Cedar Lodge Nursing Home 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, and both were looked at during this inspection.

Cedar Lodge Nursing Home is registered to provide accommodation for up to 60 older people who require residential or nursing care. At the time of our inspection there were 52 people living at the home.

The inspection took place on 7 June 2018 and was unannounced.

The last inspection of Cedar Lodge Nursing Home was undertaken in November 2016 when the overall rating was Requires Improvement.

At the time of 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 were safe living at Cedar Lodge Nursing Home because all staff looked after them well. People told us that the staff were very good and kind and they supported them when they needed it. Staff were knowledgeable about keeping people safe and the reporting procedures to follow if they had suspected or witnessed abuse. People were kept as safe as possible because potential risks had been identified and assessed to help maintain their independence. There were sufficient numbers of skilled staff and appropriate checks were carried out to help ensure only suitable staff were employed to work at the service. Safe procedures were followed to ensure that people were protected against the spread of infection. Medicines were safely stored and administered to people at the times as prescribed by their GPs.

People’s rights under the Mental Capacity Act 2005 were respected and staff followed the legal procedures when making decisions on behalf of people who lacked the mental capacity to do so for themselves. People’s needs and choices were assessed and care, treatment and support was delivered in line with people’s wishes. Staff had received training, supervision and appraisals that helped to ensure people received effective care from staff who had the skills, knowledge and understanding needed to carry out their roles. People’s nutritional needs and preferences were recorded in their care plans and the chef had regular discussions with them to ensure that meals provided were to their liking. People received support to keep them healthy. People lived in an environment that that was adapted to meet their needs. The environment had undergone a recent refurbishment and was brightly decorated.

People were treated with kindness and compassion in their day-to-day care by staff who were caring and respected their privacy and dignity. People were involved in making decisions about their care, support and treatment and their independence was encouraged by staff.

People received care that was personalised to their needs. Comprehensive care plans had been written and regularly reviewed with the involvement of people and their relatives that were responsive to their individual needs. Staff had got to know people well and were aware of people’s

needs. There was a varied programme of activities people could get involved in. Complaints and concerns were taken seriously and used as an opportunity to improve the service. End of life care was provided sensitively and in line with people’s needs and preferences.

Accidents and incidents were recorded and an analysis of why accidents or incidents had occurred or what action could be taken to prevent further accidents had been developed. The provider and staff undertook quality assurance audits to monitor the standard of service provided to people. An

action plan had been produced and followed for any issues identified. People, their re

This inspection was carried out on 1 November 2016. Cedar Lodge Nursing Home provides accommodation, nursing care, respite and residential care for a maximum of 60 older people. At the time of our inspection 58 people were living at the service.

There was a registered manager in post at the time of our inspection. 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.

Recruitment practices were not always robust because appropriate checks had not been completed before staff started work.

Incidents and accidents were not always recorded or analysed to reduce the risk of them re-occurring.

Staff were not up to date with current guidance to support people to make decisions. Where people had restrictions placed on them there was no evidence that these were done in their best interests. MCA assessments were not being completed in relation to specific decisions.

Staff had received had not always received appropriate supervision and training. However other staff were having one to one support with their manger that promoted their development. People told us they felt supported and staff knew what they were doing.

There were not always sufficient numbers of care staff deployed at mealtimes to support people. However there were appropriate numbers of staff for other aspects of care.

There were not always appropriate arrangements in place to identify and support people who were nutritionally at risk. People were not complimentary about the food at the service. People were not always supported to have access to healthcare services. The provider was not always pro-active in referring people for assessment or treatment for specialist care.

The provider did not have appropriate systems in place to regularly assess and monitor the quality of the care provided. There was a continuing breach from the previous inspection around MCA assessments that had not been addressed. Records were not always legible, up to date or reflecting the most up to date care needs.

People had not always had access to activities that were important and relevant to them. However there were a range of activities available within the service and outside for some people that lived there.

People told us they were safe at the service. Staff had a good understanding about the signs of abuse and were aware of what to do if they suspected abuse was taking place. There were systems and processes in place to protect people from harm.

Assessments were undertaken to identify other risks to people to keep them safe.

Fire safety arrangements and risk assessments for the environment were in place to help keep people safe. The service had a business contingency plan that identified how the service would function in the event of an emergency such as fire, adverse weather conditions, flooding or power cuts.

Medicines were managed, stored and disposed of safely. Any changes to people's medicines were prescribed by the person's GP and administered appropriately.

Staff treated people with compassion, kindness, dignity and respect. People's preferences, likes and dislikes had been taken into consideration. People's privacy and dignity were respected and promoted when personal care was carried out.

People's needs were assessed when they entered the service and on a continuous basis to reflect changes in their needs.

People were encouraged to voice their concerns or complaints about the service and there were different ways for their voice to be heard. Concerns and complaints were used as an opportunity to learn and improve the service.

Staff told us they would report any concerns to their manager. Staff felt that management were very supportive.

Cedar Lodge Nursing Home provides accommodation, nursing care and respite care for a maximum of 60 older people. The home was well maintained, bright, welcoming and had a pleasant, quiet atmosphere. The common rooms were well equipped with furniture; there was a piano and television.

