We inspected The Cedars on 23 and 25 May 2018. The Cedars provides accommodation and personal care to nine people who had a learning disability or were on the autistic spectrum. At the time of our inspection six people were living at The Cedars.

The Cedars is located near the centre of Gloucester, close to a range of amenities, parks and the local hospital. The home has a large enclosed communal garden and an outdoor building known as the “lodge”. There were plans in place to refurbish and create an annexe at the back of the home to cater for people who required their own personal space. People were assisted by support workers who assisted them with their day to day needs, one to one time and a range of activities.

We last inspected the home on 12 and 13 October 2016 and rated the service as “Requires Improvement”. We identified that further improvements were still required in relation to people’s care and risk assessments and the service’s quality assurance systems needed to be embedded further and show sustainability. During our May 2018 inspection we found these improvements had been sustained and we rated the service as “good”.

There was a registered manager in post. 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 care service reflected 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.

People were happy, safe and benefitted from an active and full life. People's ability to be as independent as possible was developed at The Cedars. Where possible, people were supported to take positive risks and to be in control of their care. There were enough social support workers deployed to ensure people had their one to one needs met and enable them to undertake the activities they wished.

People where possible were involved in reviewing their care needs, to ensure they were tailored to their individual life. People were at the centre of their care. Support workers knew people well and knew how to support them with their needs and goals. The registered manager and staff looked for opportunities to offer to people that would help them grow, gain confidence and live a fulfilled life.

Support workers were well supported and had the benefit of a training programme which enabled them to ensure they could provide people with the best possible care and support. Support workers understood and worked to the values of the registered manager to put people at the heart of everything they did. All support workers felt the registered manager focused on their personal development and needs, which enabled them to provide better quality support to people.

The service had a strong leadership presence. They were committed and passionate about the people they supported and were constantly looking for ways to improve. Thorough and frequent quality assurance processes and audits ensured that all care and support was delivered in the safest and most effective way possible.

We inspected The Cedars on the 12 and 13 October 2016. The Cedars is a residential and nursing home for up to eight people living with learning disabilities or autism spectrum conditions. Seven people were living at the home at the time of our inspection. This was an unannounced inspection.

We last inspected in December 2015 and found that the provider was not meeting a number of the regulations. We found that people did not consistently receive safe care and treatment, because records relating to their needs and risks had not always been maintained. While there were systems to identify concerns within the service, action was not always taken to address these concerns. Additionally people were possibly being deprived of their liberty without authorisation. Following our inspection in December 2015, the provider provided us with a plan of their actions to meet the relevant regulations. During this inspection we found a number of improvements had been made however there was still room for improvement and consistency.

At our inspection on 12 and 13 October 2016, there was a registered manager in post. They had started working at the Cedars following our inspection in December 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 provider and registered manager had implemented effective systems to monitor the quality of service people received. However as a number of systems had only recently started or been acted upon therefore it was difficult to evidence consistency and effectiveness of the systems. Healthcare professionals spoke positively over the actions the provider and registered manager had taken. Staff spoke confidently over the improvements made to the service.

People were at risk of unsafe care and treatment as their care plans did not always reflect their needs. The registered manager had clear actions in place to ensure people’s care plans were updated and rewritten shortly following our inspection.

There were enough staff deployed to meet people’s day to day needs. There was a consistent management team in place who were managing the staffing levels, by recruiting new staff. People received their medicines as prescribed at times.

People enjoyed busy and active lives at The Cedars. People were supported to access the community, and their independence and personal relationships were promoted. People were comfortable with care staff at The Cedars. Staff treated people as equals and promoted a homely atmosphere.

People were supported with their nutritional needs. Staff sought and acted upon the advice given to them by healthcare professionals. Staff had access to the training and support they needed to meet people’s day to day needs.

This inspection took place on 10 and 11 December 2015 and was unannounced. The Cedars provides accommodation and rehabilitation care and support for up to nine people who have a learning disability. They service is located near the centre of Gloucester close to a range of local amenities. At the time of our inspection eight people were using this service.

The service 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 and associated Regulations about how the service is run.

People were not always safe as the premises were not always safe and secure. Areas of the building which posed a risk to people were not always secured, chemicals used for washing clothes were accessible to people. Risks identified in fire safety audits had not been acted upon.

People told us they felt safe within the home. Care workers had knowledge of safeguarding and knew what action to take to ensure people were kept safe and free from avoidable harm.

There were systems in place to enable the provider to gather feedback from people or their relatives. The registered manager and provider had systems to identify concerns in the service; however action had not been taken to rectify these concerns and make improvements to the service.

People were supported to make decisions around their care. Staff had knowledge of the Mental Capacity Act 2005. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. However staff did not have knowledge around Deprivation of Liberty Safeguards. The registered manager had not considered Deprivation of Liberty Safeguard (DoLS) applications for people who may be being deprived of their liberty or under continuous monitoring.

