This focused inspection took place on 12 September 2017 and was unannounced. This meant the staff and provider did not know we would be visiting.

Cedar Court provides personal care and accommodation for up to 69 people, some of whom have a dementia type illness and/or nursing needs. On the day of our inspection there were 46 people using the service.

The home had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. However, the registered manager was no longer employed by the service. A new manager was in post who was managing the service and had commenced their application to be registered with CQC.

We carried out a comprehensive inspection of this service in October 2016 and rated the service as ‘Good’ overall. We carried out this focused inspection to look into concerns raised with the Commission that a number of safeguarding incidents had occurred within the service and had not been reported to us via statutory notifications. A notification is information about important events which the service is required to send to the Commission by law. This report only covers our findings in relation to these concerns. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk

At this inspection, we checked to ensure accidents and incidents had been appropriately recorded and dealt with, appropriate procedures were in place to protect vulnerable adults, staffing levels were sufficient to keep people safe, and people were protected against the risks associated with the unsafe use and management of medicines. We also checked to ensure the service was well-led. The ratings for safe and well led have remained ‘Good’ in line with the ratings allocated to these domains at our last comprehensive inspection of this service. We will check the ratings against these key questions again during our next planned comprehensive inspection of the service.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service.

The provider had taken seriously any risks to people and put in place actions to prevent accidents and incidents from occurring.

Staff were aware of how to protect vulnerable adults and clear instructions were provided on out of hours reporting.

The home was clean, spacious and suitable for the people who used the service.

Appropriate procedures were in place to ensure people received medicines as prescribed.

Records were kept securely and could be located when needed.

The service had a positive culture that was person centred and inclusive. Family members told us the manager and staff were approachable.

Staff felt supported by the manager and they were kept up to date via staff meetings and supervisions.

The provider was meeting the conditions of their registration and submitted statutory notifications in a timely manner.

This inspection took place on 28, 29 September and 7 October 2016 and was unannounced. This meant the registered provider was did not know we were inspecting the home at that time.

At our last inspection of Cedar Court published on 17 December 2015 we reported that the registered provider was in breach of the following:

Regulation 9 Person centred care

Regulation 14 Nutrition and Hydration

Regulation 15 Premises and equipment

Regulation 17 Good governance

Regulation 18 Staffing

We asked the registered provider to take immediate actions and at this inspection we found significant improvements had been made to meet these regulations.

Cedar Court provides accommodation with personal and nursing care for up to 69 older people. The building is on two levels and is split into four living areas; the Dalton, Byron, Seaton and Tempest units. The home caters for people who have lifelong conditions, those who are recovering from an injury or illness and those who have a dementia type illness. Cedar Court is set in its own gardens in a residential area near to public transport routes, shops and local facilities.

There was a new registered manager in place who had been appointed since the last inspection. 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.

People who used the service, and family members, were complimentary about the standard of care provided. They told us the staff were friendly and helpful. We saw staff treated people with dignity, compassion and respect and people were encouraged to remain as independent as possible and for some, regain skills to enable them to return to their own homes.

All the care records we looked at showed people’s needs were assessed before they moved into the home and we saw care plans were written in a person centred way.

There were sufficient numbers of staff on duty in order to meet the present needs of people using the service. The registered provider had an effective recruitment and selection procedure in place and carried out robust checks when they employed staff to make sure they were suitable to work with vulnerable people.

We saw the home had in place personal emergency evacuation plans displayed close to the main entrance and accessible to emergency rescue services if needed.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments and emergencies.

There were robust procedures in place to make sure people were protected from abuse and staff had received training about the actions they must take if they saw or suspected that abuse was taking place.

People’s nutritional needs were assessed and plans of care drawn up if they were at risk of malnutrition or choking. The cook demonstrated that she had an extensive knowledge of people’s likes and dislikes and prepared a wide selection of wholesome and popular meals to cater for people’s tastes.

We found the home had cleaning schedules in place to prevent the spread of infection.

We saw a notice board on which was displayed information about the activities for that week. During our inspection we found lots of various interesting activities taking place both inside and away from the home.

We saw the registered provider had a complaints policy in place and this was clearly displayed for people to see.

CQC monitors the operation of the Deprivation of Liberty Safeguards [DoLS] which applies to care homes. The Deprivation of Liberty Safeguards are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked af

At a previous inspection we found concerns with the home’s arrangements for managing medicines. We carried out this inspection to check whether action had been taken to address these concerns. We found that improvements had been made to make sure that people living in the home were given their medicines safely.

We spoke with one person living in the home about their medicines. They said “The nurses are very kind and make sure I get all my medicines. I have no concerns”.