Care and support are provided over two floors. Access to the first floor is by passenger lift or stairs. Modifications have been made to the home to meet the needs of people that live here. At the time of our visit 51 people lived here, some with living with dementia. People were free to access all areas of the home. The front door was locked and operated by a button release so that people were kept safe.

The inspection took place on 22 July 2015 and was unannounced.

Overall there was positive very feedback about the home and staff from the people and their relatives. However there was one particular area of concern they told us about - the quality and choice of the meals. This concern had been raised at previous residents' meetings and was commented on during the day by people and relatives. Their concerns were borne out by our observations and discussions on the day.

Everyone we spoke with praised the care and support they received from the staff and the registered manager. When asked if they would recommend the home one relative said, “I already have done so as my second relative is now here.” Another said, “Absolutely."

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.

Where people did not have the capacity to understand or consent to a decision the provider had not always followed the requirements of the Mental Capacity Act (2005). Decisions had been made for people without an appropriate assessment and review being completed. People told us that staff did ask their permission before they provided care. One person said that "They ask us and involve us, they don't just take over".

Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards to ensure the person’s rights were protected.

People told us that the quality of the food was variable and could be improved. The menu had little variation and was repeated on a four week cycle. Very little fresh produce was used, and people did not have input in the menu planning. People had enough to eat and drink. The hydration of people was high on staff’s priority as they understood how this could affect people’s health.

People were safe at Cedar Lodge. Risks to people’s health and safety had been identified and managed by the staff.

Staff had a good knowledge of their responsibilities for keeping people safe from abuse. The provider had carried out appropriate recruitment checks to ensure staff were suitable to support people in the home. Staff received training to support the individual needs of people in a safe way.

People received their medicines when they needed them, and staff managed the medicines in a safe way. Staff were trained in the safe administration of medicines, however they had not had competency checks in line with best practice.

Care plans were based around the individual preferences of people as well as their medical needs. They gave a good level of detail for staff to reference if they needed to know what support was required. People told us that they had been included in the development of their care plans, and involved in reviews.

The staff were kind and caring and treated people with dignity and respect. One person said, “The girls are fabulous, they really are. I’m more than happy with everything.”

There were enough staff to meet the needs of the people that live here. People were very positive about the staffing levels and said they received support quickly when they needed it. One person said, “There’s always someone around if I need them.” A relative said, “Staffing levels are good, nothing is too much trouble for them.”

People were supported to maintain good health as they have access to relevant healthcare professionals when they needed them.

People had activities that met their needs. The home had a dedicated activities room so that those who did not want to take part were not disturbed. The equipment and environment was personalised to the people that used it. The staff knew the people they cared for as individuals.

People knew how to make a complaint. Feedback from people was that the registered manager and staff would do their best to put things right if they ever needed to complain.

People and staff had the opportunity to be involved in how the home was managed, and the management generally listened and acted on what was said. The registered manager carried out a number of audits to check that a good quality service was being provided.

We identified one breach of the regulations. You can see what action we told the provider to take at the back of the full version of this report.

Staff told us they were well trained and we saw evidence they were fully up to date with education that ensured they had the knowledge to provide appropriate care and support.

Relatives told us they considered the staff provided exceptional care. They said it was well organised but was also homely. We were told they had every confidence in the manager that if something was not right, the issue would be resolved quickly and to their satisfaction.

People’s records were reviewed on a regular and systematic basis and the results of regular audits were shared with staff in order to continually improve care and support. Incidents and accidents were monitored and as a result the provider was able to continually assess the quality of care at Cedar Lodge.

At the time of our inspection 50 people were living in the service. Our inspection was facilitated by the registered manager. Although some people who used the service were able to tell us about their experience, others were not.

We saw that people had their individual needs assessed before admission and that they or their relatives had been involved in planning their care and support. We also saw that staff adapted to people’s changing needs.

We noted that staff treated people with warmth and respect. We saw that people looked well cared for and that those who wished to were engaged in group activities. One relative told us, “The staff here have a talent for treating people with dignity and respect”

We noted that guidance regarding safeguarding people from abuse was available to staff and they had received recent relevant training. One person we spoke with told us, “I always feel very safe here and I’ve been here a few years now”.

We saw that staff recruitment processes were thorough and that required checks had been carried out before staff were engaged. We noted that requirements relating to agency staff were equally robust.

We saw that there was an effective complaints system in place and that complaints and comments were sought from people who used the service and their relatives. A person we spoke with told us, “So far I’ve found nothing to complain about. If I did I’m sure we would just talk about it and sort it out. The manager is very helpful”.

Some people told us that they felt the care and support was good and they felt well cared for by helpful and friendly staff.

One person said that they thought that some staff did not like their job and that the care and support was inconsistent as some staff did not know what they were doing.

Some people told us that they felt the care and support was good and they felt well cared for by helpful and friendly staff.

One person said that they thought that some staff did not like their job and that the care and support was inconsistent as some staff did not know what they were doing.