Archived: The Cedars Care Home

The Cedars Care Home provides accommodation and personal care for up to 63 people. The service is spilt into two units, both of which support people who may have dementia related needs. At the time of the inspection 40 people were living in the service.

People’s experience of using this service:

The service had made improvements since our last inspection. However, further improvements were required following this inspection.

Risk assessments did not consistently reflect people’s current needs. Further work was required to ensure the consistency of recording in care plans.

There were not always enough staff to ensure people received care and support tailored to meet their individual needs.

Staff did not have access to regular supervision sessions or annual appraisals.

The provider and registered manager did not have systems in place to ensure they had oversight of the service.

Staff understood their responsibilities to safeguard people from the risk of harm. There were systems in place to ensure the safe management of medicines.

People were supported by caring and compassionate staff who supported people with patience. People's right to privacy was up held and their independence was promoted.

Relatives knew how to raise concerns or make a complaint and were confident they would be responded to appropriately.

From our discussions with the provider and the registered manager, we were assured they were committed to making the required improvements to ensure people experienced consistently good outcomes.

Rating at last inspection: At the last comprehensive inspection the service was rated as Requires Improvement (published 30 January 2018).

This is the second time the service has been rated as Requires Improvement.

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received. At the last inspection on, 28 November 2017 we found some staff were task focussed and did not have the time to offer or support and encourage people to do a meaningful activity. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the quality of the service. At this inspection, we looked to see whether the provider had implemented the action plan.

Enforcement:

During the inspection we found two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to staffing and governance. When we returned to the service for the second day of the inspection we found some progress had been made to address the concerns highlighted but continued improvements were required.

Details of action we have asked the provider to take can be found at the end of this report.

Follow up:

We have asked the provider to send us a report outlining what they are planning to do and by when to improve the quality of the service. We will check the action plan has been put into place and will continue to monitor all information we receive about this service. 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.

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

The Cedars is a ‘care home’. People in care homes receive accommodation and personal care under a contractual agreement. CQC regulates both the premise and the care provided and both were looked at during this inspection. The Cedars accommodates up to 63 people across two separate units the meadows and the main house, which have separate adapted facilities. At the time of our inspection 42 people were using the service.

This service has been recently acquired by a new provider and a new manager has been appointed and had taken up 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 service needed to provide activities for people to take part in taking into account people’s interests and hobbies. People needed further support to be given opportunities to take part in meaningful activities.

We recommend that the activity co-ordinators have training to be able to support people living with dementia to take part in activities meaningful to them and in the use of dementia friendly sensory aids.

People spoke positively about the service and the care that was provided. They told us they were listened to and staff were kind and caring.

People told us that they felt safe. Staff were clear about what was abuse and the steps that they should take to protect people. Risk’s to people’s daily life’s had been assessed.

There were adequate systems in place for the safe administration of medication and people received their medicines as intended.

Checks were undertaken on staff suitability for the role and there were sufficient numbers of staff available to meet the needs of the people living in the service.

Staff received an induction to prepare them for their role and additional training was provided to support their learning and development. However, we recommend staff have access to more face to face training especially in supporting people living with dementia.

Staff had an understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

The provider was looking at ways to improve the mealtime experience for people as one dining room had limited lighting with no windows.

People were supported to eat and drink enough to maintain a balanced diet and referred to other healthcare professionals when their health needs changed.

Care plans were written in a person centred way and were regularly reviewed to reflect people’s individual care and support.

The manager was new in post and feedback from people and staff were they were open and approachable. Staff were supported by a manager they liked and respected.

The provider had worked hard and prioritised people’s safety since taking over the service.

The provider’s quality monitoring system included regular reviews of people’s care plans, checks on medicines management and staff’s practices. Accidents, incidents falls and complaints were investigated and actions taken to minimise the risks of a re-occurrence.