About the service: Cedarwood House accommodates up to 20 people in one adapted building. At the time of the inspection there were 18 people living there. People living at the home had a range of needs. People were living with dementia. Some people's needs were associated with old age and frailties associated with old age. Other people had more complex health needs which included diabetes.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service:

¿ We found improvements were needed to people’s records to ensure they contained all the information about people and fully reflected their care and support needs.

¿ People received support that was person-centred and met their individual needs, choices and preferences. People’s engaged in a range of activities that they enjoyed and were meaningful.

¿ People were supported by staff who treated them with kindness, respect and compassion. Staff understood people’s needs, choices and histories and knew what was important to each person. People were enabled to make their own decisions and choices about what they did each day.

¿ People's health and well-being needs were met. They were supported to have access to healthcare services when they needed them. Staff received training that enabled them to deliver the support that people needed. Staff received support from the registered manager and their colleagues.

¿ Staff had a good understanding of the risks associated with the people they supported. Risk assessments provided further information for staff about individual and environmental risks. People were protected from the risks of harm, abuse or discrimination because staff knew what actions to take if they identified concerns.

¿ People were supported to receive their medicines when they needed them. There were enough staff working to provide the support people needed, at times of their choice. Recruitment procedures ensured only suitable staff worked at the service.

¿ 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.

¿ People's dietary needs were assessed and people received the support they needed with their meals. People's needs were met by the design and adaptation of the building. Complaints had been recorded, investigated and responded to appropriately.

¿ The quality assurance system helped the provider to identify areas were improvement and development were needed. People, relatives and staff were encouraged to be involved and given opportunities to provide feedback and put forward their ideas for the service.

Rating at last inspection:

¿ Good. (Report published 23 September 2016).

Why we inspected:

¿ This was a planned inspection based on the rating at the last inspection.

Follow up:

¿ We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

At our previous inspection of Cedarwood House on 6 and 12 May 2015 we found breaches in regulation. We found there were not enough staff deployed to meet people’s needs. We also found that people were not adequately supported at meal times and there was no Registered Manager in place. The provider sent us an action plan in August 2015 and told us they would address these issues by February 2016.

We inspected on the 16 and 17 August 2016 to follow up on whether the required actions had been taken. We found the provider was now meeting the legal requirements.

Cedarwood House provides accommodation and care for up to 20 people. At the time of our inspection 18 older people were living at the home aged between 77 and 96. All people at Cedarwood House were living with early stages to severe dementia. People had various long term health care needs including diabetes and other conditions which impacted on mobility putting people at risk from falls.

Cedarwood House was on two floors with five bedrooms on the first floor accessed by a lift in the dining room and 15 bedrooms on the ground floor. The ground floor also included a kitchen, a staff room, the dining room, the communal lounge, an office and a recently decorated garden or sensory room.

There was a registered manager at the home. 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.

Throughout our inspection, people spoke positively about the home. Comments included, “No complaints whatsoever, it’s lovely here” and, “I’m well looked after.” Although staff knew people well and had a good understanding of their individual needs and choices there was a lack of consistent written information which could leave people at risk of receiving care that was inappropriate or inconsistent. This had not been identified through the quality assurance system. We have made a recommendation about improving the quality assurance process.

People told us they felt safe living at Cedarwood House. There were sufficient levels of staff to protect people’s health, safety and welfare. The provider had improved staffing levels based on the dependency of people’s needs.

Medicines were managed safely including covert and PRN medication. The provider had put in place clear guidance for staff on the covert administration of medicines.

People were provided with a choice of healthy food and drink ensuring their nutritional needs were met. Staff encouraged and supported people to eat and drink well. One person said, “The food is good, we get choices.”

Staff knew the individual personalities of people they supported. We saw staff were kind, compassionate and patient and promoted people’s privacy, dignity and choice. People were encouraged to be as independent as possible and we saw friendly and genuine relationships had developed between people and staff. One person said, “The staff are helpful and cheerful and treat me well.” A staff member told us, “I would put one of my loved ones here because the carers are compassionate.”

Training schedules confirmed staff had received training in safeguarding adults at risk. Staff knew how to identify if people were at risk of abuse or harm and knew what to do to ensure they were protected. Staff had received quarterly supervisions with their manager to discuss additional training needs and development. Staff were encouraged to attend further training, with a number having achieved National Vocational (NVQ) in health and social care.

Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work and staff received a range of training that enabled them to support people living at Cedarwood House.

People’s health

The home looked after people suffering with the effects of dementia ranging from those with mild effects to those whose dementia was very severe. We spoke with two people who used the service who told us that that they were very happy at the home and that the staff were very caring. The atmosphere was very calm, relaxed and peaceful. One member of staff described it as “home from home”.

