This inspection took place on 22 August 2018 and was announced. We telephoned and spoke with relatives on 3 and 6 September 2018. The inspection was announced to ensure people who lived at the home would be present.

The Cedars is a 'care home.' People in care homes receive accommodation and nursing or 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 Cedars is registered to provide residential care and support for up to six adults with a learning disability or autistic spectrum disorder. At the time of our inspection five people were living at the home.

The care service has been developed and designed in line with 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.” Registering the Right Support CQC policy.

A registered manager was in place. 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.

At the last inspection, the home was rated overall Good with Requires Improvement in Effective. This was because the registered manager had not always taken appropriate action to ensure people had authorisations in place prior to being deprived of their liberty.

At this inspection, we found the home remained Good in Safe, Caring, Responsive, Well-led and improvements had been made in Effective. The monitoring of deprivation of liberty (DoLS) applications had improved ensuring people were not deprived of their liberty unlawfully. This inspection report is written in a shorter format because our overall rating of the home has not changed since our last inspection.

The provider had systems in place to protect people from abuse. Risks were identified, assessed and managed to minimise the potential risk to people who lived at the home. Where incidents took place, there was evidence that lessons had been learned. Sufficient staff members were deployed to meet people’s needs.

Relevant checks were completed to ensure staff had appropriate skills and were suitable to work with vulnerable adults. Staff completed specific training which equipped them to support people living at the home. Supervisions and appraisals were regularly held.

Medicines continued to be managed safely. Medicines records we viewed were accurate and up to date. The home supported people to access health professionals when required, including opticians, dentists, GPs and nurses. When guidance was given this was incorporated into people’s care plans.

The home carried out monthly health and safety checks including fire safety to ensure people lived in a safe environment. Systems were in place to ensure people would remain safe in the event of an emergency including a continuity plan to ensure people would continue to receive care following an emergency.

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 make healthy and balanced choices at meal times and people’s likes and dislikes influenced the planning of menus. People were supported to be as independent as possible. The home worked with people to identify goals to work towards and supported people to achieve these. People had regular involvement with health professionals.

Relatives told us staff were kind and caring. Staff we spoke with were knowledgeable about the people living at The Cedars and were able to describe peopl

The inspection took place on 25 February 2016 and was unannounced. A second day of inspection took place on 1 March 2016 and was announced. We previously inspected the service on 26 August 2014 and found the service was not meeting a regulation in relation to effective systems to regularly seek the views of people who used the service to enable the registered person to come to an informed view in relation to the standard of care and treatment provided. Quality systems have since been updated and the home actively seeks views from people and their relatives to improve the service.

The Cedars is a residential home that provides personal care and support for up to six adults with a learning disability or autistic spectrum disorder. At the time of our inspection there were five people living in the home.

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.

The registered manager and staff understood the principles of safeguarding and how to keep people safe from abuse.

Risk assessments were in place for people when required and there were clear links to care and support plans. There were also general risk assessments regarding the premises and environment. The home had an up to date fire risk assessment in place and each person had a personal emergency evacuation plan (PEEP) that detailed their individual support needs in the event of a fire.

Medicines were managed safely, effectively and in a way which reflected people’s individual needs. All records were up to date and fully completed, with medicine audits being carried out regularly.

Staff were recruited in a safe and consistent manner with all appropriate checks carried out. Staffing levels were consistent to meet people’s needs.

Deprivation of Liberty Safeguard (DoLS) authorisations were in place for some people who used the service. Where there was a delay experienced due to an application being with a local authority there was evidence of the registered manager requesting updates and chasing the authorisation with the local authority in question. However, appropriate action had not been taken to ensure an authorisation was in place for one person being deprived of their liberty.

Staff had up to date training in safeguarding, moving and handling, fire safety and first aid. Staff also received training in areas specific to people’s needs such as autism, epilepsy and Makaton.

Staff received regular supervision and annual appraisals. Staff told us they felt supported in their roles and they could approach the registered manager if they had any issues or concerns.

People’s preferences, likes and dislikes were taken into account when menu planning. People were given choices each meal time and offered alternatives if they did not want what was on offer.

Relatives told us they thought the service was caring and their family members were well looked after and happy. We observed staff supporting people in a caring, compassionate way and communicating with people in friendly, respectful manner.

The service provided personalised care. Staff had good knowledge and understanding of each person and knew how to support them in a way that met their specific needs. Relatives told us they felt people were looked after and well cared for in the home. Each person had a goal and activity plan in place.

There were communication profiles in place to inform staff how to effectively communicate with people and what signs people may show to express different moods and feelings.

Relatives and staff felt the service was well managed. There was an open, calm, relaxing atmosphere within the home. Staff felt supported in their roles and were kept informed and updated in rel

People who were using the service had complex needs which meant they were unable to tell us their views. Because of this we used a number of different methods to help us understand their experiences.

We considered all the evidence we gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found –

Is the service safe?

We spoke with five relatives of people who used the service. Relatives told us they were confident their family members were safe at The Cedars. One relative said, "We've never had any concerns. (My relative) seems very happy there." Another commented, “(My relative) seems keen enough to go back there (after a visit home) which is an indication of how he feels.”

