The inspection took place on 8th and 14th January 2019. The first day of the inspection was unannounced. We carried out this responsive inspection because of concerns raised by health care professionals and the local safeguarding authority.

Cedar Court Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Cedar Court is a purpose-built nursing home, able to provide care and support for up to 63 people whose care needs are associated with physical needs, mental frailty and/or dementia. At the time of our visit 47 people were using the service.

There was no 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. In the absence of a registered manager the service was operated by operational relief support manager.

We found the staffing levels to be inadequate to support the high number of people who required two staff to support them. As a result, staff spent most of their time carrying out care-related tasks in people's bedrooms, which meant they were not able to spend sufficient time engaging with people. With staff being busy caring out their tasks, some people were deprived of the care and support they needed for periods of time. This was evident from our observations and discussions with staff and people’s relatives.

Infection control monitoring within the service was in need of improvement. We found that bathrooms and some communal areas were not always clean.

The ‘grab bag’ that was supposed to be used in case of evacuation from the building contained a list of the residents that was up to date. However, the ‘grab bag’ first aid kit contained bandages that had expired in 2016.

Risks to people's health, safety and well-being had been assessed and were included in people's care plans. Records included guidance for staff to follow to protect people from the risk of harm. However, risks were not always managed appropriately in practice.

Some people told us they liked the food, but others found it was not to their taste. The menus displayed in the dining rooms was not always up to date. The dining experience was not positive for people who lived in the home.

Health care professionals told us that the service had not always sought medical advice in a timely manner.

Whilst some staff treated people in a kind and compassionate manner, this was not always demonstrated by all staff. People could not be assured their confidentiality of information was protected.

People were not always provided with opportunities to engage in meaningful activities, which depended on the availability of staff.

The provider had a complaints procedures, however, there was no evidence of all complaints being investigated and provided with a response.

Quality assurance systems were not always effective and did not identify the shortfalls we found during this inspection

People were supported to receive their prescribed medicines safely.

Appropriate arrangements were in place for reporting and reviewing accidents and incidents. This included auditing all incidents to identify any trends or lessons to be learned.

Safety checks for gas, emergency lighting and hoists had been completed and PAT testing was up-to-date.

Staff employed by the service had been subject to pre-employment checks to make sure they were suitable to work at the service and people felt cared for safely.

Staff completed induction when they started work, which included mandatory training and shadowing experienced colleagues. Staff told us they received one-to-one s

We inspected Cedar Court on 12 June 2018. This was an unannounced inspection.

Cedar Court 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.

We inspected Cedar Court on 12 June 2018. This was an unannounced inspection.

Cedar Court 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 care home accommodates up to 63 people. At the time of the inspection there were 38 people living at the service.

At our last inspection on 25 October and 1 November 2017, the overall rating was Inadequate and the service was placed into special measures by the Care Quality Commission (CQC). Five breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified. Following the inspection, we received regular action plans which set out what actions were being taken to bring the service up to standard.

We undertook this inspection on 12 June 2018 in line with our special measures guidance to see if improvements had been made. At this inspection we found significant improvements in the service. We could see that action had been taken to improve people’s safety, ensure there was enough staff, provide care that met people’s needs, ensure consent was sought in line with legislation and had effective systems and processes to monitor and improve care. However, improvements were still required in some areas which the provider was already working towards.

We were welcomed by the registered manager, the regional director and staff who were happy to see us and keen to show their caring nature and share the positive changes they had made in the last six months.

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.

We found the provider had made significant improvements to ensure people’s safety. Staffing numbers had been increased to ensure there were sufficient numbers of suitable staff to meet people's needs. The provider continuously recruited staff. The home had staff vacancies which were covered by regular agency staff to meet people's needs. Same agency staff were used to maintain continuity. The management team were doing all they could to ensure safety and maintain staffing levels. The home had robust recruitment procedures and conducted background checks to ensure staff were suitable for their roles.

People told us they were safe living at Cedar Court. Staff demonstrated they understood how to keep people safe and we saw that risks to people's safety and well-being were managed through a risk management process. There were systems in place to manage safe administration and storage of medicines. People received their medicines as prescribed. However, records relating to application of topical creams were not always completed. We also found people’s records in relation to activities and repositioning were not always up to date.

People had their needs assessed prior to living at Cedar Court to ensure staff were able to meet people’s needs. Staff worked with various local social and health care professionals. Referrals for specialist advice were submitted in a timely manner.

People were supported by staff that had the right skills and knowledge to fulfil their roles effectively. Staff told us they were well supported by the management team. Staff support was through regular supervisions (one to one meetings with th

This inspection took place on 25 October and 1 November 2017. Both visits were unannounced.

