Cedar Court Care Home

Cedar Court is a nursing home providing personal and nursing care for up to 75 older people some of whom had a physical disability or were living with dementia. The home is a large adapted building. At the time of the inspection there were 60 people living at the service.

People’s experience of using this service and what we found

Staff and the management team ensured that people and their families were at the centre of the delivery of care. People were treated as individuals whose life and experiences were considered and factored into care planning. Staff looked after people in a kind and compassionate manner and treated them with dignity and respect. People and relatives were at the centre of decision making about their care.

Staff at the service took steps to find out what people had done in the past and looked at ways to accommodate activities that there important to people. There were a range of activities available within the service and outside. Staff ensured that people who were nearing the end of their life were provided with care and compassion and that people’s last wishes were fulfilled where possible. The registered manager told us they would take steps to include more detail in people’s care plans around their specific care and end of life wishes.

The service had a strong, visible person-centred culture to help people to live their lives to the fullest. People and staff told us the registered manager and the senior staff were supportive and valued their input. The registered manager and staff worked in partnership with people's families and outside organisations to improve the care and support people received. The management team was proactive with regard to how people's support could be improved.

Rating at last inspection (and update)

The last rating for this service was Requires Improvement (published 4 November 2020). Prior to this we inspected the service in October 2019 and there were three breaches of regulation that we looked at this latest inspection. The provider completed an action plan to show what they would do and by when to improve. At this inspection we found there were improvements and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

We carried out an unannounced comprehensive inspection of this service in October 2019. Breaches of legal requirements were found in relation to people not always being treated with dignity and respect, planning of care was not always detailed and complaints were not always being investigated appropriately. The provider completed an action plan after this inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Caring, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cedar Court on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Cedar Court is a nursing home providing personal and nursing care for up to 75 older people some of whom were living with dementia. The home is a large adapted building. At the time of the inspection there were 37 people living at the service.

People’s experience of using this service and what we found

People’s records were not always up to date or accurate. We have made a recommendation around this. However, since the last inspection there had been improvements of the management of the service and people and staff were complimentary about this.

The deployment of staff at the service had improved to ensure people were supported with their needs. Staff were aware of the risks associated with people’s care and ensured that people were provided the most appropriate care. People were supported to have maximum choice and control of their lives and staff them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff received appropriate training in relation to their role and were encouraged to progress. Staff were valued and this was evident in the care they provided to people. Staff were confident in when they needed to gain advice from health care professionals in relation to people’s care. There was a robust system in place to assess the quality of care provided.

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 Inadequate (published 17 December 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations 11, 12, 17, 18 and 18 of the registration regulations. However, we have made a recommendation relating to ensuring records are accurate and up to date.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 22 October 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve need for consent, safe care and treatment, good governance, staffing and notification of incidents.

We undertook this focused inspection to check they had followed their action plan and to confirm they were now meeting legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well Led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection. The service is no longer in special measures.

Please see the Safe, Effective and Well Led sections of this full report. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cedar Court on our website at www.cqc.org.uk.

Cedar Court is registered to provide accommodation and personal care for up to 75 people who may have a nursing need, a disability or may be living with dementia. There were 67 people living at the service at the time of our inspection.

People’s experience of using this service and what we found

There had been a change in management at the service since the last inspection and the provider had not robust oversight of the quality of care during this transition. There were not always enough staff deployed at the service which left people at risk. Risks associated with people’s care was not always being managed in a safe way including the management of medicines and the cleanliness of the service. Incidents and accidents were not always followed up on to avoid the risk of reoccurrence.

Although staff received training and supervision, this was not effective in ensuring good practice within the service. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests. Pre-assessments of care and care plans did not always have accurate information about people’s care and staff did not always understand people’s needs. Although people and relatives knew how to complain they did not always feel listened to. Complaints were not always investigated fully.

People did not always have choices around their care delivery and at times were not treated with dignity and respect. Quality assurance was not always effective. Where shortfalls in care had been identified with staff this had not been addressed robustly. The leadership needed to be more effective in ensuring staff were delivering appropriate care. The provider had failed to maintain robust oversight of the service. As a result, the level of care had deteriorated from the last inspection. People did not always have access to health care professionals to support them with their care. The lay out of the service require improvements to support people that had difficulties.

People and relatives told us that staff were at times kind and caring and we did see examples of this. There were activities on offer for people although improvements were needed at the weekend. Relatives and visitors were welcomed as often as they wanted. People enjoyed the meals on offer at the service. People had access nutritious food and drink through the day.

Previous Inspection

The last rating for this service was Good (Report published 18 September 2018.)

Why we inspected

The inspection took place earlier than planned as we had received concerns about the quality of care being provided. We have found evidence that the provider needs to make improvement. Please see the Safe, Effective, Caring Responsive and Well Led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 6 September 2018 and was unannounced.

There was a registered manager in post at the time of our inspection. 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.

At our last inspection on 28 July 2018, we asked the provider to take action to make improvements in relation to the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS), how people were respected, how people received personal care, the malodour on one floor and the quality assurance. We found at this inspection that action had been taken to address these concerns.

