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Inspection carried out on 2 July 2019

During a routine inspection

About the service

The Cedar’s is a nursing home providing personal and nursing care to 42 older adults. There is a unit to care for people who are living with dementia. The service can support up to 51 people.

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

Some of the audits in place were not always effective in identifying areas of improvement. Where areas of improvement had been identified this had not always been completed. Feedback was sought from people and relatives who used the service, this was used to make changes. There was a registered manager in place who understood their responsibility around registration with us. Staff felt supported and listened to.

The care people received was safe. Individual risks to people were considered and regularly updated. There were safeguarding procedures in place and these were followed. Medicines were managed in a safe way. There were enough staff available for people and they did not have to wait for support. Infection control procedures were implemented. Lessons were learnt when things went wrong in the home.

The care that people received was effective. 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 support this practice. Staff received training and an induction that helped them support people. People had access to health professionals when needed. People enjoyed the food available and were offered a choice. The environment was adapted to meet people’s needs.

People were supported in a kind and caring way by staff they were happy with. People were encouraged to remain independent, offered choices and their privacy and dignity was maintained.

People received care that was responsive to their needs. Staff knew people well and they received care based on their assessed needs. Peoples preferences were taken in to account. People had the opportunity to participate in activities they enjoyed. There was a complaints procedure in place and complaints were responded to in line with this.

For more details, please see the full report which is on the CQC website at

Rating at last inspection

The last rating for this service was Good. (7 September 2016)

Why we inspected

This was a planned inspection based on the previous rating.

Inspection carried out on 6 July 2016

During a routine inspection

The inspection took place on 6 July 2016 and was unannounced.

The Cedars is registered to provide accommodation for people requiring personal or nursing care. The service is can accommodate up to 42 people. There were 29 people living at the home on the day of our inspection. The provider had recently developed a unit to care for ten people living with dementia. This unit was not in use on the day of our inspection.

There was a registered manager in post. 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. However, this person was now working elsewhere for the registered provider. On the day of our inspection the service was being run by the acting manager who used to be the deputy manager. This person was in the process of applying for registration with the Care Quality Commission (CQC).

People were not always supported by sufficient staff because people’s dependency and needs were not taken into account when setting staffing levels.

People told us they felt safe living at the home. People were kept safe because the acting manager and staff understood their responsibilities to identify and report potential harm and abuse. The acting manager consistently reviewed accidents and incidents to reduce the possibility of people being harmed. Risks to people's health and wellbeing were known by staff and well managed. The acting manager and staff maintained close links with external health care professionals to promote people's health. People received their medicines as prescribed from staff that had the knowledge and competence to give medicines safely.

People were able to access varied food and drink in sufficient quantities and variety to enjoy a balanced diet. People with difficulties in eating and drinking were provided with suitable food and drink and supported to eat and drink well.

People were supported by a staff team who knew them well and provided caring and compassionate care and support. People were supported by staff to make their own decisions wherever possible. People needs were assessed and planned by a staff team who ensured they were included in any decisions made about their care. People were supported to access external healthcare professionals when required to promote good health.

People were supported to maintain personal hobbies and pastimes. Relatives were enabled to visit at any time and be involved in the day to day life in the home. People knew how to raise any concerns and who they should report any concerns to. The acting manager responded to people's complaints and took action to improve the service as a result of complaints.

The acting manager was aware of their responsibilities and worked with the registered provider's systems to monitor the quality of the service people received. There was evidence of learning from incidents and investigations took place and changes were put in place to improve the service people received. The acting manager was continually discussing with people how they could provide the care and support they provided. In doing so they valued people's views about their lives in the service.

Inspection carried out on 2 July 2014

During a routine inspection

A single inspector carried out this inspection. The focus of the inspection was to answer the five key questions; is the service safe, effective, caring, responsive and well-led?

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

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

Is the service safe?

We found that the service was safe because people were protected against the risks associated with the use and management of medicines. People received their medicines at the times they needed them and in a safe way. Medicines were recorded appropriately and kept safely.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The registered manager had made applications where a person’s liberty had been considered to have been deprived at the home. These had been submitted in line with the homes policies and procedures. Relevant staff had been trained to understand when an application should be made and how to submit one.

People told us they were happy with the care they received and their needs had been met. One person told us, “It’s a really nice home, I couldn’t manage without them”.

On the day of the inspection the home was clean and there were no unpleasant odours. People who used the service said they were happy with the standard of cleanliness.

Is the service effective?

We found care plans for people were detailed and gave clear guidance to care workers about how to support people.

People told us they were generally happy with the care they received and their needs had been met.

Staff were knowledgeable about people’s needs. One person who used the service told us, “The staff are very good here, I’m looked after well.”

Is the service caring?

People were supported by kind and attentive staff who knew them well and spoke positively about people as individuals. Care records showed people were cared for using individual approaches. Staff showed a good understanding of the care needs of the people they supported.

Is the service responsive?

People’s needs were assessed before they were provided with support by the service. People’s needs were regularly reviewed and their health monitored. Where appropriate referrals were made to other health professionals this was done in a timely manner.

The provider had a complaints policy in place. The registered manager responded to complaints and concerns in a timely manner.

Is the service well-led?

We saw systems for quality assurance and monitoring at the home. These included medicines, infection control and accidents and incidents. It was clear that the registered manager carried out regular audits which ensured people received good care and support.

Staff had a good understanding of the ethos of the service and quality assurance processes were in place. People who could talk to us told us they felt involved in the running of the service and felt their opinions mattered. Staff were clear about their roles and responsibilities.

Inspection carried out on 20 June 2013

During a routine inspection

There were sixteen people living at the home at the time of our inspection. We met and spoke with eight people, three relatives, and four staff including the manager. We also spoke with two visiting health professionals. Some people were unable to share their experiences of living at The Cedars so we spent time with them in their bedrooms and communal areas to observe their care and support.

People told us they liked living at The Cedars. One person told us, “ I’m happy here. I can get up and go to bed when I want and the food is very nice.” People told us staff knew their needs well and they were well cared for.

People told us they felt very safe living at the home. The staff demonstrated a good understanding of abuse. People said they had not observed any poor practice and knew how to report any concerns.

We found that people who used the service were in safe, clean, accessible surroundings that promoted their wellbeing. People told us they were happy with the premises and their own rooms.

People we spoke with considered the staff were caring and competent in their work. We saw pre-recruitment checks had been carried out on new staff prior to them supporting people. This meant that people had their needs met by staff that were fit and able to carry out their role.

The provider had systems to assess and monitor the quality of service that people received. People’s views were sought on the service provided.