Archived: Cedar House Nursing and Residential Home

During our last inspection of the home in November 2015, we found that the provider was in breach of five regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. These were in respect of the management of risk and cleanliness and infection control, treating people with dignity and respect, providing person centred care and good governance. We sent the provider a warning notice in respect of the breach of regulation in respect of good governance. We told them that they had to meet this regulation by 1 February 2016.

In respect of the other breaches of regulation, the provider sent us an action plan and told us they would be meeting these by 1 February 2016. At this inspection, we found that the necessary improvements had been made. Therefore, the provider was no longer in breach of these regulations. However, improvements were required to make sure that people consistently received care that provided them with enough stimulation to enhance their well-being.

Cedar House Nursing and Residential Home is a service that provides accommodation and nursing care for up to 26 older people, some of whom may be living with dementia. On the day of the inspection, there were a total of 14 people living at the home.

There was a registered manager employed at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

The provider had systems in place to protect people from the risk of abuse and risks to people’s safety had been assessed, with actions being taken to reduce their risk of harm. The home and equipment that people used was clean.

There were enough staff to meet people’s care needs safely and people received their medicines when they needed them. The staff had received appropriate training and supervision to provide them with the necessary skills and knowledge to provide people with effective care.

People were treated with dignity and respect by staff who were kind and compassionate. People were asked for their consent about their care and the staff understood how to support people who were unable to consent to this themselves.

People received enough to eat and drink to meet their individual needs and timely action was taken by the staff when they were concerned about people’s health.

People’s individual care needs and preferences had been assessed. However, some people did not receive adequate stimulation to enhance their well-being.

The staff were happing working in the home and felt supported in their role. They were clear about their individual roles and responsibilities and were valued by the registered manager.

Any complaints or concerns that were raised were listened to and dealt with and there were effective systems in place to monitor the quality and safety of the care provided.

Cedar House Nursing and Residential Home is a service that provides accommodation and care for up to 26 older people, some of whom may be living with dementia. On the day of the inspection, there were a total of 19 people living at the home.

There was not a registered manager employed at the home. The home has been without a registered manager since December 2014. However, there was a manager in place who had sent in an application to register with the Commission. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

During our last inspection in May 2015, we found that the care provided to people was good. However, since that date we had received a number of concerns regarding the quality of the care that was being provided to people. We therefore conducted this comprehensive inspection in response to those concerns.

We found that risks to people’s safety were not managed well. The provider’s procedures for reporting accidents and incidents that people had experienced had not always been followed. Therefore, these incidents had not been fully investigated by the provider or action taken to reduce the risk of people having the accident or incident again. The assessment of some risks to people’s safety had not been assessed. This placed people at risk of harm.

Some areas of the home and equipment that people used were not clean which increased the risk of the spread of infection. Staff had not always had the required checks to make sure they were safe to work in care and referrals had not always been made to the local authority safeguarding team when appropriate to do so.

Most staff were kind, caring and showed compassion for the people they provided care for. However, there were occasions when some people’s dignity had been compromised and they had not been treated with respect.

People’s care needs and preferences had been assessed. However, some people’s care records did not provide sufficient information for staff on how to meet these needs and preferences. Changes in people’s care needs were not always identified in a timely manner. This had resulted in some people not receiving care when they needed it and some people had not been referred to other healthcare professionals when it had been appropriate to do so.

People had access to plenty of food and drink to meet their needs. People received their medicines when they needed them and had access to activities to complement their hobbies and interests. People were asked for their consent before the staff provided them with care.

Some staff were not clear about how people needed to be supported in line with the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards. Therefore there was a risk that these people’s rights may not be protected. However, we did not see anyone being deprived of their liberty on the day of the inspection.

The provider had failed to ensure they had effective quality assurance systems in place to monitor the quality and safety of the service provided to the people who lived at Cedar House Nursing and Residential Home. Therefore, people were at risk of receiving poor care and of being exposed to harm.

There were five breaches of the Health and Social Care Act 2008, Regulated Activities (2014) and you can see what action we have told the provider to take at the back of this report.

At this follow up inspection, dated the 28 November 2014, one inspector carried out the inspection visit. The focus of the inspection was to check that the provider had complied with the requirements of the warning notice and that the premises provided people with the environmental facilities they required. We also checked that adequate staffing levels were in place to meet people's needs.

During our inspection we looked at the improvements made to the premises and staffing levels. This meant that we have not been able to answer all of the five key questions; is the service safe, effective, caring, responsive and well-led? We have therefore concentrated on answering the question is the service safe?

Below is a summary of what we found. The summary describes what people using the service, relatives and staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

The staff treated people with respect and dignity. People living at the home, visitors and staff told us that improvements had been made to the bathing, shower and communal toilet facilities provided at the service.

People said that they could choose if they wished to have a bath or shower. They told us that the time they had to wait for a toilet to be free had reduced because there were more communal toilets available for them to use.

