In our previous inspection, there was a breach of Regulation 18, Staffing. The provider submitted an action plan outlining how improvements would be made to the service. At this inspection we found improvements had been made and this breach had been rectified.

The inspection took place on 18 and 21 May 2018. The first day of the inspection was unannounced.

Cedar Court Residential and Nursing Home provides personal and nursing care and accommodation for up to 48 people. On the day of the inspection the registered manager informed us that 46 people were living at the home.

At our last inspection we rated the service as Requires Improvement. At this inspection we found the service had improved but was still rated as Requires Improvement.

People's risk assessments provided staff with information on how to support people safely, though some assessments were not fully in place. Staff had been trained in safeguarding (protecting people from abuse) and understood their responsibilities in this area, although they were not aware of all the relevant outside agencies they could report any concerns to.

People told us they liked the staff and got on well with them. We saw many examples of staff working with people in a friendly and caring way, though the registered manager agreed that some staff were not always friendly and caring. Confidentiality of people’s information had not always been protected.

Care plans were individual to the people using the service and covered their health and social care needs. However, care staff had not read all of care plans to equip them to meet all the needs of people. Care did not always meet people's needs and . Activities were organised to provide stimulation for people and they had opportunities to take part in activities in the community if they chose.

A registered manager was in post. This is a condition of the registration of the service. 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 and associated Regulations about how the service is run.

Lessons to prevent incidents occurring had been learnt from past events. Staffing levels were sufficient to ensure people's safety.

Staff were subject to checks to ensure they were appropriate to work with the people who used the service. People were protected from the risks of infection.

People using the service and relatives we spoke with said they thought the home was safe. They thought their medicines were supplied to them safely and on time, and this had been the case when we checked.

Staff had been trained to ensure they had the skills and knowledge to meet people's needs. Staff understood their main responsibility under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) to allow, as much as possible, people to have an effective choice about how they lived their lives.

People had plenty to eat and drink and everyone told us they liked the food served.

People's health care needs had been protected by referral to health care professionals when necessary.

People and their representatives were involved in making decisions about their care, treatment and support.

People and their relatives told us they would tell staff if they had any concerns and were confident these would be followed up.

We inspected Cedar Court Residential and Nursing Home on 28 March 2017. The visit was unannounced. This meant that the staff and the provider did not know that we would be visiting.

Cedar Court Residential and Nursing Home is located in Wigston, Leicester. The service provides accommodation for up to 48 people who require nursing or personal care. There were 44 people using the service at the time of our inspection.

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.

The people using the service, relatives and members of staff told us that there were not always sufficient numbers of staff deployed to meet the needs of the people using the service. This was observed during our visit.

The records kept in relation to peoples medicines did not always correspond with the medicines held at the service. People received their medicines in a safe way.

People told us they felt safe living at Cedar Court Residential and Nursing Home. The staff team were aware of their responsibilities for keeping people safe from avoidable harm and knew to report any concerns to the management team.

Risks associated with people's care and support had been assessed to enable the staff team to provide the safest possible support. Where risks had been identified these had, wherever possible, been minimised to better protect people's health and welfare.

Appropriate checks had been carried out before new members of staff commenced work. This was to make sure that they were suitable and safe to work at the service.

People received support from a staff team that had the necessary skills and knowledge. New members of staff had received a comprehensive induction into the service when they were first employed and training relevant to their role had been provided.

People's food and drink requirements had been assessed and a balanced diet was being provided. Records kept for people assessed as being at risk of not getting the food and drinks they needed to keep them well were not always accurate.

People were supported to maintain good health. They had access to relevant healthcare services such as doctors and community nurses and they received on-going healthcare support.

People's privacy and dignity was respected and promoted by the staff team.

People had been involved in making day to day decisions about their care and support. Where people lacked the capacity to make their own decisions, evidence was seen to demonstrate that decisions had been made for them in their best interest and in consultation with others.

People had plans of care that reflected their care and support needs. These provided the staff team with the information they needed in order to properly support the people using the service.

Relatives and friends were encouraged to visit and they told us that they were made welcome at all times by the staff team.

People were supported to follow their interests and take part in social activities. An activities coordinator was employed and they supported the people using the service with both one to one and group activities.

There was a complaints procedure in place and the people using the service and their relatives and friends knew what to do if they had a concern of any kind.

Staff meetings and meetings for the people using the service and their relatives had been held. These meetings provided people with the opportunity to be involved in how the service was run.

The service was in breach of one regulation of the Health and Social Care Act 2008 (Regulated Activities Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

This inspection took place on the 2 April 2015 and was unannounced.

Cedar Court Care Home is a purpose built 48 bedded care home offering residential, nursing, respite, and end of life care. It is situated in Wigston, a residential area of Leicester.

Accommodation is on two floors with a passenger lift for access. The home has a range of communal areas including lounges, dining rooms, and a secluded garden.

At the time of this inspection there were 43 people using the service.

The home has a registered manager. This 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.

People were not always protected from the risk of unsafe care or treatment. This was because improvements were needed to the way risk assessments were written and implemented.

