The Cedars

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question Good. At this assessment the rating has remained Good. This meant people were safe and protected from avoidable harm.

This service scored 63 (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 have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

The service did not always effectively capture, analyse and learn from safety information. Audits did not consistently identify issues, including missed controlled drug signatures, gaps in medicines checks, and incomplete behaviour monitoring records. Learning was not always translated into consistent practice, particularly where care plan guidance was not followed, such as people being supported to bed earlier than stated without documented review.

Staff we spoke with told us, workloads and the use of agency staff at times impacted consistency, and records showed some learning opportunities around consent, mental capacity decisions and risk management, were not always clearly documented or reviewed. Flash meetings were in place to support information sharing, however these would have benefited from a clearer structure to ensure learning points were consistently shared and acted upon.

However, staff understood their responsibility to identify risk, raise concerns and learn from incidents. Staff told us they felt safe to speak up, escalate concerns to the registered manager, and reflect on incidents through supervision and training. One staff member said, “Safety concerns are escalated to managers and I feel able to do this.”

Incidents such as falls, injuries and changes in people’s health were reported and responded to in a timely manner. People and relatives provided examples of compassionate and timely responses by staff following incidents.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Communication needs, including language preferences, were not always clearly recorded to ensure continuity of care. We raised this with the registered manager during the assessment and spoke with staff. Staff were aware of people’s additional communication needs, however this was not reflected in the care plans. The registered manager told us they would review people’s care plans and ensure this information was captured.

The service had systems to support people safely through care pathways and transitions, including admission, transfers to hospital and access to external health professionals. People were supported to access GPs, specialist nurses, speech and language therapy (SALT) and other professionals when required. Relatives confirmed they were informed and involved in decision‑making.

Staff demonstrated a good knowledge of people’s health needs and risks, including pressure care, epilepsy, choking and moving and handling. Where people experienced changes in their health, staff acted promptly to seek medical advice and provide reassurance to both people and their families.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People’s behaviour monitoring records were not always consistently completed. We saw a lack of evidence to show oversight or reviews had taken place to identify any learning or themes. The registered manager received feedback in a positive way and evidenced an action plan outlining the improvements they were going to implement to ensure good oversight of records.

People told us they felt safe. Relatives consistently expressed confidence in staff to protect people from harm. Comments included, “I feel safe here. They look after me,” and relatives described reassurance in staff responses following incidents. One person told us about a time they had a fallen and how staff had got down on the floor and ensured they were reassured and comfortable whilst waiting for an ambulance.

Staff demonstrated a clear understanding of their safeguarding responsibilities and told us they felt confident to raise concerns. Staff feedback confirmed safeguarding concerns were escalated appropriately, and staff felt supported by management to share worries or seek guidance. Safeguarding training had been provided, and staff were able to describe how they would recognise and respond to abuse, neglect or poor practice.

Safeguarding systems were in place to manage known risks, including falls, pressure care, epilepsy, choking, infection and behaviours that may challenge. Risk assessments were present, and care was delivered using appropriate equipment such as hoists, sensor mats and specialist seating.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People were involved in decisions about their care and safety. Most people told us they felt listened to and supported to manage risks. People told us staff explained what was happening and asked for consent during care, including moving and handling, personal care and healthcare support. One person told us, “They don’t do anything I don’t want them to,” and relatives confirmed choices were discussed with them where appropriate.

Care plans included risk assessments for falls, pressure care, choking, epilepsy, mobility and behaviours. Staff demonstrated an understanding of individual risks and the equipment used to manage this safely. People used aids such as walking frames, sensor mats, hoists and specialist chairs, and said these helped them feel safe.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

Some shortfalls in environmental management and oversight were identified. The clinical room and some storage areas were untidy. Medicines storage required improvement, including the organisation of the medicines fridge. At mealtimes, limited staff presence in the main dining room affected supervision and support, which reduced assurance the environment was always safely managed during busy periods.

The dementia floor environment did not consistently support engagement or orientation. We observed limited meaningful stimulation, and the décor required review against current dementia‑friendly guidance.

However, health and safety systems were in place to manage environmental risks. Fire risk assessments had been completed, fire drills were undertaken, and emergency planning documentation, including a business continuity plan, was up to date. Safety checks and certificates were available for gas, legionella, lift servicing and LOLER equipment, with required actions completed. Equipment such as hoists, slings, sensor mats and specialist chairs were used to support people safely.

Staff were generally skilled, their deployment within the home did not always align with the specific skills required to effectively meet people’s needs. Teamwork was not always effective in delivering safe, person-centred care

Staffing levels and deployment were not always sufficient, particularly in the mornings, evenings and at mealtimes. People, relatives and staff reported staffing pressures sometimes affected choice, social interaction and timely support. During the assessment, limited staff presence was observed in the communal dining room at lunchtime, and some people felt staff did not always have time to sit and talk with them.

The service relied on agency staff at times, and both staff and relatives reported this could affect continuity and consistency of care.

However, the service had a committed and caring staff team who demonstrated the skills and knowledge needed to support people safely. People and relatives consistently described staff as kind, attentive and respectful. Staff showed good understanding of people’s individual needs, including moving and handling, pressure care, epilepsy management, choking risks and the use of specialist equipment.

Staff told us they felt supported, valued and able to raise concerns, and feedback reflected a positive team culture. Training and supervision were in place, and staff described these as helpful in developing confidence and reflecting on practice. Leadership was visible, and staff felt able to escalate safety concerns to managers.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Medicines storage required better organisation. We found topical creams were stored incorrectly in medication fridges, increasing the risk of cross‑contamination. The clinical room was observed to be untidy, which reduced assurance around clean storage and infection control standards. We raised these concerns with the registered manager during the assessment, who took immediate action to ensure medicines in the fridge were stored safely.

The provider had effective infection prevention and control (IPC) procedures in place to protect people from the risk of infection. People and relatives consistently told us the home was clean and well maintained. Cleaning activity was frequently observed throughout the assessment. One person said, “Everywhere is always clean,” a further relative described the home as “spotlessly clean.”

Environmental IPC risks were mostly well managed. Safety checks were in place and up‑to‑date, including legionella management, cleaning schedules and laundry arrangements. Relatives confirmed laundry was returned clean and well managed, including at weekends.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

Medicines optimisation was not consistently supported by robust governance and record keeping. We found missed signatures in controlled drug records, and audits had not always identified these omissions. There were gaps in controlled drug auditing, and medicines stored in fridges were not always appropriately organised, with topical creams stored alongside eye drops. These issues reduced assurance medicines systems were consistently safe and optimised.
However, people generally received their medicines as prescribed. Most people and relatives told us medicines were administered safely and on time. People said staff gave them their tablets and other medicines, including eye drops and pain relief when needed. One person told us, “I get all my tablets every day and when I need them,” and relatives said they were confident staff managed medicines appropriately.

Staff responsible for medicines had received training and competency assessments, and records showed medicines administration was carried out by suitably trained staff. People had access to healthcare professionals when medicines were reviewed or changes were required. Relatives described appropriate responses to changes in health, including the introduction of additional medicines where clinically indicated.