The inspection was unannounced and took place on the 11 and 18 April 2017. The service was last inspected in April 2015 and was rated as good.

Cedric House is registered to provide accommodation to people living with dementia who require personal care and support. The service is registered to accommodate up to 20 people. At the time of the inspection visit there were 18 people living at the service.

There was a registered manager in post within the service, who had been registered with the CQC since March 2015. 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 provider specialises in supporting people living with dementia, however we found some aspects of the service that would benefit from some improvement. For example the environment would benefit from consideration around how it could be made more dementia friendly, and the use of therapy dolls needs to be carried out in line with best practice. We have made a recommendation to the registered provider around supporting people who live with dementia.

Audit systems were in place to monitor the quality of the service being provided. However an accurate record of complaints was not being maintained by the registered manager. This meant that common themes or trends in complaints could not be identified to prevent issues from reoccurring again in the future. Other aspects of the service that were audited to a good standard included medication and the management of falls.

During meal times the majority of people enjoyed the food presented, whereas some people did not appear to enjoy what had been offered. Alternative options were not always made available. However, people received special diets where needed and appropriate action was taken to refer people to the relevant health professionals where they were at risk of weight-loss. This helped to protect people from the risk of malnutrition. We raised this with the registered manager so that this could be addressed with staff.

People were protected from the risk of abuse. Staff were aware of the different signs of abuse and how to report any concerns they may have. The registered provider had a whistleblowing policy and procedure in place which staff were familiar with. This enabled staff to report concerns inside or outside the service without fear of reprisals.

Accidents and incidents were being monitored by the registered manager, and appropriate action was being taken in response to these. Where people were at high risk of falls and had experienced multiple falls they had been referred to the appropriate health professional for support.

Recruitment processes were robust and ensured that staff employed were of suitable character to work with vulnerable people. Appropriate checks had been carried out prior to new staff starting which helped the registered manager make decisions regarding the suitability of applicants.

People had been supported to take their medication as prescribed. Medication was administered safely, and staff signed medication administration charts (MARs) to show that this had been given as required. Clear instructions were available for staff around when medicines should be administered.

People’s rights and liberties were being protected in line with the Mental Capacity Act 2005. We observed positive examples where staff gave people the option of making choices for themselves. The registered manager was aware of those family members who had the legal power to make decisions on people’s behalf, and people’s care records reflected their cognitive and mental abilities.

Staff were kind and caring towards people and positive relationships had developed between them. Family members commented positively on staf

We carried out our unannounced inspection of Cedric House on 24 November 2014.

Cedric House is a residential home, which specialises in providing care and support to people who have a diagnosis of dementia. The home is situated in a quiet residential area of Rainhill, with easy access to public transport and close to local amenities. The service is registered to provide a service to 20 people. On the day of our inspection there were 19 people living in the home.

The service had a registered manager in post, however the registered manager had been absent for over two months and the owner had managed the service during the registered manager’s absence. 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.

We spoke with four members of staff and the provider about their understanding of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). We found they had a good understanding and had acted in a lawful manner. We found that people, where possible were involved in decisions about their care and support. We saw staff positively interacting with people. At the time of our inspection there were 11 people who were subject to a Deprivation of Liberty Safeguards. People’s care records contained information regarding DoLS and how it related to individuals.

We found that care plans were regularly reviewed, with people’s social history backgrounds and people’s personal preferences clearly identified. There was documented evidence in place which showed that people’s health care needs had been met, with records showing that input from health professionals had been accessed when needed. We saw that people’s assessed dietary needs had been met.

We found the service had quality monitoring systems in place, which gave people who lived in the home, their relatives and staff the opportunity to voice their views and opinions of the service.

There was a complaints system in place and relatives we spoke with told us, they were aware of the complaints system and knew how to complain, if they needed to.

We found that the service had a robust recruitment process in place, with evidence of appropriate police checks and references being obtained.

We saw that some redecoration and refurbishment to the home had taken place, with the first floor in the process of being decorated and re-carpeted.

From our observations during our inspection, staff members always sought consent before providing any care or treatment which showed respect for the wishes of the people using services at Cedric House Care Home. We looked at five care plans during our inspection and observed pre-admission assessments were present. Risk assessments in appropriate areas, for example mental capacity and risk to falls, were reviewed on a monthly basis which ensured the continuity of care for all people. Medication was handled and given to people at the same times every day and were kept safely and disposed of appropriately.

Staff records showed that all appropriate checks were made prior to anyone starting work at the home which ensured all people using services were kept safe. All staff had the skills and knowledge required to provide good quality care to all people at the care home. There was an effective complaints system available which meant any comments or complaints people made were responded to appropriately and if required, they would be assisted in the process.

We visited Cedric House on 19 February 2013. We found the home to be clean and warm and people who used the service were well presented. The home was undertaking some improvements to the building at the time of the visit.

We observed staff delivering care in a warm and sensitive way, taking the time to speak and listen to people who used the service. We looked at care plans for five people and saw that they included appropriate information around health and support needs. The care plans were person centred and individualised, including records of people’s likes and dislikes.

We spoke with a visitor to the home. They told us “You couldn’t ask for kinder care.” The visitor also told us that the communication was excellent and that the home would always inform them if any issues occurred.

Staff had appropriate policy and procedure guidance in place. We saw that there were good standards of hygiene and cleanliness and that infection control measures were in place.

We observed people being cared for by staff who were appropriately trained and qualified for their employment. We saw that staff meetings were held regularly and training was ongoing.

We saw evidence of regular audits and that the home sought customer feedback in order to inform continual improvement. There was a complaints procedure in place and complaints were followed up appropriately.

We spoke with some of the people who live at Cedric House and with some of their relatives and friends.People were very complimentary about the care and support being provided. Some of the comments from relatives were, "They are looking after him really well. He seems contented here" "I know he is being looked after in here, that's all I want" "To be honest my friend is very well looked after" and "I think the staff are really good, very friendly, helpful and very caring".

Throughout our inspection visit we observed the care staff supporting people in a sensitive, dignified and pleasant manner. We saw members of staff spending time with people and positively interacting with them.

We observed people being moved from one area to another. One person used a zimmer frame and the member of staff was encouraging and assisting the person in a respectful and unhurried way. Another person was observed being lifted by a hoist from a chair to a wheelchair, this again was carried out in a dignified and respectful manner. People were allowed to go at their own pace,without being rushed and continullay given encouragement and kept informed of what was happening.

There was a pleasant atmosphere in the home and people generally appeared to be relaxed, comfortable and familiar with the staff team. In talking to some staff it was clear that they had a good understanding of peoples' needs and knew how to meet them.

Some of the comments from relatives were, "All of the staff are really helpful and there is always enough staff in the home" and "everything is great. I wouldn't hestitate to say if it wasn't".