This inspection took place on the 27 June 2018 and was unannounced. This meant that the provider did not know we would be visiting

Cedar House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided. Cedar House provides care for up to 31 people some of whom are living with dementia. At the time of our inspection 24 people were living at the home.

The home 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 and associated Regulations about how the service is run.

We previously carried out an unannounced inspection in July 2016 where we rated Cedar House as good. The provider had a breach under Regulation 9 HSCA Regulations 2014, Person centred care. This meant that people’s care was not always designed in such a way as to meet their needs and reflect their preferences.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve person centred care to at least good.

At this inspection we saw that the provider had taken appropriate action and the breach identified at our last inspection had been addressed.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last comprehensive inspection.

People and their relatives who we spoke to during the inspection, confirmed they felt safe living at Cedar House. Care provided was person centred and compassionate and staff knew the people they cared for very well.

Staff followed the provider’s procedures for safeguarding and were able to explain how they would keep people safe from harm or abuse. Staffing levels were suitable to meet the individual needs of people. Records reviewed showed the provider had a robust recruitment process in place to ensure that only people who were suitable to work with vulnerable people were employed to work at Cedar House.

On the day of the inspection we identified an issue was identified with the fire exit. You can read more detail regarding this later in the report.

We reviewed training records as part of our inspection and found that some training was out of date. We have made a recommendation about the timeliness of training.

Staff supervision and an appraisal system ensured staff had regular opportunities to discuss and evaluate their learning and development needs and their work performance.

Staff understood the principles of the Mental Capacity Act, 2005 (MCA) and ensured they gained people's consent before providing personal care and support. People were encouraged to be involved in decisions about their care.

The provider had a quality assurance process in place to check the quality of care provided, this included medicines management, monthly health and safety audits, premises checks and accidents log.

Activities play a big part of daily life at Cedar House and the provider places great emphasis on ensuring that people have access to activities both inside and outside of the service. Some staff have undergone specific training for people living with dementia, and the provider has invested in equipment one of which allows people to enjoy more meaningful contact with their families who live abroad.

A complaints procedure was available and people were able to provide feedback of their views of the service. This included the opportunity for attendance at residents and relative’s meetings.

Staff and relatives that we spoke to confirmed that the registered manager was both supportive and approachable. Staff confirmed they were encouraged to share ideas and improvements with both the registered manager and provide

This inspection took place on 18 and 21 July 2016 and was unannounced. We last inspected the service on 23 November 2015 and found the provider was meeting the regulations we inspected against.

Cedar House Care Home provides residential care for up to 31 people, some of whom are living with dementia. At the time of our inspection there were 28 people living at the home.

The home 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 provider had breached the regulation relating to providing person centred care. Some care plans lacked details about people’s personal needs and preferences. This included the specific support people needed to ensure their needs were met consistently.

You can see what action we have asked the provider to take at the back of the full version of this report.

People were happy with their care. People and relatives told us staff were caring and treated people with respect. One person told us, “I couldn’t say a wrong word [about staff]”. One relative told us, “They [people] are treated well. They’re lovely with them, treated like their own.”

Staff had a good understanding of safeguarding adults and whistle blowing. They knew how to report concerns and said they would not hesitate if needed. One care worker said, “If I had any concerns I would I would raise them without any hesitation.”

Medicines records supported the safe administration of medicines. Medicines administration records (MARs) were completed accurately and medicines were stored safely. People confirmed they received their medicines when they were due.

People, relatives and care workers all said there were enough staff on duty. One person said, “They’re always about.” One relative commented, “Yes, [my relative] gets lots of attention.” Effective recruitment checks were carried out before new care workers started their employment. These included requesting and receiving references and checks with the Disclosure and Barring Service (DBS).

Health and safety checks were carried out regularly to help keep the home safe, such as checks of fire safety systems and the water, gas and electrical supplies. Procedures were in place to ensure people received appropriate support in an emergency.

Incidents and accidents were investigated and action taken to help keep people safe.

Staff were well supported and received the training they needed to fulfil their caring role. Regular one to one supervisions and appraisals were carried out.

People gave positive feedback about their meals. Staff supported people to have enough to eat and drink in line with people’s assessed needs.

The provider followed the requirements of the Mental Capacity Act (MCA) 2005. Deprivation of Liberty Safeguards (DoLS) were in place for people who were unable to consent to their placement in the home. Staff had a good knowledge of how to support people with making their own choices and decisions.

