We carried out a review of the data available to us about The Cedar Gardens Care Limited on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about The Cedar Gardens Care Limited, you can give feedback on this service.
We found the following examples of good practice.
The service had implemented effective infection prevention and control measures to ensure people, their relatives and staff were protected from infections.
Systems were in place to facilitate safe visits. Relatives who visited their loved ones had access to appropriate Personal Protective Equipment (PPE) and rapid testing on-site.
Premises were cleaned and disinfected regularly and were also well ventilated. People were socially distanced where possible and had their health monitored routinely by staff.
Staff were provided with appropriate training, PPE and had access to COVID-19 testing. The registered manager sought advice from relevant authorities when needed. Infection prevention and control policies were reviewed regularly and accessible to all staff.
The Cedar Gardens Care Limited is a care home registered to provide nursing and personal care for up to 45 people. At the time of the inspection, there were 41 people living at the home.
People’s experience of using this service:
The home continues to provide a good level of care and support to people. People were treated with dignity and respect.
People told us they felt safe living at the home. Staff had a good understanding of abuse and the safeguarding procedures that should be followed to report abuse and incidents of concern.
Risk assessments were in place to manage potential risks to people, whilst also promoting their independence.
People were supported with their medicines in a safe way.
People were supported to have enough to eat and drink. Dietary preferences and support needs were accommodated.
People had access to health care professionals for routine appointments, or if they felt unwell.
People were involved in making decisions about their care and support. 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.
Adequate staffing levels were in place. We observed that staff were responsive to the needs of people living in the home.
Appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service.
Staff received regular refresher training to ensure they had the skills and knowledge to perform their roles. Specialist training was provided to make sure that people's needs were met and they were supported effectively.
A complaints procedure was in place and people knew what to do if they had a concern.
The management team was open and transparent throughout the inspection process and demonstrated a commitment to the ongoing development of the service.
There were systems in place to monitor the quality and safety of the service being provided.
The home was clean, and the risk of spreading of infections was well managed.
Rating at last inspection:
Good (Report published 28 October 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 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 Cedar Gardens Care Limited is a nursing home registered to provide accommodation for a maximum of 45 people requiring nursing or personal care. The home provides a service to adults of all ages who may have a range of disabilities including dementia, learning disability and autistic spectrum disorder, mental health, eating disorder and misuse drugs and alcohol.
There was a registered manager at the service. 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 received good overall feedback about the service. There was particular praise for how people’s health needs were addressed. The staff supported people well with healthcare matters and people had access to the nursing staff and were supported to access appropriate medical care. The service had an excellent record of pressure ulcer care utilizing the provider’s tissue viability nurse support. In addition the staff were friendly and caring towards people, and welcoming to their visitors. Nurses were knowledgeable about people’s medicines and medicines administration and storage was undertaken in an appropriate manner.
We found that the service had systems in place to recognise and report safeguarding adult concerns. There was a robust recruitment procedure and staffing was assessed on an ongoing basis to ensure the changing needs of people using the service were met. People and the environment were risk assessed and reviewed to reflect any changes in circumstances.
The service was clean and well maintained. Staff had received infection control training and understood good practice in preventing cross infection.
The service was working to the Mental Capacity Act 2005 and the management team understood their responsibilities under the Deprivation of Liberty Safeguards to ensure that people’s legal rights were being upheld.
Staff received regular supervision and training and were well supported by a proactive and accessible management team.
People were supported to eat a healthy diet and remain well hydrated and although some people liked the meals provided others were not so complimentary. We brought this to the attention of the manager who was in the process of compiling new menus to trial. She undertook to continue the work to ensure all people were happy with the selection of meals.
People had person centred plans that reflected their likes and dislikes and told staff how they wished to be supported. Care plans told staff about people’s histories and named activities that people enjoyed. There was care taken to ensure activities were varied and involved people with different cognitive functioning.
The service was well- led by a strong management team who were visible and accessible to both staff and people using the service. The registered manager and deputy manager were both passionate about their role in ensuring good care and were well supported by the nursing staff and the provider management team. People and visitors told us they could raise concerns and any issue raised was addressed immediately by the registered manager.
The views of people, their visitors and staff were sought by the management team who responded to the outcomes of surveys and initiated changes suggested.
A new system to record training required and undertaken was in place and linked with the development needs identified in supervision and appraisal meetings. This included professional nursing courses. The home had been selected to participate in a pilot training programme offered by the London Borough of Barnet which would enable them to further develop staff and offer training to other providers. This meant that people were cared for in an environment which was striving for clinical excellence.
People who use the service were protected from the risk of abuse. Staff were guided by training and documents available and people told us they felt safe in the home.
The provider had made several improvements to the premises in accordance with our last inspection.
Staff providing care to people were subject to a number of checks before starting work and received regular training. Supervision meetings took place but the provider accepted the recording of these did not demonstrate that supervisions were held as frequently as stated in the provider's policy.
Care plans were individualized, comprehensive and reviewed regularly. We saw relatives' signatures to confirm their involvement. People were receiving the care and treatment they needed.
There were ongoing problems with a number of issues relating to the premises. The home's own audit procedures identified them but they had not been resolved promptly. The lift had broken down more than once in the year and there had been no communal bathroom in working order on the first floor since October 2012. The home was not meeting its own policy which stated its premises must be fit for purpose and safe.
There were enough qualified, skilled and experienced staff to meet people's needs. One person said 'staff come when I ring the bell.'
The provider had an effective system to regularly assess and monitor the quality of service received. We were shown a large number of audits carried out in the home on an ongoing basis. Aside from the delays outlined regarding the premises, we could see that action had been as a result of these audits.
We observed that staff interacted with people while supporting them. We observed that staff treated people with respect.
We saw that people were able to make decisions about their care and the service they received. People told us that they could make decisions such as when to go to bed or get up. The relatives we spoke with told us that the home always sought their consent when decisions were made. A relative told us how they recently decided against a planned service which they thought was not beneficial for a person who uses the service.
Relatives told us that the home provided care that met people's needs. They said the home invited them to attend review meetings. They said they were satisfied with the care and thought people were well looked after. We observed people to be relaxed and presentable. A person told us that they were happy and their needs were met. They said: "I go to religious meetings". We observed people taking part in activities in the lounge. People told us that they enjoyed their activities.
People told us that the home provided good food. For example, a person said: "The food is nice; the cook is very good". From observations people appeared to have enjoyed their meals. We saw that people had an opportunity to choose the kind of food they wanted. We saw that staff supported people with their meals in a respectful and dignified manner. People who were able to do so were encouraged to eat their meals independently.
We observed that people who use the service could speak with staff if they had concerns. People we talked to confirmed that they knew how and who to complain to if they were not happy about anything. A person said: 'I know I can talk to staff or the manager'. We observed that staff were attentive to people's needs and asked people if they had concerns. We saw the acting manager was accessible to people and relatives.
Relatives talked about the staff positively. Comments they made included: 'The staff care about people; they are kind; I trust them'. However, people were not confident that there were sufficient numbers of staff. People said: "There are not enough staff here'.