Cedardale Residential Home

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

People’s needs were not robustly assessed before they moved into the service, to ensure that staff could meet the person’s needs. Assessments were not fully detailed or completed to inform staff about people’s needs. Care plans were not sufficiently detailed and lacked guidance to inform staff how to support people. People’s capacity was not always assessed, or their consent was not always sought in line with the Mental Capacity Act (MCA) 2005. We found 2 breaches of the legal regulations in relation to safe care and treatment, and the need for consent.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

While some of the people we spoke to expressed that they were generally happy with their care, our assessment found care did not always meet the expected standards. Relatives told us staff had not always recognised when their loved one’s needs had changed. One relative told us their loved one had a swollen hand that had not been identified by staff.

We observed a non-care staff member discussing a potential new placement with the local authority on the telephone. They enquired with the deputy manager if there was a room available. The staff member relayed the information to the local authority, at no point did the deputy manager or registered manager take the call to ensure there was a competent staff member completing the first stage of the assessment.

People’s needs had not been fully assessed before they moved into the service. Care plans were not sufficiently detailed to inform staff how to support people. Assessments of needs we reviewed were basic, and it was not clear how staff assessed they could meet people’s needs. For example, for one person we reviewed, there was no information within their care plan about their background or life history. Relatives we spoke with were able to tell us in great detail about people, their likes and preferences, none of which was documented within their care plan.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

While some of the people we spoke to expressed that they were generally happy with their care, our assessment found care did not always meet the expected standards. People’s consent was not always sought. When people lacked capacity, attempts were not made to have a best interest meetings or to complete capacity assessments. There was CCTV within the service, the registered manager told us she had not sought people’s consent to this constant surveillance prior to them moving in, had not assessed people’s capacity to consent to this and had not set up best interest meetings.

Staff told us they understood the requirements of the MCA, and the need to ensure people were given choice and control, however, we found this was not always the case. On the second day of our assessment, we saw people were not offered a choice of meals from plates to support their decision making. There was CCTV within the service. We discussed with the registered manager the reasoning of having CCTV within the service, and they told us they believed it was to see what occurred after an event, for example an unobserved fall. The registered manager had not considered that it was a restriction placed on people.

Processes to ensure that the MCA was complied with were not robust, or always followed. We asked to see mental capacity assessments and best interest meeting records to evidence that decisions were made in line with the MCA. The registered manager confirmed these were not always in place. One person had bed rails in place, and their care plan stated that they did not have capacity. Another person had a sensor mat in their room, that staff told us they used occasionally. There was no mental capacity assessment, best interest decision record or DoLS in place to support this restriction. CCTV was used within the service. We asked the registered manager to provide mental capacity assessments, and best interest meeting evidence to demonstrate that people had been consulted about the use of CCTV. The registered manager confirmed that when new people had moved into the service, they had been told about the CCTV, but their consent had not been sought, and processes in line with the MCA had not been followed when people lacked capacity. The provider, and registered manager failed to regularly review this restriction to ensure it remained necessary, and the least restrictive option for people.