We saw that risks to people’s safety had been identified and assessed to ensure that appropriate care and support was provided to keep people safe.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager informed us that five people were currently subject to DoLS orders. DoLS are a legal measure under the Mental Capacity Act 2005, which are put in place to ensure that people are looked after in a way that does not unreasonably restrict their freedom.

We noted that care plans contained information related to people's ability to make their own decisions. We saw that Mental Capacity Assessments had been carried out to determine if people lacked capacity to make specific decisions. Where assessments indicated that capacity was lacking, appropriate procedures were put in place to ensure that the person was protected. For instance, arrangements had been put in place for an appropriate person to manage one person's finances, as the person was unable to do this for themselves. We considered that if people did not have the capacity to consent, the provider acted in accordance with legal requirements.

We saw that where people could not consent to their care, steps had been taken to involve other appropriate people who could help to make important decisions in the person's best interests.

Care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare. We found that people who used the service were receiving the care and support they needed. The staff we spoke with could describe how they met the assessed needs of the people to whom they provided care. Relatives and health and social care professionals told us people received good, effective care.

Relatives acting on behalf of people who used the service were given appropriate information and support regarding their relative’s care and treatment and they understood the care and treatment choices available to them.

Is the service effective?

We found that people who used the service received the care and support they needed. The staff we spoke with were well informed about people’s needs and how they wanted to be supported.

From our observations and after speaking with relatives and staff, we concluded that people were supported in promoting their independence and community involvement. One relative commented, “(My son) has a really active lifestyle and loads of holidays.”

Staff received appropriate professional development. We observed that staff were knowledgeable and confident in the way they supported people. Relatives gave positive opinions about the staff team. One commented, “They’re all lovely people. They know everyone’s ways.” Another said, “They know people inside out and how to deal with them. They always seem well informed about autism.”

Is the service caring?

A relative told us, "(The staff) are very, very caring. (My relative) was in hospital for six months. One member of staff even cancelled their holiday to be there with him. I was really touched. They were absolutely fabulous with him." Another relative told us, "I've no concerns about (my family member's) care. Everyone loves (my family member)."

Is the service responsive?

Staff were well informed about the individual methods people used to communicate their wishes. We saw that staff had good face to face contact with people when they were talking and let people speak for themselves. We noted that staff knew people very well and were very sensitive to their needs. A relative of one person commented, "(My family member) makes a lot of choices. He lets staff know what he wants and they understand."

Is the service well-led?

There were a range of quality assurance systems in place. Audits were carried out to check people were cared for appropriately, for instance, to make sure medicines were managed safely.

A manager was in place who was registered with the Care Quality Commission. Staff felt supported by her and confirmed that she provided good leadership.

We received mixed views from relatives. All were happy with the care their family members received, however some had concerns that the manager did not spend sufficient time with their family members or have a thorough knowledge of them; they felt this could be partly attributed to the fact the current manager worked part-time at the service as she also managed another service. One relative commented, "The manager is very nice but she doesn't interact with (the people) there. She is only there three days a week and she tends to be in the office. I don't think she knows the people there." Another relative commented, “I can honestly say, there has been zero communication with the manager. She is invisible. We never get any communication from her; it’s invariably the other staff who tells us things.” This meant the provider had not regularly sought the views of relatives to enable the provider to come to an informed view about people’s care and treatment. We have set a compliance action in relation to this and the provider must tell us how they plan to improve.

Some of the people using the service had complex needs which meant they were unable to tell us their views: because of this we used a number of different methods to help us understand their experiences.

We observed care and found that staff could respond to people’s individual needs and cared for people in a kind and respectful way.

We spoke with two relatives of people who used the service. One person told us they thought the service was “Very Good” and the staff made their relative “Happy and occupied”.

The other relative we spoke with said “I couldn’t speak highly enough of the care my relative receives, it is second to none. My relative is always happy, relaxed, clean, tidy and dressed correctly. The staff don’t just do a job they actually care”.

There were systems in place for checking the safety and quality of the service. We saw that people living at the home were involved as far as possible in the planning and cooking of meals and people’s nutritional needs were monitored.

We found there were effective recruitment procedures in place for staff and the provider had an adequate complaints procedure in place.

Some of the people we met were not able to tell us their views but we observed how they were being cared for. We saw they were relaxed and comfortable as they went about the home. We also saw how they responded to prompts from care workers and how care workers gave them support with individual activities such as completing a jigsaw puzzle or a piece of art work. People who lived at The Cedars enjoyed taking part in a range of different outdoor activities and were able to go out to pursue personal interests.

We visited the home unannounced on 15 February 2012 and met most of the people who lived there, as well as care workers. The registered manager was on annual leave, but came in to the home and stayed until the end of the inspection visit.

Some of the people we met were not able to tell us their views. However, we observed how they were being cared for, and saw that they were happy, relaxed and comfortable as they went about the home or spent time in their rooms. We also saw them with the care workers, and saw that there were good relationships between them, as care workers gave them support with activities such as laying the table for lunch and making pictures.