Cedar Lodge provides accommodation, personal care and support for up to six adults who have a learning disability. There were four people living at the home at the time of our inspection.

This was an unannounced inspection which took place on 18 October 2017.

There was a registered manager in place, who had taken up their post since our 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. The registered manager assisted us with our inspection.

Cedar Lodge was last inspected in October 2015 where they were given an overall rating of ‘Good’. We found at this service, the level of good care provided to people had been sustained.

People were supported by caring staff. Staff treated people with respect and maintained their privacy and dignity. People were supported to be as independent as they could be and make decisions for themselves. People had access to activities that recognised their interests. The registered manager promoted community awareness within the local area. There were good relationships with people in neighbouring Ashcroft homes.

People were supported to eat safely. People who had needs related to eating and drinking had been reviewed by a speech and language therapist. Staff were knowledgeable about people’s dietary requirements and supported people to eat a varied and healthy diet.

People were provided with appropriate care as there were guidelines in place for staff on how to provide the support. Where necessary, referrals had been made to health and social care professionals to ensure that people received appropriate care. People’s care plans were person-centred and contained information relevant to people such as their care needs as well as their interests and past history.

People were helped to stay safe because staff understood any risks to people and staff took action to minimise these risks. There were sufficient staff to keep people safe and meet their needs whether people remained at home or went out into the local area. Staff understood their roles in keeping people safe and protecting them from abuse. The provider carried out appropriate pre-employment checks before staff started work.

People’s consent was sought prior to them receiving any care. Where people lacked capacity to give informed consent staff acted in line with the Mental Capacity Act 2005. This included taking the least restrictive approach with people where possible.

People’s medicines were managed safely and records demonstrated people received the medicines they required. Accidents and incidents were recorded and reviewed to ensure any measures that could prevent a recurrence had been implemented. Staff maintained a safe environment, including appropriate standards of fire safety. There was a contingency plan in place to help ensure people would continue to receive care in the event of an emergency.

People were cared for by staff who had access to the induction, training and support they needed to do their jobs. Staff told us they received regular supervision and felt the staff team worked well together and supported each other.

The provider had an appropriate complaints procedure which explained how complaints would be managed. Complaints received were responded to appropriately and discussed within the staff team.

People lived in a service which was well managed. Relatives told us the registered manager provided good leadership for the home and staff told us the registered manager gave them encouragement and support. The registered manager managed another of the provider’s registered homes but demonstrated that this did not diminish their ability to manage Cedar Lodge effectively. In addition they supported registered manage

This inspection was carried out on the 19 October 2015 and was unannounced Cedar Lodge is a home for up to five people with learning disabilities and complex physical needs. On the day of our visit ? people lived at the service.

On the day of our visit there was a registered manager. 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.

People’s needs were met because there were enough staff at the service. We saw that people were supported in a timely way with their care needs.

Accidents and incidents with people were recorded and trends analysied. Staff had knowledge of safeguarding adult’s procedures and what to do if they suspected any type of abuse. Staff had undergone recruitment checks before they started work.

People’s medicines were administered and stored safely. Risks had been assessed and managed appropriately to keep people safe which included the environment. The risk assessments for people were detailed and informative and included measures that had been introduced to reduce the risk of harm.

In the event of an emergency, such as the building being flooded or a fire, there was a service contingency plan which detailed what staff needed to do to protect people and make them safe.

People’s human rights were protected because the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty (DoLS) was followed. There was evidence of mental capacity assessments specific to particular decisions that needed to be made.

People were supported by staff that were knowledgeable and supported in their role. Staff had received all the appropriate training for their role and their competencies were regularly assessed.

People at risk of dehydration or malnutrition had effective systems in place to support them. People were weighed regularly and were supported to eat healthy and nutritious food. People had access to a range of health care professionals, such as the epilepsy nurse, dietician and GP.

Relatives told us that staff were caring. One told us, “I wouldn’t change the way staff are with (the family member), staff are very kind and caring, we are very lucky to have found this home, staff are so respectful.” We saw that staff were caring and respectful of people.

Relatives and advocates supported people in the planning of people’s care. We saw that care plans had detail around people’s backgrounds and personal history and included people’s views on what they wanted. Staff knew and understood what was important to the person and supported them to maintain their interests.

