This inspection took place on 12 September 2016 and was carried out by one adult social care inspector and was unannounced. Cedar Lodge is a residential care home specialising in providing accommodation and personal care for up to 42 people living with dementia. This registration also includes The Limes, a purpose built recovery and rehabilitation centre adjoining Cedar Lodge. The Limes provides shorter term placements for up to 15 people (mainly younger people) with a range of mental health conditions to support and enable them to move forward into the wider community. These placements were currently only referred through Somerset Partnership Trust although this was soon to change.

On the day of the inspection, there were 42 people living at Cedar Lodge and 13 people living at The Limes. There was an excellent registered manager employed at the home who was clearly passionate about providing a high quality, individualised service. They managed both units with support from a deputy manager qualified in mental health on The Limes. 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.

At the last inspection in December 2014 we found the areas of caring, responsive and well led required improvement and effectiveness was inadequate. The service had sent us an action plan and we saw all areas had been very much improved. There had been many meetings to discuss with staff and the management team how improvements could be made and these had all been addressed. For example, people on both units had opportunities at any time to voice their views about their care and be involved, privacy was respected and people and relatives felt able to make complaints knowing they would be addressed. We had raised an issue about access to the kitchen at The Limes. We found there was always open access to the kitchen and food that people wanted to eat whilst being encouraged to work towards independence in shopping and cooking, taking responsibility and meeting goals. Where restrictive equipment was used to protect people’s safety, people and their representatives were involved or the appropriate best interest decisions made using the correct processes to protect people’s rights.

People were supported by very kind, caring and compassionate staff who often went the extra mile to provide them with excellent, high quality care. This high standard of care enhanced people's quality of life and wellbeing. The staff were extremely passionate about providing people with support that was based on their individual needs, goals and aspirations. They were pro-active in ensuring care was based on people’s preferences and interests, seeking out activities in the wider community and helping people live a fulfilled life.

People had access to activities that complemented their individual hobbies and interests. Links with the local community had been established and people were supported to participate in community events and other events that were important and meaningful to them. This provided them with a sense of purpose and wellbeing.

The staff were happy working in the home and felt very supported in their role. They were clear about their individual roles and responsibilities and felt valued by the registered manager and the wider senior management team. Good leadership was demonstrated at all levels with pro-active effort to encourage ideas from staff to further benefit the people in their care and maintain a strong, stable staff team with a shared goal. Each individual staff member was engaged in sourcing new opportunities for people and putting ideas into practice. There were effective systems in place to monitor the quality and safety of the care provided.

There was a strong cul

This unannounced inspection took place on 2 December 2014.

The last inspection of Cedar Lodge was carried out on 21 October 2013. No concerns were raised at that inspection.

Cedar Lodge is registered to provide accommodation and personal care for up to 57 people. There are two areas of Cedar Lodge one being the Limes which can accommodate up to 15 people from the age of 25 who have an enduring mental health illness and the other called  Cedar Lodge where people living with dementia receive care and support.

There is a registered manager in post who has overall responsibility for both the Limes and Cedar Lodge. 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 living on the Limes were not always empowered to express their views, to feel they had a voice and be involved in the arrangements for meeting their care needs. Their human rights to privacy and confidentiality were not always respected and upheld.

There was an inconsistent approach to ensuring people felt able and confident to make complaints. People on the Limes told us they did not feel able to make a complaint or voice their view. One person told us “They don’t talk with me about any decisions, we are not asked about things.” However on Cedar Lodge people spoke of being able to talk with the manager and staff about their worries and concerns. One person said “I know there is always someone I can talk to about anything that is bothering me.”

People on the Limes did not always have the opportunity to have their nutritional needs met because of restrictions on accessing food and drinks. People on Cedar Lodge received the necessary support to ensure their nutritional needs were met.

There were not arrangements in place to ensure where equipment was used to protect people’s health and welfare and in their best interests consent was obtained.

People told us they felt safe and how there were always enough staff to provide them with the care they needed. One person told us “The staff are all very kind and understanding” another said “The staff are all friendly, they keep me safe.”

We observed how staff supported people on Cedar Lodge who were at times distressed or disorientated. They kept people safe by responded in a positive way to people who potentially were placing themselves or others at risk of harm.

Risks of abuse to people were minimised harm because staff were aware of their responsibilities to report any concerns about possible abuse. Recruitment arrangements minimised the risks of abuse to people because the necessary checks were undertaken.

People were supported and cared for by staff who received the necessary training specific to the needs of people who used the service. This gave them the skills and knowledge about how to meet people’s care needs effectively. They received good support with regular individual supervision.

People had access to community health services such as GPs as well as specialist community health and mental health services.

There was a calming, relaxed and caring environment on Cedar Lodge where people’s mental health needs and how it impacted on their behaviour and understanding were respected and understood. People were cared for by kind and respectful staff in a welcoming and caring environment. People said how kind and friendly staff were. We saw staff spent time talking and listening to people. There was an inviting and welcoming environment.

People had the opportunity to live their lives as they chose with staff enabling people to make choices about their routines. Activities were arranged on Cedar Lodge which suited people abilities and choices however on the Limes people had limited opportunities for activities.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

We spoke with a number of people who live at Cedar Lodge and The Limes, they told us; "They look after us very well", "This is an A plus place", "The food is very good here", "I have only been here two weeks but I am finding my way around", "I am grateful to be here, I'm not very good in the kitchen but I am learning", "The manager here is a block of gold, as God is my truth" "I like it here they look after us very well" and "The TV cameras should come here to see what a good home is"

Family members that we spoke with told us "When we came and looked around, we did not have an appointment, it felt welcoming and the atmosphere was right", "My Mum has been here two years, she has dementia and the staff have been fantastic" "I think I have chosen well for a care home", "They put her earrings in and do her nails", "I got my husband a different room, the staff are wonderful, they are very kind", "I have no concerns about the care in the home, "They always knock on the door before they come in", "I told a number of staff about a person's incontinence, they told me the person refused to be changed, the situation was resolved"

We spoke with a visiting General Practitioner who told us they were involved with people's care planning and " I have no concerns about Cedar Lodge, the staff are open to suggestion and I feel we have a good relationship" "Having worked as a Complex Care GP I feel I know the staff at Cedar Lodge"

We also spoke with two visiting physiotherapists who told us "It is good to see instructions carried out and I have not seen anything to bother me"

We spoke with 12 people who live in the service and with four family members who were visiting during our inspection. 11 people said that they were very happy with the service. One man said he was unhappy but did not want to talk about it. Another said of Cedar Lodge "We are all one happy family here". Another person told us that they were learning how to be independent and that they hoped to move onto their own flat in the future. On being asked if they liked the staff we were told "Of course, I wouldn't be here otherwise would I?"

All the family members told us that it had been a very difficult decision to place their loved one in a home, but that Cedar Lodge had made the transition as easy as possible. We were told that family, friends and even pets are welcome to visit whenever they like. And that the staff go out of their way to make visits as comfortable and stress free as possible.

We saw that everyone was appropriately dressed and that many of the women had their nails done. One person showed us the hairdressing saloon. People where engaged in conversion with each other and with the staff. There was a positive atmosphere and we saw evidence of lots of activity both with-in and outside of the home. On the wall of the dining room was a display of recent photographs and in one of the lounges people were preparing for Valentines Day.

Staff addressed everyone by name and we saw that they knew people well and treated everyone with dignity and respect.