Cedrus House

Cedrus House provides accommodation, nursing and personal care for up to 70 older people. There were 69 people living in the home on the day of our inspection.

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

People told us they felt safe and happy living at Cedrus House. People were positive about the care and support they received and told us they were treated with dignity and respect by staff knowledgeable about them and their support needs.

People praised the caring nature of the staff. There was a warm and friendly atmosphere at the care home. It was clear that people were relaxed and comfortable; and they had positive relationships with staff members.

Staff were aware of safeguarding arrangements and knew what action to take to keep people safe. We received some mixed feedback about staffing levels however we also received positive comments that staff were visible, and people received their care in a timely manner. The registered manager was closely monitoring staffing levels to ensure they remained sufficient.

There were enough staff to meet people's needs. Staff were recruited safely, and appropriate checks were carried out. Medicines were managed safely.

People’s risks were managed safely. Risk assessments in place were person centred, thorough and gave clear information for staff on how to support people to reduce these risks. The home was clean and there were good infection control practices in place.

People’s needs were assessed, and information was used to create detailed care plans which supported staff to provide person-centred care. A range of group and individual activities were provided for people to participate in. A relative told us, “They do a lot of activities and more so now with the new manager. [Family member] loves it when the exercise person comes and lots of other [people] seem to enjoy that. They go out on quite a few outings which is lovely. They share lots of pictures and it is nice that relatives can see what their family member has been doing.”

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's views were sought and used to drive improvement within the home. The registered manager understood the importance of their role and had made all notifications to CQC as required by law.

The registered manager and provider had good oversight of the service. Quality checks and audits were effective in identifying and generating improvements to ensure the safety and quality of the care people received. People and relatives said the service was well managed and they would recommend the service to others.

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 25 January 2018.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cedrus House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Cedrus House provides accommodation, nursing and personal care for up to 70 people. At the time of our inspection there were 63 people living in the service. There are six individual units within the building. Each floor is divided into two suites, with each suite having its own dining room and living area.

There was a registered manager in post. 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.

Our previous inspection of 4 July 2016 found that the service was rated as Good overall, but we found that improvements were needed in Well-Led, we found that staff had not consistently followed clinical guidance and the key question was rated as Requires Improvement. During this inspection we found that sufficient improvements had been made in this area and we rated Well-Led key question as Good. All the other key questions apart from Safe have been rated as Good, unfortunately Safe has been rated as Required Improvement. Overall, Cedrus House has been rated as Good.

There had been several significant thefts from people using the service since our last in inspection in July 2016. The provider had taken advice from the police, who had investigated the thefts, and had taken steps to protect people from this abuse and were working towards identifying the thief. There had been no further thefts since our inspection, but we could not be confident that the action taken would be effective enough to stop the thefts from happening. People told us that, although the experience was upsetting and worrying, they believed the registered manager was taking appropriate action to stop their money and property going missing.

During this inspection, people who lived in the service told us that they felt safe and well cared for. They believed that the staff knew what support they needed and that they were trained to meet those needs and to keep them safe. There were enough staff on duty, including senior staff, catering and housekeeping, to protect people from harm. Risks to people were assessed and steps had been put in place to safeguard people from harm without restricting their independence unnecessarily. People’s medicines were managed safely.

People were asked for their consent by staff before supporting them in their day to day care. Staff were provided with training in safeguarding adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager knew how to make a referral if required. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported to eat and drink enough to maintain a balanced diet. They were also supported to maintain good health and access healthcare services.

We saw many examples of positive and caring interactions between the staff and people who lived in the service. People were able to express their views and staff listened to what they said and took action to ensure their decisions were acted on. Staff protected people’s privacy and dignity.

People received care that was personalised and responsive to their needs. The service listened to people’s experiences, concerns and complaints. They took steps to investigate complaints and to make any changes needed.

The service was well led by the registered manager who felt they were well supported by their line manager, the regional director and the organisation. People using the service and the staff they managed told us that the registered manager was open, supportive and had good management skills. There were systems in place to monitor the quality of service the organisation offered people. Statutory notifications received showed us that the registered manager understood their registration requirements.

Further information is in the detailed findings below

Cedrus house provides accommodation, nursing and personal care for up to 70 people. At the time of our inspection there were 58 people living in the service. There are six individual units within the building. Each floor is divided into two suites, with each suite having its own dining room and living area.

There was a registered manager in post. 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.

Our previous inspection of 13 and 22 October 2015 found that improvements were needed in how the service completed assessments to accurately reflect individual needs and risks. There was also concern that clinical governance systems were not effective. The provider wrote to us and told us how they were addressing these shortfalls. During this inspection we found that some improvements had been made.

There were processes to monitor the quality and safety of the service provided and to understand the experiences of people who lived at the service. This was through regular communication with people, surveys, spot checks on staff during the night, and a programme of other checks and audits. However, some audits could be used more effectively to implement further learning and change. Whilst the management team had made continued progress in addressing more effective systems and procedures, some were not yet fully embedded in practice, and we found that clinical guidance was not consistently followed.

Staffing numbers were assessed against and reflected people’s dependency needs, and we saw that staff responded to people in a timely manner. Staff took their time with people when delivering their care, and people were not rushed. However, we received some comments which indicated that the management team should review its current provision to ensure people’s needs are met at all times.

Care plans and risk assessments contained clear and detailed information which supported staff to meet people's needs. There was opportunity to improve care plans further by developing a more person-centred approach which focusses on a person’s whole life, including their emotional and social care needs.

Staff received the necessary training and support to enable them to do their jobs. The service had introduced monitoring tools which checked staff knowledge and understanding once training was completed.

Procedures were in place which safeguarded the people who used the service from the potential risk of abuse. Staff understood the various types of abuse and knew who to report any concerns to.

Staff understood the principles of the Mental Capacity Act (MCA), and gained people's consent before they provided care. People told us they were encouraged to make choices about their daily lives. There were procedures in place to ensure that people who could not make decisions were protected, and we found assessments had been completed.

Staff respected people’s privacy and dignity at all times and interacted with people in a caring, respectful and professional manner.

Safe recruitment procedures were in place, and staff had undergone recruitment checks before they started work to ensure they were suitable for the role.

Systems were in place to ensure people's medicines were managed in a safe way, and people received their medicines in a timely manner. People were supported to maintain good health and have access to relevant healthcare services.

We saw people received a good choice of food and drink, and people's individual food requirements were well catered for.

A complaints procedure was in place. People’s concerns and complaints were listened to and addressed in a timely manner.