Archived: Cedar Court Care Home

Cedar Court Care Home is a purpose built care home that provides accommodation and nursing care for up to 75 people. There were 51 people living in the home on the day of our visit. It has a designated unit that specialises in the provision of care for people living with dementia. Accommodation is arranged over three units. Albert unit provides nursing care for 30 people, Edinburgh unit provides care for 29 people living with dementia and Alexander unit provides support for 16 people who require residential care.

At the last comprehensive inspection this provider was placed into special measures by CQC. This inspection found that there was enough improvement to take the provider out of special measures.

The home is located close to Cranleigh Village and within easy access to local amenities and facilities. Bedroom accommodation is arranged over two floors. A passenger lift provides access to the first floor. Bedrooms are single occupancy and all have en suite facilities. There is a large garden to the side and rear of the service and a large car park is available at the front.

This inspection took place on 13 January 2016 and was unannounced.

The home was run by a registered manager, who was present on the day of the inspection visit. ‘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 were treated well by staff who were kind and caring. People’s privacy and dignity was now being respected.

People were now protected from abuse because staff were able to recognise the signs of abuse and had undertaken training regarding safeguarding adults.

Staff now understood their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). DoLS authorisations had been submitted where restrictions were imposed to keep people safe. However one person’s best interest had been considered when they needed support to make decisions.

Assessments were now in place for identified risks, which had improved following our last inspection. .

Care planning had improved although one care plan was inconsistent with the person’s care needs. People were now encouraged and supported to be involved in their care.

People’s bedrooms had been decorated to a good standard and were personalised with their own possessions.

People were supported to keep healthy. People were registered with a local GP who visited the home weekly. Visits from other health care professionals also took place.

People had sufficient food and drink, although the lunch time meal was a little disorganised at times on the dementia unit.

We looked at the medicine policy and found all staff gave medicine to people in accordance with this policy. Medicines were managed safely.

Previously there were not enough staff working in the home to meet people’s needs and people had to wait for care. There were now sufficient staff available to support people and adequate ancillary staff were also employed to enhance the care provided.

Staff recruitment procedures were safe and the employment files contained all the relevant checks to help ensure only the appropriate staff were employed to work in the home.

Staff supervision and appraisal were now taking place and staff now received regular formal supervision from their line manager.

People had access to a range of activities which were overseen by an activities coordinator. People on the dementia unit required more support to engage in activities and this was disorganised at times on the morning of our visit.

The standard of cleanliness was an issue at the last inspection and the service was in beach of our regulations. During this visit we found the service was clean and fresh and people were satisfied with the general cleanliness throughout the service. Infection control audits were in place and there was a nominated person deployed in the service to undertake these audits as part of their clinical role.

People had been provided with a complaints procedure and knew how to make a complaint. We noted two complaints received since our last inspection had been resolved using the complaints process. .

At our last inspection the service was not being well managed. People and staff felt unsupported by the lack of leadership in the service. Since then there was a new registered manager in post and the service was now being well managed. Feedback from people included they felt listened to and the manager spoke with them every day.

The standard of record keeping had improved since our last visit and records relating to the care of people and the management of the home were kept up to date.

Staff were aware of the home’s contingency plan, if events occurred that stopped the service running. They explained actions that they would take in any event to keep people safe. The premises provided were safe to use for their intended purpose.

Below is a summary of what we found. The summary is based on our observations during our visit, discussions with people who used the service, their relatives, the staff supporting them and looking at records.

Is the service safe?

Some people told us they felt safe living in the home. They said they could talk to the manager and the staff if they felt upset or unsure about anything. Other people were not able to communicate with us because of their poor communication skills. Safeguarding procedures were in place and staff understood their role and responsibility in safeguarding. However we saw that 40% of the staff employed in the home had either not undertaken updated training in safeguarding nor had undertaken training since being employed in the home.

We saw safe manual handling procedures being undertaken and saw no negative practices during our visit.

The service was clean and safe and provided people with safe access to all areas of the home.

The staff recruitment practice was thorough.

Is the service effective?

People's health care needs were assessed with them whenever possible and written in a care plan. Arrangements were in place for people to have visits from GP when appropriate to monitor their individual health care needs. People also had effective support from other health care professionals. For example the chiropodist, physiotherapist and the dietician.

Is the service caring?

People who used the service told us the staff were very caring and always treated them well. We saw the staff on duty were kind and caring and spoke with people who used the service in a polite and respectful manner. We saw staff explained things to people when they were having difficulty to understand. For example the food they chose or when to expect a visit from relatives. We saw people were supported to eat their meals by staff in a sensitive and caring way and they took the time to enable people to be as independent as possible. People who used the service told us that staff always found time to talk with them and that nothing was too much trouble for them.

Is the service responsive?

The service was responsive to the needs of people who used the service. For example when a risk had been identified the provider responded with an action plan to minimise the risk but allowed the individual to be as independent as possible. This included the management of people's mobility and people using communal areas in the home. We saw the service had responded to a virus that caused some people to feel unwell and managed the situation in line with their policies and procedures that ensured people affected were nursed well again.

Is the service well led?

The home had recently employed an experienced manager who was in the process of becoming registered with The Care Quality Commission. They had support of a deputy manager and well established staff team who had a good understanding of the needs of the people who used the service.

There was a good auditing system in place for the monitoring of service provision and to recognise improvement when required. There were regular health and safety audits undertaken to ensure the health and welfare of people who used the service and to promote a safe working environment. We saw complaints and accidents were monitored and lessons learnt from the outcome of these.

You can see our judgements on the front page of this report.

Many of the people who used this service had a diagnosis of dementia and some were not able to communicate with us in a meaningful way. Therefore we used our Short Observational Framework for Inspection (SOFI) to enable us to observe people's experiences of the care provided on the first floor of the home.

The people and their relatives that we spoke with were overall very positive about the home. One person's relative told us 'I find this a pleasant place for my mother to be in. She is involved with the activities and enjoys taking part.' Another person told us 'The staff really care for me.'

We found that people had consented to the provision of their care.

People had care plans in place, the contents of which they had been had been consulted about.

The home was clean and hygienic.

There were robust recruitment processes in place and relevant checks in relation to staff had been completed.

There were a range of processes in place to monitor the quality of the service provided.

The people we spoke to were very pleased with the quality of the care. One person told us that the 'care is wonderful'. A relative told us 'It's the best thing that ever happened'. The relatives that we spoke to expressed that they felt safe in the knowledge that the person being cared for was treated with kindness and dignity. This was also what we observed in relation to the care provided.

The provider was ensuring that people's past experiences and wishes were taken into account in the planning and delivery of care. Systems were in place to ensure that care was delivered safely. When we identified an issue the manager acted immediately to resolve it. We saw that medications were handled appropriately and that systems were in place to safeguard people from abuse. There was a complaints system that people or their relatives had been able to use to raise issues of concern in addition to residents meetings.

We found that the staffing levels were adequate. However some people told us that on occassions the staff were under pressure.