The inspection took place on 27 April 2015 and 1 May 2015. This was an unannounced inspection. We last inspected Cedar House Care Home in November 2013. At that inspection we found the home was meeting all the regulations that we inspected.
Cedar House Care Home provides residential care for up to 31 people, some of whom are living with dementia. At the time of our inspection there were 23 people living at the home. The home had 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.
We found the provider had breached Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider did not have accurate records to support and evidence the safe administration of medicines. We saw staff were signing to confirm medicines had been given at times of the day when the medicine wasn’t due. We also found gaps in medicines administration records (MARs) for 11 out of the 23 people who used the service. This was where medicines had not been signed for to confirm whether they had been given or not. You can see what action we told the provider to take at the back of the full version of the report.
People and family members told us the home was safe. One person said, “Staff are always popping in and out.” They also said, “I feel at ease with the staff.” One family member said, “[My relative] being here, has given us peace of mind.” They only gave us positive feedback about the care at the home. One person said the care was, “Brilliant, the staff are so caring.” They went on to say it was, “Like home from home.” One family member said they were, “Happy with the care. [My relative] is fine. Any concerns they [staff] let us know.” Another family member said, “[The] care is great.”
Prior to our inspection we received an anonymous complaint. This alleged staff members were frightened to ‘whistle blow’; that people’s toileting needs were not met in a timely manner; the manner in which a senior staff member talked to residents and insisting staff must start to get people up from 4am on a morning. We found staff we spoke with did not feel uncomfortable to raise concerns without the fear of reprisal. They also had a good understanding of safeguarding adults. We found people had their needs met quickly. Family members commented, “Enough staff, they are always available if we need anything”, “Staff see to [my relative] straightaway”, “Very good, [staff are] always on hand when we shout for them.” People and family members only gave us positive feedback about the staff working at the home. One person said, “They [staff] are so courteous and nice. They are nice set of people.” One family member said, “Lovely lasses, kind.” They went on to say the staff were, “Genuinely caring and it’s natural. You never see a miserable face, they are always smiling.” We carried out our inspection at 6am and found some people were already up and dressed. We were unable to confirm with people whether this had been their choice. Staff were considerate and ensured people were comfortable.
Staff told us there were enough staff on duty during the night. One staff member said staffing levels were, “Alright during the night. A few [people] like a lie in and they go to bed at different times.” Another staff member said, “Generally fine. Depends on what kind of night.” The provider undertook regular assessments of staffing levels. However, we found the analysis did not take account of particular pressure points throughout the day, such as meal-times and getting people in and out of bed. The provider had recruitment and selection procedures to check new staff were suitable to care for and support vulnerable adults. People using the service had been given the opportunity to take part in recruiting new staff.
We found from viewing care records that people were assessed against a range of potential risks, such as falls, mobility, oral health and skin damage. Where required action was taken to help keep people safe.
People and family members were happy with the home’s environment. One family member commented, “Beautiful home, the cleanliness is spot on.” They also said the home was, “Always clean, [my relative’s] room is done every day.” The provider undertook a range of checks to ensure the home and equipment were safe for people using the service. The provider had procedures in place to deal with emergency situations. People’s care and support needs in an emergency had been assessed. The provider had made adaptations to the service to make it suitable for people living with dementia. There were systems to log and investigate incidents and accidents. Incidents and accidents were analysed and action taken to keep people safe.
People were happy with the staff delivering their care. One person said, “Lovely set of staff here. Nothing is a problem”, and, “I honestly couldn’t praise them enough, all staff.” Staff received regular supervision and appraisal. They also received the training they needed to fulfil their caring role.
The provider followed the requirements of the Mental Capacity Act 2005 (MCA), including the Deprivation of Liberty Safeguards (DoLS). DoLS authorisations had been approved for all people requiring authorisation. Applications had been made in the person’s best interest with input from various professionals and in some cases an advocate.
Staff were knowledgeable about the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Staff were able to tell us about their responsibilities under MCA. They were also able to tell us about the capacity of people living in the home and support they needed to make decisions. People who were able to make their own decisions were asked to give their consent before receiving care. One family member said, “Staff always ask first.” Staff were clear about the individual strategies in place to support people who displayed behaviours that challenged the service.
People were supported to meet their nutritional needs. One person said the, “Food is fabulous.” They also told us there was variety in the meals available. People’s care records we viewed contained information about their food preferences, including likes, dislikes and any allergies people had. We observed over a lunch-time that people received the care and support they needed with eating and drinking.
People were supported to meet their healthcare needs. Care records confirmed people had regular access from a range of health professionals. These included GPs, community nurses, chiropodists.
We observed people received regular interaction from staff who were kind, caring and considerate. We saw staff members asked people if they needed anything and offered them drinks and biscuits. One family member said staff had, “Reminiscence chats, they sit and talk to people.” They also said, “Staff seem to know people well.” People were treated with dignity and respect. One person said, “[Staff] show you the most respect. They are careful not to embarrass you. This is right across the board.” One family member said staff “always” treated their relative with dignity and respect. Staff described how they delivered care in order to maintain a person’s dignity.
On admission staff gathered information about people to help them provide the care people wanted. This included developing bespoke ‘life histories’ about people. People had their needs assessed on admission into the home. The assessment and other information gathered about preferences were used to develop personalised care plans. One family member said, “Yes, we told them everything about [my relative].” They also said they had, “Been involved in reviews about [my relative’s] care.” Care plans were reviewed regularly. However, the record of the review was often brief and did not provide meaningful information about people.
Family members said people were able to take part in activities such as watching TV, listening to music, bingo and entertainment. Another family member said, “In summer they take them [people using the service] out.” They also said, “There is always something going on.” One person said, “There is lots to do. Staff will say, let’s have a game of this.” Staff said people could take part in activities, such as playing dominoes and bingo, watching TV or reading the paper. However, not all activities we observed were positive and appropriate for people living with dementia. We have made a recommendation about this.
People and family members knew how to complain if they were unhappy. Nobody raised any concerns with us during the inspection. One family member said they, “Know about the complaints procedure.” They also told us they had, “Not used it [complaints procedure]”, and had, “No concerns.” There was an agreed system in place to log and investigate complaints. There were opportunities for people and family members to give their views about the care delivered at the home. This included a regular ‘Resident and relative forum meeting’ and questionnaires.
The provider undertook a range of audits to check on the quality of care provided. Medicines audits were infrequent and had not been successful in identifying gaps in medicines records in a timely manner.