The inspection took place on 23 August 2017 and was unannounced.

The Cedars provides nursing and residential care for up to 56 older people some of whom may be living with dementia or physical disabilities.

At the last inspection, the home was rated good. At this inspection we found the home remained good.

The provider had a set of audits in place to monitor the quality of care provided. However, we found that they had not identified concerns around recording of wound and continence care. In addition, they had not identified that topical medicines such as creams were not appropriately managed.

We have recommended the provider follow the best practice guidelines in recording care around these areas.

There were enough staff available to meet people’s needs and staff received appropriate training and support which enabled them to provide safe care to people. Appropriate recruitment checks were completed to ensure staff were safe to work with people living at the home.

Staff were kind and caring and knew how to provide care which supported People's individual needs. Staff knew how to identify and report abuse and the registered manager investigated concerns raised. Risks to people were identified and care was planned to minimise the risks to people’s wellbeing.

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 home supported this practice. Where necessary people had been referred for a Deprivation of Liberty Safeguards assessment and staff supported people to make choices about their care.

People were supported to take part in a wide range of activities which included accessing the local area. People were encouraged to identify activities that they would enjoy and staff worked to help them completed these activities.

We inspected The Cedars on 24 October 2014. This was an unannounced inspection which meant that staff and the provider did not know we would be visiting.

The Cedars provides accommodation for up to 56 older people who require nursing or personal care. There were 53 people living in the service when we carried out our inspection some of whom lived with dementia and had complex nursing care needs.

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 and associated Regulations about how the service is run.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection no people had had their freedom restricted.

People who lived in the home and their relatives were happy with care provided. They said they felt safe and were treated with compassion and dignity.

We found examples of care and support which enabled people to maintain their independence as far as they could, to feel included in the way the home was run and to receive care in the way they wished. Staff provided care and support in a warm and caring manner.

Staff understood people’s needs, wishes and preferences and they had been trained to provide effective and safe and care which met people’s individual needs.

People and their relatives were able to raise any issues or concerns and action was taken to address them.

There were robust arrangements for ordering, storing, administering and disposing of medicines.

We found that people were provided with a choice of nutritious meals. When necessary, people were given extra help to make sure that they had enough to eat and drink.

People had access to a range of healthcare professionals when they required specialist help.

The registered manager assessed and monitored the quality of the service provided for people.

The home had established strong links with local community groups which benefited people who lived in the home.

The home had been accredited with a Gold Standards Framework award since 2005 which is a comprehensive quality assurance system which supports care homes to provide quality care to people nearing the end of their life.

There were 51 people living at The Cedars on the day we visited. We spoke with three people who lived in the home, a relative and a visitor. We also spoke with domestic staff kitchen staff and care workers.

We saw staff were polite and kind to people and always asked their consent before providing any care. One person told us, “Staff always knock before coming in.”

We saw most care plans had not been signed by the person receiving care or their representative to say they were happy with the plan. While no one told us they were unhappy with the care they received, there was no check they had been fully involved in decisions about their care.

People told us they were happy with the care they received.

We looked around the home and saw all areas were clean, tidy and odour free. One person we spoke with told us, “I am happy with the cleanliness of the home.”

People we spoke with told us the care they received at The Cedars met their needs. One person we spoke with told us, “You can rest assured there are no problems.” A relative told us the home was “Absolutely wonderful” and said their parent had been 150% better since living there.

Records showed people were involved with their care and had signed their care plans to indicate they were happy with them. There were systems in place to review care plans monthly with people using the service and quarterly with relatives involvement.

We saw there were good relationships between members of the care staff and people who lived at the home. One person told us the staff were, “All very approachable and nice.”

We saw people had a choice of food at lunch and tea time. However staff were not always pro active in engaging with people whilst assisting them with their meal.

We saw the medication was not always safely secured in the trolley during the medication round.

Records showed there were systems in place to support and train staff.

One person living at the home told us, “I’m very satisfied with everything.”

Another person said, “The nurses and carers all seem very nice. The food is very good, we get soup with every meal. If you go hungry it would be your own fault. The home is really nice and very clean.”

We spoke with a relative who told us, ”We are very satisfied, the meals are quite adequate, there’s plenty to eat and drink. People get offered fresh fruit each day. There’s always plenty of staff around and they all seem very pleasant.”

A GP who was visiting the service told us, “I’m not a regular visitor to this home but as far as I can see people seem to be well looked after. The staff seem to know about people’s needs. I have no concerns.”