People using the service and relatives we spoke with said they thought the home was safe and had a ‘culture of openness’ which contributed to people feeling safe. Staff were trained in safeguarding (protecting people from abuse) and understood their responsibilities in this area.

Some people using the service, relatives, and staff told us that on occasions they thought there weren’t enough staff on duty to meet people’s needs promptly.

People using the service and relatives told us they thought medicines were given safely and on time. Some improvements were needed to the way medicines records were kept.

People told us they were happy with the competence and skills of the staff who were knowledgeable about the people they cared for, and had a good understanding of how best to meet their needs. Records showed staff had a thorough induction and on-going training.

Staff understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and the home’s training records showed they had attended courses on this.

People said they liked the food. We observed the lunchtime meal being served. The dining room was nicely decorated with fresh flowers on the tables. The menus were in large print and advised that alternatives were available for main courses and puddings. Staff asked people what they wanted and individual requests were met.

All the people we spoke with told us they liked the staff and got on well with them, and we saw many examples of staff working with people in a kind and sensitive way. People said they were actively involved in making decisions about their care, treatment and support. People also said staff protected their privacy and dignity and we observed this in practice.

People told us they received personalised care that met their needs. Records showed their preferences, for example getting up and going to bed times and whether they preferred a bath or a shower, were met. Care plans were individual to the people using the service and focused on their strengths and preferences.

People said they were happy with the activities provided. Records showed that the amount of activities had increased in the last few months and people had the opportunity to take part in individual or group activities depending on what they preferred. We observed activities being provided and the atmosphere was lively and people appeared occupied and contented.

People told us they would have no hesitation in speaking out if they had any concerns. Records showed that if a complaint was received, however minor, staff responded appropriately.

People and staff said they were happy with how the home was run and said the registered manager was approachable and committed to improving the service. People had the opportunity to share their views about the service at meetings and on an individual basis and changes were made as a result of their input.

The registered manager and staff carried out audits and checks to ensure the home was running smoothly. Records showed they took prompt action if any improvements were needed to the service.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities)

Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

During our inspection we answered five key questions: is the service safe, effective, caring, responsive, and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at, and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People said they felt safe at Cedar Court and would speak out if they had any concerns. One person told us, “The staff look after us very well and are always kind, but if that ever changed I would tell the manager.” Relatives also said they would report any concerns to staff. One relative commented, “If I was upset about something here I’d tell the carers, but I know I could tell the management too if I needed to.”

Staff had been trained in safeguarding (protecting vulnerable people from abuse) and knew what to do if they were concerned about the well-being of any of the people who used the service. They also knew how to escalate a concern if they felt it had not been properly addressed.

Staff had been safely recruited with background checks done to help ensure they were fit to work with the people who used the service.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

At our last pharmacy inspection the home was given a warning notice for safe management of medicines. Our pharmacist found this had been met and people were being given their medicines when they needed them, and in a safe way.

Is the service effective?

Since we last inspected care plans had been re-written to make them more person-centred, setting out people’s likes, dislikes and preferences. For example, one person’s specified they liked jelly babies, mint imperials, and chocolate and stated ‘ensure X has a good supply of their favourite sweets’. We met this person in their room and found this was the case.

At our last two inspections of Cedar Court people raised concerns about the quality of mouth care in the home and we told the provider to address this. At this inspection some improvements had been made. New care plans and risk assessments were in place for people who needed mouth care, for example those who were ‘nil by mouth’ and/or receiving palliative care.

We talked to the people who used the service and their relatives about mouth care. Some said it had improved and they were now satisfied. Other felt there was still room for improvement. One person said, “It’s still a bit hit and miss.” One care plan and risk assessment had not been updated to show the level of assistance one person needed with their mouth care. We reported this to the management team who agreed to update the care plan.

Is the service caring?

People told us they were pleased with the current staff team. One person who used the service said, “The care staff are very bubbly, I like that and it makes for a good atmosphere.” A relative commented, “The staff treat all the residents with respect and look after them brilliantly.”

People said the staff coped well when the home was busy. One person said, “I’ve no complaints about the staff. Sometimes there’s a lot to do and the home is a bit hectic but the staff deal with it well and are all very helpful.”

All the staff we met were positive, caring and friendly. We saw evidence of team working across all the staff groups. For example one of the cleaning staff comforted a person who used the service when they spilt a drink, and went to get a care worker to assist them in changing.

The home had recruited some new permanent staff and were keeping the use of agency staff to a minimum. This meant the people who used the service and their relatives had the opportunity to get to know individual staff members, build up relationships with them, and experience continuity of care.

Is the service responsive?

People told us they were happy with the care provided. One person said, “Everything’s good, I like it here.” Another person commented, “The girls bring my tea to my room, they’re fantastic.” Relatives also said they were satisfied with the care. One relative told us, “Through all the changes the care has always been good.” Another said, “The staff here know how to care for the residents properly.”

We saw staff were kind when they cared for people and did not rush them. One care worker brought a person into the lounge and spent time helping them decide where they wanted to sit. They brought them a jug of juice and a cup and made sure they were comfortable before they left. Another care worker reassured a person who was distressed and held their hand until them were calm.