Records confirmed people had regular input from professionals in line with their needs, such as community nurses, consultants, GPs and a chiropodist.

Three care workers had recently completed additional training in relation to meaningful activities for people. The activity programme as being redeveloped to reflect people’s needs. We observed people had regular one to one with staff and activities were taking place when we visited.

People knew how to complain but they told us they did not have any concerns about their care. Two complaints had been thoroughly investigated and resolved.

People said the home was well-led and had a good atmosphere. The provider carried out regular quality assurance checks which had been successful in identifying areas for

We carried out an announced comprehensive inspection of this service on 27 April 2015 and 1 May 2015. A breach of legal requirements was found because records did not support the safe management of medicines. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach of the regulations relating to the safe management of medicines.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met the legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Cedar House Care Home on our website at www.cqc.org.uk.

We found the registered provider had made sufficient progress with the assurances given in the action plan. Guidance was available for staff to refer to about the specific medicines system operated at the home. Regular medicines audits were now carried out, including a specific check of MARs. Audits had been successful in identifying some missing signatures. Trained and competent staff administered medicines.

We found one particular issue where people’s MARs had not been signed due to staff being unable to locate the MARs. Due to the timing of the registered provider’s medicines audits issue would not have been detected and investigated. We have made a recommendation about this.

People living in the home and their relatives made positive comments about the support they received from staff at Cedar House. One relative told us “They are a beautiful set of people” and another told us “It feels like a house, rather than a home.”

We found that people received the care and support that they needed and individual needs were established before people started using the service.

We saw that staff supported people in a sensitive and engaging way and one visitor told us “They always have a smile on their faces.”

Staff were fully supported to meet people’s needs because they received regular supervision sessions and training and the service had an effective recruitment and selection procedure in place and carried out relevant checks when recruiting staff.

The home had systems in place to regularly check the quality of care and actions had been taken where issues had been identified. Residents and relatives were regularly consulted for their views about their care and treatment.

People we spoke with were positive about the care they, or their relative, received within Cedar House Care Home. Comments from people included "My mother is eating more, we're not worried about her like we used to be" and "The manager told me they would send someone to pick me up to visit my wife if I couldn't get here, you can't ask for more than that".

Each resident had their own bedroom and had the opportunity to personalise it. Many of the bedrooms within the service had ensuite facilities which were decorated appropriately.

People using the service and relatives were complimentary and spoke positively about the care provided at the service and staff. Their comments included “the staff are all lovely” and “likes and dislikes are taken into account”.

The inspection took place on 27 April 2015 and 1 May 2015. This was an unannounced inspection. We last inspected Cedar House Care Home in November 2013. At that inspection we found the home was meeting all the regulations that we inspected.

Cedar House Care Home provides residential care for up to 31 people, some of whom are living with dementia. At the time of our inspection there were 23 people living at the home. The home had 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.

We found the provider had breached Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider did not have accurate records to support and evidence the safe administration of medicines. We saw staff were signing to confirm medicines had been given at times of the day when the medicine wasn’t due. We also found gaps in medicines administration records (MARs) for 11 out of the 23 people who used the service. This was where medicines had not been signed for to confirm whether they had been given or not. You can see what action we told the provider to take at the back of the full version of the report.

People and family members told us the home was safe. One person said, “Staff are always popping in and out.” They also said, “I feel at ease with the staff.” One family member said, “[My relative] being here, has given us peace of mind.” They only gave us positive feedback about the care at the home. One person said the care was, “Brilliant, the staff are so caring.” They went on to say it was, “Like home from home.” One family member said they were, “Happy with the care. [My relative] is fine. Any concerns they [staff] let us know.” Another family member said, “[The] care is great.”

Prior to our inspection we received an anonymous complaint. This alleged staff members were frightened to ‘whistle blow’; that people’s toileting needs were not met in a timely manner; the manner in which a senior staff member talked to residents and insisting staff must start to get people up from 4am on a morning. We found staff we spoke with did not feel uncomfortable to raise concerns without the fear of reprisal. They also had a good understanding of safeguarding adults. We found people had their needs met quickly. Family members commented, “Enough staff, they are always available if we need anything”, “Staff see to [my relative] straightaway”, “Very good, [staff are] always on hand when we shout for them.” People and family members only gave us positive feedback about the staff working at the home. One person said, “They [staff] are so courteous and nice. They are nice set of people.” One family member said, “Lovely lasses, kind.” They went on to say the staff were, “Genuinely caring and it’s natural. You never see a miserable face, they are always smiling.” We carried out our inspection at 6am and found some people were already up and dressed. We were unable to confirm with people whether this had been their choice. Staff were considerate and ensured people were comfortable.

