The Cedars

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question Good. At this assessment the rating has remained Good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 67 (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 did not always make sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Some care plans lacked clear information on consent, communication needs, preferred routines and escalation actions. Daily records did not always reflect care plan guidance. We identified missed opportunities to evidence specialist input and ensure care plans were updated to accurately reflect current needs.

However, the service had systems in place to assess people’s needs and care pathways, including physical health, emotional wellbeing, communication, sensory impairment and safety risks. Care plans we reviewed showed detailed assessments for people with complex needs, including falls, mobility, continence, anxiety, blindness, dementia, Multiple Sclerosis and end‑of‑life care.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

People received care and treatment that was evidence‑based and consistent. Staff demonstrated knowledge of people’s health conditions and risks. Appropriate equipment and interventions were used, such as pressure‑relieving mattresses, hoists, sensor mats, mobility aids and continence products, to support safe and effective care.

Care plans contained detailed guidance for staff on managing specific health conditions, skin integrity, nutrition, hydration and emotional wellbeing. People had access to healthcare professionals including GPs, SALT and specialist nurses, when required. Relatives reported improvements in health outcomes for their family members. One relative told us about how their family member had a reduction in falls, while another told us their family member’s condition had stabilised since admission.

Staff were caring and knowledgeable of the people they provided care for. Staff recorded and evidenced in daily records the care provided, this covered if any learning for the future or further progression to appropriate people was needed.

However, the provider did not always consistently evidence monitoring and review of some care interventions. Behaviour monitoring tools, fluid charts and repositioning guidance were not always fully completed or reviewed. Audits did not consistently identify issues such as missed controlled drug signatures. Some care plans did not clearly reflect current care methods or include escalation guidance if risks increased.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Some care plans lacked up‑to‑date detail on communication needs, consent, routines or professional input, and review dates had occasionally lapsed due to staffing pressures. The use of agency staff at times also affected continuity, with some staff less familiar with people’s needs. One person told us, “If you need help they are there.”

Staff worked collaboratively with each other and with external professionals to meet people’s needs. Care records and feedback from relatives showed GPs, specialist nurses, SALT and other professionals were involved when required. Relatives told us they felt informed and included in decisions about care, including advance care planning.

Staff demonstrated good knowledge of people’s health conditions and communicated relevant information through handover processes and daily coordination, including flash meetings. These meetings supported information sharing about risks, health changes and end‑of‑life needs. However, these would have benefited from a more consistent structure to ensure learning and actions were clearly shared with all staff.

Relatives we spoke with, told us positively about communication with staff and management, describing care as coordinated and responsive. Examples were seen of staff working together to respond to incidents safely, such as supporting people following falls and managing complex moving and handling needs. One relative told us, “[Person] is very safe here, they hoist them properly and always use two staff.”

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.
The provider supported people to maintain and improve their physical and emotional health. People and relatives told us health needs were responded to promptly, and one person said, “They look after my health too.” There was access to healthcare professionals and ongoing monitoring of long-term conditions.

People were supported to access health professionals as required. Staff followed guidance to manage conditions such as dementia, epilepsy, and pressure care. Care plans included information on nutrition, hydration, skin integrity, mobility and emotional wellbeing, and staff understood how to support these needs safely.
People’s mental and emotional wellbeing was considered. Staff supported people’s routines, provided reassurance, encouraged social interaction and respected spiritual needs, with visits from the local community and family involvement. Some people were supported to access the community, such as garden centres, family outings or church services.
 

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The provider had systems in place to monitor people’s health and wellbeing and respond to changes in need. People and relatives shared positive outcomes, including improvements in stability, reduced falls and better management of long term conditions. One relative told us, “[Person] was having many falls at home, they have had nothing at all here. That’s the level of care.”
People’s weight, skin integrity, mobility and risks, such as pressure damage and choking, were monitored. Staff took action when concerns were identified, including seeking medical advice and adjusting care. Families spoke positively about staff communication and felt informed about changes in health and care planning. One relative said, “They keep me up to date with what they eat and how they are doing.”
Staff and the registered manager demonstrated pride in the care provided and the outcomes people had and were achieving.
 

The provider mostly told people about their rights around consent and respected these when delivering person-centred care and treatment.
Documentation did not always fully evidence consent and best interest decision making. Some care plans lacked clear records of consent, Mental Capacity assessments, or how people’s preferences had been reviewed and agreed, particularly where routines appeared driven by staffing patterns. In a small number of cases, care plans did not clearly reflect people’s stated wishes, such as preferred bedtimes, or provide evidence these had been reviewed with the person or family. We raised this during the assessment to the registered manager. The registered manager responded immediately and told us they would review people’s care plans.

People told us staff respected their wishes and involved them in decisions. One person said, “They don’t do anything I don’t want them to,” and another told us, “They always ask me and explain what they are doing.” Relatives also confirmed involvement in decisions, particularly where people had complex needs.

Staff demonstrated an understanding of the Mental Capacity Act (MCA) and could explain how they supported people who lacked capacity to make specific decisions. Where appropriate, Deprivation of Liberty Safeguards (DoLS) applications had been made, and families told us they had been consulted. Advance care planning, including ReSPECT discussions and DNACPR decisions, had been considered with people and relatives. One relative said, “They involve me and keep me informed about decisions.”