Cedar Court Nursing 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 Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Cedar Court Nursing Home accommodates 25 people in one adapted building. At the time of our unannounced inspection there were 17 older people, some of whom were living with dementia, living at the service.

This inspection took place on the 16 January 2018 and was unannounced. At the last comprehensive inspection on 13 January 2017 we rated the service as requires improvement. At this inspection the necessary improvements had been made and we rated the service as good.

Why the service is rated good.

The Care Quality Commission (CQC) records showed that 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 2008 and associated Regulations about how the service is run.

Staff had an understanding of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Staff knew how to report any suspicions of harm and poor care practice. Information and guidance about how to report concerns, together with relevant contact telephone numbers were available as a prompt for staff to refer to.

People were assisted to take their medication as prescribed. Processes were in place and followed by staff members to ensure that infection prevention and control was promoted and the risk of cross contamination was reduced as far as possible.

There were building adaptations in place to help people with limited mobility. This meant that people could access all of the services internal areas and the garden.

Staff assisted people in a caring, patient and respectful way. People’s privacy and dignity was maintained and promoted by the staff members supporting them.

People and their relatives were given the opportunity to be involved in the setting up and review of their individual support and care plans. Staff encouraged people to take part in activities and maintain links with the local community to promote social inclusion. People’s friends and family were encouraged by staff to visit the service and were made to feel welcome.

People were supported by staff to have enough to eat and drink. People were assisted to access a range of external health care professionals and were supported by staff to maintain their health and well-being.

People were supported by staff and external health care professionals, when required, at the end of their life, to have a comfortable and as dignified a death as possible.

People had individualised care and support plans in place which documented their needs. These plans informed and prompted staff on how a person would like their care and support to be given, in line with external health care professional guidance.

Individual risks to people were identified and monitored by staff. Plans were put into place to minimise people’s risks as far as possible to allow them to live as safe and independent a life as practicable.

The registered manager had a recruitment process in place and staff were only employed within the service after all essential safety checks had been suitably completed. Staff were trained to be able to provide care which met people’s individual needs. The standard of staff members’ work performance was reviewed by the registered manager through supervisions and appraisals. This meant that the staff felt supported to carry out their role.

Compliments about the care and support provided

Cedar Court Nursing Home provides accommodation, nursing and personal care for up to 25 older people including those living with dementia. Accommodation is provided on one level. There were 22 people living in the home during this inspection.

This inspection was unannounced and took place on 13 January 2017. The previous inspection took place on 17 June 2015 and overall was rated as good. However, we had received concerning information about the care that was being provided to the people living at Cedar Court Nursing Home and as a result of this we brought the date of this inspection forward.

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

The CQC monitors the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Staff had received training and had an understanding to ensure that where people lacked the capacity to make decisions they were supported to make decisions that were in their best interests. People were only deprived of their liberty when this was lawful.

People’s dignity was not always respected. People privacy was protected and staff sought, and obtained, permission before entering people’s rooms to provide personal care.

The provider had a recruitment process in place and staff were only employed within the home after all essential safety checks had been satisfactorily completed.

Staffing numbers were adequate to ensure people’s care needs were met. However staff were task led and had little time for social interaction.

Care plans provided detailed information on how people’s care needs need to be met and had been reviewed on a regular basis. Wherever possible people or their families were involved in the planning of the care people received.

People’s health, care and nutritional needs were met. People were provided with a varied, balanced diet and staff were aware of people’s dietary needs. Staff referred people appropriately to healthcare professionals when this was needed. People received their prescribed medicines and medicines were stored in a safe way.

The provider had an effective complaints process in place which was accessible to people, relatives and others who used or visited the service.

Cedar Court Nursing Home is registered to provide accommodation and nursing care for up to 25 older people There were various communal rooms for people to use. The home is a single storey building. There were 23 people living at the home at the time of our inspection.

