The Cedars

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question Good. At this assessment the rating has remained Good. This meant people’s needs were met through good organisation and delivery.

This service scored 64 (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 mostly made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Some people said routines such as getting up, going to bed or time spent in communal areas were influenced by staff availability rather than personal preference. One person told us, “There’s not many staff on a morning,” and another said, “There’s no one to chat to as staff don’t always have the time.” Records did not always clearly capture people’s communication needs, specialist input or agreed changes to routines, limiting assurance that all staff could deliver personalised care consistently. We raised this during the assessment to the registered manager who informed us there was enough staff to cover people’s needs. However, they agreed to review where staff were deployed around the home.

People were supported to receive care that reflected their individual needs, preferences and life experiences. Many people told us staff knew them well and provided care in ways which respected familiar routines and personal choices. One person told us, “They know me well and what I like,” and another told us, “They wash me how I like to be washed and don’t do anything I don’t want.”

Care plans included information about people’s health conditions, communication needs, personal care preferences, spiritual wishes and emotional support, and staff demonstrated understanding of how to support these in practice. Relatives shared positive examples of person‑centred care, including support for appearance, dignity, faith and family involvement. One relative said, “They take time to find out about [Person] and their family,” and another relative commented, “They respect her wishes while keeping her safe.”

People were supported to maintain connections with what mattered to them, such as spending time with family, accessing religious support, enjoying preferred activities or simply sitting quietly listening to music. Staff showed sensitivity to people’s emotional needs, providing reassurance and adapting their communication where people were anxious, living with dementia or sensory loss.

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

The service provided coordinated and continuous care, with systems in place to support people as their needs changed. People and relatives we spoke with told us care was reliable and staff understood people’s routines and health needs. One person told us, “They look after me,” and a relative commented, “[Person is very safe here and well cared for.” Families reported confidence in staff and continuity of care, particularly where staff knew people well.

Staff told us they worked together across shifts and to maintain continuity. This was supported by handovers and flash meetings, these supported day‑to‑day coordination of care, including sharing information about health changes, risks and priorities.

The provider mostly supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Some care plans lacked clear detail about communication needs, consent, preferred routines and specialist input, which reduced assurance all staff had access to the same information. A small number of people told us they were unsure how to make a complaint or raise concerns, indicating opportunities to improve how information about complaints was shared.

However, people and relatives were given the information they needed to understand their care, make decisions and feel reassured. People told us staff explained care in ways they could understand and kept them informed about what was happening. One person told us, “They always speak to me very nicely and explain things,” and another told us, “They keep me informed about my care.”

Relatives described good communication with staff and management, particularly where people had complex needs or health changes. Families said they were involved in care planning, one relative told us, “If I wasn’t happy, mum wouldn’t be here.”

Information about people’s daily care, health needs and wellbeing was usually shared through conversations with staff, care reviews and informal updates. Noticeboards, care records and staff explanations supported understanding of routines and safety arrangements, and relatives felt confident they knew who to contact if they had concerns.

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

People and relatives were listened to and involved in decisions about care, and most felt staff were approachable and responsive. People told us staff took time to talk with them and respected their views. One person told us, “They know me well and what I like,” and another commented, “They always speak to me very nicely.”

Some people were unclear about how to make a complaint, and others felt staffing pressures limited opportunities for conversation and meaningful involvement.

Feedback from people and relatives had led to positive changes, demonstrating the service listened and responded. For example, concerns about access at the front door resulted in new arrangements to improve responsiveness, which relatives said had made a difference. Regular conversations, meetings with families and informal updates helped people feel heard and reassured.

Staff described an open culture, where listening to people and families was valued and concerns were shared with management. Staff felt confident to raise issues and said people’s feedback was discussed within the team. One staff member told us it was “a safe space to talk openly.”

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it.

Equity of access was not always consistent, particularly during periods of staffing pressure or environmental constraint. People with higher dependency needs or living upstairs experienced reduced access to communal areas and outdoor space. People living with dementia or sensory impairments had limited access to meaningful activities at times, and some specialist needs, such as communication preferences or sensory support, were not always fully reflected in care plans.

However, people were mostly able to access care and support in a fair and inclusive way. The service supported people with a wide range of physical, sensory, cognitive and emotional needs, including dementia, visual impairment, mobility limitations and anxiety. People told us staff adapted their approach to help them feel safe and understood. One person told us, “They explain things to me because I can’t see properly.”

The service made reasonable adjustments to promote access, such as providing mobility aids, adapted equipment, assistance with eating and drinking, support with communication and the use of reassurance and clear explanations. Relatives confirmed staff were responsive to individual needs, with one saying, “They respect her wishes while keeping her safe.”

Staff and leaders mostly listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

People with higher levels of dependency, sensory impairment or dementia did not always experience the same level of engagement, activity or choice as others. Limited staffing at key times reduced opportunities for social interaction and meaningful activity, which disproportionately affected people living with dementia or those unable to self‑advocate. The registered manager provided a detailed action plan during the assessment, this detailed improvements to be made around activities and, staffing deployment and the interaction and activities people with dementia could be involved in.

The service aimed to ensure people experienced fair, inclusive and person‑centred care, and many people and relatives reported positive and safe outcomes. People felt staff were kind and attentive, and relatives described confidence in care delivery and outcomes, including improvements in safety, health stability and comfort. One relative said, “[Person] was having many falls at home, he is safe here and not fell. That’s the level of care,” while another relative told us, “She is very safe here and well cared for.”

Staff worked to meet a wide range of needs, and people with complex health conditions received appropriate support. Families were involved in care planning and reviews, which supported shared decision‑making and helped tailor care to individual needs.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

The provider had systems in place to plan for people’s current and future needs, and people and relatives told us they were involved in discussions about care planning and changes in health. Advance planning was evident for many people, including consideration of DNACPR decisions, ReSPECT forms, DoLS authorisations and best‑interest discussions, with families involved where appropriate.

Staff were aware of people’s end‑of‑life preferences where relevant and described involving families and professionals to ensure care remained appropriate and compassionate.

Some people were clear about their future preferences, including hospital admission, resuscitation decisions and who should be contacted if their health deteriorated.