At our previous inspection we found examples of care plans and risk assessments that were not fit for purpose. For example, some care plans and risk assessments did not give staff clear instructions on how to support people.

At this inspection care plans and risk assessments had been improved. The management team said staff had been reviewing and updating them and most were complete.

Is the service well-led?

Since we last inspected the leadership of the home had changed. A management team was in place and a new acting manager in post. She had applied to CQC to become the new registered manager. The management team and acting manager were working together to bring about improvements to the home.

People told us they were happy with the new management arrangements. One relative said, “The new (acting) manager is a people-person. She was at the relatives meeting and she’s on our wavelength. She’s making it easier for staff to do their jobs. Morale had been low but staff seem much happier now.”

People were consulted about their care. The acting manager was holding monthly 'residents and relatives' meetings to explain what was being done to improve the home. This gave the people who used the service and their relatives the opportunity to comment on progress, make suggestions, and give feedback. The relatives we spoke with said they found these meetings useful and appreciated being involved in decisions about the home.

The home had a system to assure the quality of the service they provided. The way the service was run had been regularly reviewed. Records showed prompt action had been taken to improve the service or put right any shortfalls they had found.

People said they liked living at Cedar Court and the care was good. One person told us, “I’m really happy here and my children think it’s lovely – like a hotel.” Another person commented, “The carers are nice. They treat you well and are very respectful.”

People told us they were satisfied with the food provided. One person said, “I can’t knock the cooking. If you don’t like what’s on the menu the staff will put themselves out for you and go and get you something else.” Another person commented, “They do some lovely meals. They do a nice salad with everything in it.”

People said they liked the staff at Cedar Court. One person told us, “The staff are pretty good. They are always busy but they do find time for a quick chat.” Another person commented, “I get on well with all the staff. They are very helpful, as is the manager. If something’s wrong you can tell her. She’s solved a few problems for me.”

People told us they were happy with how the home looked. One person said, "It’s a very smart looking place and always lovely and clean.” Another commented, “There’s been lots of improvements and redecorating since I came here. It looks fantastic now.”

Some care plans for mental health were unsatisfactory and not all care plans/risk assessments had been regularly reviewed. Improvements were also needed to the way medication was managed and administered in the home. The manager has agreed to address these issues.

People were encouraged to make choices about their care, activities, and meals. One person said, “When they put me to bed they make me so comfy. They ask me if my pillows are right and whether I want the lamp left on or not.” Another person told us, “The staff come and see me at about 10am and ask me what I want for lunch.”

People told us they liked the staff team and got on well with them. One person said, “The carers are wonderful – they do everything with a smile.” Another person told us, “They’re not short of staff here. I’m always well-looked after. The staff are excellent.” We observed staff spending time with people, chatting to them and taking an interest in what they were doing.

People said they thought the home had improved in the last few months. One person told us, “They’ve redecorated and it looks lovely.” A relative commented, “The new manager seems really good and the home has definitely improved since she’s been here. The new décor is fantastic – I love visiting now.”

The people who used the service and relatives told us the new manager was approachable easy to talk to. A relative said, “Nothing’s too much trouble for the new manager – I’m very impressed with her.”

People told us the care was good but said they sometimes had to wait for assistance due to staffing levels. One person said, “The staff are lovely and they do meet my needs but I have to wait my turn and sometimes it’s a long wait.” People said they had choice about their daily routine. One person told us, “If you don’t want to get up you don’t have to – it’s up to you.”

Group activities were provided in one of the lounges but some people who tended to stay in their rooms did not know what activities were on or how they could take part. One person told us, “There are no activities here as far as I’m aware.” Another person said, “I can’t do group activities, I’m not well enough to get to the lounge.”

People said they felt safe in the home and trusted the staff. One person told us, “I’d speak to any of the staff if I had a complaint or there was anything else wrong. There’s plenty who are easy to talk to.” Another person commented, “I’ve never felt anything but safe here.”

People told us they thought the staff were well-trained and knew how to provide appropriate care. One person told us, “The carers seem to know what they’re doing and if they don’t know they ask me or one of the nurses.” Another person commented, “The nurses seem very knowledgeable and if I have any problems I always ask them for advice.”

This was a follow-up inspection to look at areas of non-compliance identified at our previous inspection on 22 August 2013.

When we visited all areas of the home were clean and tidy. Staff were motivated and got on well with the people who used the service. A range of activities were on offer from the home's activities co-ordinator.

At our last inspection people’s mental health and other needs were not being fully recognised or met at Cedar Court. Since then some improvements had been made to how these needs were assessed and met via staff training, new more person centred care plans/risk assessments, and regular reviews. However some care plans/risk assessments were still not fit for purpose.

At our last inspection medicines were not being managed safely and the provider agreed to take action to improve the situation. At this inspection we conducted a sample audit of 12 people’s medicines. We found three people did not have some of their prescribed medicines available. We noted gaps in some medicine administration records and also medicine errors which had not been identified by the service. This meant that we could not be assured people were being given their medicines as intended by prescribers.