Cedar Oak Healthcare Services Ltd

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question good. At this assessment the rating has changed to inadequate. This meant there were widespread and significant shortfalls in leadership. Leaders and the culture they created did not assure the delivery of high-quality care.

The service was in breach of legal regulation in relation to the governance of the service.

This service scored 36 (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 have a shared vision, strategy and culture embedded or reflected in practice.

The provider told us they were passionate about providing people with good care. However, significant and widespread shortfalls identified during this assessment showed that systems had not been embedded to ensure this vision was met. The lack of care planning, risk management, and the failure to ensure safeguarding concerns were reported put people at a significant risk of harm. The lack of communication in relation to people’s care plans and rota management meant that people were unable to fully take control of their care and support. Although staff spoke positively about the support they received, the way training and spot checks were delivered meant there was a risk that people may not receive safe and effective care in line with their needs.

Following our assessment the provider informed us they had employed the services of a quality consultant to support the strengthening an implementation of systems. Evidence was forwarded to show this process was underway.

The provider did not demonstrate inclusive or effective leadership and did not operate with integrity, openness or transparency which prevented effective oversight of the service and undermined trust. Leaders did not have the skills, knowledge, experience and credibility to lead effectively.

The provider did not share information in an open and transparent way. During our assessment we asked the provider for basic information regarding the number of people receiving personal care. Despite asking the provider for this information in a number of different ways, the provider did not provide the full information. When we identified a number of people whose names they had not shared the provider initially stated this was due to errors in the local authority information, relatives making unreasonable demands and staff copying notes from other people which made the information incorrect. The provider later confirmed they had omitted 18 people from the list of those receiving personal care, stating this was due to the pressures of the assessment process. This was not a credible explanation given the assessment was announced and the significance of the omission

The provider acknowledged areas of concern had not been identified due to a lack of understanding in areas such as reporting safeguarding or consistently ensuring staff were safe to remain working within the service. They did not demonstrate a skilled approach in identifying these issues as risks or implementing actions to ensure risks to people’s safe care were mitigated.

Over half of the people and relatives we spoke with were not aware of the registered managers name and did not believe they had met or spoken to them. People told us they mainly dealt with administrator, and the care field supervisor should they have any concerns. This alongside the lack of knowledge regarding people’s needs demonstrated a lack of understanding and oversight of the needs of the people they were supporting.

People did not always feel they could speak up or that their views would be listened to, meaning concerns may not always be raised or addressed.

Relatives did not always feel able to report concerns and did not always feel issues were taken seriously. Some relatives provided examples of concerns where they did not feel the provider and staff had listened such as staff leaving calls early. A relative told us that although in general they were happy with the care their family member received, there had been concerns they had not felt able to report, indicating they did not feel confident in doing so.

Other relatives told us they felt the office staff were accessible and they were able to discuss any problems they had or issues with the support openly. One relative said, “From what I have seen the [office staff] are very switched on with answering our queries. [They] are very reassuring and always come back to me.”

The provider sent out periodic surveys regarding people’s views of the service. However, these were basic questions and did not explore people’s views in sufficient depth to identify areas for improvement. The feedback shared appeared consistently positive with all those responding stating they were happy with their care. The service had also received a number of compliments and positive reviews regarding the care they provided. Particular areas of practice highlighted were the kindness and positive attitude of staff.

The provider did not always work towards an inclusive and fair culture by improving equality and equity for people who worked for them. However, in other areas we found the cultural needs of staff were valued and respected.

People’s care records showed that on occasions staff were subjected to racial abuse by the people they supported. Staff told us they understood people were living with dementia and may therefore not fully understanding the implications of what they were saying. However, the provider had not implemented additional measures to support and acknowledge the impact on staff experiencing these issues such as additional welfare calls. There was no reference or guidance to staff within people’s care plans where this was a known issue.

In other areas the provider ensured the needs of staff were understood and systems were implemented to support this. Examples included ensuring staff were able to take time off for religious and cultural celebrations and facilitating longer holiday periods for staff who needed to travel long distances in order to spend time with their families.

The provider did not have effective systems of governance, accountability or oversight to identify, assess and manage risk, or to monitor quality and safety.

Auditing systems were ineffective and not fit for purpose. Audits did not identify issues in the quality of care, record keeping, reporting to external professionals or staffing arrangements. In some areas, audits were of little value in assessing service quality. For example, spot checks and supervision audits only recorded how many had taken place and did not assess staff performance, areas for improvement or quality of care delivery. Despite leaders being aware of significant risks, audits consistently indicated no concerns, demonstrating a failure to identify and respond to known risks.

Daily care records were repetitive and task-focused, lacking meaningful, person-centred information or detail regarding risks. However, care plan audits failed to identify these significant concerns, further demonstrating ineffective oversight of care quality and record keeping.

Following our assessment the provider forwarded evidence to show they were updating audit and review systems. This work will need time to be embedded and sustained into practice.

The provider did not always understand or fulfil their duty to collaborate and work in partnership, with others to support people effectively. which led to delays in responding to concerns and reduced the effectiveness of joint working.

The provider had failed to ensure they notified CQC of important incidents, demonstrating gaps in their understanding of regulatory responsibilities. This included sharing information in relation to safeguarding allegations. The provider told us they took responsibility for this oversight as they had not been aware of the need to submit notifications for a range of safeguarding concerns identified during our assessment. Partners in the local authority also shared concerns regarding the provider not sharing information as required, which had led to delays in actioning concerns.

In other areas, partners working with the provider shared positive feedback regarding their approach and support. One professional working alongside the service told us, “I have had recent involvement with this agency. I found the response from the agency to be swift, person centred and professional.” They went on to detail the service had paid attention to detail and actioned a change to the person's care package as required.

The provider did not have a culture of continuous learning, improvement or innovation. They did not encourage creative ways of delivering equality of experience, outcome and quality of life for people.

The provider did not have systems in place to drive improvements. There was no structured or effective service improvement plan meaning actions could not be implemented, tracked or evaluated. Where audits had been completed such as accidents and incidents and complaints action notes were listed. However, it was not clear what the actions meant or how and who would complete the monitoring. For example, statements such as ‘Compliance and rota checks strengthened’ were regularly recorded as actions with no detail regarding how this had been done or how this would be monitored for effectiveness.

The provider had failed to identify audit systems were not effective in identifying concerns. They had not questioned all audits showing no or few concerns despite the number of people being supported and the complexity of their care needs. This demonstrated a fundamental lack of understanding of the importance of continuous learning and improvement.

Following our assessment the provider forwarded a range of documents to evidence the action they were taking along with a service action plan. These systems will take time to become embedded and sustained within the service.