Cedars Lodge

We previously inspected Cedars Lodge in December 2017, at which time the service was rated requires improvement. At this inspection, the service was rated good. This was because we found medicines administration practices were not in line with good practice and were not well audited. At this inspection we found medicines practices to be in line with good practice and oversight of them was robust. As the appropriate improvements have been made, the service was rated good at this inspection.

Cedars Lodge 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 supports people living with a learning disability.

The care service is designed and run in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. The registered manager was also responsible for the management of the provider’s other small service nearby and was supported by an assistant manager.

Medicines administration practices were now safe and in line with national best practice guidance. This included improvements to homely remedies, ‘when required’ medicines, and prescribed creams. Staff were trained appropriately, had their competence assessed and demonstrated a good knowledge of people’s medicinal needs.

Risk assessments were specific to people’s individual needs and did not restrict people’s freedoms to keep them safe. Staff demonstrated a good knowledge of the risks people faced and how to help them minimise them.

Staffing levels were appropriate to people’s needs and to ensure the service was not task orientated; rotas were planned in advance.

Staff understood their safeguarding responsibilities. They knew what to do should they have concerns about people’s wellbeing or safety. People who used the service felt safe and secure.

Training and support was well planned and effective. The induction covered all core areas and ensured new staff had the skills and confidence to support people. Staff told us they were well supported.

People had a choice of meal options and were encouraged to improve their own cooking skills.

People were supported to have maximum choice and control of their lives in the least restrictive way possible. Staff had received training in the Mental Capacity Act (2005) and consent was evident in care planning and through day to day interactions.

Care plans contained sufficient detail for staff to ensure people’s needs were met and that visiting healthcare professionals could understand people’s recent healthcare needs and wellbeing. Care plans had been reviewed and audited.

People who used the service were clear that staff were patient and respectful with them. We observed such interactions, as well as good levels of mutually shared humour. Relatives confirmed that people got on well with staff.

People who used the service played an active role in planning and accessing the outings and activities they were interested in. Staff supported them to be as independent as they could be in this.

There had been no complaints but people who used the service were clear they knew how to complain and to whom, if they needed. An appropriate, accessible policy was in place.

The assistant manager and registered manager interacted well with people who used the service and staff. Audits were in place and the managers demonstrated an awareness of areas of recent good practice. They were aware of their responsibilities with regard to making appropriate notifications to CQC.

The culture was open, inclusive and the atmosphere vibrant and welcoming. People felt at home and part of the home.

We previously inspected Cedars Lodge in October 2015, at which time the service was meeting all regulatory standards. At the inspection of October 2015 we rated the service as good. At this inspection we rated the service as requires improvement.

Cedars Lodge 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.

Cedars Lodge is a small dormer bungalow near Sunderland City Centre in its own grounds. The service provides care and support for four adults who have learning disabilities.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. They had taken over the management of the service three weeks prior to the inspection, following the resignation of the long-term registered manager.

Medicines had not been effectively audited and we found instances of poor practice in relation to topical medicines, medicines administration records and homely remedies.

We found areas of good practice with regard to medicines prescribed to be taken ‘when required’. De-escalation strategies were used well to ensure staff did not overly rely on medication to help reduce people’s anxieties.

People who used the service felt safe and behaved in a manner that demonstrated they were comfortable with and trusting of staff. Relatives and external professionals raised no concerns about people’s safety.

There were sufficient staff to meet people’s needs safely and staff had received training in safeguarding.

All areas of the building were clean and well maintained by the provider.

Effective pre-employment checks of staff were in place, including Disclosure and Barring Service checks, references and identity checks.

Risk assessments were detailed, person-centred, involved people in their planning and practice and gave staff clear guidance about how to help keep people safe.

People had access to a range of primary and secondary healthcare, such as GPs, nurses and psychiatry.

Staff were trained in a range of core areas such as health and safety, medicines administration, infection control, first aid and fire safety. Staff had also received training to equip them to better meet the needs of people who used the service, such as autism awareness, epilepsy awareness and how to identify and de-escalate challenging behaviours.

Staff had not always received regular supervisions or regular team meetings. Staff told us they were well supported otherwise and that they could raise any concerns they had on an ad hoc basis. The new registered manager had planned supervision sessions and team meetings.

People were involved in shopping and preparing meals and helped themselves to drinks and snacks during our inspection.

The premises were well suited to people’s needs, with en suite facilities and ample dining and lounge space.

The registered manager and staff had a good understanding of the Mental Capacity Act 2005. 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.

People who used the service received a good continuity of care from a stable team of staff who knew them well and there was an effective keyworker system in place, with information handed over at each shift.

The atmosphere at the home was welcoming, relaxed and inclusive, with people encouraged to exercise choice in day-to-day decisions and longer-term choices, such as their education and employment. People who used the service had achieved a range of positive outcomes with regard to developing their independence.

Person-centred care plans were in place and contained good levels of detailed, although this was not always easy to cross-reference as it was held across a number of files. Regular reviews of care plans took place with people and their relatives involved.

Staff were extremely positive about the new registered manager’s impact, confirming they felt supported and more empowered than previously. We observed people interacting comfortably with the registered manager and deputy manager, and there was no evidence of the recent change of leadership having a detrimental impact on people.

The culture at the service was open and inclusive, with staff encouraged to contribute ideas and a registered manager who was receptive to feedback.

Improvements in terms of quality assurance and scrutiny were required, particularly with regard to medicines and care files. The registered manager acknowledged this and had an action plan in place detailing who was responsible for these actions and when they would be completed by.

We found the provider to be in breach of the regulations in relation to the safe administration of medicines. You can see what action we told the provider to take at the back of the full version of the report.