The inspection team who carried out this inspection consisted of two inspectors. They spoke with twelve of the twenty-four people who were living at the home, seven relatives and eight staff members. During the inspection, the two inspectors worked together to answer the five key questions; is the service safe, effective, caring, responsive and well-led?Below is a summary of what we found. The summary describes what people using the service, relatives and 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 told us that the staff working at The Cedars Nursing and Residential Home were kind and treated them with respect. However, they told us that they often had to wait for help because the staff were busy. They and their relatives said that there were not enough staff working in the home to always provide people with the care and support they required, when they needed it. Improvements were needed to ensure that there were sufficient numbers of staff on duty to meet the needs of people living at the home. A compliance action has been set for this and the provider must tell us how they plan to improve.
The environment was not seen to be safe, clean and hygienic in all areas. Infection control procedures were not robust and parts of the environment were in need of refurbishment, redecoration and the deep cleaning or replacement of carpets and other flooring. Improvements were needed to ensure that the environment, bathing, toilet and laundry facilities were fit for purpose and met people's needs. Two compliance actions have been set for this and the provider must tell us how they plan to improve. We have also taken enforcement action against the provider to protect the health, safety and welfare of people using the service.
Some people's care planning records provided unclear information and guidance to staff that put people at risk of receiving inappropriate and unsafe care and support. Staff did not all follow people's care plans or the correct procedure when assisting people to move. Improvements were required to ensure that accurate and consistent records were held and people were safely cared for. A compliance action has been set for this and the provider must tell us how they plan to improve.
The service was meeting the requirements of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguarding (DoLS). There was a process in place in relation to DoLS and policies and procedures were held by the provider. Staff had been trained and knew when a DoLS application was needed and the manager knew how to submit a DoLS application to ensure that people who could not make decisions for themselves were protected.
Is the service effective?
People's health and care needs were assessed by staff but had not been reviewed with them or their family member. Specialist dietary needs had been identified in care plans but people's choices were not always respected. People were not all provided or assisted with drinks and were not fully protected from the risks associated with dehydration. Relatives told us their family member did not always receive the care and attention they required because they had to sometimes wait over one hour for a staff member to be free to assist them.
Our observations showed that people were left alone in the communal lounge and conservatory for nearly one and a half hours. One person told us, 'The staff take a long time to answer the call-bell but once they get to you they will do anything to help you.' Improvements were needed to ensure that people received the care and attention they required. A compliance action has been set for this and the provider must tell us how they plan to improve.
The service is not suitably designed to meets people's needs. People did not have access to bathing facilities and the one shower facility provided was not suitable for everyone to use. There was only one communal toilet working on the ground floor and people told us they were unable to use the toilet when they wished to.
Is the service caring?
People were supported by staff who used a kind and attentive approach. We saw that the staff were patient and encouraged people to be as independent as possible. People told us that the staff were sometimes busy but did not rush them. However, people did not have their dignity and welfare fully protected because staff were not able to take them to the toilet when they chose.
Is the service responsive?
People said that when they rang the call-bell they had to wait for the staff to be available. The care and support provided was adjusted to meet the needs of each person but care and risk assessments did not always contain clear instructions to staff. A record was held of people's preferences, interests and diverse needs. However, people's choice to get up at a certain time in the morning was not always respected. Relatives told us that staff members consulted their family member and encouraged them to make their own decisions. People did not have access to a range of planned daily activities. Improvements were needed to ensure that people had their needs and choices appropriately responded to and respected. A compliance action has been set for this and the provider must tell us how they plan to improve.
Is the service well led?
Staff spoken with understood the whistleblowing policy but did not all have a clear understanding of the ethos of the home. Robust quality assurance processes were not in place that showed us that the shortfalls identified had been addressed. Relatives told us that they were not asked for their feedback on the service their family member received. Visitors said that they had not felt listened to when they had made a suggestion or raised their concerns. Staff said that they were well supported by the manager. People told us that the manager was approachable but the home appeared to be disorganised, at times. Improvements were needed to ensure that the feedback and concerns people raised were listened to and action taken. A compliance action has been set for this and the provider must tell us how they plan to improve.