Cedar View Care Centre

Cedar View Care Centre is a care home providing personal and nursing care to 52 people at the time of the inspection. The service can support up to 65 people. Cedar View Care Centre is a purpose-built care home arranged over three floors each of which has separate adapted facilities. The home provides support to people with nursing needs including adults with complex health needs. One of the floors specialises in providing care to people living with dementia.

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

There were safeguarding procedures in place and staff had a clear understanding of these procedures. Appropriate recruitment checks had taken place before staff started work. There were enough staff deployed throughout the home to meet people’s needs. People’s medicines were managed safely. There were systems in place for monitoring, investigating and learning from incidents and accidents. There were procedures in place to reduce the risk of infections.

People’s care and support needs were assessed when they moved into the home. Risks to people had been assessed to ensure their needs were safely met. Staff were trained and supported to meet peoples care needs. People were supported to maintain a healthy balanced diet and they had access to health care professionals when they needed them. The design of the premises was meeting people's needs. 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 consulted about their care and support needs. There was a range of activities to support people’s need for social interaction and stimulation. Staff understood the importance of working within the principles of the Equality Act and supported people in meeting their diverse needs. People had access to end of life care and support when it was required. There was a complaints procedure in place. Complaints were recorded and acted on.

The registered manager and staff worked in partnership with health and social care providers to plan and deliver an effective service. People and their relative’s views about the service were considered through surveys and residents and relative’s meetings. There were systems in place to monitor the quality and safety of the service and any learning was identified and acted on. Staff told us they enjoyed working at the home and they received good support from the management team.

Rating at last inspection and update.

The last rating for this service was requires improvement (published 9 October 2020) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

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.

For more details, please see the full report which is on the CQC 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

Cedar View Care Centre is a residential care home providing personal and nursing care to 31 people aged 65 and over at the time of the inspection. The service can support up to 65 people over three floors in one adapted building which includes one floor specialising in care for people living with dementia. At the time of our inspection the ground floor was closed for refurbishment.

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

People did not always receive care that protected them from foreseeable harm, because risks such as those from choking and diabetes were not always managed in a personalised way.

There was a clear assessment process so people’s care could be planned and delivered in line with good practice standards. However, although the provider was in the process of making care plans more personalised, there was not always enough detail for staff to provide person-centred care that took into account people’s preferences and backgrounds. This included a lack of information about people’s communication needs. We also found planned activities did not always take these into account, although there was a variety of things for people to do.

We have made a recommendation about making care plans more person-centred.

People and their relatives felt the service was safe. Staff discussed known risks regularly, including safeguarding people from abuse. There were enough staff to care for people regularly and they were recruited in a safe way. We found some errors in medicines records but judged that medicines were managed safely on the whole. The provider took appropriate measures to protect people from the risk of infection, in particular those related to the spread of Covid-19.

Relatives described staff as “amazing” and “excellent.” People appeared well-kempt and there were systems to ensure people received the personal care they needed. Staff kept people informed about changes to their care and what was happening in the home, and supported people to stay in touch with relatives while they were unable to visit for infection control reasons.

There was an open culture where people and staff were free to express their views about the service. There were systems to ensure staff were aware of their roles and responsibilities.

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 requires improvement (published 12 February 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We undertook this inspection to check on specific concerns raised with us about neglect and poor standards of personal care. A decision was made for us to inspect and examine those risks. CQC have introduced targeted inspections to follow up on previous breaches or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

As a result of receiving this information, we undertook a focused inspection to review the key question of Safe only. We undertook a targeted approach to review parts of the key questions of Effective, Responsive and Well-led.

We reviewed the information we held about the service. No areas of concern were identified in the other key question or the other parts of the key questions we reviewed under our targeted approach. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe section of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cedar View Care Centre on our website at www.cqc.org.uk.

Enforcement

We have identified a breach of the regulation in relation to safe care and treatment. 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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Cedar View Care Centre is a residential care home providing personal and nursing care to 41 people at the time of the inspection. The service can normally support up to 65 people over three floors in one purpose-built building, with one floor specialising in providing care to people living with dementia. However, at the time of our inspection the home had temporarily reduced its capacity to a maximum of 46 people due to building work.

