Archived: Cedar Lawn

The service provides accommodation and personal care for up to 37 older people. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The accommodation is over two floors and 29 people were living at the home on the day of our inspection.

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.

At our previous inspection in February 2016, we rated the service as Outstanding in the key areas of caring and well-led. At this inspection we found people continued to receive a high standard of care. However, significant changes in the staff team had caused challenges over the last 12 months which meant the overall rating of the service has now changed to Good.

There were enough staff to meet people's needs safely and respond to their requests for assistance. The provider's recruitment procedures ensured staff were of a suitable character to work with people who lived in the home. People’s care plans included an assessment of their needs and identified the individual risks to their safety. Staff understood their responsibility to work in a safe way and report any concerns to the registered manager.

People were cared for by kind and compassionate staff, who knew people's individual preferences and how they wanted their care provided. Staff understood people's risks and abilities and received updated information at shift handovers to ensure the care they provided was responsive to any changes in people's needs. Staff received regular training and support to ensure the support people received was effective and safe.

People were supported to maintain a nutritionally balanced diet. People’s medical conditions were explained in their care plans and staff worked in partnership with other healthcare professionals to ensure people’s medical and health needs continued to be met and responded to. People's medicines were managed, stored and administered safely in line with GP and pharmacist prescription instructions.

The registered manager and staff understood their responsibilities under the Mental Capacity Act 2005. They told us everyone who lived at the home had the capacity to express their wishes, which ensured they received effective support with no restrictions on their liberty.

People's equality, diversity and human rights were respected because one of the provider’s values was, “We treat every person as a unique individual.” Staff promoted people's dignity and respected their privacy. People were offered opportunities to engage in activities and conversations that met their physical, social and spiritual needs.

The home was adapted, decorated and furnished to meet people's needs. Staff had training in infection prevention and control and understood the importance of maintaining a clean environment.

Staff enjoyed their job because they were part of a supportive staff team who communicated and worked well together. Staff respected the registered manager’s leadership and described senior staff as visible and approachable. Systems were in place for the provider and registered manager to assess and monitor the quality of the service and respond to people's feedback. People were happy with the quality of care they received.

Cedar Lawn is a residential care home providing accommodation for up to 37 older people who require personal care and who may be living with dementia. The home has two floors and access to a well maintained garden area, including a recently refurbished patio area, backing onto fields. At the time of our inspection visit there were 32 people living at the home.

Cedar Lawn care home had a registered manager in place. 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.

Throughout our time at Cedar Lawn we saw and experienced a very strong person-centred culture and staff understood and were proud to say that people were their priority and at the centre of all their thinking. Staff had an empowering and empathetic attitude to support people and ensured that the person got what they wanted from their lives and not what the service said they could have. Staff told us that people were not passive recipients of care and support but active participants who had broad and diverse aspirations in relation to their lives. Staff demonstrated they were highly skilled in understanding the importance of meaningful relationships with people.

All of the people we spoke with and their relatives told us people felt very safe living at Cedar Lawn and were extremely satisfied with the service they received. Without exception comments about staff and the management team were highly complementary. Comments about the overall care provided were particularly positive. Staff had an excellent understanding of the types of abuse that may occur and knew how to report abuse should they need to. All staff were trained in safeguarding and received a yearly update to refresh their skills and knowledge.

There were detailed risk assessments in place for each person who lived at the home that related to each person's care and support. There was noticeable attention given to peoples’ individuality in every aspect of the assessments which contained detailed information on how staff should assist people to minimise the risks. We found staff were acting to minimise the risks. There were processes in place to manage risks in connection with the operation of the home and the manager was highly effective in managing the risks to protect people from harm.

There were enough qualified, skilled and experienced staff to meet people's needs. Recruitment and selection processes were in place to ensure staff were of a suitable character to work with people who lived at the home.

Recording of medicine administration showed that people received their medication as prescribed. People told us they received their medicines correctly.

People we spoke with were able to tell us that they had been involved with the care planning process and had agreed to the content of their plans. There was a strong person centred ethos, which was embedded throughout the home, this ethos was intended to make people feel valued, supported and included. Members of staff we spoke with were extremely positive and enthusiastic about the standard of care they provided. All staff had up-to-date mandatory training and had undertaken additional training relevant to their roles. Mandatory training included a range of health and safety training as well as training in medication management and safeguarding. Staff told us that they had received regular meetings with their line manager which we verified in the supervision records.

All of the staff had received training on the Mental Capacity Act 2005 (MCA) and were aware of the Deprivation of Liberty Safeguards (DoLS). They demonstrated an understanding of the requirements of the MCA so that they could ensure peoples’ rights were being protected.

There was a choice of food and people could have drinks and snacks whenever they wanted them. We saw people were offered drinks and snacks throughout the day. Mealtimes were an extremely enjoyable and sociable occasion. People received the food and drink they required to maintain their health.

Staff were consistently caring and considered how people’s privacy and dignity were protected. People told us that staff were always respectful and attentive towards them. Staff knew the people they cared for well. This included knowledge of people’s likes and dislikes, how they could communicate, their backgrounds and the relationships that were important to them.

People’s needs were assessed and care and support was planned and delivered in line with their individual care plans. There was a strong emphasis on personalised care and staff had an exceptional understanding of peoples' specific care and support needs. People told us that they were supported to access healthcare services that met their needs, preferences and assisted them to maintain their health. External health care professionals spoke highly about the standard of care provided and about the compassion shown consistently by the staff team.

All of the staff we spoke with said that staff morale was excellent and that their seniors and manager were visible, approachable and responsive to suggestions made to improve the quality of service. There was a strong and passionate senior team in place who knew the standard of care delivered was of the highest quality. Everyone we spoke with had huge confidence in the registered manager and responded affectionately and warmly to them. We saw continuously that the registered manager demonstrated passion and commitment to providing an excellent service for people and their relatives. The manager was an excellent role model who used their extensive knowledge of health and social care to advocate for people. The registered manager always emphasised the importance of a person centred culture. The culture in the service was open and encouraged staff to bring forward ideas for improving care. Staff embraced the culture of the person as the centre of all support and care delivered. The registered manager and the service were highly respected by external health care professionals.

We observed staff interaction and talked with care staff about how they met the needs of people they supported.

Staff demonstrated a clear understanding of people's needs and engaged with people in a positive manner. People appeared relaxed and happy in the company of the staff and were not hesitant when they approached them.

The relatives and visitors we spoke with told us they were happy with the care at Cedar Lawns.

We looked at the care planning documentation and we found that care plans were very detailed and demonstrated that staff treated each person as an individual based upon their needs.

We saw that people's nutritional needs had been identified and people were provided with a good choice of food. People told us they were happy with the choices available to them.

Systems were in place to ensure that medicines were managed appropriately on people's behalf.

Staff told us they were supported by the manager and had access to regular training.

We found the home was well led and had systems in place to monitor the quality of the service provided at Cedar Lawns.