CQC report explained · a nursing home
What the CQC found at Cedrus House
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People were protected from abuse and avoidable harm. Inspectors found that risks were assessed, medicines were managed safely, the home was clean and infection control arrangements were effective.
- Effective?
- Good
- People's needs were assessed before admission and care was planned around their health, diet and preferences. Staff had induction, training and supervision, and worked with health professionals when needed.
- Caring?
- Good
- People and relatives described staff as kind, respectful and caring. Inspectors observed staff offering reassurance, protecting privacy and supporting people's independence.
- Responsive?
- Good
- Care was personalised and people were supported to take part in activities and maintain relationships. Complaints were investigated and responses were provided.
- Well-led?
- Good
- Inspectors found good management oversight, effective audits and a service improvement plan. People, relatives and staff were involved through meetings and feedback.
What inspectors found, October 2023
Cedrus House is rated Good; inspectors found safe, kind and personalised care, with some mixed feedback about staffing levels.
Inspectors visited without notice on 18 August 2023. They spoke with people living in the home, relatives and staff. They also observed care and checked care plans, medicines records, recruitment files, training records, audits and maintenance records.
The overall rating was Good. All five areas were rated Good: Safe, Effective, Caring, Responsive and Well-led. People said they felt safe and happy, and inspectors found kind care, good risk management, safe medicines practice and detailed care planning.
There was some mixed feedback about staffing, especially when staff were absent or unwell. Inspectors found staff were visible and responded quickly, while management was monitoring staffing closely. Some decoration was described as tired, with plans to improve it.
The Safe rating had improved from Requires Improvement at the previous inspection to Good. Effective, Caring, Responsive and Well-led remained Good. The previous overall rating was Good, published on 25 January 2018.
Kind and respectful care
People and relatives spoke very positively about how staff treated them. Inspectors observed staff being kind, thoughtful and reassuring.
“Staff supported people in a respectful and caring way.” from the report
Personalised support
Care plans included people's likes, dislikes, lifestyle and interests. Staff knew people well and adapted care to their needs and wishes.
“Care plans provided clear guidance for staff to follow which included information about people's likes, dislikes, lifestyle, and interests.” from the report
Safe medicines and risk management
Medicines records were complete and matched stock balances. Risks such as falls, eating and drinking, skin damage and health conditions were assessed with guidance for staff.
“Medication records were complete and matched stock balances.” from the report
Activities and family involvement
People had access to group and individual activities, outings and social areas. Relatives could receive more information about the activities their family member had enjoyed.
“Lifestyle co-ordinators were in place who provided a range of group and one to one support, including trips out in the local community.” from the report
Management oversight
The manager and provider used audits and feedback to monitor the home and identify improvements. People, relatives and staff were able to share their views.
“Quality checks and audits were effective in identifying and generating improvements to ensure the safety and quality of the care people received.” from the report
Tired decoration
minorInspectors found the home clean and free of hazards, but noted that some decoration looked tired. Plans were in place to improve areas.
“The registered manager had recognised that some of décor was somewhat tired, and plans were in place to enhance areas.” from the report
- 01How many staff are normally on duty for the area where my relative would live, and how do you cover sickness and other absences?
- 02What changes have been made to staffing levels since the inspection, and how do you check that people receive care promptly?
- 03Which areas of the home had tired decoration, and when are the planned improvements due to be completed?
- 04How will relatives be kept informed about the activities their family member has taken part in?
- 05What private arrangements are now available for relatives when someone is nearing the end of their life?
This was an unannounced inspection covering all five key questions, including infection prevention and control. This explanation was written from the published report of 19 October 2023 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, January 2018
Cedrus House was rated Good overall, but Safe was Requires Improvement because inspectors could not be confident people's belongings were protected from theft.
This was a comprehensive, unannounced inspection on 20 and 23 October 2017. Inspectors spoke with people living in the home, relatives and staff. They reviewed care records, recruitment files, audits and policies.
Overall, the home was rated Good. Effective, Caring, Responsive and Well-led were all rated Good. Inspectors found enough staff, safe medicines management, kind interactions, personalised care and a manager who was visible and approachable.
Safe was rated Requires Improvement. There had been several significant thefts from people since the previous inspection. The provider had reported the thefts, involved the police and safeguarding team, and introduced measures such as lockable storage. However, inspectors felt there had not been enough time without further thefts to be confident that people's property was fully protected.
The previous inspection had rated Well-led Requires Improvement because good procedures were not always embedded. This inspection found that the necessary improvements had been made, so Well-led was rated Good.
Kind and respectful care
Inspectors saw staff respond calmly and courteously. People said staff listened to them and treated them with respect.
“People's right to privacy and dignity was respected and promoted.” from the report
Enough staff
Inspectors found enough staff on duty to meet people's needs. Call bells were answered quickly during the inspection.
“During our inspection, we found that there were enough staff on duty to keep people safe and to meet their needs.” from the report
Personalised support
Care records included people's interests, preferences and life histories. This helped staff provide support in the way people wanted.
“The service ensured that people's care records were personalised to include information about them, such as their hobbies, interests, preferences and life history.” from the report
Improved leadership
The previous Well-led concerns had been addressed. The manager and provider used regular checks to identify and act on problems.
“At this inspection, we found the service had taken the necessary action to embed good practice into the service people received.” from the report
Thefts of money and belongings
seriousSeveral significant thefts had occurred since the previous inspection. Although action had been taken and no further thefts had been reported since 12 October 2017, inspectors said it was too soon to be confident that people were fully protected.
“There had been several significant thefts from people using the service since our last in inspection in July 2016.” from the report
Protection from further thefts not yet proven
seriousThe home had introduced lockable storage, an office safe and other measures, but inspectors could not yet confirm that these measures would be effective over time.
“However, this was not a sufficient time lapse to reassure us that the people's belongings were safe and that they were properly protected against having their belongings and money stolen.” from the report
Food quality had recently dipped
minorA relative reported that meals had worsened after a chef left. The manager recognised this and said quality had improved after recruiting a new chef.
“The registered manager acknowledged that a change of staff had led to the quality of the food going down.” from the report
- 01What measures are now in place to prevent money and belongings being stolen?
- 02How are reports of missing money or property investigated, and how are families kept informed?
- 03Can residents use lockable storage or the office safe, and who can access these?
- 04How do you check that staffing levels remain enough at busy times, including evenings?
- 05What changes were made to food quality after the change in kitchen staff?
This was a comprehensive inspection covering all five key questions; Safe was rated Requires Improvement and the other four questions were rated Good. This explanation was written from the published report of 23 January 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.
Every inspection of Cedrus House
5 rated inspections over 8 years: the service has held its Good rating throughout.
- October 2023Goodcurrent ratingstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- January 2018Goodstayed GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- September 2016Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- December 2015Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- October 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Good
- April 2015
Registered with the Care Quality Commission on 14 April 2015.
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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