Cedar Oak Healthcare Services Ltd

On this page

• 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 changed to requires improvement. This meant people’s needs were not always met.

The service was in breach of legal regulation in relation to person-centred care.

This service scored 54 (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 were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

People, or their relatives, were not routinely involved in designing their care plans. The majority of people and relatives we spoke with or visited told us they had not seen a copy of their care plan and had not knowingly been involved in reviews of their care. One person told us, “That was all done at the hospital I believe. I haven’t seen anything.” A relative told us, “There’s nothing in the house and I haven’t seen it. They do ring occasionally and ask if we are happy with everything, but they don’t call it a review.” This meant people did not always have oversight or input into how their care was planned and reviewed.

The provider told us relatives were able to review their family members care records on the electronic system, however, most of the people and relatives we spoke with were not aware of this or did not know how to access the system. People did not have copies of their care plan in their home for them to refer to. Where files belonging to Cedar Oak were in people’s homes these contained contact details and policies rather than details of people’s care.

People and their relatives told us individual staff member ensured they asked them what care they would prefer and talked about the support they were providing. One person told us, “They tell you what they are going to do and give me the opportunity to change it.”

There were shortfalls in how the provider shared information and monitored the service which meant people’s care was not always flexible and supportive of choice and continuity. However, staff were aware of how to contact healthcare professionals when required.

People and their relatives were not able to fully plan their care as they were not aware of the hours they were entitled to. When we asked people and their relatives if staff stayed the full duration of their care call a number of people told us they were unable to answer as they were not aware how long the call should be. One person told us, “I really can’t answer that as I have no idea how long they are supposed to be here. I can say that it does vary how long they are here.”

Records showed that staff did not always stay the full duration of the call. This was confirmed by a number of people and relatives we spoke with. One person told us, “I don’t feel rushed, but they do tend to leave a lot earlier when they’ve finished.” The person told us they would like to spend the extra time going for a walk, but not all carers offered them the option.

In other areas, we found the provider was aware of how to access health care support should this be required. They told us they had built up positive working relationships with referral teams, and this was confirmed by professionals working in the team. “Our experience with them is that they are always responsive and reactive as appropriate. They keep us informed about the care they are delivering, flagging where necessary if a change to the package of care is required. Clinical records are always provided on request.”

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

People did not always have communication plans in place to inform staff how information should be presented. We reviewed care plans for 2 people who needed support due their living with dementia. Despite their care records making reference to them having difficulties in processing information the communication element of their care plan stated they had no needs in this area. Another person’s care plan stated they preferred to communicate through a range of methods including speech, gestures and written notes. However, a review of the person’s care records did not reflect these methods were used to support the persons communication.

In other instances, we found communication plans gave a good description as to how staff should approach the person and how to offer different options to enable them to make choices.A copy of the service user guide to the service was available in people’s homes. This was available in a range of different formats on request.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result. The provider had a complaints policy in place and the majority of people and relatives spoken with felt they were able to raise concerns. However, systems to investigate, monitor and respond to concerns were not consistently followed.

Although the provider kept a log of complaints, we found these were not always comprehensively investigated, and the person did not always receive a written response regarding the action taken. One relative told us this had left them with continued concerns regarding how well staff understood their family members’ needs. In addition, we found information shared by relatives regarding how complaints had been dealt with was not in line with the provider's records or information shared with CQC during our assessment. This meant relatives were left under the impression that a different action had been taken to that recorded by the provider.

The majority of people we spoke with told us they had not had cause to raise a complaint but felt general issues raised were addressed. Relatives told us they felt able to speak to the staff in the office and felt they would take any concerns raised seriously.People and relatives were provided with information regarding how to raise a concern. This information was available in accessible formats on request.

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

Records showed people received the correct number of calls each day, although people and their relatives were not provided with a copy of the rota. This meant that whilst they were aware of an approximate time staff would arrive, they did not always know when times were changed and did not always know who to expect in their home. Whilst some people we spoke with accepted this, others found this frustrating. One relative told us, “We are never quite sure who is coming, but they are all nice people.” Another person told us, “We never get the same carers coming here, and we never know who is coming, or when. It would help if they wore badges so that I could know who they are. They were meant to arrive at 6 pm yesterday, so when they hadn’t arrived by 7.30 pm I rang and cancelled them.” In contrast, other people told us they had set carers who kept them informed of who would be completing their calls and at what times.

Staff and leaders actively 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.

Where people had care plans in place, this highlighted their needs in areas such as cultural needs, disabilities and religious beliefs. This guided staff on people’s needs in these areas to ensure staff followed protocols and respected people’s beliefs. Staff had completed training in Equality and Diversity and were able to provide examples of how they respected people’s views.

People were not always 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 lives.

People were not supported in making decisions regarding the support they wished to receive at the end of their life. This was of particular concern as the service supported a number of people who were discharged from the hospital, requiring palliative care. The provider told us they did not feel people would wish to speak about this matter at this time so they had not implemented a system to ensure people’s wishes were recorded where this was something they wanted to do.

In addition, we found that staff only completed a short training session on supporting people at the end of their life. The provider told us they had recently completed a train the trainer course to enable them to offer further guidance for staff. We saw this was presented as an agenda item at the last staff meeting, although there was no specific record of what was discussed.

Staff worked alongside other healthcare professionals to support people at the end of their lives. This included the local hospice, GP and the community nursing team.