Background to this inspection
Updated
9 October 2020
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 Care Act 2014.
Inspection team
This inspection was carried out by three inspectors. The inspection was also supported by two Experts by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. One Expert by Experience attended the home during the inspection to speak with people using the service and gain their views. The second Expert by Experience contacted people’s relatives by phone to request feedback.
Service and service type
Cedar House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a 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 had a manager registered with the Care Quality Commission. 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.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection and formal notifications that the service had sent to the CQC. Notifications are information that registered persons are required to tell us about by law that may affect people’s health and wellbeing.
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all this information to plan our inspection.
During the inspection
We spoke with 11 people living at the home and three visiting relatives about their experience of the care provided. We spoke with six members of staff including one of the directors of the organisation, the operational director of care (who was also the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider), the registered manager, two senior care staff and one care worker.
We reviewed a range of records. This included four people’s care records and eight people’s medication records. We looked at six staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including quality assurance, training records and health and safety were also reviewed.
After the inspection
We continued to seek clarification from the registered manager to validate evidence found. We looked at policies and procedures the registered manager sent to us. We spoke with three members of staff including the cook and two care staff. We further spoke with six relatives by phone to gain their feedback.
Updated
9 October 2020
About the service
Cedar House is a residential care home providing accommodation and personal care for up to 17 people aged 65 and over, some of whom may have dementia. At the time of the inspection there were 16 people living at the home. The home is an adapted detached residential house. There is a garden to the rear of the property.
People’s experience of using this service and what we found
People told us they felt staff were kind and caring and felt safe living at Cedar House. However, we found significant concerns throughout the inspection. The home was dirty and parts of the home including the kitchen and furniture was in a state of disrepair. The home smelled strongly of urine and there were concerns around infection control in the kitchen area. People did not always have access to call bells.
There were few activities available to people and activities were not planned with an understanding of people living with dementia. Staff were not deployed across the home in a way that met people’s needs adequately. There was poor management oversight of the home and auditing processes were ineffective.
We observed some warm and caring interactions between staff and people. However, we also found instances where people were not treated with kindness and compassion. People who stayed in their bedrooms were often left alone for long periods of time. People were not always supported in a way that met their needs and ensured their physical and emotional well-being.
People did not always have choice around planning menus. Food was not always provided that was suitable for people. We have made a recommendation around this.
People’s personal risks were well assessed and provided staff with information on how to minimise known risks. People told us they were given their medicines on time. Staff understood safeguarding and how to keep people safe from abuse. Staff received regular training to support them in their role.
Care plans had been reviewed since the last inspection and were much more person centred. People were not involved in menu planning, although the cook told us that they asked people what they wanted each day. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
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 requires improvement (published 26 February 2019). We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following this inspection, the provider completed an action plan for breaches of regulations 12 and 18, supporting people with oral hygiene and staff deployment respectively, to show what they would do and by when they would improve. At this inspection enough improvement been made around regulation 12. However, regulation 18, in relation to staffing, had not been addressed and the provider was still in breach of regulations.
At the last inspection we also issued two warning notices for regulations 9 and 17, relating to care planning / provision of activities and management over sight and quality assurance respectively. The provider partially met the warning notice for regulation 9 and there had been a significant improvement in care planning, However, the provision of activities and engaging people was still poor and the provider remains in breach of regulation 9. The provider had failed to address the issues around regulation 17 and remains in breach.
At this inspection we also found a further breach around regulation 15, premises and equipment. People did not always have access to call bells, furniture, fixtures and fittings were in a state of disrepair. There was a new breach of regulation 12 around infection control. The home was found to be dirty and infection control was not addressed.
In summary, at this inspection we found beaches of regulations 9, 12, 15, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection.
We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive 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 House on our website at www.cqc.org.uk.
Enforcement
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
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.
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.