Archived: The Cedar Grange

The Cedar Grange is a residential care home providing personal care to 43 people at the time of the inspection in one adapted building across two wings. The service can support up to 58 people.

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

People's medicines were not consistently recorded and stored in a safe way. Quality assurance tools in relation to people's medicines and recruitment had not consistently identified where improvements were required.

People received support from trained staff who knew them well. People's needs were documented in care plans to ensure staff understood how to support them.

People received their medicines as prescribed. People were supported by sufficient staff. Where people became distressed, staff understood how to support them to feel calmer and safe.

People felt able to give feedback about their care. People had access to health and social care professionals as these were required.

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 requires improvement (published 21 February 2020). 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

We received concerns in relation to the quality of care at the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained requires improvement.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

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.

About the service

The Cedar Grange Care Home is a residential home for up to 58 people who have personal care support needs. However, during the inspection the home was undergoing some refurbishments and reduced the capacity to 42 people. There were 32 people living there at the time of the inspection.

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

We found that people’s medicines were not always handled safely. Medicine administration records (MAR) had missed signatures. There were controlled medicines that were not in lockable cabinets. There was no evidence of safe operating procedures relating to medicines within the service. Care files did not contain information on how to give people covert medicines safely.

Care files did not always have hoist risk assessments completed for people that were required to use them to move. Care files did not appropriately identify strategies for risk prevention, to allow staff to ensure people’s risk of pressure ulceration was managed in a safe way.

We observed there was limited interaction between staff and people at meal times. People did not always receive their lunch in a timely manner and there was a risk it could go cold before being served. People told us that they did not feel staff respected their independence

Care files were inconsistent with the level of detail when documenting people’s end of life wishes.

People did not always feel they could maintain positive relationships.

The registered provider failed to ensure that people’s care records were accurate and up to date.

Quality audits had been completed, however, they failed to highlight issues that were found during the inspection. The provider did not undertake audits on controlled medicines.

Ineffective quality assurance systems meant that the provider could not always continuously learn, improve and innovate. We found the registered manager did not complete any audits that focused on people’s dining experience.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The registered manager had a system to ensure that staff received their mandatory training. The training matrix illustrated that staff had completed the provider mandatory training in a timely manner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This was the first inspection of the service.

Why we inspected

This was a planned inspection based on our published timescales.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

Enforcement

We have identified two breaches of regulation. Regulation 12 the registered person failed to ensure risks relating to the safety, health and welfare of people using the service were assessed and managed safely. The registered person failed to protect people from the risks associated with the unsafe management of medicines. Regulation 17 the registered person had not established an effective system to enable them to assess, monitor and improve the quality and safety of the service provided.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan for 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.