People’s rights were protected because staff acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Appropriate assessments had been completed where people’s capacity was in doubt and applications to the Local Authority were submitted if people were being restricted in their best interest. Staff gained consent from people before care was delivered.

People and their relatives told us that staff were kind and caring and treated people in respectful and dignified way . This was confirmed through our observations. People had choices around their care and felt involved in their care planning. Relatives and friends were welcomed at the service to visit people. People and their relatives were given support when making decisions about their preferences for end of life care. Religious services were available for people that wanted.

There were effective systems in place to assess the quality of care and to make improvements. This included audits, meetings and surveys where feedback was sought. Improvements were made as a result of this. Staff worked with organisations outside of the service to support the care being provided to people.

Start by saying what the provider had done to address the concerns we found last time, so move evidence highlighted in comments to here.

There were appropriate number of care staff to support people when they needed it. People told us that they felt safe and supported at the service. The management of medicines was safe by staff who had the appropriate training. Staff understood the need for good infection control practice to reduce the risk of spreading infections.

The environment was set up to meet the needs of people living at the service particularly for those people living with dementia. People were able to access the service independently where appropriate.

People and relatives felt that staff were competent in their roles. Staff received training and supervision and felt supported by their managers. Nurses were kept up to date with their clinical training. People told us that the care they received was effective.

There were appropriate plans in place to ensure that risks to people were managed. Staff understood what to do to minimise risks in relation to people. Emergency evacuation plans were in place and staff understood what to do if an emergency occurred at the service. Where people had accidents and incidents, actions were taken to reduce the risk of them reoccurring.

Staff had received training in safeguarding people from abuse and they had a good knowledge of what they needed to do if they suspected abuse. Staff at the service had robust recruitment checks undertaken before they started work.

People enjoyed the meals at the service and said they had sufficient choices. People’s healthcare needs were monitored including weight loss and any changes in their health. People had access to appropriate healthcare professionals where needed. Healthcare professionals were positive about the care being delivered at the service.

People had a range of activities that they could be involved in including those that were cared for in their rooms. People that were socially isolated in their rooms had one to one activities arranged for them. Care plans were detailed and included specific guidance for staff to ensure that people’s needs were met. Staff communicated changes to each other about any changes in people’s care.

Complaints were investigated, recorded and responded to appropriately. People and staff felt the management of the service had improved significantly. Staff said they felt empowered and valued. We could see that they staff team worked well together and that staff enjoyed working there.

The manager had informed the CQC of significant events including incidents and accidents and safeguarding notifications.

There was a registered manager in post and present on the day of the inspection. 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.

People's human rights were not always protected because the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty (DoLS) were not being followed. MCA assessments were not always completed where needed. Staff did not always understand MCA or why it was important to understand if people had capacity to make decisions. There were some staff that did have an understanding of MCA and its principles. Where restrictions were in place this was not always supported by a MCA.

There were aspects to the care that people received that was not always dignified. Some areas of the service smelled strongly of urine and people did not always look clean and well presented. People were not always able to communicate with staff whose first language was not English. Other aspects of care to people was kind and considerate to people’s needs. People and relatives said that staff were caring and kind to them and treated them with respect. People and relatives were involved in their care planning and the care that was provided was person centred.

The provider did not always have robust systems in place to regularly assess and monitor the quality of the care provided. Concerns we identified were not always picked up on the providers audits. Where concerns were picked up on audits these were not always addressed. Records kept for people were not always up to date and did not always reflect the most appropriate care.

There were enough staff to support the needs of people at the service. When people required support this was provided quickly by staff. We did raise with the registered manager that staff were not always visible on the dementia unit which was a risk. The registered manager told us that this would be addressed.

People were protected from the risk of abuse and staff understood their roles and responsibilities. People told us that they felt safe. One relative told us, “The care is really good and my relative feels safe and happy here.”

Staff understood the risks to people. Staff encouraged and supported people to lead their lives as independently as possible whilst ensuring they were kept safe. People’s medicines were managed in a safe way. In the event of an emergency plans were in place to keep people safe. Accidents and incidents were monitored and action taken to reduce the risks.

Staff received appropriate training and supervision to provide effective care to people. People felt that they were being supported by staff that were effective in their role. Staff felt that they had sufficient training and support. Staff that worked at the service had appropriate recruitment checks before they started work.

People enjoyed the food at the service. Staff supported peoples nutritional and hydration needs and people accessed health care professionals when needed.

Care plans detailed and had specific guidance to staff on how best to support people. Staff communicated with each other the changes to people care. People were able to participate in a range of activities both inside and outside of the service.

Systems were in place if complaints, concerns and compliments were received. The provider actively sought, encouraged and supported people's involvement in the improvement of the service.

People told us the staff were friendly and management were always approachable. Staff were encouraged to contribute to the improvement of the service. Staff told us they would report any concerns to their manager. Staff felt that management were very supportive and staff felt valued.

The registered manager had informed the CQC of significant events.