Cedardale Residential Home

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

There was a lack of robust and effective processes in place to ensure that the service was well managed. Systems to ensure that learning and improvements were made through effective auditing were not robust. The registered manager and provider failed to identify the widespread issues highlighted within this assessment. The registered manager failed to identify that the culture within the service was not always positive and didn’t always promote positive outcomes for people. There was a lack of joined up working from the service with other organisations to share learning and best practice. We found a breach of the legal regulation in relation to good governance.

This service scored 32 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff did not demonstrate that they had a well-developed understanding of equality, diversity and human rights. Staff showed a lack of understanding about how to support people living with dementia. Staff did not describe people in a positive or dignified way.

Processes to ensure that staff shared the same values were not robust and effective. Staff meetings were infrequent and were not used as an opportunity to provide a positive, listening culture, focusing on learning. For example, when people fell, this was not regularly discussed in team meetings to ensure staff understood risks to people. We asked the registered manager if there was a communication book for staff and they told us they removed this as it was an opportunity for staff to argue with each other.

Staff told us they felt supported by the registered manager. The registered manager failed to identify that the way staff supported people was not in line with good practice for people living with dementia, for example, infantilizing. Records reviewed showed that staff raised concerns about management being abrupt. It was not clear what action was taken in relation to this.

Processes to ensure that the registered manager and leaders at the service had the skills and experience to lead the service were not effective. The registered manager told us that they did not work with the provider’s other service. There was limited support for the registered manager to access or share good practice or learning.

Staff told us they felt confident to share concerns internally, but staff did not have a good understanding of how to raise concerns externally, for example with the local authority safeguarding team. One staff member told us, “I'm very straight and to the point, If I need something I won’t hold back.”

Processes to ensure staff felt confident to raise concerns were not always effective. Whilst staff told us they were confident that if they raised concerns, management would take action, we identified one instance where staff shared concerns about the conduct of other staff. Records showed that staff shared concerns about staff not completing personal care for people, and falsely documenting that they had. It was not clear what, if any action had been taken to address this concern.

Although staff told us they felt they were treated with respect, we found that this was not always the case. Staff were not supported after incidents of concern to ensure they received any support they needed.

Processes to ensure that leaders continually reviewed and improved the culture of the service in the context of equality, diversity and inclusion were not robust. There were not effective processes to effectively and proactively engage with and involve staff, for example removing the communication book. The registered manager had not considered other ways of ensuring that staff could share concerns outside of team meetings.

There was a lack of guidance for staff to follow in relation to risks to people. Staff we spoke with had limited knowledge about risks to people and how best to support them. For example, a member of staff we spoke with told us a person who was at risk of skin breakdown could re-position themselves. The guidance for this person said they needed reminding and encouraging. The registered manager failed to identify that staff knowledge and guidance were not clear on the support people needed. There was not sufficient oversight of guidance to ensure it was sufficient to inform staff how best to support people.

Although the registered manager and deputy manager completed audits on a range of areas throughout the service, these had not been effective as they did not identify any issues highlighted within our assessment. For example, we identified that medicine was not managed safely, and that staff had not identified that controlled drugs were not well managed. The manager completed walk rounds which included considering if there was any malodours within the service. During our assessment we identified areas within the service which were highly odorous, and relatives also shared concerns about malodours. The registered manager reviewed and updated care plans, however they failed to identify that care plans were not always sufficiently detailed and lacked key guidance to inform staff how to support people. This included health conditions including constipation, the risk of stroke and heart attack, and how to support someone if they were distressed.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The registered manager told us that the service operated in isolation. The service did not work with the providers other service, or with any other local homes. There was a lack of sharing of information from other organisations. It was not clear how information relating to incidents was shared with staff. Staff meeting notes showed that staff meetings were infrequent and did not discuss incidents, accidents and any learning.

There was a lack of robust systems to ensure that lessons were learnt, and improvements were made when things went wrong. For example, there had been a number of unwitnessed falls, however there was a lack of review to understand any circumstances which could have impacted the fall, for example, staffing. Following a person falling, there was a lack of review of the person’s care plan or sharing learning with staff.