This inspection took place on 30 May 2018 and was unannounced.

Cedar Grange is a residential care home for up to 18 older people. There were 18 people staying in the home when we inspected.

At the last comprehensive inspection on 8 January 2016 we rated the service as ‘Good’ and there were no regulatory breaches. At this inspection we found the overall rating for the service remained ‘Good’ and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Staff understood safeguarding procedures and how to report any concerns. Medicines were managed safely and people received their medicines when they needed them.

Staff recruitment procedures ensured staff were suitable to work in the care service. Staff received the training and support they required to carry out their roles and meet people’s needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Although some people and relatives felt there were not enough staff, we found staffing levels were sufficient. However, we asked the registered manager to review the early morning routines to ensure people were not being rushed or having to get up early. Following the inspection the registered manager confirmed the action they had taken to review the routines and staffing levels.

Risks were assessed and well managed, although the recording and monitoring of people’s behaviour that challenged others needed to improve. Following the inspection the registered manager confirmed they had addressed this with staff and put a more robust monitoring system in place.

People received person-centred care which was reflected in their care plans. People’s nutritional needs were met. People had access to healthcare services and systems were in place to manage complaints.

Activities were provided however the provider had identified the range and variety could be improved. A staff member had recently been appointed to lead activities and was working with people to meet individual interests and needs.

People and relatives spoke positively about the care they received and praised the staff who they described as kind and caring. People were treated with respect and their privacy and dignity was maintained.

The service was well managed. The management team led by example and promoted person-centred care. Effective quality audit systems were in place.

We carried out an unannounced comprehensive inspection of this service on 8 January 2016. At that time the service was given a quality rating of 'good' overall. After that inspection we received concerns in relation to safeguarding and compliance with the Mental Capacity Act and Deprivation of Liberty Safeguard legislation. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those. 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

Cedar Grange is a registered care home providing accommodation for 18 older people. The home is a large detached property located in the Holmfield area of Halifax and can be easily reached by public transport from the town centre. There are three lounges and a dining room on the ground floor and bedroom, both single and doubles are available on the ground and first floors, some of which have en-suite toilet facilities.

At the time of the focused inspection on 16 June 2017 there were 18 people using the service.

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 living at Cedar Grange and we found staff understood how to keep people safe from harm. Robust systems were in place to make sure people were protected from any financial abuse.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. The legal requirements relating to Deprivation of Liberty Safeguards (DoLS) were being met.

This inspection took place 8 and 27 January 2016 and was unannounced.

Cedar Grange is a registered service providing accommodation for 16 older people. There were 14 people living at the service at the time of our inspection. The service is a large detached property located in the Holmfield area of Halifax and can be easily reached by public transport from the town centre.

The service had a registered manager in place. 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.

Staff were available at the times people needed them and had received training so that people's care and support needs were met.

Staff understood their responsibility to safeguard people from harm. Where risks associated with people's health and wellbeing had been identified, there were plans to manage those risks. Risk assessments ensured people could continue to enjoy activities as safely as possible, access the community and maintain their independence.

People were involved in decisions about their care and told us that they received support in the ways they preferred.

People told us that staff encouraged them to remain as independent as possible and that they were supported to pursue their hobbies and interests. People were supported to maintain relationships with people important to them and visitors were welcomed at the home.

The service had a number of activities for people to join in with. Parties and trips out were documented for people to go on or reminisce.

Care records were created from initial assessments. Plans were created with people and their relatives. Plans were written in a person centred way and listed peoples personal preferences and like and dislikes.

People received a nutritious diet, had a choice of food, and were encouraged to have enough to drink.

People were referred to external healthcare professionals to ensure their health and wellbeing was maintained.

Staff were aware and people acknowledged they were treated with dignity and respect. We observed examples of staff providing support in a respectful manner. Staff had a good knowledge of the individual people they supported.

Medicines were managed so that people received their medication as prescribed and we saw medicines were checked and stored in a safe way.

Staff understood the principles of the Mental Capacity Act (MCA), and care workers gained people's consent before they provided personal care.

There were processes to monitor the quality and safety of the service provided and to understand the experiences of people who lived at the service. This was through regular communication with people and staff, surveys, observation competency checks on care workers to make sure they worked in line with policies and procedures.

The service had a robust system for checks and audits. Arrangements were in place so that actions were taken following concerns raised, for the benefit of people who lived at the home.

On the day of our visit 13 people were living at Cedar Grange.

During our visit we spoke with the provider, the manager, the lead senior carer and three staff. We also spoke with two people who used the service and one visitor.

We observed interactions between staff and the people who used the service. We heard staff asking people what they would like to do and explaining what was happening.

As part of our inspection we looked at the care plans for three people who used the service. We saw they provided sufficient information to enable care staff to meet the needs of each individual.

People living at the home were encouraged to make their own choices about their life at the home.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

We found that the service was taking steps to ensure people who live there were protected from the risk of infection.

Staff were being properly checked to make sure they were suitable and safe to work with older people and there were enough qualified, skilled and experienced staff to meet people’s needs.

Comments from people who used the service included;

“The girls are wonderful.”

“The staff are lovely.”

One relative we spoke with said, “The care is top notch.”

We spoke with six people who live at the home and three members of staff. These are some of the things they told us:

“I like it here, the staff are very kind.”

“The home is kept clean and tidy and I like my room.”

“The food is good and we get a choice.”

“I am proud to work here.”

“It’s a good, reliable staff team and I enjoy working here.”

We saw that staff were attentive and there was a warm, homely atmosphere. A quiz which was taking place during our visit generated a lot of laughter; people also told us that the homes’ cat was very popular.

People who use the service told us they were happy living at the home and they were well looked after. They told us that the home was warm and comfortable and the bedrooms and communal areas were always kept clean and tidy.

We spoke with two visitors who told us that staff are always professional in their approach to providing care and support and appeared competent and well trained.

We set out to answer our five questions:

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during

the inspection, discussions with people using the service, the staff supporting them and

looking at records.

Is the service safe?

We found people were treated with respect and dignity by the staff. People told us they felt safe in the building. We saw the homes policy on safeguarding and whistleblowing. The service was safe, clean and equipment was maintained. Rotas were completed in advance to ensure sufficient staff were around at all times. The home had an on call person who could respond out of hours.

All staff before working in the home had a check against the Disclosure and Baring Service (DBS). This raised any previous involvement with the police or vulnerable adults and children to the attention of the service.

Is the service effective?

We saw people’s health needs were assessed with them and they were involved in the writing of their care plans. Specialist equipment was sourced and referrals to other professionals were made when appropriate. Visitors confirmed that they were able to see people in private and that there were no set visiting times.

Is the service caring?

People were supported by kind attentive staff. We saw care workers showed patience and gave encouragement when supporting residents. In peoples care records we saw their likes, dislikes, aspirations and diverse needs had been recorded and care and support was had been provided in line with peoples wishes.

Is the service responsive?

Cedar Grange had many activities in and outside the home. This helped people keep involved in their local community. People told us they knew how to make a complaint if they wished. We saw one complaint had been followed through and feedback was given. People can therefore be assured that complaints are investigated and action is taken as necessary.

Is the service well-led?

We saw the services worked well with other agencies. We spoke with a visitor from another agency that told us, "Information is always passed on and followed through." This ensured people received their care in a joined up way. The service had a quality assurance system in place. Records seen by us identified shortfalls which had been addressed promptly.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of how the home was run and the processes in place. This helped to ensure people received good quality service at all times.