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

People did not always feel staff had time to talk and listen to them. Staff often carried out routine care tasks without engaging people in conversation or telling them what they were doing. This may have compromised people’s dignity. However, when staff spoke to people they were kind and respectful and staff were good at understanding how to support people who were distressed. People did not always feel involved in planning their care, but there was evidence their relatives were involved. Staff gave people choices about their day to day care such as meal choices and personal care routines, and supported people to do as much for themselves as possible.

The provider carried out regular checks of the quality of the service. While some of these were effective, this was not consistent as they had not identified issues we found with care records, care interactions and staff supervision. The registered manager monitored the culture of the service to make sure staff provided care in a person-centred way. They were open and honest and understood their regulatory responsibilities. Staff worked well together and shared information efficiently. The provider invited people, their relatives and staff to give feedback about the service and used this to help them improve the service. The provider worked well with other agencies such as local authorities.

There were enough staff to care for people safely and safe recruitment checks helped ensure they were suitable for the role. Medicines were managed safely. Staff did regular checks to make sure the environment was safe and hygienic. The provider made sure they learned lessons when things went wrong. There were systems to protect people from abuse and foreseeable harm. People had risk assessments about risks that were specific to them. However, some of the risk management plans associated with these did not contain enough detail.

We have made a recommendation about personalising risk assessments.

People’s needs were assessed and their care was delivered in line with best practice. Staff received the training they needed. Although nurses did not receive regular one to one meetings to support them, the provider immediately put plans in place to do this. Other staff were well supported. People had the support they needed to access healthcare services and had enough to eat and drink, although feedback about the food was mixed. The home environment was suitably adapted for people’s needs. 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 received personalised care based on detailed care plans. Staff knew about people’s needs, preferences, likes and dislikes. Although some information in care plans was potentially confusing or out of date the provider was aware this needed improvement and was in the process of resolving the issue. The care people received at the end of their lives took into account their comfort, dignity and previously expressed wishes. People received information in a format they understood. People had opportunities to engage in meaningful activities, socialise and have support with religious needs. The provider was responsive to people’s complaints and concerns.

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 24 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Cedar View Care Centre is a four storey purpose built residential nursing home on the outskirts of Croydon that provides a nursing, support and personal care service for up to 65 older people. It was divided into three areas Maple on the ground floor, Poplar on the first floor and Willow on the second floor. Access between floors was provided by two passenger lifts. On the day of our inspection Poplar had not yet opened and there were twenty seven people using the service.

The service had a library, hairdressing salon, laundry, a coffee area, children’s play area, a cinema and sweet shop, an art gallery, secure gardens and access to the local park. Each floor had two sitting rooms one of which had an adjacent dining area and a kitchenette. The bedrooms were single en-suite and there were two larger suites also located on each floor. The catering department, laundry, staff room and some amenities for people were located in the basement area. The environment had different coloured zones and appeared light, clean and well maintained.

The registered manager was not at the service when we inspected and we were told they had recently resigned but were still on a period of notice. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. The service was being managed by the deputy manager and the operations manager. The operations manager explained that the post of service manager had been advertised and they were hoping to recruit as soon as the right candidate could be found. Both the deputy and operations manager gave us assurance that the service was being managed effectively during this time.

People and their relatives told us they felt safe at the service. Staff knew how to recognise signs of potential abuse and followed the right reporting procedures.

People were supported by staff who received appropriate training and support to do their job well. Staff felt supported by managers. There were enough qualified and skilled staff at the service.

Care records focused on people as individuals and gave clear information for staff. People who used the service and their relatives were complimentary about staff and the quality and the standard of care received. Staff supported people in a way which was kind, caring, and respectful.

The service had systems in place for the safe storage, administration and recording of medicines.

People made positive comments about the food at the service and preferences and dietary needs were being met. Staff were attentive while supporting people at mealtimes to ensure people had sufficient amounts to eat and drink and they communicated with people in a kind and sensitive way. People’s nutritional needs were monitored and appropriate actions taken where required.

Staff were aware of the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) that ensured people’s rights were protected.

People enjoyed a variety of activities and spoke positively about the activity co-ordinator.

People and staff were asked for their views on how to improve the service. Staff felt listened to and supported by their manager.

The provider had systems in place to help them understand the quality of the care and support people received. Accidents and incidents were reported and examined. The manager and staff used this information to make improvements to the service.