This announced inspection took place on 9 May 2018. At our last inspection in April 2016 we had no concerns about the quality of care and had rated this service as good. At this inspection we found the service was not consistently safe, effective or well led and we rated it as requires improvement.

Cedar Gardens is a care home which supports people who have a learning disability. We inspected this service on 9 May 2018. This inspection was announced, as we gave the provider a call the previous day to ensure someone would be available within the 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 Gardens accommodates six people in one adapted building. There were five people who were living at the home on the day of our visit.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. We found the provider followed these values to ensure people lived as ordinary life as possible.

People received safe care and were supported by staff who knew how to protect them from harm however there were some incidents that had not been fully responded to. The management team were not aware of all incidents, to ensure people were always receiving the safest care. Staff were aware of people’s individual risks and plans were in place to minimise these while maintaining the person’s independence. Staffing was arranged based on people’s individual needs and what activities were happening in the home. Staffing remained flexible to suit the people living at the home. People received their medicines when required, however the management of people’s medicines was not always safe. People lived in a clean environment, staff had the right knowledge and equipment to protect people from potential risk of infection.

Staff were not always supported to receive training that reflected people’s changing needs. There were no competency checks in place to identify any potential further learning or development for staff. People’s mental capacity had been considered when making decisions about their care. However, where people were making decisions about their future the provider had not supported people to have an advocate to support them with decision making. People were supported by staff who knew their individual dietary requirements and how to support them in the right way. People had access to healthcare professionals when they required them. The environment had been adapted to support the people who lived there.

People were treated well which had a positive impact on their well-being. People were supported by staff who were kind and caring towards them. Staff helped people to make choices about their care and the views and decisions they had made about their care were listened and acted upon.

People and where appropriate their family members were involved in the planning and review of their care and support. People were supported to continue with their hobbies and interests which reflected people’s individual interests. Information was provided to people should they wish to raise a complaint. People who lived at the home were not receiving any end of life care. The staff we spoke with acknowledged this was an area to discuss with people and advised that when it was the right time for each person this would be discussed in a sensitive and individual way.

The registered manager left the service two months prior to our inspection. The service was being supported by the provider’s other registered manager alongside a team leader. The provider who was also the owner of the home visited often to s

This inspection took place on 7 April 2016 and was unannounced.

Cedar Gardens is registered to provide accommodation and personal care for a maximum of six people with learning disabilities or autistic spectrum disorder. There were five people living at the home on the day of our visit. At the time of our inspection, there was a registered manager in post. 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 told us they felt safe and supported by the care staff. Care staff knew and understood how to reduced people’s risk of harm or abuse. All staff told us they would protect people from harm and were confident in recognising the potential signs of abuse.

Care staff were available when people needed them had care staff that were available and there were sufficient numbers of staff to provide care to all people living at the home. Where people had risks identified as part of their daily living, care staff provided support to reduce those risks. People told us they received their medicines as prescribed and at the correct time.

Care staff told us their training reflected the needs of people who lived at the home. Where people had not been able to consent to certain aspects or decisions about their care, records of decisions had been completed.

People had access to drinks and food throughout the day and night. Where people required support to prepare their meals care staff helped them. People had accessed other healthcare professionals to support them.

People told us they liked the care staff and had developed positive and respectful relationships. People told us the care staff were very kind and caring in their approach. People’s privacy and dignity were respected. People felt supported and empowered to be independent in all aspects of their lives.

People were involved in the planning of their care and told us they were regularly involved in updating these. People’s care plans recorded their care needs in an individual way that reflected their preferences and life histories.

People were happy to raise any concerns or worries directly with the care staff. People felt the staff were able to provide solutions or answers at that time. The registered manager was keen to answer people’s concerns and we saw this happing when people raised concerns with them.

People were seen to approach and make requests through the day with all staff, including the registered manager. The registered manager told us it that being approachable and visible within the home helped them maintain a homely environment which people liked.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service caring?

• Is the service responsive?

• Is the service effective?

• Is the service well led?

Below is a summary of what we found. The summary is based on the people we spoke with who used the service, the staff who supported them and from looking at records.

At the time of our inspection five people lived at the home. Two people were in the home when we arrived in the morning which we were able to speak with them. We spoke with two relatives and an advocate. We spoke with one member of staff, the registered manager and the provider.

Is the service safe?

People told us they felt safe with the staff that cared for them. There were procedures in place to keep people safe. Staff understood how to safeguard the people they supported.

People were protected against the risks associated with medicines because the provider had made improvements following out last inspection in November 2013. There were now appropriate arrangements in place to manage medicines.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberties Safeguards which applies to care homes. The provider had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. This meant that people would be safeguarded as required.

Is the service effective?

