About the service: The Cedars is a small residential care home located in Baildon, near Bradford. It provides accommodation and personal care to up to 12 people aged 65 and over. At the time of the inspection 9 people were living in the service.

People’s experience of using this service:

People, relatives and health professionals provided very positive feedback about the service and the level of care provided to people. Staff were dedicated in providing people with a highly personalised and companionate service. There was a lovely atmosphere within the home and the staff and management team all knew people extremely well. The service was homely, decorated to a very high standard and kept very clean.

Medicines were not always managed in a safe or proper way. Overall, risks to people’s health and safety were appropriately assessed, although improvements were needed to the pre-assessment process for new residents.

There were enough staff deployed to ensure people received prompt care and support. Recruitment practices were not consistently operated in a safe way. Formal systems of staff supervision and appraisal needed to be put in place.

People received a good and varied diet and the management team went out of their way to provide people with food in line with their individual choices and preferences. People were treated equally and fairly and their human rights upheld.

People’s needs were assessed and people received care and support in line with their choices and preferences. The service worked effectively with health professionals to help meet people’s needs. There was an excellent range of activities and social opportunities for people.

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.

Systems to assess, monitor and improve the service needed improving. The registered manager was very ‘hands on’ and this was sometimes at the detriment to ensuring robust systems and documentation were in place. The service needed to assess and monitor its activity on a regular basis to ensure it was meeting the requirements of our regulations and standards.

Rating at last inspection: At the last inspection in January 2018 the service was rated as Requires Improvement overall.

Why we inspected: We inspected the service to follow up on the warning notice we issued the provider at the last inspection in January 2018.

Enforcement: Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up: We will meet with the provider to discuss our concerns and monitor their governance arrangements on an ongoing basis.

The Cedars is a ‘care home’ in Baildon, Bradford. People in care homes receive accommodation and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. The care home accommodates 12 people in one adapted building.

The inspection took place on 30 January 2018 and was unannounced. At the previous inspection in January 2016 we identified one breach of regulations relating to ‘Good Governance. “Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to ensure compliance with the regulations.

At this inspection we found issues remained with the organisation, presence and relevance of documentation. Although we did not identify any significant risks to people, if appropriate and robust documentation is not maintained there is the risk of unsafe of inconsistent care delivery.

A registered manager was 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 registered manager and provider were very ‘hands on’ and provided highly person centred care. There was a dedication to ensuring people had fulfilling lives and the best possible care and support experience. However the ‘hands on’ nature of the registered manager was at the detriment to maintaining appropriate documentation, with a lack of administration support to carry out these duties. This lack of robust documentation meant the service could not consistently evidence safe, effective care and a well led service, despite some really positive feedback about the service from people, relatives and staff and positive interactions observed during the inspection.

People were safe from abuse living in the home. People said they felt safe and safeguarding procedures were in place to help protect people. Whilst the staff we spoke with had a good understanding of each person and the risks they presented, this was not always underpinned by robust and up-to-date risk assessments which increased the risk of inconsistent or appropriate care.

The premises was maintained to a high standard with very pleasant fixtures and fittings and a warm and homely feel. Key maintenance checks were undertaken in most areas, although we identified some concerns relating to fire safety which we referred to the Fire Service.

Medicines were managed safely and people received their medicines as prescribed. However protocols were required to support the safe and consistent use of “as required medicines”

There were enough staff deployed to ensure people received prompt care and support. Staff had time to spend with people as well as completing care and support tasks. Recruitment procedures were in place but documentation did not always evidence some of the recruitment decisions made.

Staff knew people well and were knowledgeable about the topics and questions we asked them about. However staff training was not well organised and we were unable to evidence staff had received training in a number of areas.

The service was compliant with the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity, decisions were made in their best interest. There was a culture of seeking consent before any care and support interventions.

The service worked effectively with a range of health professionals to meet people’s individual needs. Technology was utilised to help ensure care needs were met.

People had access to home cooked food which they said was of high quality. People had a range of choices which were adapted to people’s individual needs.