This unannounced inspection took place on 17 June 2015. At our previous inspection on 28 April 2014 we found the provider was not meeting all the regulations that we looked at. We found concerns in relation to care and welfare of people. The provider sent us an action plan detailing when the improvements would be made by. During this inspection we found that improvements had been made.

At the time of this inspection the home did not have 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.

We found that staff treated people in a way that they liked and that there were sufficient numbers of staff to safely meet people’s needs. People received care which had maintained their health and well-being. Relatives were very happy with the care provided.

Medicines were stored correctly and records showed that people had received their medicines as prescribed. Staff had received appropriate training for their role in medicine management.

Staff supported each person according to their needs. This included people at risk of malnutrition or dehydration who were being supported to receive sufficient quantities to eat and drink.

Staff respected people’s privacy and dignity. They knocked on people’s bedroom doors and waited for a response before entering. People told us that staff ensured doors were shut when they were assisting them with their personal care.

People’s needs were clearly recorded in their plans of care so that staff had the information they needed to provide care in a consistent way. Care plans were regularly reviewed to ensure they accurately reflected people’s current needs.

People confirmed they were offered a variety of hobbies and interests to take part in and people were able to change their minds if they did not wish to take part in these.

People’s views were sought and used to improve the lives of people. Quality assurance systems were in place to monitor the home although these were not all effective. The management were unable to provide evidence of all documents requested during this inspection. We asked for these to be sent to us but we have not received them.

During this inspection we spoke with ten people who use the service, four visitors, five staff, the manager and the provider.

We considered out inspection findings to answer 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?

This is the summary of what we found:-

Is the service safe?

We found that staff had received appropriate training to carry out their roles. Staff we spoke with understood their responsibilities in reporting any concerns in regards to safeguarding vulnerable adults. We saw that people’s moving and handling hoists and fire equipment had been serviced regularly to ensure peoples safety.

Is the service effective?

People had their health monitored and saw a range of health care professionals to maintain their wellbeing. Staff were well supported and had the required training to do their jobs well. Staff were knowledgeable about people’s care and support requirements. Not all the care records reflected people’s current needs and this could put people at risk of not receiving the appropriate care with their identified needs.

Is the service caring?

We spoke with ten people who use the service and four visitors and most were complimentary about the staff and felt they or their relatives were well cared for. We saw that people were given time to perform differing tasks which allowed them to be as independent as possible.

Is the service responsive?

People’s needs were assessed but not all care records had been updated to reflect their current needs. People were given the opportunities to join in activities and visitors were able to visit the home at any time. People and their families were given the opportunities to express their views about the running of the home through relative meetings.

Is the service well led?

The manager has been in post since August 2013 and has recently applied to register with the Care Quality Commission. Quality assurance systems were being further developed to ensure that all aspects of the service were monitored and improvements made where necessary.

We completed this inspection as a result of concerning information we had received. We were told that some people had not received all of the nursing and personal care they needed, medication had not always been managed in a safe way and that the arrangements to reduce the risk of infections were not sufficient. In addition, we were told that there were not enough staff on duty to safely provide people with the assistance they needed. Also, it was said that the provider did not operate a robust recruitment and selection procedure to ensure that vulnerable people were safeguarded from abuse.

We spoke with three people who used the service and with two relatives. They gave us positive feedback about the service. A person said, “The staff are very kind to me and they help me a lot.”

People had safely received all of the nursing and personal care they needed.

There were effective infection control arrangements to ensure that good standards of cleanliness and hygiene were maintained.

There were reliable arrangements for managing medication so that people reliably received all of the medicines that had been prescribed for them.

There were enough qualified, skilled and experienced staff to enable people's needs for care to be met. This included staff receiving the training they needed to care for people in a safe way.

Records showed that the provider operated a robust recruitment and selection procedure.

We completed this inspection as a result of concerning information we had received. We were told that on occasions there were not enough staff on duty to safely provide people with the nursing and personal care they needed. In addition, we were informed that the provider did not operate a robust recruitment and selection procedure to ensure that vulnerable people were safeguarded from abuse.

