Archived: The Cedars Residential Care Home

Updated 1 August 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 25 and 26 June 2018 and was unannounced.

The inspection team comprised of one adult social inspector and an assistant inspector.

Before the inspection visit we reviewed the information which was held about The Cedars. This included notifications we had received from the registered provider such as incidents which had occurred in relation to the people who were being supported. A notification is information about important events which the service is required to send to us by law.

A Provider Information Return (PIR) was received prior to the inspection. This is the form that asks the provider to give some key information in relation to the service, what the service does well and what improvements need to be made. We also contacted commissioners and the local authority prior to the inspection. We used all this information to plan how the inspection should be conducted.

During the inspection we spoke with the home manager, two care team leaders, two members of staff, kitchen staff, one domestic assistant, one activities co-ordinator, one healthcare professional, five people who lived at the home and three relatives.

We also spent time reviewing specific records and documents, including four care records, five staff personnel files, staff training records, five medication administration records, audits, complaints, accidents and incidents, health and safety records, action plans, policies and procedures and other documentation relating to the overall management of the service.

In addition, a Short Observational Framework for Inspection tool (SOFI) was used. SOFI tool provides a framework to enhance observations during the inspection; it is a way of observing the care and support which is provided and helps to capture the experiences of people who live at the home who could not express their experiences for themselves.

Updated 1 August 2018

This inspection took place on 25 and 26 June 2018 and was unannounced.

The Cedars Residential is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The Cedars is registered to provide residential care and support for up to 27 people. At the time of the inspection, there were 20 people living in the home. The home is purpose built and accommodation can be found across two floors. The first floor is accessible by a passenger lift and there is also an accessible staircase.

At the time of the inspection there was no registered manager in post. 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. A manager was appointed in March 2018; they had submitted the relevant registration paperwork to CQC.

During this inspection we found a number of improvements were needed as the registered provider was found to be in breach of regulation 12 (Safe care and Treatment), regulation 17 (Good Governance) and regulation 19 (Fit and Proper Persons Employed) of the Health and Social Care Act, 2008. We are taking appropriate action to protect the people who are being supported by The Cedars.

We looked at medicine management processes and found that people were not fully protected against the risks associated with medication administration. We identified that recording procedures were not always followed by staff, topical (cream) preparations were not safely managed and PRN protocols (as and when needed medication) needed to be improved.

We identified that the quality assurance and governance systems were not effectively in place. Audits and checks were not robust enough and were not suitably assessing, monitoring or identifying areas of improvement that were needed. We found medication audits to be ineffective, recruitment practices were not always safely followed and health and safety management systems were not completed as routinely as they should have been.

We reviewed recruitment processes to ensure the staff who were employed were suitable to work with vulnerable adults. We found the recruitment processes in place were not robust enough. We identified concerns regarding employment histories and the suitability of references. The recruitment files we checked contained the relevant Disclosure and Barring Service checks (DBS) however, we discussed with the manager that recruitment processes needed to be reviewed and improved upon.

You can see what action we took at the back of this report.

Whistleblowing policies were in place however we received mixed feedback from staff about their understanding of whistleblowing and the importance of complying with such policies.

We recommend that the registered provider reviews their whistleblowing policies and procedures.

People and relatives told us that the staff provided a safe level of care. Staff were familiar with safeguarding procedures and explained how they would keep people safe. Staff had also received the necessary safeguarding adults training.

People’s risk assessments identified risks to their health and wellbeing. These helped to ensure people’s ongoing safety and welfare was monitored and risks were mitigated. Risk assessments were regularly reviewed and it was evident throughout the course of the inspection that staff were familiar with the different levels of risk that needed to be managed.

During the inspection we found the staffing levels were satisfactory. We observed staff supporting people in accordance with their individual needs. The support was given in a timely, responsive and kind manner; the staffing rotas evidenced consistent staffing numbers with good deployment of staff. Feedback from people living at the home, relatives and staff confirmed staffing levels had improved and the use of agency staff had decreased.

We reviewed infection prevention control procedures which were in place. We found the home to clean, hygienic and odour free. Staff were provided with personal protective equipment (PPE) such as aprons, disposable gloves and hand gel and they were aware of the importance of complying with infection prevention control measures.

The registered provider had a number of different health and safety checks in place. Such audits and checks help to maintain the safety of the environment people are living in. Although most of health and safety monitoring systems were completed we identified a number of weekly and monthly checks that were incomplete.

We checked to see if the registered provider was complying with the principles of the Mental Capacity Act, 2005 (MCA). We found that people were appropriately assessed, the appropriate deprivation of liberty safeguards (DoLS) had been submitted to the local authority. Where necessary ‘best interest’ decisions were made with the appropriate peoples and/or representatives.

Staff told us that they were fully supported in their roles. Staff received a good standard of training and were supported to enhance their learning and development. Routine supervisions and annual appraisals had been scheduled for each staff member.

People received support with their nutrition and hydration support needs. Any identified risk was monitored, referrals were made to the necessary healthcare professionals and records indicated the guidance which needed to be followed accordingly.

The registered provider supported people with the appropriate equipment required to maintain their independence. However, we discussed how further developments could be made to help support people who were living with dementia.

We received positive feedback about the quality and standard of food provided. People and relatives expressed that there was enough choice, people’s likes and preferences were taken in to account and the kitchen staff were familiar with the different dietary needs that needed to be accommodated.

We observed positive interaction between staff and the people they supported. Staff were attentive and provided a warm, kind and caring approach when helping people with day-to-day activities. Staff were observed supporting people in a calm, relaxed and friendly manner.

People’s private and sensitive information was protected in line with General Data Protection Regulation (GDPR). Confidential information was securely stored and not unnecessarily shared with others.

There was an open visiting policy for friends and family. Relatives expressed that they felt welcomed in to the home, they found staff to be friendly and kind and believed the staff went 'above and beyond' to provide care and support to people and their loved ones.

A person-centred approach to care was evident in the care files we reviewed. The information recorded in the care records enabled staff to familiarise themselves with likes, dislikes and preferences of the people they supported.

There was an activities co-ordinator in post at the time of the inspection and we received positive feedback about the variety of activities that were arranged. Activities included, bingo, dominoes, quizzes, entertainment and external trips out.

A complaints procedure was in place and people and relatives we spoke with were aware of this procedure. We discussed with the manager how this area of quality and responsivity could be further developed.

The registered provider had a number of different policies and procedures available for staff to access. Staff were aware of the policies including privacy and dignity and code of conduct.

The registered provider was aware of their responsibility to inform the CQC of any notifiable incidents in the home. We were provided with the statutory notifications which had been submitted as well as safeguarding referral which had been submitted to the local authority.