The laundry and sluice rooms were in the process of being refurbished. Staff had the use of an increased number of hoists and could assist people to move, when they requested help.

Staffing levels had been increased and there were enough staff on duty to ensure people had their needs met.

Below is a summary of what we found. The summary describes what people using the service, relatives and staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People told us that the staff working at The Cedars Nursing and Residential Home were kind and treated them with respect. However, they told us that they often had to wait for help because the staff were busy. They and their relatives said that there were not enough staff working in the home to always provide people with the care and support they required, when they needed it. Improvements were needed to ensure that there were sufficient numbers of staff on duty to meet the needs of people living at the home. A compliance action has been set for this and the provider must tell us how they plan to improve.

The environment was not seen to be safe, clean and hygienic in all areas. Infection control procedures were not robust and parts of the environment were in need of refurbishment, redecoration and the deep cleaning or replacement of carpets and other flooring. Improvements were needed to ensure that the environment, bathing, toilet and laundry facilities were fit for purpose and met people's needs. Two compliance actions have been set for this and the provider must tell us how they plan to improve. We have also taken enforcement action against the provider to protect the health, safety and welfare of people using the service.

Some people's care planning records provided unclear information and guidance to staff that put people at risk of receiving inappropriate and unsafe care and support. Staff did not all follow people's care plans or the correct procedure when assisting people to move. Improvements were required to ensure that accurate and consistent records were held and people were safely cared for. A compliance action has been set for this and the provider must tell us how they plan to improve.

The service was meeting the requirements of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguarding (DoLS). There was a process in place in relation to DoLS and policies and procedures were held by the provider. Staff had been trained and knew when a DoLS application was needed and the manager knew how to submit a DoLS application to ensure that people who could not make decisions for themselves were protected.

Is the service effective?

People's health and care needs were assessed by staff but had not been reviewed with them or their family member. Specialist dietary needs had been identified in care plans but people's choices were not always respected. People were not all provided or assisted with drinks and were not fully protected from the risks associated with dehydration. Relatives told us their family member did not always receive the care and attention they required because they had to sometimes wait over one hour for a staff member to be free to assist them.

Our observations showed that people were left alone in the communal lounge and conservatory for nearly one and a half hours. One person told us, 'The staff take a long time to answer the call-bell but once they get to you they will do anything to help you.' Improvements were needed to ensure that people received the care and attention they required. A compliance action has been set for this and the provider must tell us how they plan to improve.

The service is not suitably designed to meets people's needs. People did not have access to bathing facilities and the one shower facility provided was not suitable for everyone to use. There was only one communal toilet working on the ground floor and people told us they were unable to use the toilet when they wished to.

Is the service caring?

People were supported by staff who used a kind and attentive approach. We saw that the staff were patient and encouraged people to be as independent as possible. People told us that the staff were sometimes busy but did not rush them. However, people did not have their dignity and welfare fully protected because staff were not able to take them to the toilet when they chose.

Is the service responsive?

People said that when they rang the call-bell they had to wait for the staff to be available. The care and support provided was adjusted to meet the needs of each person but care and risk assessments did not always contain clear instructions to staff. A record was held of people's preferences, interests and diverse needs. However, people's choice to get up at a certain time in the morning was not always respected. Relatives told us that staff members consulted their family member and encouraged them to make their own decisions. People did not have access to a range of planned daily activities. Improvements were needed to ensure that people had their needs and choices appropriately responded to and respected. A compliance action has been set for this and the provider must tell us how they plan to improve.

Is the service well led?

Staff spoken with understood the whistleblowing policy but did not all have a clear understanding of the ethos of the home. Robust quality assurance processes were not in place that showed us that the shortfalls identified had been addressed. Relatives told us that they were not asked for their feedback on the service their family member received. Visitors said that they had not felt listened to when they had made a suggestion or raised their concerns. Staff said that they were well supported by the manager. People told us that the manager was approachable but the home appeared to be disorganised, at times. Improvements were needed to ensure that the feedback and concerns people raised were listened to and action taken. A compliance action has been set for this and the provider must tell us how they plan to improve.

We found that there was a detailed assessment of needs for each of the people whose records we reviewed. These had been reviewed in November 2013. In addition, each person had a set of personalised care plans and risk assessments. These were also reviewed in November 2013 to ensure the information reflected the current needs of the person. One person told us, "Everything's lovely here." Another person told us, "I'm very happy here."

We found that people were cared for in a clean and hygienic environment, which promoted their dignity.

We found that there were enough suitably qualified, experienced and skilled staff to meet people's needs. We spoke to two people using the service about the staff at Cedar House; one person told us "I couldn't fault the staff, really." Another person we spoke with told us, "They're lovely, they really do help." Another person using the service felt that they didn't always have their call bell answered in a timely manner, although we did not see evidence of this on the day of inspection.

We found that there was an adequate complaints system in place at the service, and people were made aware of how to complain.