Background to this inspection
Updated
13 May 2021
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.
As part of CQC’s response to care homes with outbreaks of COVID-19, we are conducting reviews to ensure that the Infection Prevention and Control practice was safe and the service was compliant with IPC measures. This was a targeted inspection looking at the IPC practices the provider has in place.
This inspection took place on 26 March 2021 and was unannounced.
Updated
13 May 2021
Cedar Grange is a care home which offers nursing care and support for up to 60 predominantly older people. At the time of the inspection there were 52 people living at the service. Some of these people were living with dementia. The service occupies a large purpose built detached house over two floors. The service is divided in to four separate units.
This unannounced comprehensive inspection took place on 22 May 2018. The last comprehensive inspection took place on the 14 and 17 March 2017 when the service was not meeting the legal requirements. The service was rated as Requires Improvement at that time. People's safety was not always protected. We identified issues in the recording and management of risks to some people. People who were vulnerable due to not being physically mobile, were not protected against the risk of other people entering their bedrooms and engaging in activities which were harmful. We took enforcement action against the service due to the concerns found at that inspection. We returned to carry out a focused inspection on 9 August 2017 to check on the action taken by the provider to meet the requirements of the regulations. At the focused inspection we found the service had made improvements and was no longer in breach of the regulations. However, the service rating of Requires Improvement was not changed at that inspection, as we required to see that changes were sustained over time. At this comprehensive inspection we found the service had sustained the changes made and had continued to make further improvements. The service is now rated as Good.
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 is required to have a registered manager and at the time of the inspection there was a registered manager in post. 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 and associated Regulations about how the service is run.
We spent time in the communal areas of the service. Staff were kind and respectful in their approach. They knew people well and had an understanding of their needs and preferences. People were treated with kindness, compassion and respect. The service was comfortable and appeared clean with no odours. People’s bedrooms were personalised to reflect their individual tastes.
The premises were well maintained. The service was registered for dementia care. There was little pictorial signage at the service to support people who were living at the service with dementia, who may require additional support with recognising their surroundings. The décor of three of the units did not identify places easily for people. We have made a recommendation about this in the Effective section of the report.
The premises were regularly checked and maintained by the provider. Equipment and services used at Cedar Grange were regularly checked by competent people to ensure they were safe to use.
Care plans were well organised and contained accurate and up to date information. Care planning was reviewed regularly and people’s changing needs were recorded. Daily notes were completed by staff. Risks in relation to people’s daily lives were identified, assessed and planned to minimise the risk of harm whilst helping people to be as independent as possible.
The service had identified the minimum number of staff required to meet people’s needs and these were being met. The service had a number of staff vacancies at the time of this inspection and these posts were being filled by agency staff. The service was facing challenges in recruiting new staff. We were told this was due to businesses in the local area offering higher rates of pay.
There were systems in place for the management and administration of medicines. People received their medicine as prescribed. Regular medicines audits were being carried out these were effectively identifying if errors occurred, such as gaps in medicine administration records (MAR).
Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy.
People had access to activities. Activity co-ordinators were in post providing some planned activities five days a week. Some people were supported to go out supported by staff, to attend appointments, have coffee or visit local attractions.
Technology was used to help improve the delivery of effective care. One person had movement sensors fitted in their room so that staff would know when they were moving around and may need support.
Risks in relation to people’s daily life were assessed and planned for to minimise the risk of harm. People were supported by staff who knew how to recognise abuse and how to respond to concerns. The service held appropriate policies to support staff with current guidance. Mandatory training was provided to all staff with regular updates provided. The manager had a record which provided them with an overview of staff training needs.
Staff were supported by a system of induction training, supervision and appraisals.
People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005. The principles of the Deprivation of Liberty Safeguards were understood and applied correctly. However, some information in care plans was misleading and could lead to some family members being asked to make decisions for which they did not hold the appropriate legal power to make. We have made a recommendation about this in the effective section of the report.
The manager was supported by the provider and a team of motivated and committed staff. The staff team felt valued and morale was good. Staff told us, “I am very happy here, it is a nice place to work” and “The manager is really good, she had made a lot of changes and is very approachable, her door is always open.”
There were effective quality assurance systems in place to monitor the standards of the care provided. Audits were carried out regularly by both the registered manager and members of the senior staff team.