CQC report explained · a residential care home
What the CQC found at Cedar Grange Ltd
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found sufficient staff, safe recruitment, detailed risk assessments, clean premises and safe medicines administration. Some instructions for as-required medicines were not detailed enough.
- Effective?
- Good
- People's needs were assessed and staff were trained and supported. Inspectors found that one person needed continuous help to eat their meal, and some people needed extra help to choose food.
- Caring?
- Good
- Staff treated people with kindness, compassion, dignity and respect. Staff knew people well and supported their independence, privacy and personal preferences.
- Responsive?
- Outstanding
- The home provided a very wide range of activities, quiet spaces, community links and personalised support. End-of-life care was described as outstanding, with support for people's wishes and for relatives to stay overnight.
- Well-led?
- Good
- Managers promoted a person-centred culture and used audits, feedback and care records to identify improvements. Staff said they felt respected, valued and supported.
What inspectors found, September 2019
Rated Good overall, with Outstanding personalised activities and end-of-life support, but inspectors identified some gaps in medicines guidance and mealtime support.
This was an unannounced planned inspection on 13 August 2019. Two inspectors spoke with people, relatives and staff, observed care, and reviewed care, medicines and management records.
The home was rated Good for Safe, Effective, Caring and Well-led. Inspectors found people were protected from harm, staff were trained and caring, care was based on people's needs, and managers used checks to monitor quality.
Responsive care was rated Outstanding, improving from Good at the previous inspection. Inspectors highlighted the wide range of activities, individual support, community links and strong end-of-life care.
There were some areas to improve. Some as-required medicines instructions were not detailed enough. One person needed more support during meals, and some people needed better help to choose their food. The manager said action had been taken after the inspection on the mealtime issues.
Personalised activities
Activities were based on people's interests, past lives and individual needs. The home also offered quiet areas and one-to-one activities for people who did not enjoy large groups.
“The provider had created an outstanding activities programme and developed experiences for people to enjoy and reminisce.” from the report
End-of-life care
The home supported people to remain in familiar surroundings where possible. Relatives could stay overnight and staff worked with healthcare professionals to provide comfort and follow people's wishes.
“The provider offered people a home for life.” from the report
Kind and respectful staff
Staff knew people well and built trusting relationships. Inspectors saw staff comforting people, protecting privacy and helping people maintain their appearance and independence.
“Staff treated people with kindness and compassion.” from the report
Community and social links
People were supported to take part in trips, gardening, caring for animals and visits from children in the local community.
“The registered manager increased the home's ties to local community groups to enhance people's everyday lives.” from the report
As-required medicines guidance
needs fixingSome written instructions for medicines given when needed were not detailed enough to guide staff fully. The manager was told about this during the inspection.
“Some protocols for administering medicines as required (PRN) could have been written in more detail to offer staff guidance.” from the report
Support at mealtimes
needs fixingInspectors saw that one person needed continuous support to finish their meal, rather than the occasional support they received. They also saw that some people needed extra help, such as seeing the meal or a photograph, to make a choice. The manager later said these changes had been put in place.
“Our observations showed a person needed continuous support from staff to enable them to eat all their meal, rather than the occasional support they received.” from the report
- 01How are as-required medicines instructions checked now to make sure they give staff enough guidance?
- 02How do you make sure each person receives the level of support they need throughout meals?
- 03How do you help people who need to see the meal or a photograph before choosing what to eat?
- 04How are each person's end-of-life wishes recorded and reviewed with them and their relatives?
- 05How do you make sure activities continue to reflect each person's interests, abilities and anxieties?
This was an unannounced inspection of the care home covering all five key questions, including both the premises and the care provided; all five ratings were reviewed. This explanation was written from the published report of 20 September 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, February 2017
Rated Good; inspectors found kind, effective care, with some safety and management issues that were addressed or needed improvement.
This was an unannounced inspection on 16 and 17 January 2017. Inspectors observed care, spoke with people, relatives and staff, and checked care records, staff files, medicines records and management records.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found that people were generally safe, treated kindly, supported by trained staff and helped to maintain their health and interests.
