CQC report explained · a residential care home
What the CQC found at Cedar House
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found appropriate staffing, safeguarding training, suitable recruitment checks and safe medicine arrangements. Some preventative information in one person's risk plan was recorded in different places and was due to be reviewed.
- Effective?
- Good
- People's needs were assessed before they moved in, and staff received induction, training and supervision. The home provided varied food and worked with health professionals. Inspectors recommended improvements to the environment for people living with dementia.
- Caring?
- Good
- People said they were happy with their care. Staff knew people well, respected privacy and dignity, and supported independence and relationships with family and friends.
- Responsive?
- Good
- Care plans reflected people's needs, preferences and routines. Activities were available and complaints were dealt with appropriately, although there was not a formal activity programme.
- Well-led?
- Good
- Inspectors found effective checks to monitor and improve care quality and safety. Staff and relatives said communication and support from the management team were good.
What inspectors found, May 2021
Cedar House is rated Good; inspectors found safe, kind care and improvements since the previous inspection, with some dementia-friendly signs still needed.
This was an unannounced follow-up inspection on 8 and 12 April 2021. One inspector spoke with people, staff, relatives and visiting professionals. They observed care and checked care plans, medicine records, staff files and management records.
All five areas were rated Good: Safe, Effective, Caring, Responsive and Well-led. Inspectors found suitable staffing, safe medicine systems, trained staff, personalised care and effective management checks. People told inspectors they felt safe and were treated with dignity and respect.
The previous rating was Requires Improvement, with three breaches of regulation. Inspectors found that the home had made enough improvements and was no longer in breach. They recommended further work to make the environment more supportive for people living with dementia.
Safe medicines
Medicine storage, ordering and administration had improved since the previous inspection. Staff training, competency checks and regular audits were in place.
“At this inspection processes were now in place to keep medicines stored securely and ensure they were ordered, available when needed and administered in line with prescribed guidelines.” from the report
Kind and respectful care
People described staff positively. Inspectors saw staff offer support and protect people's privacy and dignity.
“People were treated with dignity and respect and their independence was promoted.” from the report
Personalised support
Care plans included people's needs, preferences, routines and communication needs. Staff knew people well and involved relatives in care planning.
“Care plans had information about people's specific needs, personal preferences, routines and how staff should support them.” from the report
Improved management
The home had introduced stronger checks, incident reviews and learning sessions. It was no longer in breach of the regulations identified at the previous inspection.
“There were effective systems in place to monitor, assess and improve the quality and safety of service people received.” from the report
Food and nutrition
People spoke positively about the food. Care plans recorded dietary needs as well as likes and dislikes.
“People were positive about the quality of the food.” from the report
Dementia-friendly signs
minorThere were not enough signs or orientation clues in some corridors and bedroom areas. Inspectors made a recommendation for the home to seek best-practice advice.
“We recommend that the service finds out more about current best practice, in developing a more supportive environment in relation to the specialist needs of people living with dementia.” from the report
Risk information in different places
minorSome preventative information was not recorded together in one person's electronic care plan. The manager agreed to review this immediately.
“Whilst risk assessments were in place, we found that some preventative information was recorded in different places on the electronic care plan.” from the report
No formal activity programme
minorActivities were available and people were encouraged to join in, but there was no formal programme. The activity organiser asked people each day what they wanted to do.
“Whilst a formal activity programme was not in place the activity organiser told us they asked people daily what they would like to do and had different themes for each day.” from the report
- 01What changes have you made to signs and orientation clues for people living with dementia since this inspection?
- 02How do you make sure all preventative risk information is recorded together and kept up to date?
- 03How are activities planned for each person, given that there was not a formal activity programme?
- 04How do you check that medicines continue to be stored, ordered and given exactly as prescribed?
- 05How will you involve relatives in care-plan reviews and updates?
This was an unannounced follow-up inspection covering all five key questions, and it also checked infection prevention and control arrangements. This explanation was written from the published report of 5 May 2021 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, September 2019
Rated Requires Improvement; inspectors found risks with medicines, care planning, activities, staff training and quality checks.
