The inspection took place on 7 January 2019 and was announced. We do this to ensure there is some at the service to help with the inspection.

We previously inspected Cedars Lodge in December 2017, at which time the service was rated requires improvement. At this inspection, the service was rated good. This was because we found medicines administration practices were not in line with good practice and were not well audited. At this inspection we found medicines practices to be in line with good practice and oversight of them was robust. As the appropriate improvements have been made, the service was rated good at this inspection.

Cedars Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service supports people living with a learning disability.

The care service is designed and run in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service had a registered manager in place. 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. The registered manager was also responsible for the management of the provider’s other small service nearby and was supported by an assistant manager.

Medicines administration practices were now safe and in line with national best practice guidance. This included improvements to homely remedies, ‘when required’ medicines, and prescribed creams. Staff were trained appropriately, had their competence assessed and demonstrated a good knowledge of people’s medicinal needs.

Risk assessments were specific to people’s individual needs and did not restrict people’s freedoms to keep them safe. Staff demonstrated a good knowledge of the risks people faced and how to help them minimise them.

Staffing levels were appropriate to people’s needs and to ensure the service was not task orientated; rotas were planned in advance.

Staff understood their safeguarding responsibilities. They knew what to do should they have concerns about people’s wellbeing or safety. People who used the service felt safe and secure.

Training and support was well planned and effective. The induction covered all core areas and ensured new staff had the skills and confidence to support people. Staff told us they were well supported.

People had a choice of meal options and were encouraged to improve their own cooking skills.

People were supported to have maximum choice and control of their lives in the least restrictive way possible. Staff had received training in the Mental Capacity Act (2005) and consent was evident in care planning and through day to day interactions.

Care plans contained sufficient detail for staff to ensure people’s needs were met and that visiting healthcare professionals could understand people’s recent healthcare needs and wellbeing. Care plans had been reviewed and audited.

People who used the service were clear that staff were patient and respectful with them. We observed such interactions, as well as good levels of mutually shared humour. Relatives confirmed that people got on well with staff.

People who used the service played an active role in planning and accessing the outings and activities they were interested in. Staff supported them to be as independent as they could be in this.

There had been no complaints but people who used the service were clear they knew how to complain and to

The inspection took place on 5 December 2017 and was announced. This meant we gave the provider 24 hours notice to ensure there would be someone at the service when we visited. We did this because it is a small service where people are often out during the day.

We previously inspected Cedars Lodge in October 2015, at which time the service was meeting all regulatory standards. At the inspection of October 2015 we rated the service as good. At this inspection we rated the service as requires improvement.

Cedars Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Cedars Lodge is a small dormer bungalow near Sunderland City Centre in its own grounds. The service provides care and support for four adults who have learning disabilities.

The service had a registered manager in place. 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. They had taken over the management of the service three weeks prior to the inspection, following the resignation of the long-term registered manager.

Medicines had not been effectively audited and we found instances of poor practice in relation to topical medicines, medicines administration records and homely remedies.

We found areas of good practice with regard to medicines prescribed to be taken ‘when required’. De-escalation strategies were used well to ensure staff did not overly rely on medication to help reduce people’s anxieties.

People who used the service felt safe and behaved in a manner that demonstrated they were comfortable with and trusting of staff. Relatives and external professionals raised no concerns about people’s safety.

There were sufficient staff to meet people’s needs safely and staff had received training in safeguarding.

All areas of the building were clean and well maintained by the provider.

Effective pre-employment checks of staff were in place, including Disclosure and Barring Service checks, references and identity checks.

Risk assessments were detailed, person-centred, involved people in their planning and practice and gave staff clear guidance about how to help keep people safe.

People had access to a range of primary and secondary healthcare, such as GPs, nurses and psychiatry.

Staff were trained in a range of core areas such as health and safety, medicines administration, infection control, first aid and fire safety. Staff had also received training to equip them to better meet the needs of people who used the service, such as autism awareness, epilepsy awareness and how to identify and de-escalate challenging behaviours.

Staff had not always received regular supervisions or regular team meetings. Staff told us they were well supported otherwise and that they could raise any concerns they had on an ad hoc basis. The new registered manager had planned supervision sessions and team meetings.

People were involved in shopping and preparing meals and helped themselves to drinks and snacks during our inspection.

The premises were well suited to people’s needs, with en suite facilities and ample dining and lounge space.

The registered manager and staff had a good understanding of the Mental Capacity Act 2005. 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.

People who used the service received a good continuity of care from a stable team of staff who knew them well and there was an effective keyworker system in place, wi

This inspection took place on 29 September 2015. This was the first inspection of this care home which was registered with the Care Quality Commission on 28 October 2014.

Cedars Lodge is a large detached house that is registered to provide four places for people with autism spectrum condition. The bedrooms are spacious and the accommodation is modern for the young people who lived there. There were three people living at the house at the time of this inspection.

Cedars Lodge 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.

People said they liked the home and felt comfortable there. Relatives and care professionals told us the service was safe. Staff were clear about how to recognise and report any suspicions of abuse. They told us they were confident that any concerns would be listened to and investigated to make sure people were protected. Potential risks to people’s health and safety were well-managed in a way that did not compromise their independence. People who could manage their own medicines were supported to do so; otherwise staff managed these in a safe way for people.

Relatives and care professionals said the service provided effective, specialist support for people with autism spectrum condition. Staff were very well trained in autism to help them understand the individual challenges faced by the people who lived there. New staff received in-depth induction training when they started work. Staff said they felt “supported” by the registered manager and by the provider.

Staff understood the Mental Capacity Act 2005 for people who lacked capacity to make a decision and Deprivation of Liberty Safeguards to make sure they were not restricted unnecessarily. People were supported to take acceptable risks so they had as independent a lifestyle as possible. People were involved in shopping, choosing and preparing meals so that they increased their daily living skills.

People’s needs were continuously reviewed by the provider and external health care professionals. One healthcare professional told us, “The communication between the staff and us is very good. They are always able provide us with comprehensive information about how [my client] has been.”

People said the staff were “very nice” and “very pleasant”. One person commented, “The staff are great.” Staff had a very positive, encouraging and supportive approach with each person. Relatives and care professionals said all the staff were “very caring”, “friendly”, “warm” and “very welcoming”. One relative told us, “I never thought I would find anywhere or anyone who could look after [my family member] as well as I could – but I have!”

Staff engaged with people in an empathetic and respectful way. One relative told us, “My [family member] tells me staff speak to him with dignity and compassion and I have seen this myself.” Another relative told us, “The staff are consistently caring and attentive and seem to genuinely enjoy their work there.” One relative described how staff always came out to welcome someone back into the house if they had been away for a few days. The relative commented, “They always greet [my family member] so warmly and ask how he’s been and what he’s been doing.”

People had been individually assessed and their care was planned to make sure they got the right support to meet their specific needs. People enjoyed a range of vocational activities outside of the home. People’s choice about whether to engage in these activities was respected. One person had been supported to find paid and voluntary work and staff also helped people to find activities in the local community that they might be interested in.

People had information about how to make a complaint or comment. They said they would comfortable about telling the registered manager if they had any concerns. Relatives said any issues, however minor, were always acted on. There had been no  formal complaints about this service.

People, relatives and care professionals felt they could comment on the service at any time as well as and at regular reviews. Relatives and staff felt the organisation was well run and the home was well managed. There was an open, approachable and positive culture within the home and in the organisation. Staff felt there was good teamwork within the home and that there was good communication between staff at all levels of the organisation. The provider had a quality assurance system to check the quality and safety of the service provided.