Updated
12 March 2022
Cedar House is registered to provide two regulated activities; accommodation for persons who require nursing or personal care and personal care. The service has a care home and also provides a domiciliary care service to people living in supported living schemes.
The care home was last inspected in December 2015; however, this was the first comprehensive inspection of the domiciliary care service.
We have written our report under the headings Care Home and Domiciliary Care Service to ensure that our specific findings for both services are clear.
Care Home
This inspection took place on 22 and 23 February 2018 and was unannounced.
Cedar House is a residential care home for six people with enduring mental health conditions, learning disabilities and complex healthcare needs. On the day of our inspection there were five people using the service.
At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.
At this inspection we found the service remained Good.
People told us that they felt safe living at Cedar House. Care staff demonstrated a clear understanding of what it meant to protect people and the steps they would take to keep people safe and free from harm.
Risk assessments identified people’s individual risks and provided detailed guidance for care staff on how to mitigate or minimise risk in order to keep people safe.
The provider followed robust recruitment processes to ensure that only care staff assessed as safe to work with vulnerable people were employed.
People received their medicines safely, on time and as prescribed. The provider had systems in place to ensure the safe management of medicines.
Accidents and incidents were recorded, monitored and analysed in order to support further learning and improvement.
Care staff received regular support and development through training supervision and annual appraisals in order to effectively carry out their role.
At the last inspection we found that some people using the service may have had their liberty restricted without the appropriate authorisations in place. At this inspection we found that this had been addressed. 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.
We observed kind and caring interactions between people and care staff, where people had built positive relationships with the care staff that supported them.
People and relatives knew who to speak with if they had a complaint or concern and were confident that their concerns would be dealt with appropriately.
Care plans were detailed and person centred and provided clear information about the person, their likes, dislikes, choices and preferences on how they wished to be supported.
Appropriate management oversight systems in place ensured that there was continuous monitoring of the care and support people received. Where issues or gaps were identified processes in place supported learning and improvement to allow the delivery of high quality care.
Further information is in the detailed findings below
Domiciliary Care Service
This inspection took place on 22 and 23 February 2018 and was unannounced.
This is the first comprehensive inspection of this service. Cedar House provides the regulated activity of personal care. This service provides care and support to people living in a number of ‘supported living’ settings, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. Not everyone using the service receives the regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.
The service aims to support people with enduring mental health conditions, learning disabilities and complex healthcare needs. At the time of this inspection there were three people receiving personal care.
Cedar House currently provides the regulated activity within two supported living schemes. One scheme accommodated two people and the second scheme accommodated six people.
People using the service lived in a single ‘house of multi-occupation’ shared by people across North London. Houses of multiple occupation are properties where at least two people in more than one household share toilet, bathroom or kitchen facilities.
There was a registered manager in place at the time of this inspection. However, a second manager had submitted an application to the CQC to become the registered manager of the regulated activity ‘personal care’ so that the registered manager overall would then be the registered manager solely of the regulated activity of ‘Accommodation for persons who require nursing or personal care’. 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.
People and relatives told us that they and their relative felt safe with the care and support that they received.
A safeguarding policy was available and accessible which related to keeping people safe from abuse. Care staff understood the key principles of safeguarding people and the actions they would take if people were subject to or at the risk of harm.
Care plans contained detailed risk assessments which identified and assessed people’s individual risks and provided risk management strategies in order to ensure that care staff were provided with sufficient information so as to keep people safe and free from harm.
We observed appropriate staffing levels that met the needs of people appropriately. The provider had robust recruitment processes in place which checked and assessed potential care staff identity, conduct in previous employment and carried out a criminal record check.
Medicines were managed, recorded and administered safely. Appropriate arrangements were in place which ensured that people received their medicines safely and as prescribed.
All accidents and incidents were recorded and monitored. After each accident or incident a post incident meeting was held to analyse the information in order to learn and improve the way in which each incident was handled and managed.
A regular programme of training and development was in place for each care staff in order to ensure that each care staff had the appropriate skills to provide effective care and support. In addition care staff received regular supervision and annual appraisals in order to support them in their role.
People’s needs and choices were comprehensively assessed before they were offered a place at the supported living scheme. People’s likes, dislikes, choices and preferences were taken into account so that an appropriate package of care could be developed and delivered.
People were appropriately supported with their nutritional and hydration needs. People were supported to plan their weekly menus which incorporated their likes and dislikes as well as ensuring a health and balanced diet was maintained.
People were supported to maintain good health and had access to a variety of healthcare services where appropriate.
The service understood the core principles of the Mental Capacity Act 2005 and effectively applied this where required in order to support people effectively and in line with current legislation. Care staff were able to demonstrate the ways in which they obtained consent from people. They understood the need to respect a person’s choice and decision where they had the capacity to do so.
We observed caring, kind and respectful interactions between people and care staff. Care staff knew the people they supported very well and we observed them to be responsive to people in a way which took into account the individual’s personality, behaviour and health needs.
We observed people to be involved in how they wanted to receive their care and support. People were able to choose the activities that they found interesting and wished to participate in ensuring autonomy and independence where possible.
People and relatives knew the managers and care staff that delivered care and support and were happy to raise any concerns and issues with them. The service to date had not received any complaints.
The provider had a number of processes in place which enabled the service to monitor and evaluate the quality of care provision in order to continuously learn and improve. The service regularly requested feedback from people who used the service.
Care staff told us and records confirmed that the provider held regular staff meetings which enabled effective communication exchange and encouraged staff to discuss issues and areas for improvement.