Cedar Lodge

Updated 4 October 2022

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 Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by one inspector.

Service and service type

Cedar Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and we looked at both during this inspection.

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We gained feedback from partner agencies within the local authority. We examined the monthly information submission received since our last inspection. The provider was asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all of this information to plan our inspection.

During the inspection

We toured the whole premises. We observed care and support between people and care staff supporting them. We spoke with two people. We examined a number of records relating to recruitment, staffing, care plans, auditing and management oversight.

Updated 4 October 2022

About the service

Cedar Lodge is a residential care home providing personal care to up to 25 people. The service provides support to older people, people living with dementia and younger adults. At the time of our inspection there were 18 people using the service. Accommodation is over two floors and there is a shaft lift to access the upper floor.

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

The provider’s governance systems in monitoring the quality and safety of the service were still ineffective. The provider was reactive to events that arose and did not use effective systems to proactively identify risk with planning for improvement of the service and meet challenges that arose. One example was a risk posed to people and staff in obtaining timely insurance. There was a reliance on other system partners such as the local authority to support the service to resolve this.

Since our last inspection the registered manager has worked along with the support of partner agencies to improve Cedar Lodge. However, the provider has continued not to have effective oversight of the service. There continued to be a lack of provider audits with action plans and timely completion of essential works needed. For example, in relation to repairs and upkeep of the premises. There was minimal evidence of provider input in monitoring the service.

Risks to people identified at our last inspection had been mitigated to a degree. With support from the local authority a system was now in place. Risk management plans had been reviewed and updated, but action to keep people as safe as they could be had not been appropriately taken. For example; to mitigate the risk of falls over low banisters, whilst we were told by the registered manager wood had been purchased, banisters had not been installed.

The environment was cleaner. A deep clean had taken place. Additional staff were employed to maintain cleanliness at weekends. However, we had to point out to the registered manager continued cleanliness concerns, such as dirty toilet raiser seats, a soiled shower chair and stained bedding. The registered manager responded to our identified shortfalls and ensured these were dealt with.

The environment had not been upgraded to maintain cleanliness. There were still damp and mould in a bathroom, flooring had not been replaced in any bathroom, en-suite or toilets. Flaking paint was still evident in an en-suite shower. The laundry room still had no wash hand basin. This meant people and staff were still at risk of cross infection. Basic maintenance had taken place such as painting five bedrooms.

Additional care staff have been recruited and resident numbers have reduced. This had led to people being more appropriately supported and cared for.

The registered manager had worked well with the local authority safeguarding team and had acted upon their recommendations. This had led to more effective safeguarding systems in place to protect people from the risk of harm or abuse. Best interest assessors have been involved in review of people’s needs and up-skilling staff which meant consent was better understood and documented.

People were better supported to have choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the provider had accessed systems of support through the local authority to better address their responsibilities under the Mental Capacity Act.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 24 March 2022).

At our last inspection we found breaches of the regulations in relation to keeping people safe from avoidable harm, a lack of staff and records such as risk assessments and care plans were not adequate. The provider completed an action plan after the last inspection to tell us what they would do and by when to improve.

Outcome

This service has been in Special Measures since 24 March 2022. During this inspection the provider demonstrated that some improvements have been made. The service is no longer rated as inadequate in safe and well led. Therefore, this service is no longer in Special Measures.

At our last inspection we recommended that people should have individual information relating to medicine administration. At this inspection we found people had medicine profiles that explained to staff how best to support each individual with their medicines.

Why we inspected

We carried out an unannounced targeted inspection of this service on 1 August 2022.

We undertook this inspection as we had been made aware that the service was struggling to obtain insurance and to check if the provider had made improvements to meet the legal requirements from our last inspection. This report only covers our findings in relation to the key questions safe and well-led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

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

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.

Enforcement and recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have found ongoing breaches in relation to ineffective management and governance of this service and ineffective management oversight of cleanliness and hygiene at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.