Archived: The Cedar Grange

The Cedars Grange is a care home providing personal care for up to 58 people. Some of the people in the home are living with dementia. People have access to their own bedroom along with communal spaces including lounges and gardens. The home is one adapted building that operates two separate wings. At the time of our inspection 36 people were living in the home.

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

People were not supported to have maximum choice and control of their lives. Staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The home had improved since our last inspection. Where people displayed periods of emotional distress improvements were needed to ensure care plans were fully reflective of this and what this meant for people. Protocols that related to the administration of medicines for agitation also required further detail. Systems that had been introduced since our last inspection to manage the quality within the service, needed to improve to ensure they identified all areas of improvements.

Risks to people were assessed and monitored, when incidents occurred these were reviewed. Medicines were managed in a safe and people received these as prescribed when needed. There were enough suitably trained and recruited staff to support people. There were procedures in place to ensure people were protected from potential abuse. We also found infection control procedures were in place and followed.

People were happy with care they received and the staff that supported them, they felt the home had improved and involved with the process. People were treated in a kind and caring way. Their dignity and privacy were considered, and their independence promoted. When people had cultural needs, these were now considered.

When people had health needs these were considered and reviewed, and the home worked with external agencies and professionals to ensure people received the correct levels of support. People received foods in line with their dietary requirements and enjoyed a choice of foods that they were offered.

There were now systems in place to govern the home, audits in place were identifying areas of concerns and action was then taken. People felt able to complain and there were procedures in place. Staff felt involved with the running of the home, they felt supported and listened to by the new manager and the provider.

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 the service was inadequate. (Published 15 September 2022.)

This service has been in Special Measures since 16 September 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

At this inspection we found the provider remained in breach of regulations. You can see what action we have asked the provider to take at the end of this full report.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

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

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 have identified breaches in relation to capacity and consent.

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 Grange is a care home providing personal care for up to 58 people. Some of the people in the home are living with dementia. People have access to their own bedroom along with communal spaces including lounges and gardens. The home is one adapted building that operates two separate wings. At the time of our inspection 53 people were living in the home.

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

Risks to people were not managed in a safe way and when needed action was not taken to ensure people’s safety. When incident such as falls had occurred, action had not been taken to reduce the risk of reoccurrence. Potential safeguarding incidents had not been investigated or report and there was a lack of confidence these had been dealt with appropriately, placing people at risk of harm. People did not receive their medicines as prescribed; some people did not receive their medicines at all. There was a lack of detailed guidance in place for ‘as required’ medicines meaning people may not have these when needed. There were no evidence lessons were being learnt when things went wrong.

People did not always have access to health professionals and when advice had been sought this had not always been followed. There were not enough suitably trained staff to support people.

There was a closed culture created in the home, where people relatives and staff did not feel concerns were listened to or action taken when needed. Complaints were not always recorded or actioned. The systems in place were not robust to ensure areas of improvement were identified. When concerns had been identified action had not always been taken. We had not been notified about all significant events within the home to ensure appropriate action had been taken.

People were not supported by staff to have the maximum possible choice, control and independence, as there was a lack of understanding about how people should be supported. All restriction had also not been fully considered. There was a lack of understanding around this and staff provided us with inconsistent views of how people would be supported.

Peoples cultural needs had not been considered and people were not able to communicate in a language or format that was import to them. People were not involved with their care or were not always able to make choices throughout their day.

People enjoyed the food and were offered a choice. The environment was adapted to consider people’s needs. There were initial assessments for people which considered their needs and relatives were involved with this.

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 the service under the previous provider was requires improvement, published on 22 December 2020.

This service was registered under the new provider with us on 5 July 2021 and this is the first inspection.

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

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding concerns and an ongoing police investigation in the home. A decision was made for us to inspect and examine those risks.

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

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.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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 overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.