The Cedars

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.

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. On the day of our visit there were 16 people using the service.

There were policies and procedures in relation to safeguarding the people who used the service. Staff were aware of their responsibilities to ensure that people were protected from the risk or potential risk of harm.

Records were in place to monitor any specific areas where people were more at risk and explained what action staff needed to take to protect them. There were enough staff on duty to meet the needs of the people.

Background checks had been carried out on staff before they started to work for the provider to make sure they were suitable to work with vulnerable people.

There were systems in place to manage people's medicines so that they received them when they needed.

Care and support was delivered in a safe way by staff who had received appropriate training. Staff received appropriate support to meet the needs of people. They were clear about their roles and responsibilities.

The provider had policies and procedures in relation to the Mental Capacity Act 2005 to guide and inform the staff.

People were provided with a choice of suitable and nutritious food and drink that they enjoyed. Staff continually monitored people’s condition and where necessary sought the assistance of other health and social care professionals.

We saw people using the service were supported by kind and attentive staff. People expressed their views and were involved in making decisions about the care and support they received.

People were treated with respect and their diverse needs had been recorded. Staff encouraged people to be as independent as possible.

People’s needs were assessed and care and support were delivered in line with their individual care plan. Staff regularly reviewed people’s care plan and any changes that were identified were addressed.

The provider took account of complaints and comments to improve the service. There was a system in place to log people’s comments and learn from them.

The provider had quality assurance and audit systems in place. From discussions with the management team, it was clear that they routinely reviewed practice to improve the care and support provided to people who used the service.

There was a registered manager in post. 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 2008 and associated Regulations about how the service is run.

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. On the day of our visit there were 14 people using the service.

People said they felt safe and would talk to staff if they had concerns. Staff demonstrated their understanding of the service’s safeguarding policy and knew how to ensure people were protected from abuse.

Risk assessments clearly identified any risk and gave staff guidance on how to minimise the risk. They were designed to keep people and staff safe while allowing people to develop and maintain their independence.

Appropriate measures were in place to ensure staff assisted people to take their medicines safely. People were supported to have their nutritional needs met and there was guidance in care records as to how to meet these.

People were supported by a consistent staff team who knew them well and had received training specific to their needs. Staff were supported through supervision and appraisals. They felt supported to carry out their roles and were in regular contact with the registered manager.

The service considered people’s capacity using the Mental Capacity Act 2005 (MCA) as guidance. People’s capacity to make decisions had been assessed. Consent was sought before care and support was carried out.

The service worked in partnership with other health professionals to ensure people received effective care and support.

Staff were caring and treated people with respect and dignity. They had a good understanding of people’s needs, hobbies and interests. People were involved in decisions made about their care and support needs. The service encouraged them to participate in meaningful activities.

People, relatives and staff spoke positively about the service and said it was managed well. There were clear lines of accountability.

There were systems in place to manage, monitor and improve the quality of the service provided. Survey results from people and their representatives were positive and any issues identified were acted upon.