Staff were extremely kind and

The Cedars is a two storey building with twelve beds. It is situated in Baildon, with good transport links to Bradford and Shipley areas. The Cedars is a care home without nursing which provides personal care and accommodation. On the day of inspection, 11 people were living in the home who were all female

The inspection was unannounced and took place on 27 January 2016.

A registered manager was 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.

People and their relatives all told us that staff were kind and treated them with a high level of dignity and respect. We observed care and support and found this to be the case, with staff displaying a high level of warmth and friendliness towards people.

Staff had an in depth knowledge of the people they were caring for, which meant they were able to provide a highly personalised care. Staff understood people’s individual likes, dislikes and preferences.

People told us they felt safe in the home. Staff had a good understanding of how to control risks to people’s health, safety and welfare.

The building was warm and homely and kept well maintained. The atmosphere within the home was very pleasant with staff constantly engaging with people and any visitors to the home.

Medicines were safely managed and people received their medicines at the times they needed them.

There were enough staff to ensure people received a high level of care, support and companionship. Staff displayed a good knowledge of the people and subjects we asked them about.

People told us the food was good. We saw people were provided with a variety of food. Where people were at risk of malnutrition, appropriate steps were taken by the service to help control this risk.

People’s healthcare needs were met. The service regularly liaised with external professionals where specialist advice was required.

The service was meeting the legal requirements of the Deprivation of Liberty Safeguards (DoLS) and Mental Capacity Act (MCA).

A variety of activities were available to people. We observed staff interacted positively with people throughout the inspection in order to keep them occupied. This was supplemented by games, puzzles and external visitors such as singers. People were encouraged to develop and maintain links with the local community.

People told us they had no cause to complain and were highly satisfied with the service.

People, relatives and staff told us the service was well managed. They all said the service provided high quality care which met individual needs.

Improvements were required to documentation relating to people’s care and support assessments and plans and documentation relating to the management of the service such as training records and polices. The service did not have a robust system in place to assess, monitor and improve its quality, although we did see this was done informally by the registered manager by ensuring a high level of presence within the home, and retaining a high level of understanding of people and their individual requirements.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) 2014. Regulations. You can see what action we asked the provider to take at the back of this report.

We spoke with four people who used the service and they told us they enjoyed living at the home and were very complementary about the care and support provided by the manager and staff. One person said, "It would be for the worse if they changed anything here," and another person said, "It's very good we are well looked after."

We found staff were well supported in their role and were provided with an appropriate level of support and training in order for them to carry out their role effectively.

People were protected against the risk of abuse. Staff received training in safeguarding to protect vulnerable adults. The policies and procedures were available to all staff in relation to safeguarding.

We also found the provider had an accurate Statement of Purpose (SoP) and it contained the necessary information including aims and objectives, the kinds of services provided, names of key individuals working for the service, legal status of the provider and details of the office address.

There was an effective complaints system in place. The manager told us if complaints were made they would be responded to appropriately.

We spoke with three people who used the service. They all spoke highly of the care they received and told us they would without hesitation recommend it to anyone.

One person said, "I love it here, the food is lovely, the staff are brilliant," another person said "I am very comfortable here it's lovely." Another person said " I am well looked after I can stop in bed, get up when I want, the food is very good indeed I have no complaints, the staff are wonderful."

The care records we reviewed showed people who used the service were involved in making care decisions and had consented to their care. The care plans were up to date and people had their health and welfare needs met.

We spoke with two members of staff who were very complimentary about the care home and the support they received. One care worker told us, "I love it, I love my job I wish I had done it years ago, it's just like home from home." Another said, "I like working here everybody is really nice, they are lovely ladies and they appreciate everything you do for them."

During the inspection we saw staff interacting with people in a considerate and respectful way. The staff also gave clear instructions to people they were supporting and time to respond. We also saw people being moved appropriately during our visit.

We saw there was enough staff on duty and we did not see anyone having to wait for assistance. We spoke with staff who told us there was enough staff on duty to carry out their roles.