We found there were enough qualified, skilled and experienced staff to enable people’s needs for care to be met. A person said, "I like seeing the staff around because I do need help and they check on me at night too."

Records showed that the provider operated a robust recruitment and selection procedure. This included completing security checks on new staff to help ensure that they were suitable to care for vulnerable people.

Having enough staff on duty and making sure that they were trustworthy supported the provider's ability to safely care for people.

All of the five people with whom we spoke gave us positive feedback about the service. One of them said, “The staff help me a lot and they’re all very kind and nice to me. They help me get comfortable in bed and they check on how I’m doing.”

Documents and records gave a clear and up to date account of the care provided for each person. We saw that safe, reliable and responsive support had been provided to ensure that people ate and drank enough. We also noted that people had been helped to keep their skin healthy by reducing the pressure and friction that can cause ulcers.

We found that care and ancillary staff had the necessary knowledge and skills to provide people with the care they needed. However, records showed that they had not received all of the training which the provider considered to be necessary.

People’s needs were assessed and they were cared for as described in their individual care plans. However, care and treatment was not always planned well enough to provide staff with adequate guidance. This resulted in some people gaining a lot of weight and pressure relieving mattresses not always having been maintained at the appropriate pressure.

People had access to advice and treatment of health care professionals, such as dieticians and district nurses.

The service provided a four week rotating menu cycle, which included an alternative meal option. All main and alternative meals included a source of protein, which ensured all meals were nutritionally balanced. A mix of fresh and frozen vegetables was available, as was fresh fruit.

We found that people who needed help to eat and drink were provided with this help. They were helped to sit in appropriate positions and support from aids was provided for people who needed help to eat independently.

Drinks were offered at the lunch time meal and a further three times before the next meal. Water jugs were available in people’s rooms and one person confirmed that staff members would be around to refill their glass when they had time.

Not all records about people were written as quickly as they should have been and some had only started to be kept after concerns had been identified. For example, when pressure relieving mattresses were found to be too hard for the person using them.

People told us that staff members explained what they were going to do before providing any care or support to them and asked if they were happy for it to go ahead. A visitor told us that staff members discussed any issues concerning their relative before they took action.

People said that they were well cared for and were able to decide how to spend their time. Visitors we spoke with also commented that they were happy with the care their relatives received. Staff members spent time with people who could not easily communicate and encouraged them to be involved in their surroundings. They communicated well with people and supported people who were anxious.

People confirmed they would be able to make a complaint if they were not happy with anything, but that they could not think they would ever have to do this. People’s relatives also felt they could raise any concerns and have them dealt with.

The purpose of this inspection was to check that improvements had been made in relation to medication management at the home. We did not speak to people living in the home about medicine management on this occasion.

We did not talk to people living at the service about their medicines on this occasion.

The purpose of this visit was to assess improvements made in relation to shortfalls identified during our previous review of compliance in June 2011. At this visit we did not request information directly from people using the service however at our previous visit in June 2011 people did share with us their views about the quality of care provided by Cedar Court.

People we talked with spoke highly of the home’s staff and we received a number of positive comments including: ‘Staff are all very nice’; ‘Staff are great, especially those young ones’. Relatives commented: ‘Staff tell me what’s going on with my husband, he’s looked after well’ and: ‘The care at Cedar Court is more personal than other homes I’ve been to’. People also told us that the premises were homely and the atmosphere in the home was good. However people did raise concerns with us about the lack of activities to keep them stimulated; the occasional stale smell of urine; that their concerns were not always addressed and the poor quality of the food.

We specifically asked people about the availability of hoists and moving and handling equipment and they told us there was enough equipment when they needed it. People also reported that staff were considerate and talked to them respectfully. Two people told us they were enjoying their lunch that day and the food was generally good.