We inspected Cedar Court Nursing Home on 8 January 2019. The service is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Cedar Court Nursing Home provides nursing care and accommodation across two floors for up to 30 older people and younger adults with physical disabilities. On the day of our visit 26 people were using the service.

At the last inspection in June 2016, the service was rated ‘Good’ in all the key questions. At this inspection, we found the fundamental care standards were not being fully met, resulting in the rating for the service changing to ‘Requires Improvement.’

At the time of our inspection there was a registered manager in post and they were present during the day of the inspection. A registered manager is a person who has been registered with the Care Quality Commission (CQC) to manage the service. Like registered providers they are “registered persons”. Registered persons have the legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated regulations about how the service is run.

The registered manager and provider had not always recognised when accidents and incidents needed to be referred to the local authority safeguarding team. This meant they had not been independently reviewed to determine if any actions were required to protect the person and if improvements in practice were needed.

The staffing levels in place did not ensure people’s safety was consistently monitored or their needs met in a timely or appropriate way. This impacted on the activities available to people, as the activities coordinator spent a large proportion of their time supporting people with their meals and drinks. This reduced the time they had available to support people in recreational and social activities. The staffing levels also impacted on the support people required to eat their meals and resulted in people having to wait for support, or be supported at the same time as another person; which did not respect their dignity.

Improvements were needed to the management of medicine. The stock balance of medicines, for people accessing the service for respite did not match the balance recorded on their medicine record. This meant we could not check that people had received their medicines as prescribed. Risks to people’s health and safety were in general assessed but some improvements were identified.

The provider had acted to address staff conduct when needed, but had not made referrals to all relevant external organisations. This meant that not all organisations in place to protect the public had not been notified; to enable them to assess the information, make a judgement and take action if needed. The provider has now taken action to address this.

Quality monitoring systems were in place to support the registered manager in driving improvement. However, they had not, at the time of the inspection identified all of the improvements we found were needed.

The environment met people’s mobility needs but there was a lack of signage around the home to support people to find their way around and enhance their orientation. People and their representatives were involved in decisions relating to the planning of their care, but in practice people’s preferences regarding their personal care routine was not always sought.

Staff were clear about what constituted abuse or poor practice and were clear on their responsibilities to report any concerns. Recruitment checks were done before staff started working at the home, to check they were suitable to support people. Checks were in place for the prevention and control of infection and in general these were effective.

Staff had the equipment needed to assist people safely and understood about people’s individual risks. The provider checked t

This inspection visit took place on the 20 and 21 June 2016 and was unannounced.

Cedar Court Nursing Home provides nursing and personal care for up to 30 older people and younger adults with physical disabilities. There were 28 people who used the service at the time of our visit.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our previous visit on the 13 November 2013 the service was meeting the regulations that we checked.

People told us and we saw there were sufficient staff available to support them. Staff had knowledge about people’s care and support needs to enable support to be provided in a safe way. Staff told us that they were supported by the management team and were provided with the relevant training to ensure people’s needs could be met.

Staff understood what constituted abuse or poor practice and systems and processes were in place to protect people from the risk of harm. Systems were in place and followed so that medicines were managed safely and people were given their medicine as and when needed. Thorough recruitment checks were done prior to employment to ensure the staff were suitable to support people.

Assessments were in place that identified risks to people’s health and safety and care plans directed staff on how to minimise identified risks. Plans were in place to respond to emergencies to ensure people were supported in accordance with their needs. Care staff told us they had all the equipment they needed to assist people safely and understood about people’s individual risks. The provider checked that the equipment was regularly serviced to ensure it was safe to use.

Staff gained people’s verbal consent before supporting them with any care tasks and helped people to make their own decisions. People received food and drink that met their nutritional needs and preferences, and were referred to healthcare professionals to maintain their health and wellbeing.

People were supported to socialise and take part in activities to promote their wellbeing. People told us that they liked the staff and we saw that people’s dignity and privacy was respected by the staff team. Visitors told us the staff made them feel welcome and were approachable and friendly.

