The inspection took place on 20 and 23 October 2017 and was unannounced. The service had previously been inspected on 27 June 2016.

Cedrus House provides accommodation, nursing and personal care for up to 70 people. At the time of our inspection there were 63 people living in the service. There are six individual units within the building. Each floor is divided into two suites, with each suite having its own dining room and living area.

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.

Our previous inspection of 4 July 2016 found that the service was rated as Good overall, but we found that improvements were needed in Well-Led, we found that staff had not consistently followed clinical guidance and the key question was rated as Requires Improvement. During this inspection we found that sufficient improvements had been made in this area and we rated Well-Led key question as Good. All the other key questions apart from Safe have been rated as Good, unfortunately Safe has been rated as Required Improvement. Overall, Cedrus House has been rated as Good.

There had been several significant thefts from people using the service since our last in inspection in July 2016. The provider had taken advice from the police, who had investigated the thefts, and had taken steps to protect people from this abuse and were working towards identifying the thief. There had been no further thefts since our inspection, but we could not be confident that the action taken would be effective enough to stop the thefts from happening. People told us that, although the experience was upsetting and worrying, they believed the registered manager was taking appropriate action to stop their money and property going missing.

During this inspection, people who lived in the service told us that they felt safe and well cared for. They believed that the staff knew what support they needed and that they were trained to meet those needs and to keep them safe. There were enough staff on duty, including senior staff, catering and housekeeping, to protect people from harm. Risks to people were assessed and steps had been put in place to safeguard people from harm without restricting their independence unnecessarily. People’s medicines were managed safely.

People were asked for their consent by staff before supporting them in their day to day care. Staff were provided with training in safeguarding adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager knew how to make a referral if required. 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 were supported to eat and drink enough to maintain a balanced diet. They were also supported to maintain good health and access healthcare services.

We saw many examples of positive and caring interactions between the staff and people who lived in the service. People were able to express their views and staff listened to what they said and took action to ensure their decisions were acted on. Staff protected people’s privacy and dignity.

People received care that was personalised and responsive to their needs. The service listened to people’s experiences, concerns and complaints. They took steps to investigate complaints and to make any changes needed.

The service was well led by the registered manager who felt they were well supported by their line manager, the regional director and the organisation. People using the service and the staff they managed told us that the registered manag

The inspection took place on 4 July 2016, and was unannounced.

Cedrus house provides accommodation, nursing and personal care for up to 70 people. At the time of our inspection there were 58 people living in the service. There are six individual units within the building. Each floor is divided into two suites, with each suite having its own dining room and living area.

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.

Our previous inspection of 13 and 22 October 2015 found that improvements were needed in how the service completed assessments to accurately reflect individual needs and risks. There was also concern that clinical governance systems were not effective. The provider wrote to us and told us how they were addressing these shortfalls. During this inspection we found that some improvements had been made.

There were processes to monitor the quality and safety of the service provided and to understand the experiences of people who lived at the service. This was through regular communication with people, surveys, spot checks on staff during the night, and a programme of other checks and audits. However, some audits could be used more effectively to implement further learning and change. Whilst the management team had made continued progress in addressing more effective systems and procedures, some were not yet fully embedded in practice, and we found that clinical guidance was not consistently followed.

Staffing numbers were assessed against and reflected people’s dependency needs, and we saw that staff responded to people in a timely manner. Staff took their time with people when delivering their care, and people were not rushed. However, we received some comments which indicated that the management team should review its current provision to ensure people’s needs are met at all times.

Care plans and risk assessments contained clear and detailed information which supported staff to meet people's needs. There was opportunity to improve care plans further by developing a more person-centred approach which focusses on a person’s whole life, including their emotional and social care needs.

Staff received the necessary training and support to enable them to do their jobs. The service had introduced monitoring tools which checked staff knowledge and understanding once training was completed.

Procedures were in place which safeguarded the people who used the service from the potential risk of abuse. Staff understood the various types of abuse and knew who to report any concerns to.

Staff understood the principles of the Mental Capacity Act (MCA), and gained people's consent before they provided care. People told us they were encouraged to make choices about their daily lives. There were procedures in place to ensure that people who could not make decisions were protected, and we found assessments had been completed.

Staff respected people’s privacy and dignity at all times and interacted with people in a caring, respectful and professional manner.

Safe recruitment procedures were in place, and staff had undergone recruitment checks before they started work to ensure they were suitable for the role.

Systems were in place to ensure people's medicines were managed in a safe way, and people received their medicines in a timely manner. People were supported to maintain good health and have access to relevant healthcare services.

We saw people received a good choice of food and drink, and people's individual food requirements were well catered for.

A complaints procedure was in place. People’s concerns and complaints were listened to and addressed in a timely manner.

We carried out this inspection on the 21 August 2015. It was unannounced. The service has not been previously inspected before as it is a new location. We brought forward a planned comprehensive inspection because of concerns received. At the time of our inspection there were thirty four people using the service on the ground and first floor, the top floor has not yet opened.

At the time of this inspection the home had a registered manager. 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 protected from avoidable harm and abuse that may breach their human rights. There were sufficient staff on duty and staff had received the training they required to care for and keep people safe including safeguarding people. The service had emergency plans in place and carried out regular tests of equipment for example fire doors.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines safely.

There was a robust recruitment procedure in place and staff were supported through supervision.

Staff understood how the mental capacity act (MCA) and deprivation of liberty safeguards (DoLS) protected people to ensure their freedom was supported and respected. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals. DoLS provide legal protection for those vulnerable people who are, or may become, deprived of their liberty.

People had access to a range of health care professionals to help maintain their health. A varied and nutritious diet was provided to people that took into account their dietary needs and preferences so that their health was promoted and choices could be respected.

People told us they could speak with staff if they had any worries or concerns and felt confident they would be listened to. We saw staff care for people with kindness and respect.

There were systems in place to monitor and improve the quality of the service provided, but had not fully taken account of all areas to be monitored. The service was using both a paper based and electronic recording care system. We saw that notes were made regarding peoples care on each shift, but we could not see how this related to the care plan. We also saw a number of care plans that had not been updated. Although staff were knowledgeable about the people in their care there were inconsistencies in recording of peoples weights and what they had eaten and had to drink over a period of time.

We saw people participated in a range of daily activities both in and outside of the home which were meaningful and promoted independence.

Regular checks and audits were undertaken to make sure full and safe procedures were adhered to. People using the service and their relatives had been asked their opinion via surveys, the results of these had been audited to identify any areas for improvement.

We carried out an unannounced comprehensive inspection of this service on 21 August 2015. After that inspection we received concerns in relation to how the service supported people living with diabetes. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Cedrus House on our website at www.cqc.org.uk

This focused inspection took place on 13 October 2015 and was also unannounced.

The service is registered to accommodate up to 70 people. On the day of this inspection there were 35 people living in the service.

There was 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.

The pre-admission assessment we viewed had not been fully completed. It did not provide the service with a full picture of the person’s care and support needs so that the service could decide whether they could meet their needs.

Care plans did not consistently reflect people’s needs, not always being fully completed and containing contradictory assessments of a person’s ability. Quality monitoring system did not identify that the assessment was incomplete and therefore a risk

Staff had received training in diabetes but were unable to recall the training.

Clinical governance systems were not effective and did not ensure that staff received up to date guidance and information and that people received safe care. Some guidelines had not been updated in line with current guidance and where policies had been reviewed these had not been disseminated to relevant staff.