Cedar Grange

Cedar Grange is a 'care home' providing accommodation across two buildings for up to 31 people who require personal care; some of whom lived with dementia. At the time of the inspection 26 people were living at the service.

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

Areas of risk were not always robustly assessed and monitored. Some areas of the service and equipment were not appropriately cleaned, which placed people at risk of infection.

Systems to monitor safety and quality of care had not identified some issues which could negatively impact on people's experiences.

We found some improvements were needed around the administration and recording of medicines. We made a recommendation about this.

People and their relatives were happy with the service. People told us they felt safe living at Cedar Grange, and staff were familiar with the safeguarding procedure.

Staff were recruited safely. There were enough staff to meet people's care needs.

Staff were supported by the management team and worked closely with healthcare professionals to meet people's needs.

The service did not have a manager who was registered with the CQC as required. A new manager had recently been recruited by the provider.

The manager had sought some feedback from people’s relatives following this inspection. Staff were updated about changes to people's needs and any changes to the service.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 22 March 2019).

Why we inspected

We initially carried out an announced IPC outbreak; this was to follow up on IPC arrangements. However, additional concerns were identified and it was agreed that the inspection would be expanded, as a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at IPC measures under the 'safe' key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Cedar Grange on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment and good governance of the service at this inspection.

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

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service: We received very positive views from people about the support provided to them. People said they felt safe and staff were respectful.

People received their medicines safely and on time and their health was well managed. Staff had positive links with health care professionals which promoted people’s wellbeing.

Care and support was tailored to each person's needs and preferences. People and their relatives were fully involved in developing and updating their planned care.

Staff had received appropriate induction, training and support to enable them to carry out their role. Appropriate recruitment checks were carried out to ensure staff were suitable to work in the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

The registered manager with the staff team and led by example to ensure people received a good service. People and staff told us the registered manager and senior team were approachable and listened to them when they had any concerns. All feedback was used to make continuous improvements to the service.

More information is in the Detailed Findings section below. For more details, please see the full report which is on CQC website at www.cqc.org.uk.

Rating at last inspection: Good (report was published 25 August 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The home is registered to provide accommodation and care for up to 31 older people, including people who are living with dementia. On the day of the inspection there were 29 people living at the home, including one person who was having respite care. The home is situated in the village of Cherry Burton, close to the town of Beverley, in the East Riding of Yorkshire. There are various communal areas where people can spend the day and a large garden. There is a passenger lift so people can access the first floor of the premises.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager who was registered with the Care Quality Commission (CQC). 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.

On the day of the inspection we saw that there were sufficient numbers of staff employed to meet people's individual needs. New staff had been employed following robust recruitment and selection policies and this ensured that only people considered suitable to work with vulnerable people worked at Cedar Grange.

People told us that they felt safe living at the home. People were protected from the risks of harm or abuse because there were effective systems in place to manage any safeguarding concerns. The registered manager and care staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm.

Risk assessments identified any areas of concern in respect of people’s care and support needs, and there were strategies in place to reduce these risks but still promote independence.

Staff confirmed that they received induction training when they were new in post and told us that they were happy with the induction and on-going training provided for them. This included training on the Mental Capacity Act 2015 (MCA) and Deprivation of Liberty Safeguards (DoLS).

We checked medication systems and saw that medicines were recorded, stored, administered and disposed of safely. Staff who had responsibility for the administration of medication had received appropriate training and no-one who we spoke with raised any concerns about how they received their medicines.

People who lived at the home, visitors and social care professionals told us that staff were caring and that they respected people’s privacy and dignity. We saw that there were positive relationships between people who lived at the home, visitors and staff. Visitors told us they were made welcome at the home and were kept informed about their relative’s well-being.

Care plans recorded people’s individual needs and how these should be met by staff. It was clear that staff had a good understanding of people’s specific needs and how they wished to be supported.

We saw that people’s nutritional needs had been assessed and people told us that they were very happy with the food provided. We observed that people’s individual food and drink requirements were met and that they were offered a choice at each meal time.

The complaints procedure was clearly displayed in the home and people told us that any complaints they made or concerns they expressed were listened to and acted on. There were also systems in place to seek feedback from people who lived at the home, visitors and staff.

People who lived at the home, visitors and staff told us that the home was well managed. Quality audits undertaken by the registered manager were designed to identify any areas of improvement to staff practice that would promote people’s safety and well-being. Staff told us that, on occasions, feedback received at the home was used as a learning opportunity and to make improvements to the service provided.