Relatives told us that they were able to see people who lived in the home in private and that visiting times were flexible. They also told us the home were accommodating and welcoming to visitors.

It was clear from speaking with staff that they had a good understanding of the people’s care and support needs and that they knew them well. Staff spoke about people as individuals and we observed that staff listened to people’s views and opinions.

The registered manager was updating the care records to ensure they reflected their care needs in detail. The registered manager told us that they were dedicating time to enable them to complete this.

Is the service caring?

We spoke with two people who used the service, two relatives and an advocate. We asked them for their opinions about the staff that supported them. What people told us was positive, one person said, “Yes, they (staff) are good”. A relative told us, “They (staff) look after X very well”.

People were supported by staff who demonstrated a clear understanding of their needs. People were treated with respect and dignity by the staff on duty. When we spoke with staff it was clear that they genuinely cared for the people they supported.

We looked at people’s preferences and interests and found that care and support had been provided in accordance with people’s wishes. We saw that the care people received reflected what we read in their care records.

Is the service responsive?

The registered manager was responsive to people’s needs. We saw examples where people were supported to attend hospital appointments when they were required.

People completed a range of activities within the service. People told us they were supported by staff with activities that they enjoyed.

Is the service well-led?

Staff were clear about their roles and responsibilities. They told us the registered manager listened to them.

The registered manager told us that they had sent out questionnaires to the people who lived in the home and their relatives. Where comments had been made these had been acted upon. This meant that the provider had taken appropriate steps to gather people’s views of the running the home and had acted upon them.

The provider had quality assurance systems in place. We saw records that identified shortfalls and the actions that had been taken to address them.

When we visited Cedar Gardens we found that five people used the service and we met and spoke with two of these people. We spoke with one members of staff who provided care, the acting care manager and the registered manager. We read the care records for two people who used the service. We observed care practice and staff interactions with people when they were delivering care.

We found that staff had an understanding of the needs of the people who used the service. We found that care and support was planned and delivered in a safe way, in line with people's individual care needs. One person told us, "The staff help me."

We found that systems were in place to deal with complaints. We found that the home worked well with other services to ensure the health and wellbeing of the people who used the service.

We found that the provider did not have systems in place to gain the consent to care and treatment of people who used the service.

We found that people were not protected from the risks of inadequate nutrition and dehydration.

We found that medicines were not kept safely or administered as prescribed.

We spoke with four out of the five people who lived at the home. All of the people we spoke with told us that they liked living there. One person said, "It’s very nice, they’re very nice people here. The staff are nice and the food is nice." Another person said, “I like it here – I’m quite happy.”

The people that we spoke with told us that they felt listened to and that they had residents’ meetings.

People told us that they were encouraged and supported to do things for themselves. One person said, "I do washing up and laundry.” Another person said, "I hoover, mop and polish," while a third person said, "I do my own bedroom and make my bed. I do my own clothes.”

We found that people who lived at the home felt safe and that staff had received training in safeguarding, knew how to raise concerns and felt they would be supported by the provider if they did raise concerns. Staff had also been trained in areas relevant to the specific needs of the people they were providing care to. We looked at care plans for three people living in the home and found that these contained detailed guidance for staff on how to meet their needs.

We also looked at records which showed that the provider was regularly monitoring the quality of its service.

We did not speak directly to the people who use the service about the outcomes in this report.

We followed up concerns in relation to people's choices within the home and how the home supports them. We found that continued and further improvements were needed.

We looked at staffing levels in the home, we were concerned that there was not enough staff to meet people's needs. We found that the home must make improvements to the staffing arrangements in the home. They need to do this to ensure that people's needs are met.

We spoke with the staff and the manager about the systems the home has in place to monitor the quality of the service. We saw that a system has now been created but further improvements are needed.

People told us they were happy living in the home. They said they are given opportunity to go out and had recently been on holiday.

There were six people using services at Cedar Gardens when we visited. We met and introduced ourselves to all the people using services over the two days we visited. We spoke to four people using services in more depth to get their views of the service. People told us, “I was alright coming to live here.” and “I like it here because it’s’ nice and big.”

People told us about their care plans and how staff supported them. One person told us, “I like being here, I feel safe.” People we spoke with told us they were happy living at Cedar Gardens and liked the staff.

We asked people what they did during the day and they told us about shopping trips and going on holiday. One person told us “I love going on holiday with Cedar Gardens.” Another person said,” I love the dinners here.” One person however told us, “We don’t do much at weekends.”

People told us about seeing their GP and dentist and having other regular health care checks.

Relatives we spoke with had no concerns about the care of their family member. One relative told us, “They go out of their way to make things good for him.” Relatives told us that staff had worked hard to make things better for their family members. One relative told us, “I cannot think of a single fault with the home.”