The inspection took place on 16 July 2018 and was unannounced. This meant the service did not know we would be visiting. We carried out a further announced visit to the service on 18 July 2018 to complete the inspection.The Cedars Rest Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a 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 a large adapted Victorian property located in the Bowdon area of Trafford, Greater Manchester. Accommodation is provided over several different levels, accessed by either a passenger lift or stairs. Rooms are mainly single en-suite with some shared rooms being available.
The service is registered with CQC to accommodate up to 34 people and at the time of this inspection, 30 people were accommodated, the majority of whom were living dementia or memory problems.
We last inspected The Cedars in April 2016. At that time, we rated the service ‘Good’ overall. This inspection was prompted in part by notification of an incident following which a person using the service sustained a serious injury and subsequently died. This incident is subject to an ongoing investigation and as a result this inspection did not examine the specific circumstances of the incident. However, initial enquiries carried out by CQC regarding the incident indicated potential concerns about the risks associated with communal outside spaces, risk of falls and the management of accidents and incidents. This inspection examined those risks.
At this inspection we identified three breaches of regulations related to risk assessment, buildings and premises, and governance. We have also made a recommendation concerning equality, diversity and human rights.
This overall rating is now ‘Requires Improvement.' You can see what action we have asked the provider to take at the back of the full report.
The service had a registered manager. 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.
We found the service had failed to pay due regard to guidance published by the Health and Safety Executive in 2014 concerning the management of health and safety in care homes. Environmental risk assessments did not appropriately assess and mitigate risks associated with people who used the service accessing the communal outside space whilst unsupervised.
The majority of people who used the service lived with dementia or memory problems but we found the environment within service was not dementia friendly. This contributed to people being disoriented and unable to navigate their way around the home independently.
The service continued to operative effective systems and procedures which sought to protect people from abuse. Staff could describe the signs and behaviours they would look out for that would alert them to the possible consequence of abuse.
Medicines were ordered, stored, administered and disposed of safely.
Feedback from people who used the service and their visiting relatives remained positive about the quality of food and drink on offer. Food was freshly prepared and a variety of choices were offered.
Before a person moved into The Cedars, a pre-admission assessment was completed which sought to ensure the service could meet the needs of potential new users of the service, and to ensure that any potential new admission did not negatively impact on the needs of existing people who used the service.
The routine day-to-day physical health needs of people who used the service continued to be met. People had regular access to community based health services such as a GP, district nurses, an optician and a dentist.
People were cared for by staff who were skilled, competent and well trained to carry out their roles.
Without exception, people and their relatives told us they considered staff at The Cedars to be caring. During the inspection we observed staff interacting with people in a compassionate, caring and respectful way.
People were encouraged to maintain relationships with people that mattered to them and there were no prescriptive visiting times.
The service continued to provide personalised care, designed around each person’s needs and wishes. Care files were comprehensive and of a good quality and contained information about people’s backgrounds, likes, dislikes, personal preferences, medical and social needs.
Care plans had been written with the involvement of people and/or their relatives and provided staff with good explanations about how each person wanted to be supported.
We reviewed the homes approach to end of life care and found the service continued to be engaged in the ‘Six Steps’ End of Life Care Programme. This is the North West End of Life Programme for Care Homes and is co-ordinated by local NHS services.
Meetings were conducted regularly with people who used the service, their relatives and staff. Records showed the service reviewed feedback from people and their relatives and where required, appropriate action was taken to respond to concerns and improve the quality of care provided.
Newly introduced systems for audit, quality assurance and questioning of practice were not operated consistently to ensure compliance with regulations.