Archived: Cedar Falls Care Home

Cedar Falls Care Home is a residential care home providing personal care to 38 people aged 65 and over at the time of the inspection. The service can support up to 39 people.

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

Service management and leadership had been inconsistent and areas for improvements were identified in the quality monitoring and accurate record keeping. We found concerns relating to documentation which had not been identified by internal checks and audits. Medicines identified 'as required' or PRN medicines were not being consistently recorded when given.

Accurate information had not been included in people’s risks assessments and their known risks were not accurately recorded, meaning potential for people to receive care which had not met their needs.

Staff knew how to recognise potential abuse and who they should report any concerns to. People had access to equipment that reduced the risk of harm. There were sufficient staff on duty to meet people’s needs.

People had a choice of food and were supported to maintain a healthy diet in line with their needs and preferences. Staff were trained to meet people’s needs and acted promptly to refer people to healthcare professionals when required.

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 enjoyed positive and caring relationships with the staff team and were treated with kindness and respect. People’s independence was promoted as staff were careful not to do things for people they could do for themselves.

People were supported by staff who knew about their needs and routines and ensured these were met and respected. Staff and relatives knew how to complain and were confident that their concerns would be listened to. The provider worked well with partners to ensured people’s needs were met.

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 16 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement Action

Since the last inspection we recognised that the provider had failed to have a registered manager. This was a breach of regulation.

We have identified a breach in relation to Regulation 17, Good Governance as the provider had not ensured good governance had been maintained to ensure systems were assessed monitored and used to improve the quality and safety of the services provided at this inspection.

Full information about CQC’s regulatory response to this is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of governance and safety. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

There was a registered manager in post at the time of the inspection. 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.

At our last inspection carried out 18 March 2016 we asked the provider to make improvements to identifying and managing risks to people, medicine management, understanding and application of The Mental Capacity Act 2005 (MCA), the design and decoration of the service, quality assurance systems did not drive improvements and Closed Circuit Television cameras (CCTV) were in operation without the correct legal procedures having been followed. During this inspection, we found the provider has taken appropriate action to make the required improvements.

People were safe. Staff understood how to identify abuse and take appropriate action and could support people to manage risks to their safety. There was sufficient staff to keep people safe and the registered manager had systems in place to ensure staff were recruited safely. Medicines were stored, administered and managed safely. Staff supported people to have their prescribed medicines when they needed them.

People were supported by staff that had the required skills and knowledge. Staff could describe how they used the training to develop their practice. People had a choice of meals. Staff understood how to support people to manage nutritional and hydration risks. People were supported to maintain their health and wellbeing. Staff were able to access a range of health professionals as required to support people with their care.

People had good relationships with staff. Staff understood people’s needs and took time to get to know them. People could make decisions and choices about their care and support and were supported by staff to decide about all aspects of their care. Staff made sure people’s privacy was protected. They treated people with respect and maintained their dignity.

Staff understood people’s needs and preferences. They could describe in detail peoples wishes, likes and dislikes. Staff ensured people were involved in planning their care and support and involved other people where appropriate. People had access to activities and were supported to pursue their individual interests. People knew how to raise a concern or complaint and the provider had a system in place to ensure all complaints were appropriately investigated and responded to. Complaints were used as an opportunity to learn and improve the service.

People told us they had good relationships with the management team. People and staff were involved in developing the service. Staff were supported by the registered manager. Staff told us they received support to help them understand their role and provide effective support to people. The registered manager had systems in place to monitor the quality of service people received. The systems were used to drive improvements.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic. Equipment at the home had been well maintained and serviced regularly. There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies. A person who lived there said to us "The staff are very obliging, nothing is too much trouble." A family member said "I go to bed at night and sleep well because I know they are looking after my relative."

Staff records demonstrated that mandatory training was up to date and that staff were trained sufficiently to meet the needs of people who lived there. Staff had received specialised one-to-one training in the care of people with dementia.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

Relatives told us that they were happy with the care that was delivered and that people's needs were met. It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and that they knew them well. People were cared for by staff who were supported to deliver care safely and to an appropriate standard. Staff had received training to meet the needs of the people living at the home and told us that they were satisfied with the standard of the training.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. Staff took into account the complex needs of people when planning activities so that they could take part safely. A person who lived there told us that living there was very positive with "excellent staff." Staff said that they were very happy with the level of professional and emotional support they received from the management team.

Is the service responsive?

People's needs had been assessed before they moved into the home. Records confirmed people's preferences and interests and lifestyle passports/social histories were used to help staff understand each person's personality and emotional state. People had access to activities that were important to them and were supported to maintain relationships with their friends and relatives.

Is the service well led?

Staff had a good understanding of the ethos of the home and robust quality assurance processes were in place. A relative told us that the manager had an open-door policy and that they had never had an issue but that they would feel confident in approaching the manager if there was a problem. Food was prepared freshly on site by catering staff who were trained to be able to meet the complex nutritional needs of people. Staff told us that they were clear about their roles and responsibilities and that management support was of a high standard and helped them to do their job effectively.

The people living at the home and visitors we spoke with were generally complimentary of the staff and the care provided at the home. One person said: 'I am very, very happy here'. We saw that staff were available to support people with their care needs. Medication was dispensed to people as prescribed by a clinician.

Generally the staff we spoke with said they felt supported. An induction was available for new staff to ensure they had the necessary knowledge prior to starting work. We saw that there was a training matrix in place which recorded the training undertaken by staff, this included safeguard training (protecting vulnerable adults). We saw that there were some gaps in the training that staff had received.

There were systems in place for the registered manager and the provider to monitor the quality of the service provided at Cedar Falls.