Cedar House

Updated 31 December 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The team consisted of two inspectors

Service and service type

Cedar House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Cedar House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 5 relatives about their experience of the care provided. We spoke with 5 members of staff including the area manager, registered manager, senior care worker and 2 care workers.

We reviewed a range of records. This included 3 people’s care records and multiple medication records. A variety of records relating to the management of the service, including policies and procedures were reviewed.

Updated 31 December 2022

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

Cedar House is a respite care home providing personal care to six people at the time of the inspection. The service can support up to seven people.

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

Right Support:

The service did not support people to have the maximum possible choice, control and independence. Staff did not support people in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Staffing levels led to staff focusing on completing tasks and failing to promote people’s strengths. There was a lack of meaningful activities to support people’s interests. Restrictions placed upon people were not monitored so it was not possible to review and plan care to reduce restrictions.

The environment was not safe, well-furnished or well-maintained so did not always meet people’s needs. Care plans did not support people’s ability to be involved in planning their own care. Medicines were not managed safely. Staff supported people to play an active role in maintaining their own health and wellbeing.

Right Care:

Staff understood how to protect people from poor care and abuse. However, the care provided at times placed people at risk of harm. Staff had training on how to recognise and report abuse and they knew how to apply it to protect people. There were not enough staff to meet people’s needs and staff were task focused. People’s care plans had not recently been reviewed with them or their relatives and were not in an accessible format.

Right Culture:

Staff turnover was high, so people did not receive personalised care from a staff group who knew them well. Agency staff did not know people or their needs well. Staff did not fully reflect best practice in the way they cared for people and did not always follow the registered manager’s instructions to keep the service safe.

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

Rating at last inspection

This service was registered with us on 24 August 2020 and this is the first inspection.

The last rating for the service under the previous provider was Good, published on 7 March 2020.

Why we inspected

The inspection was prompted in part due to concerns received about the overall quality of the care provided. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the safety of the care provided, the numbers of staff available to support people, not ensuring people’s rights to make decisions and to keep them in the building were managed in line with legal requirements and the overall monitoring of the home at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.