There were some shortfalls. Fire evacuation instructions did not say exactly where people should be moved inside the building. Inspectors also found limited staff visibility at times, one medicines record with two missing signatures, some dementia-unfriendly areas and out-of-date policies. The fire instructions were updated within 24 hours, and other issues were discussed with managers.
Care planning and risk reviews
Risks were recorded and reviewed with input from people, relatives and staff. Changes in need led to updates to care plans and risk assessments.
“Risk was appropriately assessed and regularly reviewed and changes made to care plans where required.” from the report
Kind and respectful staff
Staff knew people well, offered choices and supported privacy and dignity during personal care.
“People's right to privacy and dignity were respected by staff through the provision of care and the choices that they were offered.” from the report
Personalised support
Care records included people's histories and preferences. The home offered activities, social events and support for cultural and faith needs.
“People were encouraged to take part in reviews of their care.” from the report
Health and nutrition
People had regular contact with community healthcare professionals and were offered a choice of nutritious meals, including food adapted to their needs.
“People were supported to maintain their health through regular contact with community-based healthcare professionals.” from the report
Quality monitoring
Audits covered areas such as infection control, health and safety, catering and care plans. Actions were identified and completed within suitable timescales.
“The service used robust quality audit processes to monitor performance and identify issues and errors.” from the report
Fire evacuation instructions
seriousThe instructions for moving people to safety within the building did not identify the precise safe locations. Updated instructions were provided within 24 hours.
“The instructions did not indicate exactly where it was safe to move people to within the building.” from the report
Staff visibility and dependency reviews
needs fixingOn the first day, some people were left without access to a carer for prolonged periods. Inspectors also found that dependency assessments had not been recently reviewed, so staffing needs were to be checked.
“On the first day of the inspection we saw that some people were left without access to a carer for prolonged periods.” from the report
Medicines signatures
needs fixingTwo signatures were missing on one medicines record for a laxative. The home later confirmed that the medicine had been given but not signed for.
“On one sheet we identified two missing signatures for a laxative.” from the report
Dementia-friendly environment
needs fixingSome parts of the building were less suitable for people living with dementia. One relative said some features distressed their family member, and some helpful contrasting features were not present.
“However, some areas of the building were more suited to the needs of people living with dementia than others.” from the report
Out-of-date policies
minorSome policies had not been reviewed consistently and contained old information. This was discussed with the registered manager.
“We noted that the review of these policies was not consistent and that some contained out of date information.” from the report
- 01What changes were made to the fire evacuation instructions, and when were they last tested?
- 02How do you now review people's dependency assessments and make sure enough staff are visible in shared areas?
- 03How are medicines administration records checked so that every dose is signed for?
- 04What changes have been made to the building to support people with different stages of dementia?
- 05Have all policies been reviewed and updated since this inspection?
This was an unannounced inspection of the overall service and covered all five CQC questions, including improvements since the previous inspection in November 2015. This explanation was written from the published report of 21 February 2017 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Cedar Grange Ltd
5 rated inspections over 4 years: the service has improved, from Inadequate to Good.
- September 2019Goodcurrent ratingstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: OutstandingWell-led: Good
- February 2017Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- January 2016Requires improvementstayed Requires improvementSafe: GoodEffective: Requires improvementResponsive: GoodWell-led: Requires improvement
- August 2015Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- March 2015InadequateSafe: InadequateEffective: InadequateCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- June 2014
Report published without a new overall rating.
- January 2014
Report published without a new overall rating.
- August 2013
Report published without a new overall rating.
- February 2013
Report published without a new overall rating.
- May 2012
Report published without a new overall rating.
- April 2012
Report published without a new overall rating.
- February 2012
Report published without a new overall rating.
- January 2012
Report published without a new overall rating.
- March 2011
Registered with the Care Quality Commission on 14 March 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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Most charge £980 to £1,270 a week. 34 can care for a couple. 11 years' experience on average.
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