Staff listened to people’s views and people knew how to make a complaint or raise concerns. There were processes in place for people and their relatives to express their views and opinions about the service provided. People felt the service was well managed and they were asked to express their views and be involved in decisions related to the planning of their care. There were systems in place to monitor the quality of the service to enable the manager and provider to drive improvement.

We visited Cedar Court Nursing Home to follow up one area of non compliance from our previous visit. We did not speak with people who used the service during this visit, although we spoke with the agency registered nurse was on duty and reviewed the systems in place relating to the recording and administration of medication.

We saw that medication was being administered safely. The registered nurse locked the medication trolley each time they gave out medication to people. They took one person’s medication at a time, assisted that person to take their medication and then returned to sign the medication administration record.

We saw that clear instructions were written on the medication administration records advising the registered nurses that aspirin must be dissolved prior to administration. The registered nurse told us that they followed these instructions when administering medication.

People told us they were well looked after. One person told us care staff respond to their needs in “an efficient manner.” People told us staff spoke to them respectfully when they were delivering care. One person told us they felt their privacy and dignity was respected. They said they were encouraged to make choices about their care, for example, choosing what clothes to wear. One person told us they did not feel well looked after or that staff listened to them.

People’s needs had been assessed before they moved into the service. Information about how people needed to and wished to be cared for was recorded. People and their relatives had been involved in developing their care plans. People’s support, treatment and care were recorded in their care plan, assessments and risk assessments. Care plans provided guidance for staff on how to deliver care.

Medication was not being kept safely or administered to people in a safe way. Medication was potted up to give to people later in the day. The medication trolley was also left open and unattended whilst the registered nurse was giving out medication.

The number of care staff on duty has increased in recent months. Staff told us they enabled them to spend more time assisting people with their care.

A complaints procedure was available and on display. Two people spoken with told us they knew they could raise concerns. Care workers were also able to discuss the complaints procedure.

We asked people what it was like living at Cedar Court Nursing Home. One person spoken with said “It’s not bad living here.” Two other people told us the routine was relaxed, and they had a choice about what time they got up and went to bed. They told us they enjoyed being outside and made good use of the enclosed garden and the greenhouse, where they were growing vegetables.

One person told us they liked living at Cedar Court Nursing Home because it made them feel safe knowing staff were around all the time to provide support. They told us care workers provided support and assistance when required but encouraged them to remain as independent as possible.

People told us about the activity co-ordinator who organised a range of activities and events. They told us she organised games, chair exercises, arts and crafts and growing plants in the greenhouse. People told us they could join in with activities if they wished. One person who chose to stay in their room told us the activity person did not visit them. However, we saw written evidence to support the activity co-ordinator did spend time with people in their rooms as well as with people in the communal areas.

We asked people about the meals provided. Three of the six people spoken with told us the “meals could be better.” They told us they were offered a choice of meals, but sometimes the food wasn’t cooked very well. One person said “the meals are not really well produced and it depends on who is cooking the meal.” This person described vegetables with meals as being cooked so badly it was like eating “squidgy water.”

We asked people if they knew about their care records. People told us they knew they had a care plan, and they had been asked to read and sign to say they agreed with the plan. One person told us they had requested to change their GP and had been assisted to do so by the registered manager. People told us they were happy with the care and support staff gave them and were able to describe the support provided.

One person told us the majority of care workers were very pleasant, although some were not always considerate, especially when the hoist was being used. This person told us they sometimes found the position of the straps of the hoist sling painful. They told us when they have asked care workers to reposition the straps, some care workers do not respond to this request and usually say “It’ll only be a minute.”

We asked people what they would do if they were unhappy. People told us they would tell a member of staff and they were confident the issues would be dealt with.

We spoke to three people who had been at the home between a few days and 13 months.

All three expressed satisfaction with the service received. They told us the staff were friendly and the care given was very good. They said the enjoyed the activities offered by the activity coordinator and were happy with the quality and choice of food offered. One person said the best compliment they could give is that they felt this was now their home and they didn’t want to leave.

Two people’ visitors were spoken with. Both confirmed they were happy with the service offered. Both people’s visitors confirmed they had been involved in the care planning for their relative and told us that the home kept them informed of any developments in their relative’s treatment and health. Both people’s visitors confirmed they had confidence in the home to look after their relative and felt they provided a good level of care.