This was an unannounced inspection on 31 July and 1 August 2019. Inspectors spoke with nine people, seven relatives and five staff. They also observed care and checked care, medicine, recruitment and management records.
There were enough staff, the home was clean, and people generally felt safe. Meals and access to healthcare were positive. However, medicines were not always stored safely, some prescribed medicines were not always received, and fire safety checks were not up to date.
Inspectors found that care was not consistently kind, respectful or personalised. Care records were sometimes inaccurate, people did not always get meaningful activities or choices, and staff training and inductions were not robust.
The overall rating and all five question ratings were Requires Improvement. This means the home was not consistently meeting people's needs and there was limited assurance about safety and management. The previous overall rating was Good, published on 11 February 2017.
Enough staff
People and relatives said there were enough staff. Inspectors saw staff respond promptly and call alarms were answered in good time.
“The deployment of staff was appropriate and there were enough staff to meet people's needs.” from the report
Food and drink
People spoke positively about the meals. They could usually choose where to eat and have alternatives, and staff supported people to eat without rushing them.
“Where people required staff assistance to eat, this was done sensitively, and staff engaged with people well.” from the report
Clean home
The home was clean and hygienic. Staff had infection control training and access to protective equipment.
“Staff followed the service's procedures to maintain a reasonable standard of cleanliness and hygiene within the service.” from the report
End of life care
Inspectors found no evidence that people receiving end of life care had received poor care. The home worked with healthcare professionals to support comfort and dignity.
“The service worked with healthcare professionals, including the local palliative care team, to provide good end of life care.” from the report
Medicines and risk management
seriousSome medicines were not securely stored. Audits found medication inconsistencies, and action plans were not completed. Risk records did not explain clearly enough how risks would be reduced.
“Effective arrangements were not in place to mitigate risks for people using the service.” from the report
Fire safety checks
seriousNight staff had not taken part in a fire drill since 2017. Fire alarm and emergency lighting checks were also overdue when inspectors visited.
“The provider's schedule of fire alarm tests recorded this should be completed at weekly intervals.” from the report
Staff training and induction
needs fixingTraining was provided by people who were not accredited trainers with subject expertise. Some staff had delayed or incomplete Care Certificates, and supervision was not always regular.
“We recommend the registered provider seek independent advice and guidance to ensure robust systems are in place for induction, training and supervising staff.” from the report
Personal care and dignity
seriousCare was variable. One person went more than five and a half hours without support to check continence needs or change continence products, and staff did not provide planned social interaction.
“On the second day of inspection the person was observed to not receive any support to have their continence needs checked or continence products changed for a continuous period of over five and a half hours.” from the report
Activities and care plans
needs fixingPeople were not routinely supported to follow their interests or take part in social activities. Some care plans were contradictory or inaccurate.
“Suitable arrangements were not in place to ensure people using the service had the opportunity to participate in social activities that met their needs.” from the report
Quality monitoring
seriousManagement checks did not identify the shortfalls found by inspectors. Audits did not always record the problems found or the corrective action taken.
“Effective robust arrangements were not in place to monitor the service and identify and address shortfalls.” from the report
- 01How are medicines such as thickening powder and topical creams now stored securely?
- 02How do you check that people receive all their prescribed medicines, and what happens when an audit finds a discrepancy?
- 03How are staff training, Care Certificates, inductions and supervision kept up to date?
- 04What regular activities are now available, and how are they matched to each person's interests and preferences?
- 05How are care plans checked so that they accurately describe each person's needs, risks and support?
This was an unannounced comprehensive inspection covering the home, the care provided and all five CQC questions; all five ratings had deteriorated from Good at the previous inspection. This explanation was written from the published report of 18 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.
Every inspection of Cedar House
4 rated inspections over 6 years: the service has held its Good rating throughout.
- May 2021Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- September 2019Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- February 2017Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- March 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- November 2013
Report published without a new overall rating.
- October 2012
Registered with the Care Quality Commission on 8 October 2012.
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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