Archived: Cedar Court Residential and Nursing Home

Cedar Court Nursing and Residential Home is a residential nursing home providing personal and nursing care to older people and people living with a dementia. It can support up to 68 people in a single, purpose-built building. There were 55 people using the service when we inspected.

People’s experience of using this service and what we found

Risks to people were not always effectively recorded, monitored or acted on. Care records were not always consistent or person-centred. Improvements were needed in adapting the service to meet the needs of people living with a dementia.

We made a recommendation around activities for people living with a dementia.

Staffing levels were monitored and recruitment checks carried out. People were safeguarded from abuse. Effective infection control processes were in place.

Staff received training, supervisions and appraisals. 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.

People received kind and caring support from staff who knew them well. People and relatives told us staff treated people with dignity and respect and promoted their independence.

The provider had an established complaints process. Systems were in place to provide end of life care where needed.

Feedback was sought and acted on. Staff spoke positively about the culture and values of the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 31 October 2017).

There was also an inspection on 8 May 2019 however, the report following that inspection was withdrawn as there was an issue with some of the information that we gathered.

Why we inspected

This was a planned re-inspection because of the issue highlighted above.

Enforcement

We have identified breaches in relation to premises safety, monitoring and recording risk, care plans and good governance processes at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Cedar Court provides personal care and accommodation for up to 69 people, some of whom have a dementia type illness and/or nursing needs. On the day of our inspection there were 46 people using the service.

The home had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. However, the registered manager was no longer employed by the service. A new manager was in post who was managing the service and had commenced their application to be registered with CQC.

We carried out a comprehensive inspection of this service in October 2016 and rated the service as ‘Good’ overall. We carried out this focused inspection to look into concerns raised with the Commission that a number of safeguarding incidents had occurred within the service and had not been reported to us via statutory notifications. A notification is information about important events which the service is required to send to the Commission by law. This report only covers our findings in relation to these concerns. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk

At this inspection, we checked to ensure accidents and incidents had been appropriately recorded and dealt with, appropriate procedures were in place to protect vulnerable adults, staffing levels were sufficient to keep people safe, and people were protected against the risks associated with the unsafe use and management of medicines. We also checked to ensure the service was well-led. The ratings for safe and well led have remained ‘Good’ in line with the ratings allocated to these domains at our last comprehensive inspection of this service. We will check the ratings against these key questions again during our next planned comprehensive inspection of the service.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service.

The provider had taken seriously any risks to people and put in place actions to prevent accidents and incidents from occurring.

Staff were aware of how to protect vulnerable adults and clear instructions were provided on out of hours reporting.

The home was clean, spacious and suitable for the people who used the service.

Appropriate procedures were in place to ensure people received medicines as prescribed.

Records were kept securely and could be located when needed.

The service had a positive culture that was person centred and inclusive. Family members told us the manager and staff were approachable.

Staff felt supported by the manager and they were kept up to date via staff meetings and supervisions.

The provider was meeting the conditions of their registration and submitted statutory notifications in a timely manner.

At our last inspection of Cedar Court published on 17 December 2015 we reported that the registered provider was in breach of the following:

Regulation 9 Person centred care

Regulation 14 Nutrition and Hydration

Regulation 15 Premises and equipment

Regulation 17 Good governance

Regulation 18 Staffing

We asked the registered provider to take immediate actions and at this inspection we found significant improvements had been made to meet these regulations.

Cedar Court provides accommodation with personal and nursing care for up to 69 older people. The building is on two levels and is split into four living areas; the Dalton, Byron, Seaton and Tempest units. The home caters for people who have lifelong conditions, those who are recovering from an injury or illness and those who have a dementia type illness. Cedar Court is set in its own gardens in a residential area near to public transport routes, shops and local facilities.

There was a new registered manager in place who had been appointed since the last inspection. 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.

People who used the service, and family members, were complimentary about the standard of care provided. They told us the staff were friendly and helpful. We saw staff treated people with dignity, compassion and respect and people were encouraged to remain as independent as possible and for some, regain skills to enable them to return to their own homes.

All the care records we looked at showed people’s needs were assessed before they moved into the home and we saw care plans were written in a person centred way.

There were sufficient numbers of staff on duty in order to meet the present needs of people using the service. The registered provider had an effective recruitment and selection procedure in place and carried out robust checks when they employed staff to make sure they were suitable to work with vulnerable people.

We saw the home had in place personal emergency evacuation plans displayed close to the main entrance and accessible to emergency rescue services if needed.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments and emergencies.

There were robust procedures in place to make sure people were protected from abuse and staff had received training about the actions they must take if they saw or suspected that abuse was taking place.

People’s nutritional needs were assessed and plans of care drawn up if they were at risk of malnutrition or choking. The cook demonstrated that she had an extensive knowledge of people’s likes and dislikes and prepared a wide selection of wholesome and popular meals to cater for people’s tastes.

We found the home had cleaning schedules in place to prevent the spread of infection.

We saw a notice board on which was displayed information about the activities for that week. During our inspection we found lots of various interesting activities taking place both inside and away from the home.

We saw the registered provider had a complaints policy in place and this was clearly displayed for people to see.

CQC monitors the operation of the Deprivation of Liberty Safeguards [DoLS] which applies to care homes. The Deprivation of Liberty Safeguards are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. We found the registered provider was following legal requirements in the DoLS.

The registered provider had a robust quality assurance system in place and gathered information about the quality of their service from a variety of sources including people who used the service and their family and friends. The registered provider’s organisation collected this information and provided additional oversight and monitoring of the home. The staff and registered manager reflected on the work they had done to meet peoples’ needs so they could see if there was any better ways of working.

We spoke with one person living in the home about their medicines. They said 'The nurses are very kind and make sure I get all my medicines. I have no concerns'.

All of the people we spoke with were happy with the care provided. Comments included 'My (relative) has been in here 5 years now and I feel the staff are very caring towards them, which is a great comfort', 'I like it here, I am well looked after' and 'I would rather be at home but I can't manage on my own. This is a nice home with good staff.'

People all said they felt it was a safe home and they had confidence in the staff. We spoke with some relatives, who also said they felt their family member was safe when in the care of Cedar Court staff. One person said 'I have no worries whatsoever as I have observed the staff for a few years now and they are very kind to residents.'

We looked at how medicines were managed in the home. We found some records for the 'loose' stocks were not correct. We looked at a sample of three loose packets or bottles of medication. We found there were more medicines left than there should have been, according to the records.

The provider had a clear policy on obtaining feedback from people using its services. This included information from sources such as residents and relatives meetings, complaints and survey questionnaires.