans were developed around the individual’s needs and preferences. We saw that there were risk assessments together with plans on how the risks were to be managed. People told us that they had been supported with taking every day risks. They said they enjoyed participating in everyday activities.
The Care Quality Commission monitors the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and are required to report on what we find. The MCA sets out what must be done to make sure the human rights of people who may lack mental capacity to make decisions are protected. The DoLS are a code of practice to supplement the main MCA code of practice. The registered manager and staff had a good understanding of MCA and DoLS. There were no DoLS authorisations in place at the time of our inspection visit.
People told us that they had agreed to their care. We saw that mental capacity assessments had been carried out where people were not able to make decisions for themselves.
People told us that they knew how to complain. The service had a clear complaints procedure in place which was prominently displayed. We saw that complaints had been well recorded and any lessons learned from them had been actioned.
People were supported to be able to eat and drink sufficient amounts to meet their needs. They told us that the food was good and said that they were able to choose alternatives if they were not happy with the choices offered on the menus.
We found that people’s healthcare needs were met. People told us that they had access to a range of healthcare providers such as their GP, dentists, chiropodists and opticians. The service kept clear records about all healthcare visits.
We found that the service had an effective quality assurance system. People told us that either the provider’s representative, the registered manager or the deputy manager was in the home every day. Regular meetings had been held for the people living in Cedar House and for the staff.
People told us that they felt listened to. Their views and opinions had been sought and the service had made appropriate improvements.
People told us that they felt safe. They said that the manager and the staff were all very friendly, caring and kind. Staff interaction throughout our inspection visit was good. Staff had been given information and training on safeguarding adults and they showed a good awareness of the procedures.
Staff told us that they felt well supported by the management team. The training was good. Staff said that all of their training was delivered face to face. One staff member told us, 'You get the chance to ask questions and to test your knowledge, with e-learning you cannot ask questions if you are not sure about anything.'
The provider had good quality assurance processes. Regular audits of the service's systems and practices had taken place. People received safe, effective and compassionate care from a well led service that responds quickly to their changing needs.