Background to this inspection
Updated
18 April 2020
The inspection: We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team: The inspection team consisted of three inspectors and an assistant inspector.
Service and service type: The Cedars is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service manager has applied to be registered with the Care Quality Commission and is awaiting the outcome of their application. The registered manager and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection: The first day of inspection was unannounced. The second and third days of inspection were announced to ensure that senior staff would be in the office to support the inspection.
What we did before inspection: We reviewed information we had received about the service since the last inspection. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During the inspection: We spoke with ten people who used the service about their experience of the care provided. We spoke with seven members of staff including the nominated individual, manager, group support manager and care staff. The nominated individual is responsible for supervising the management of the service on behalf of the provider.
We reviewed a range of records. This included five people’s care records and medication records. We looked at four staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection: We continued to seek clarification from the provider to validate evidence found.
Updated
18 April 2020
About the service: The Cedars is a residential care home that provides accommodation and personal care for up to 28 older people. People who live at the home access nursing care through the local community healthcare teams. At the time of the inspection 25 people were living at the home.
People’s experience of using this service: The provider and senior staff had completed audits on the home to support quality checks. However, these checks had not prevented repeated and new shortfalls in the quality of service provision. The provider had failed to notify the appropriate authorities of safeguarding events and the commission of statutorily notifiable events.
There were enough staff to meet peoples' basic needs. Staff training was provided but did not always ensure people’s specific needs were covered. Staff recruitment procedures were not followed appropriately. Staff had not received regular supervision.
Care plans were not consistently person centred and there was a lack of detailed guidance within peoples' risk assessments for staff to follow.
Medicines were stored safely. Some improvements are required in relation to medicine administration and documentation. People had not received access to regular oral health and other appointments.
The service did not provide people with regular access to the local community and activities were lacking for people that did not partake in group activities.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However, the service had not followed guidance fully when making best interest decisions. We have made a recommendation about this.
People were supported for by a staff team who were kind and caring. Staff had good relationships with people and knew them well.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update: The last rating for this service was Requires Improvement (published 31 January October 2019). The service remains rated Requires Improvement. This service has been rated Requires Improvement since 2016 for over four consecutive comprehensive inspections.
The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.
Why we inspected: This inspection was scheduled based on the previous rating.
Enforcement: We have identified eight breaches in relation to governance, risk assessments, medicine management, recruitment, staffing, the environment, and statutory notifications at this inspection. We placed additional conditions on the provider's registration to enable them to focus on making improvements.
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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.