We observed staff speaking with people who use the service in polite and simple language, showing them choices such as with clothes or food and giving the person time to think about their answer. We saw that care plans were detailed and focused on the person’s needs. They set out clearly how the staff assisted people on a daily basis with basic personal care to stimulating activities.

We observed some of the morning medication being administered. The staff member was seen to follow the home’s policy. They informed the person that it was time for their medication and answered their questions calmly and politely. The staff member was able to describe the purpose of some basic medications in addition to their side effects. We noted that they waited to ensure that the medication had been swallowed safely before returning to sign the medication chart.

We saw the training records for all staff which included all mandatory training and dementia awareness. Attendance was confirmed by certificates in the personnel files

There were 19 people living at Cedarwood House at the time of this inspection visit. We spoke to three people using the service, two relatives, and three staff members, including the manager.

We used a number of different methods to help us understand the experiences of people using the service, as they had complex needs. This meant they were not always able to tell us their experiences. We spent time with people using the service and observed their interaction with each other and the staff. We saw that interaction between people in the home was positive and constructive.

We saw staff asked for people’s consent before they provided any care or treatment. People who were able to, told us they were asked for their consent before any care and support was provided. They told us they were happy living at the home and with the care and support provided. All feedback received about the home was positive. One relative called the home ‘’marvellous.’’

We looked at the systems and processes that the home had in place to ensure the people using the service were protected from abuse. These processes ensured that staff knew what constituted abuse and what to do if it was suspected.

We saw there were enough appropriately trained staff in place to meet the needs of the people living in the home.

We looked at the systems and processes the home had in place to respond to complaints. These processes ensured complaints could be raised and resolved to people's satisfaction.

People we spoke with were happy to talk to us. They told us that staff “do their best” and they “were very happy living at the home”.

We inspected Cedarwood House on the 6 and 12 May 2015. Cedarwood House provides accommodation and care for up to 20 people. On the day of our inspection 17 older people were living at the home aged between 76 and 103. All people at Cedarwood House were living with varying degrees of dementia. People had various long term health care needs including diabetes and other conditions which impacted on mobility putting people at risk from falls. Cedarwood House was last inspected in December 2013 where they were judged compliant with the Regulations inspected.

An acting manager was in post however they were not the registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider. The previous registered manager had left their post in October 2014.

Throughout our inspection, people spoke positively about the home. Comments included, “Nice place to live” and, I’m happy with the home.” However, we identified a number of areas that required improvement. Although audits had been completed these did not identify all areas that needed action.

People told us they felt safe living at Cedarwood House. However we found staffing levels at busy periods and night time were not sufficient to protect people’s health, safety and welfare.

Although medicines were managed safely there was not clear guidance for staff and a blanket approach to the administration of covert medicines. We have made a recommendation.

People’s dignity was not promoted at meal times. Meal times were not a positive experience for some people. However people were provided with a choice of healthy food and drink ensuring their nutritional needs were met.

Staff knew the individual personalities of people they supported. We saw staff were kind and compassionate however we also found examples where people’s privacy, dignity and choice had not been promoted.

The lay out of the premises in certain areas impacted on people being able to move freely around the home independently.

The provider employed a part time activities co-ordinator at Cedarwood House; they were seen to interact with people positively however at the times when they were not working people’s social needs were not consistently met.

Relatives and staff spoke positively regarding the acting manager however they were not registered with the CQC and we found they did not have complete over sight and control of all aspects of the home. Staff supervisions were not occurring as frequently as the previous registered manager had indicated.

Training schedules confirmed staff members had received training in safeguarding adults at risk. Staff knew how to identify if people were at risk of abuse or harm and knew what to do to ensure they were protected.

Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work and staff received a range of training that enabled them to support people living at Cedarwood House.

People’s health and wellbeing was closely monitored and staff regularly liaised with healthcare professionals for advice and guidance.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the acting manager understood when an application should be made and how to submit one.

Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure decisions were made in the person’s best interests.

People’s friends and family were made welcome and relatives spoke positively about the welcome they received. One told us, “I can pop in anytime and know I will be made welcome.”

Assessments were undertaken prior to people moving into the home and care plans designed to assist staff in being responsive to people’s needs.

A complaints procedure was in place and regular satisfaction surveys were undertaken with people, their relatives and staff.

Staff meetings were used as a forum to share key operational information about the running of the service and provide updates on individual people.

The provider had ensured there were systems in place to ensure rolling improvements to the service were routinely undertaken.

We found breaches in Regulations. You can see what action we told the provider to take at the back of the full version of this report.