The Care Quality Commission (CQC) has told Coveberry Limited that further improvements need to be made at Cedar House in Canterbury, following a comprehensive inspection which took place in June.
Cedar House is a specialist hospital which offers low secure services for people with a learning disability or autistic people who have a forensic history, challenging behaviour and complex mental health needs. The service has six wards and capacity for 39 people.
Management of the service was taken over by Coveberry Limited in November 2020 and this was the first inspection of the service under the new provider. Under the previous provider the service was rated inadequate overall. Coveberry Limited has made some improvements to the service, including decorating and adding new flooring, bathrooms and kitchens on some wards, but further improvements and repairs still needed to be made to ensure that all wards were fully fit for purpose.
Following the inspection, Cedar House has been rated requires improvement overall.
The service has also been rated requires improvement for being safe, effective and well-led. It was rated good for being caring and responsive.
Karen Bennett-Wilson, CQC’s head of hospital inspection for mental health, said:
“We had a number of concerns when we inspected Cedar House in June. We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities (where appropriate) that most people take for granted.
“However, the design and layout of the hospital building and the overall size and scale of the service is institutional and does not support the delivery of modern, effective care for people with a learning disability or autistic people. Although the provider has endeavoured to make improvements to the environment, further work still needs to be done to ensure that people using the service are in an environment that is safe, well maintained and meets their physical and sensory needs.
“Improvements also need to be made to staffing levels and staff training and supervision, to ensure that consistently good care is provided to people. That said, the service was delivering kind and compassionate care and people were safe and supported to be independent as possible and have control over their lives. People spoke highly of the staff and the care they received and had access to a range of psychological therapies and good physical healthcare. There were also plenty of activities on offer such as cycling, camping in a tree house and trips to the beach or to eat out.
“The provider does have a plan in place to address the issues we found, and we will continue to monitor the service to ensure that the improvements are made in a timely manner.”
Inspectors found the following issues at the service:
- Occasionally the service did not have enough staff. This meant that people did not always have access to activities
- Some staff fed back they did not always feel supported and felt some pressure due to staffing challenges, such as when there was a number of agency or temporary staff on shift
- Most staff had regular supervision, but some staff were not given supervision in the timeframes set in the provider’s policy. The hospital was in the process of ensuring staff were offered supervision appropriately
- Care records were in the process of being moved to a new system, so were not always consistently easy to find. This meant that if staff could not find required information in a timely manner there was a risk of people not getting care in line with their care plans
- Positive behaviour support plans (PBS) were being used, but at the time of inspection these were only being used on three of the six wards. The other wards were still using individual support guidelines (ISG). Staff said that using PBS had improved the quality of care and reduced incidents. PBS was being introduced across the service but was needed on the other wards to ensure a consistent and robust model of care was being used across all wards
- Some refresher training for some staff such as basic life support and food safety had been delayed due to the COVID-19 pandemic.
However:
- Leaders had the skills, knowledge and experience to perform their roles and understood the service they managed. They had a vision for the service and for each person who used the service. They were visible in the service and approachable for people and staff
- Staff knew and understood the provider’s vision and values and how to apply them in the work of their team. All managers and staff inspectors spoke with were passionate about the care people received and had this at the forefront of the work they did on a day-to-day basis
- Trained staff and specialists provided care, support and treatment to meet people’s needs in a clean environment
- People were supported to be as independent as possible in a secure environment and to have control over their own lives. Their human rights were upheld
- People received kind and compassionate care from staff who protected and respected their privacy and dignity and understood each person’s individual needs
- People’s risks were assessed regularly and managed safely. People were involved in managing their own risks whenever possible. Restrictive practices were only used as a last resort, for the shortest time and in situations where people were a risk to themselves or others. If restrictive practices were used, there was a reporting system in place and there were comprehensive reviews to try and reduce the use of these practices
- People were safe from abuse. Staff understood how to protect people from abuse and the service had regular meetings with the local authority to monitor and manage any safeguarding concerns
- People received care, support and treatment that met their needs and aspirations. Care focused on people’s quality of life and followed best practice. Staff used clinical and quality audits to evaluate the quality of care
- People had clear plans in place to support them to return home or move to a community setting (as appropriate). However, some people had not been able to move on as quickly as would be expected due to lack of appropriate services available to them.
Full details of the inspection are given in the report published on our website.
For enquiries about this press release please email regional.engagement@cqc.org.uk.
Journalists wishing to speak to the press office outside of office hours can find out how to contact the team here (Please note: the duty press officer is unable to advise members of the public on health or social care matters).
For general enquiries, please call 03000 61 61 61.