The Cedars

Updated 20 May 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

The inspection was carried out by 1 inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service provides care and support to people living in a supported living setting, so that they can live as independently as possible. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people's personal care and support.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post.

Notice of inspection

We gave the service 48 hours' notice of the inspection. This was because we needed to be sure that the provider would be in the office to support the inspection.

Inspection activity started on 20 March 2023 and ended on 02 May 2023.

What we did before the inspection

We used information gathered as part of the monitoring activity that took place on 15 March 2023 to help plan the inspection and inform our judgements. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 3 people who used the service and 7 relatives about their experience of the care provided. We spoke to the manager and the area manager and 3 staff members. We reviewed a range of records. This included people's care records and selected medicines records. We looked at 3 staff files in relation to training and supervision and a variety of records relating to the management of the service.

Updated 20 May 2023

The Cedars is a domiciliary care service that provides care and support to people in a shared house where supported living support was provided by the service. A supported living service is one where people live in their own home and receive care and support in order to promote their independence. People have tenancy agreements with a landlord and receive their care and support from the domiciliary care agency. The service predominately supports people with a learning disability or autistic people. On the day of our visit there were 7 people using the service.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support:

The service is a large house split into 2 separate sections, located within the local community and its amenities. People were able to use communal areas as they wished and to have privacy for themselves if they chose to be alone. People were observed to spend time in their bedroom or in the communal lounge. People had a choice about their living environment and were able to personalise their bedrooms. Staff enabled people to access healthcare provision and services as needed to ensure their healthcare needs were met.

People were not always supported with their medicines in a way that promoted their independence and achieved the best possible health outcome. Improvements were required in relation to some aspects of medicine management including effective audits.

Right Care:

People received care and support that was kind and caring. People's care plans and risk assessments reflected their needs and the level of support to be provided by staff. However, some risk assessments had not been regularly reviewed or updated.

Right Culture:

Staff were responsive to people's needs and evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate.

However, quality audit systems were not always effective as they had not identified issues around recruitment, medicine management and staff inductions.

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 good (published 18 November 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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

Enforcement and recommendations

We have identified breaches in relation to recruitment practices, medicines management and quality assurance.

We have made a recommendation about staff inductions and supervisions.

Please see the action we have told the provider to take at the end of the report.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.