Cedar Court

Updated 23 January 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 13 and 20 November 2018 and was announced. We gave 24 hours’ notice of the inspection, because we needed to be sure people would be in when we visited. The inspection was carried out by one inspector.

Before the inspection we checked information we held about the service. This included notifications the provider had sent us about events or incidents that occurred and which affected their service or the people who used it. We contacted the local authority’s adult safeguarding and quality monitoring team as well as Healthwatch England, the national consumer champion for health and social care, to ask if they had any information to share.

We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection we spoke with four people who lived at Cedar Court, the registered manager, two team leaders, and four other members of staff.

We checked three people’s care plans, risk assessments, daily notes and medication administration records. We reviewed recruitment records for three members of staff, as well as training, supervision and appraisal records for the staff team. We looked at meeting minutes, quality assurance audits and a selection of other records relating to the management of the service.

Updated 23 January 2019

This inspection took place on 13 and 20 November 2018 and was announced. We gave 24 hours’ notice of the inspection, because we needed to be sure people would be in when we visited.

Cedar Court is registered to provide personal care to older people who may also be living with dementia, a learning disability or autistic spectrum disorder, mental health needs, a physical disability or sensory impairment.

This service provides care and support to people living in specialist ‘extra care’ housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is rented, and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. The Care Quality Commission (CQC) does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service.

Not everyone using the service or living at Cedar Court receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

This was the first inspection of Cedar Court since its registration. At the time of the inspection there were 19 mainly older people using the service.

The service had a registered manager. They had been the registered manager since December 2017. A registered manager is a person who has registered with the 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 also managed another of the provider’s services and split their time between the two locations. They were supported by two team leaders in the management of the service.

Care plans and risk assessments did not always contain enough information to guide staff on how to manage risks associated with people's health needs. Although staff showed a good understanding of how to manage risks to people’s safety, it is important that detailed risk assessments are also in place to support and guide consistent and safe care. Protocols needed to be implemented to guide staff on when to administer ‘as required’ medicines. Staff had been trained to administer medicines.

The registered manager had systems in place to monitor and audit the quality of the service, but we made a recommendation in relation to assessing, recording and auditing risks.

People who used the service told us they felt safe with the support that staff provided. Staff were safely recruited and the registered manager made sure enough staff were deployed to meet people’s needs. People who used the service told us staff were reliable, arrived when they needed and provided care and support in an unrushed way.

Staff were trained to recognise and respond to any safeguarding concerns. They recorded information about any accidents and incidents that occurred. The registered manager was developing a system to audit and analyse accidents and incidents to help identify any patterns or trends. Staff took steps to minimise the risk of spreading infections.

The provider employed a small team of staff who worked closely with people who used the service. Staff showed a good understanding of people’s needs and how best to support them. People who used the service told us staff listened to them and were responsive. Staff worked in a person-centred way and were knowledgeable and skilled in the way they supported people to maintain their independence.

The registered manager explained plans that were being made to deliver end of life training for staff and to implement an end of life care policy and procedure.

People who used the service gave positive feedback about the skilled and effective care staff provided. Staff completed regular training. The registered manager used supervisions and spot checks to monitor staff’s performance and support them to continually learn and develop in the role.

Staff had training on the Mental Capacity Act 2005. They sought people’s consent before providing support and this was recorded in their care plans.

Staff helped people when needed to prepare meals and drinks and to make sure they ate and drank enough. They worked with healthcare professionals and provided support to make sure people could access healthcare services when needed.

The service was caring. People told us staff were kind, respectful and supported them to maintain their dignity. Staff offered people choices and helped them to make decisions.

People told us they felt able to speak with staff or the registered manager if they had any worries or concerns. There had not been any complaints, but the provider had a system to manage and respond to any complaint if needed.

People told us the service was well-led. Staff gave positive feedback about the management of the service and told us advice, guidance and support was always available when they needed it.

Staff worked well as a team, there were effective systems to share information about changes and improvements to the service. There was an open, inclusive and person-centred culture. Staff were committed to maximising people’s independence and the rotas, training and management of the service supported staff to deliver this.