We saw all staff knocked on doors before entering, ensuring people’s privacy was respected. People we spoke with said they were happy with the staff. Comments included, “It couldn’t be better” and “I like the staff, they are kind to me.”

All of the people we spoke with were happy with the care provided. Comments included “My (relative) has been in here 5 years now and I feel the staff are very caring towards them, which is a great comfort”, “I like it here, I am well looked after” and “I would rather be at home but I can’t manage on my own. This is a nice home with good staff.”

People all said they felt it was a safe home and they had confidence in the staff. We spoke with some relatives, who also said they felt their family member was safe when in the care of Cedar Court staff. One person said “I have no worries whatsoever as I have observed the staff for a few years now and they are very kind to residents.”

We looked at how medicines were managed in the home. We found some records for the ‘loose’ stocks were not correct. We looked at a sample of three loose packets or bottles of medication. We found there were more medicines left than there should have been, according to the records.

The provider had a clear policy on obtaining feedback from people using its services. This included information from sources such as residents and relatives meetings, complaints and survey questionnaires.

People told us they were happy and their privacy was respected.

People said they received enough to eat and drink. They said, "the food is always tasty and "it is nice and hot".

People told us their home was clean, comfortable and warm. They said, "staff work very hard to keep the place clean" and "it always seems clean and smells pleasant".

They said their visitors were made to feel welcome and information sharing between relatives and the provider was good.

We spoke with people on the residential care unit located on the ground floor. One person said, “This is a lovely place, the staff are very kind and caring. I have my own telephone in my room so that I can keep in touch with my family and some old friends of mine. I have no concerns or complaints at all.”

Another person said, “I received lots of information about this place before I came to live here, I then visited and decided this was the place for me. I am now very settled and I have nothing to worry about.”

One person said, “I am very satisfied with the care that I receive. I enjoy the meals, and I have made quite a few friends here. I am very content.”

One relative said, “This is a very nice place, we are always made to feel very welcome when we visit. The care my relative receives is very good.”

Another relative told us, “We have no complaints at all, the care my mother receives is very good.”

We spoke with people about the staffing arrangements. One person told us, “All the staff are very good, I get on with some of them more than others, but overall they are good.”

We spoke with visitors to the Seaton unit. One relative told us that they were very concerned about staffing levels on the unit. They said, “My relative is highly dependent and needs two staff at all times for their personal care needs. There have been times when I’ve visited and there were no staff around the main lounge area for up to 30 minutes. They were helping other people, but I get very concerned when that happens because my relative is not only very dependent, but also has very challenging behaviours, as do some others who are left without supervision. I am very worried that my relative will attempt to walk on her own and fall, or be attacked by another resident.”

Another relative said, “The staff do a wonderful job, there is just not enough of them.”

This inspection took place on 22 and 23 April 2015 and was unannounced. This meant the service did not know we would be arriving to carry out the inspection.

Cedar Court provides accommodation for 68 people and is located in Seaham, County Durham. The home is divided into four units. There are two units downstairs; Byron unit accommodates up to 12 people with dementia care needs and Dalton provides 22 residential care needs. Upstairs Tempest unit has accommodation for 12 people with nursing care needs, and Seaton unit can accommodate up to 22 people with nursing and dementia care needs. The Seaton unit number also included five beds used for intermediate care and treatment. This means people leaving hospital can have a further period of care before they return to their own homes or are assessed as needing further care provision.

We last carried out a full inspection of the service in June 2013 where we found the provider was not compliant with our regulations in relation to the administration of people’s medicine. We undertook a follow up inspection in December 2013 and found the provider had made improvements and people were safely receiving their medicines.

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. We found the service had a registered manager in post.

During our inspection we found the registered manager had a refurbishment plan in place to improve people’s environment.

We saw the provider had checks in place for gas and electric supplies to the home.

We found there were some hazards in the home where people were put at risk of trips and falls and risks associated with fire safety.

Staff told us they had received training in areas appropriate to their role. During our inspection staff were being trained in moving and handling in the building.

We found the service did not always meet people’s nutrition and hydration needs.

People and their relatives told us they had mixed experiences of being involved in their care planning.

We saw people who needed glasses and hearing aids were not always supported by staff to wear them.

Relatives told us they were made to feel welcome when they came into the home.

We saw the registered manager had put in place monthly audits to monitor the quality of the service. We saw where they had found deficits actions were taken.

The registered manager had put in place staff meetings and staff supervision meetings to provide staff with support, guidance and direction.

We found people’s records were not confidentially maintained.

We found a number of breaches of regulations. You can see what action we told the provider to take at the back of the full version of the report.