People were supported by staff that were given appropriate information to enable them to respond to people effectively. Where it had been identified that a person’s needs had changed staff were providing the most up to date care. People were able to take part in activities which they enjoyed.

Relatvies said if they needed to make a complaint they would know how to. There was a complaints procedure in place for people to access if they needed to and this was in a pictorial format for people to understand.

Staff said that they felt supported. One member of staff said that that they felt supported with the management team..

Systems were in place to monitor the quality of the service that people received. This included audits, surveys and meetings with people and staff.

At the time of our visit there were five people who lived at Cedar Lodge. We carried out this inspection to look at the care and treatment that people who used the service received.

As part of our inspection we spoke with four staff and three relatives of the people who lived in the home. We also reviewed three care plans. We were unable to speak with most of the people who used the service because of their complex needs, so we used observation to inform our judgements. We were however, able to speak with one person and another indicated, by using body language, their understanding to our questions.

We considered our inspection findings to answer questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

Is the service safe?

We found during our inspection that people were cared for in an environment that was safe, clean and hygienic. We found the building, clean and generally well maintained.

We noted that the provider has ensured that where people lacked capacity to give their consent a mental capacity assessment had been carried out.

We spoke with relatives who told us they felt their family member was safe at Cedar Lodge. One relative told us they had “No concerns.”

Is the service effective?

It was evident from our observations and from speaking to staff that they had a clear understanding of people’s needs. Two of the relatives we spoke with told us they had seen improvements in the behaviour of their family member since they had lived at Cedar Lodge.

Is the service caring?

We saw that people were supported by kind and attentive staff. We saw that people were supported to do things, such as put on their coats when they went out. One relative told us “It’s by far the best. The staff are caring. It’s not just a job, it’s a vocation and there’s a difference.”

Is the service responsive?

People who used the service had a keyworker who regularly reviewed the needs of the person. The relatives that we spoke with told us they were involved in these reviews. One relative told us the service had responded immediately to a change in their family member’s health. Another relative said “I don’t think anyone could have done any better” in response to the this question.

Is the service well-led?

Staff that we spoke with told us they felt supported and were encouraged to progress professionally. We heard from relatives that they felt the management of the service was good. One relative told us “The Cedar Lodge staff are brilliant.”

We observed people involved in daily life at the home, such as preparing for and clearing away after meals, and when asked, people they said they enjoyed doing this.

People told us or signed that they liked the food and their rooms.

One person told us they felt safe living at their home and would go to a member of staff they named if anyone upset them.

We found the home to be well maintained, hygienic and clean.

We saw that staff had the skills to support people with limited verbal communication skills, for example through the use of Makaton sign language and gestures.

We saw that there were enough staff to meet people’s needs in a timely manner and that staff received appropriate professional development and support.

We found that comments and complaints that people made were responded to appropriately.

The four of the service users who live in the home told us they liked living there. They told us the staff were kind and caring. People said the food was good and that they eat well.

Some people were more aware of their care plans and one person told us that they know what care to expect. They all said they liked to go out to various events and activities. Somebody returned from a trip to the cinema and told us that the likes to do this every week. Staff supported service users with limited verbal communication skills to communicate with us through Makaton sign language and gestures.

Our visits were undertaken by two Compliance Inspectors across two days. Our visit on the 28 October was unannounced and we found the building fresh and clean. Our visit on the 26 was announced in order to facilitate that the registered manager be present.

We saw that people who used the service were free to move around the service independently. Some people choose to join us for part of the inspection by showing us around their service. We saw staff were attentive to people and had a good knowledge of their needs and communication methods. We observed that people were relaxed in the company of staff and sought out their company and interaction.

We saw that staff offered choices and sought consent before offering care, and information was included in formats and languages to assists people understanding. This meant the person's consent would be better informed. However, where people were thought not to have capacity the provider did not always act in accordance with the Mental Capacity Act 2005. They did not always follow procedures to establish capacity where decisions to restrictions people’s freedoms were made on their behalf in order to ensure that people’s rights were protected.

We saw that people were supported to be able to eat and drink sufficient amounts to meet their needs. We saw people being supported to be independent and make their own drinks and snacks. Some people were involved in household chores such as meal preparations, setting and clearing tables and loading of the dishwasher.