Staff told us there were enough staff on duty during the night. One staff member said staffing levels were, “Alright during the night. A few [people] like a lie in and they go to bed at different times.” Another staff member said, “Generally fine. Depends on what kind of night.” The provider undertook regular assessments of staffing levels. However, we found the analysis did not take account of particular pressure points throughout the day, such as meal-times and getting people in and out of bed. The provider had recruitment and selection procedures to check new staff were suitable to care for and support vulnerable adults. People using the service had been given the opportunity to take part in recruiting new staff.

We found from viewing care records that people were assessed against a range of potential risks, such as falls, mobility, oral health and skin damage. Where required action was taken to help keep people safe.

People and family members were happy with the home’s environment. One family member commented, “Beautiful home, the cleanliness is spot on.” They also said the home was, “Always clean, [my relative’s] room is done every day.” The provider undertook a range of checks to ensure the home and equipment were safe for people using the service. The provider had procedures in place to deal with emergency situations. People’s care and support needs in an emergency had been assessed. The provider had made adaptations to the service to make it suitable for people living with dementia. There were systems to log and investigate incidents and accidents. Incidents and accidents were analysed and action taken to keep people safe.

People were happy with the staff delivering their care. One person said, “Lovely set of staff here. Nothing is a problem”, and, “I honestly couldn’t praise them enough, all staff.” Staff received regular supervision and appraisal. They also received the training they needed to fulfil their caring role.

The provider followed the requirements of the Mental Capacity Act 2005 (MCA), including the Deprivation of Liberty Safeguards (DoLS). DoLS authorisations had been approved for all people requiring authorisation. Applications had been made in the person’s best interest with input from various professionals and in some cases an advocate.

Staff were knowledgeable about the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Staff were able to tell us about their responsibilities under MCA. They were also able to tell us about the capacity of people living in the home and support they needed to make decisions. People who were able to make their own decisions were asked to give their consent before receiving care. One family member said, “Staff always ask first.” Staff were clear about the individual strategies in place to support people who displayed behaviours that challenged the service.

People were supported to meet their nutritional needs. One person said the, “Food is fabulous.” They also told us there was variety in the meals available. People’s care records we viewed contained information about their food preferences, including likes, dislikes and any allergies people had. We observed over a lunch-time that people received the care and support they needed with eating and drinking.

People were supported to meet their healthcare needs. Care records confirmed people had regular access from a range of health professionals. These included GPs, community nurses, chiropodists.

We observed people received regular interaction from staff who were kind, caring and considerate. We saw staff members asked people if they needed anything and offered them drinks and biscuits. One family member said staff had, “Reminiscence chats, they sit and talk to people.” They also said, “Staff seem to know people well.” People were treated with dignity and respect. One person said, “[Staff] show you the most respect. They are careful not to embarrass you. This is right across the board.” One family member said staff “always” treated their relative with dignity and respect. Staff described how they delivered care in order to maintain a person’s dignity.

On admission staff gathered information about people to help them provide the care people wanted. This included developing bespoke ‘life histories’ about people. People had their needs assessed on admission into the home. The assessment and other information gathered about preferences were used to develop personalised care plans. One family member said, “Yes, we told them everything about [my relative].” They also said they had, “Been involved in reviews about [my relative’s] care.” Care plans were reviewed regularly. However, the record of the review was often brief and did not provide meaningful information about people.

Family members said people were able to take part in activities such as watching TV, listening to music, bingo and entertainment. Another family member said, “In summer they take them [people using the service] out.” They also said, “There is always something going on.” One person said, “There is lots to do. Staff will say, let’s have a game of this.” Staff said people could take part in activities, such as playing dominoes and bingo, watching TV or reading the paper. However, not all activities we observed were positive and appropriate for people living with dementia. We have made a recommendation about this.

People and family members knew how to complain if they were unhappy. Nobody raised any concerns with us during the inspection. One family member said they, “Know about the complaints procedure.” They also told us they had, “Not used it [complaints procedure]”, and had, “No concerns.” There was an agreed system in place to log and investigate complaints. There were opportunities for people and family members to give their views about the care delivered at the home. This included a regular ‘Resident and relative forum meeting’ and questionnaires.

The provider undertook a range of audits to check on the quality of care provided. Medicines audits were infrequent and had not been successful in identifying gaps in medicines records in a timely manner.