CQC report explained · a nursing home
What the CQC found at Cedar Lodge Nursing Home
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, August 2018
Cedar Lodge Nursing Home was rated Good; inspectors found kind, safe care and improvements since the previous inspection.
Inspectors visited without warning on 7 June 2018. They spoke with people living in the home, relatives, staff and healthcare professionals. They reviewed care plans, medicines records, complaints, accidents, staff files, training and quality checks.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough trained staff, safe medicines arrangements, personalised care plans, kind care and a varied activities programme.
The previous inspection in November 2016 rated the home Requires Improvement. Problems with mental capacity decisions, quality checks and notifications to CQC had been corrected by this inspection.
An audit had found that one morning medicines round had finished later than planned. The home changed its approach, and the medicines round observed during this inspection finished by the target time.
Kind and respectful staff
People and relatives described staff as caring and kind. Inspectors observed polite conversations and staff respecting privacy and dignity.
“Throughout our visit we observed staff interacting with people in a courteous and caring manner.” from the report
Personalised care
Care plans contained detailed information about people's routines, preferences, health and support needs. Staff knew people well and used this information in daily care.
“Care plans were held electronically and were person centred and very detailed.” from the report
Safe staffing and medicines
Inspectors found enough staff with the right skills and safe recruitment checks. Medicines were stored, given and recorded safely.
“People were supported by sufficient numbers of staff with the right skills and knowledge to meet their individual needs.” from the report
Improved management systems
The home had introduced audits and action plans to monitor care and follow up problems. This addressed weaknesses found at the previous inspection.
“During this inspection we found that required improvements had been made.” from the report
Previous delay in medicines rounds
minorAn audit found that a morning medicines round had taken longer than planned. The home changed how the round was organised, and inspectors saw it completed by the target time during this visit.
“An issue identieid during one audit was that the morning medicines round which started at 08:30 was not completed until 11:15.” from the report
- 01How do you make sure morning medicines rounds are completed on time for every person?
- 02How will my relative and our family be involved in creating and reviewing their detailed care plan?
- 03Which activities are currently available, and how do you match them to each person's interests and abilities?
- 04Have all building works and refurbishment been completed, and how do you manage any remaining disruption?
- 05How do you check that mental capacity assessments and best-interest decisions remain up to date?
This was an unannounced inspection of the overall service and covered all five CQC questions; the previous inspection had rated the home Requires Improvement. This explanation was written from the published report of 3 August 2018 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, March 2017
Rated Requires Improvement; inspectors found kind care but serious gaps in consent, nutrition, records and management.
This was an unannounced inspection on 1 November 2016. Inspectors spoke with people living in the home, relatives and staff. They reviewed care records, medicines, recruitment files and management records.
People were treated with kindness, dignity and respect. Medicines were managed safely, people felt safe, and staff understood how to report abuse. However, recruitment checks were not always complete, accident records were inconsistent, and staff were not always deployed well at mealtimes.
The home did not consistently follow the law on consent and restrictions. Some people at nutritional risk did not receive the support or healthcare referrals they needed. Records and quality checks were also not reliable.
The overall rating of Requires Improvement means the home was not consistently meeting the standards expected. Caring was rated Good, but Safe, Effective, Responsive and Well-led were all rated Requires Improvement.
Kind and respectful staff
Inspectors saw staff treating people warmly and protecting their privacy and dignity. People could make choices about their daily routines.
“Staff treated people with compassion, kindness, dignity and respect.” from the report
Safe medicines
Medicines were stored, administered and disposed of safely. Records were checked and medicines were reviewed by the GP.
“People's medicines were managed safely and people understood what medicines they received.” from the report
Safeguarding awareness
Staff understood the signs of abuse and knew how to report concerns. Safeguarding procedures were in place.
“Staff had knowledge of safeguarding adults procedures and what to do if they suspected any type of abuse.” from the report
Complaints handled
People knew how to complain, and the complaints reviewed by inspectors had been investigated. Relatives were kept informed about changes to people's needs.
“Complaints and concerns were taken seriously and used as an opportunity to improve the service.” from the report
Consent and restrictions
seriousThe home did not complete decision-specific capacity assessments or properly record best-interest decisions for restrictions such as bed rails and lap belts. This was a continuing breach from the previous inspection.
“As care and treatment was not always provided with the appropriate consent this is a continued breach of regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.” from the report
Nutrition and healthcare
seriousSome people who had lost weight did not receive the recorded support, regular weighing or timely specialist referrals they needed. People also reported problems with the food and waiting times.
“People's nutritional needs were not always being met.” from the report
Incomplete records and checks
seriousCare plans, food and fluid charts and other records were not always accurate, legible or up to date. The home's audits had not identified these problems.
“Appropriate systems were not in place to assess, monitor and improve the quality of the service, and the records were not always complete, accurate and legible.” from the report
Recruitment checks
needs fixingSome staff files did not contain suitable references from previous employers, and one file had unexplained gaps in work history. This meant the provider could not always show that candidates were suitable.
“Recruitment processes were not always robust.” from the report
Mealtime staffing
needs fixingPeople who needed help to eat were sometimes left waiting because staff were busy elsewhere. Some people waited more than 45 minutes for their meal.
“People that were not on a soft diet waited at the table for over 45 minutes before they were given their meal.” from the report
Activities not available to all
needs fixingSome people did not have access to activities that mattered to them. Activities were sometimes limited by the size of the room or were offered only to selected people.
“People did not always have access to activities that were important and relevant to them.” from the report
- 01How are you now completing decision-specific capacity assessments and recording best-interest decisions for restrictions such as bed rails, lap belts and locked doors?
- 02What changes have you made to support people who lose weight, including weighing, food and fluid records and specialist healthcare referrals?
- 03How do you make sure enough staff are available to help people eat and that meals are served without long waits?
- 04How are care plans, food and fluid charts and other records checked so they remain accurate, legible and up to date?
- 05What has changed in recruitment checks and incident reporting since this inspection?
This was an unannounced inspection of the overall service, covering all five CQC questions, and it followed up a breach about capacity assessments found at the July 2015 inspection. This explanation was written from the published report of 28 March 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 Lodge Nursing Home
3 rated inspections over 3 years: the service has held its Good rating throughout.
- August 2018Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- March 2017Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- September 2015GoodSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- October 2013
Report published without a new overall rating.
- April 2013
Report published without a new overall rating.
- October 2011
Report published without a new overall rating.
- September 2011
Report published without a new overall rating.
- July 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 5 January 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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