Cedar Court is a care home registered to provide accommodation for people who require personal or nursing care. It is located in a purpose-built facility and can accommodate up to 63 people whose care needs are associated with physical needs, mental frailty and/or dementia. At the time of our visit 43 people were using the service, most of whom lived with dementia. Prior to our inspection, we had received concerns about staffing levels, people’s safety and lack of social interaction between staff and people.

There was a registered manager in post at the time of our inspection. However, the registered manager resigned from their post after the first day of our inspection. 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.

There was a high number of people at the service who needed two staff members to assist them with their personal care and when mobilizing using a hoist. However, the staffing levels were insufficient to meet the needs of people. As a result, staff were occupied with providing care in people's bedrooms without being able to spend enough time engaging with people. This meant that when staff provided care to some individuals, other people were left without the care and support they needed for significant periods of time. This was evident from our observations and discussions with staff and relatives. Some relatives were concerned that they could not locate staff when they visited the home.

We could not be sure that people received assistance from staff when they needed it, because call bells were not available to some people. There was no alternative system in place for people to call for assistance.

Risk assessments and care plans were in place for each person. Although risks to people had been identified, the steps to be taken to deal with those risks were not always clear. Care plans did not always give enough detail to staff to enable them to manage those risks. People did not receive appropriate monitoring which placed them at increased risk of harm. For example, people were not always supported to eat and drink.

The premises were not free from offensive odours. The odour of urine was noted in different places, such as people’s rooms and the communal areas, in the course of the inspection. The home was unclean, both people’s bedrooms and the communal areas were untidy.

Although staff had received training in relation to the Mental Capacity Act (MCA). However, this learning was not applied. Capacity assessments were not decision-specific or individualised for each person. Where people lacked capacity to make decisions, capacity assessments and best interest's decisions were not completed where they should have been, for example in relation to the use of bed rails.

We observed interactions between staff and people. We found the culture of the service to be task focused. Meeting the individual needs of people was not priority in this culture. End of life care plans were in place, however, due to the low staffing levels staff could not spend time with people in the last days of their lives.

People’s social needs were met on a group level, however, due to the staffing levels the service was unable to meet individual social needs of people.

The provider had a range of quality monitoring arrangements in place to monitor care and plan ongoing improvements. This included audits, surveys and regular health and safety checks. However, the systems in place had not identified the shortfalls found at our inspection.

People were protected by the provider's recruitment procedures. The provider made appropriate pre-employment checks to ensure

We carried out this unannounced inspection on 8and 12 July 2016.

Cedar Court is a purpose-built nursing home caring for up to 63 people whose care needs are associated with physical needs, mental frailty and/or dementia. At the time of our visit 62 people were using the service, most of whom lived with dementia.

There was a registered manager in post at the time of our inspection. 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 told us they felt safe and staff were aware of their responsibility to keep people safe. Risks to people's safety were appropriately assessed and managed.

Systems were in place to make sure people received their medicines safely. Arrangements were in place for the recording of medicines received into the home and for their storage, administration and disposal.

Staff knew what action to take if they were concerned that someone was being abused or mistreated. The provider's whistleblowing policy protected staff to make disclosures about poor staff conduct or practice, and staff confirmed the manager would take responsive action if they reported such problems.

Staff had been recruited safely to ensure they were suitable to work with vulnerable people. There were sufficient numbers of suitable staff to meet people's needs and people received their medicines as prescribed.

We found the premises were clean and tidy. There was a record of essential inspections and maintenance carried out. The service had an infection control policy and measures were in place for infection control.

Staff had a good understanding of the Mental Capacity Act 2005 and we saw people’s consent was sought routinely. People were supported to make their own decisions wherever possible, and staff took steps to support people to do this. Where people were unable to make a decision, there was a best interest decision recorded within their support plan. We saw the person concerned and relevant people had been involved in making best interest decisions. This meant people were given the opportunity to participate in decision making and decisions were made in the person's best interests. The service had effectively implemented the Deprivation of Liberty Safeguards (DoLS) as required.

Records showed staff received the training they needed to keep people safe. The manager had taken action to ensure that training was kept up-to-date and future training was planned.

Staff told us they felt supported by the management and received supervision and appraisals, which helped to identify their training and development needs.

People had access to healthcare when they needed it and recommendations from healthcare professionals were implemented.

Staff prepared appropriate care plans to ensure people received safe and appropriate care and support. Each person had a personalised care plan containing information about their likes and dislikes as well as their care and support needs. The care plans were updated in line with changing needs and people and their relatives were involved in making decisions regarding their care.

People’s healthcare needs were closely monitored and responded to. Staff were considerate and caring. Their knowledge of the individual choices and preferences of people enabled them to provide people with relevant care and support.

The management appreciated and acted on people's and relatives’ opinions on the service, including complaints. Such information was used to implement changes and enhance the functioning of the service. People and staff had confidence in the manager as their leader and were complimentary about the positive culture within the service. There were systems and processes in place to help monitor the quality of the