Archived: Cedars Residential Care Home

Updated 29 March 2017

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, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on 28 and 29 November 2016. The inspection on 28 November was an out of hours inspection starting at 20.00. Both inspections were unannounced.

The inspection team on 28 November consisted of two inspectors. On the 29 November it consisted of two inspectors and an expert-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. Our expert had experience of services for older people and of dementia care.

Before we inspected we reviewed the information we held about the service. This included any statutory notifications that had been sent to us. A notification is information about important events which the service is required to send us by law.

We spoke with ten people who used the service, three relatives, one visiting professional, two senior care staff , five care staff, an agency staff member, the administrator, the deputy manager and the registered manager. We observed staff providing care and support and we used the Short Observational framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not communicate with us easily. Following the inspection we contacted staff at the local authority quality and improvement team.

We reviewed eight care plans, seven medication records, three staff files, staffing rotas for the six weeks leading up to the inspection and records relating to the quality and safety of the service and its equipment.

Updated 29 March 2017

The inspection took place on 28 and 29 November 2016 and was unannounced.

At our inspection on 25 and 28 June 2015 we found that the service required improvement and was rated Inadequate with regard to its safety. At our last inspection on 6 and 28 July 2016 we found that the service had not made the required improvements and was in breach of eight regulations. We made requirement actions for these breaches, rated the service Inadequate and placed the service into Special Measures. Services in special measures are kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, are inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

At this inspection we found that, although some improvements were evident, the required improvements had not all been put into place and our concerns about the safety and effectiveness of the service remained. The overall rating for this service remains ‘Inadequate’ and the service therefore continues to be in special measures while we consider our regulatory response which, in line with our enforcement policy, may lead to taking action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

The service provides accommodation for up to 63 people, some of whom are living with dementia. At the time of our inspection 57 people were resident. The service is split into two buildings which operate quite separately.

A registered manager was 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 2008 and associated Regulations about how the service is run.

Risks were assessed and documented in care plans but staff did not always manage risks effectively and people were not always safe. We continued to see practices which placed people at risk, including poor moving and handling techniques.

The provider did not have sufficient oversight of the safety of the service and risks were not effectively monitored. The service was not always proactive in managing the risks related to the prevention of pressure sores for people with limited or no mobility.

Infection control measures were in place and concerns highlighted by our previous inspection had been addressed.

There were not always enough skilled and experienced staff to meet people’s needs promptly. There was a lack of strategy in place regarding the deployment of staff. There was a recruitment procedure in place but the skills and experience of staff was not clearly established and verified before employing them. Staff received an induction and the training they needed to carry out their roles but staff practice did not always demonstrate that they put this learning into place.

Staff were trained in safeguarding people from abuse and the manager referred incidents appropriately to the local authority safeguarding team for investigation.

Medicines were managed safely and well. Staff were trained to administer medicines and their competence to do this was checked.

Staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The MCA ensures that people’s capacity to consent to care and treatment is assessed. If people do not have the capacity to consent for themselves the appropriate professionals and relatives or legal representatives should be involved to ensure that decisions are taken in people’s best interests according to a structured process. DoLS ensure that people are not unlawfully deprived of their liberty and where restrictions are required to protect people and keep them safe, this is done in line with legislation. The service did not always act accordance with the MCA and staff did not demonstrate a good understanding of DoLS.

People who used the service praised the food and people were referred to dieticians if they required this. Support at mealtimes for people who needed help or encouragement to eat and maintain their weight varied and in some cases was poor. Oversight of people’s nutritional needs and recording related to this was not always good, although some improvement was evident.

Some staff were very caring and treated people respectfully, ensuring their dignity was maintained. Others were less caring and did not consider people’s dignity and comfort.

People were involved in planning and reviewing their care but this was not always evident for those people with significant needs related to their advanced dementia.

People were not supported to follow a wide range of hobbies and interests. People living with dementia and those unable to go out independently lacked stimulation and most people were not meaningfully occupied. Staff understanding of the needs of people with dementia was poor.

A complaints procedure was in place but records did not always show how issues raised were followed up or actions taken.

Staff felt they were well supported by the management team and found them approachable.

Systems designed to assess and monitor the quality of the service were in place but were not always effective. The provider had oversight of issues affecting the service but did not have an effective management system in place to bring about the required improvements and motivate and manage the staff to deliver these.

We found several continued breaches of regulations during this inspection. We have also shared our concerns with the local authority contracts and quality and improvement teams.