This inspection took place on 25 October and 1 November 2017. Both visits were unannounced.Cedar Court is a care home registered to provide accommodation for people who require personal or nursing care. It is located in a purpose-built facility and can accommodate up to 63 people whose care needs are associated with physical needs, mental frailty and/or dementia. At the time of our visit 43 people were using the service, most of whom lived with dementia. Prior to our inspection, we had received concerns about staffing levels, people’s safety and lack of social interaction between staff and people.
There was a registered manager in post at the time of our inspection. However, the registered manager resigned from their post after the first day of our 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.
There was a high number of people at the service who needed two staff members to assist them with their personal care and when mobilizing using a hoist. However, the staffing levels were insufficient to meet the needs of people. As a result, staff were occupied with providing care in people's bedrooms without being able to spend enough time engaging with people. This meant that when staff provided care to some individuals, other people were left without the care and support they needed for significant periods of time. This was evident from our observations and discussions with staff and relatives. Some relatives were concerned that they could not locate staff when they visited the home.
We could not be sure that people received assistance from staff when they needed it, because call bells were not available to some people. There was no alternative system in place for people to call for assistance.
Risk assessments and care plans were in place for each person. Although risks to people had been identified, the steps to be taken to deal with those risks were not always clear. Care plans did not always give enough detail to staff to enable them to manage those risks. People did not receive appropriate monitoring which placed them at increased risk of harm. For example, people were not always supported to eat and drink.
The premises were not free from offensive odours. The odour of urine was noted in different places, such as people’s rooms and the communal areas, in the course of the inspection. The home was unclean, both people’s bedrooms and the communal areas were untidy.
Although staff had received training in relation to the Mental Capacity Act (MCA). However, this learning was not applied. Capacity assessments were not decision-specific or individualised for each person. Where people lacked capacity to make decisions, capacity assessments and best interest's decisions were not completed where they should have been, for example in relation to the use of bed rails.
We observed interactions between staff and people. We found the culture of the service to be task focused. Meeting the individual needs of people was not priority in this culture. End of life care plans were in place, however, due to the low staffing levels staff could not spend time with people in the last days of their lives.
People’s social needs were met on a group level, however, due to the staffing levels the service was unable to meet individual social needs of people.
The provider had a range of quality monitoring arrangements in place to monitor care and plan ongoing improvements. This included audits, surveys and regular health and safety checks. However, the systems in place had not identified the shortfalls found at our inspection.
People were protected by the provider's recruitment procedures. The provider made appropriate pre-employment checks to ensure that only suitable staff were employed. Staff understood their responsibilities in terms of safeguarding and knew how to report concerns if they suspected abuse.
Medicines were administered as prescribed.
Staff were provided with an induction when they started work, which included mandatory training and shadowing experienced colleagues. Staff told us they received one-to-one supervision and this was demonstrated by the records we checked.
The home had a robust complaints policy and records showed complaints were responded to in line with it. People and their relatives told us they knew how to make complaints.
The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be 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.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
During this inspection we identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.