Two people did not always receive support around their social and emotional needs, and went long periods of time without positive engagement from care workers. Other people had access to activities outside of the home, and clearly enjoyed the variety of activities and events they were supported to attend.

People's needs were assessed and any risks in relation to their care were identified. However, there was not always clear guidance for care staff to follow to ensure people’s needs were met. People’s care plans did not always reflect people’s current needs.

People were supported by care workers who were knowledgeable and had access to the training they needed to meet people’s needs. Care workers felt supported however they did not always receive supervision (one to one meetings with their line manager) which may limit their professional development.

People were supported and cared for by kind, caring and compassionate care workers. Care workers knew the people they cared for and what was important to them. Care workers supported people to stay as independent as possible.

Where people had specific dietary needs these were met by attentive care workers, who knew how to support people and the risks around their nutritional needs.

The service was responsive to people's changing needs and made sure people had their visits when they needed. People and their relatives were involved in planning their or their relative’s care. Staff were trained to identify concerns or changes with people's needs.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

One adult social care inspector carried out this inspection. The focus of the inspection was to answer the five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and staff told us, what we observed and what records we looked at.

If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

Risk assessments were seen to be thorough and individualised for each person living at the home. There was a thorough analysis of the risks and guidance was provide for staff regarding risk management plans.

The service was safe, clean and hygienic because the environment was observed to be clean and well maintained with good infection control monitoring procedures in place.

Staff and management understood the requirements of the Mental Capacity Act (2005). There was comprehensive documentation to support this. People’s capacity had been assessed and only where there was a lack of capacity were decisions made on their behalf in best interests meetings.

Is the service effective?

People’s health and social care needs were assessed before they came to live at the home. Subsequently they were seen to be involved in the developing of their care plans. People said “I like to go swimming and meet my friends" and “I choose what we do each day and I like the music and dancing I do each week”.

People told us that they were very happy with the care provided and that they liked the independence they were encouraged to maintain.

Is the service caring?

People were treated with dignity and respect. People told us that they liked living at the Cedars. Staff were observed interacting with people in a respectful and caring way, listening to their views and responding to them appropriately.

People’s preferences, interests, wishes, aspirations and diverse needs were recorded in their care plans. This meant that care and support was provided in accordance with their wishes.

Staff said that the care plan documentation was straightforward to understand. This meant that care and support was delivered in way that met the individual's needs.

Is the service responsive?

People who used the service were seen to express their views to staff about how they wished to spend their day. There were also notes of meetings between staff and people who use the service which demonstrated that ideas were put forward by people and these views were taken into account when plans for activities were made.

Is the service well-led?

The provider had a quality assurance systems which evaluated medication, health and safety, infection control, safeguarding as well an overall "registered provider monitoring visit". This system included an action plan to meet any plans for improvement of the service.

The service worked well with other agencies such as the Community Mental Health Team and the Community Learning Disability Team.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time of this inspection. We have advised the provider of what they need to do to remove the individual's name from our register.

We spoke with three people about the care and support they received and they all told us that staff talked to them about their care needs. During our visit we observed staff talking to people about how they wanted to spend their time and what they wanted to eat and drink.

Care plans were personalised to each individual's needs and from the people we observed we saw that they accurately reflected their needs and wishes. Appropriate arrangements were in place in relation to the recording of medicine. There were enough qualified, skilled and experienced staff to meet people’s needs.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time of this inspection. We have advised the provider of what they need to do to remove the individual's name from our register.

During our visit we spoke with three people who were able to communicate their views of living in the home. They told us they were happy living in the home, staff treated them respectfully and they were able to make choices about their daily living. People told us “I like living here, I have friends” and “I like going out for rides and we are going for a Chinese meal on Thursday”. We observed staff offering people choice and supporting them to do what they wanted in the home and to go out. Staff interactions were respectful and at the pace of the person they were working with.

Care plans were personalised to each individual's needs and risk assessments were completed where appropriate. However, not all care plans provided up to date details of how people’s needs should be met. This was because care plans had not been regularly reviewed. Care was provided in an environment that was safe, well maintained and met people’s needs.

People told us they liked living at the home. One person said, "I like my bedroom and my DVDs," and, "I like the staff, I like everything here." Another person said "It's fine here. I like it. I like my room," and, "The staff are nice. I like all the staff."

People living at the home told us that they were able to have their say about the way the home was run through residents' meetings called 'Your Voice'.

They said they were able to make choices around household chores. Staff encouraged them to be involved if they wanted to, for example by bringing down their laundry in individual baskets, and one person regularly helped out with hoovering. One person said, "I'm not into chores," and this choice was respected by staff.

People told us they felt safe at the home. They knew how to raise concerns both formally and informally. They also told us they felt they would be supported if they did raise a concern. One person said, "If I'm not happy I can speak to my keyworker or any of the staff." They told us that staff knew how to meet their needs.