This inspection took place on 15 and 16 December 2016 and was unannounced. The previous inspection was carried out in June 2014 and no concerns were identified.

Cedar House Residential Home is registered to provide personal care and accommodation for up to 29 people .There were 21 predominantly older people using the service during our inspection; who were living with a range of health and support needs.

Cedar House is a large detached property situated in a residential area just outside Hythe. There were 26 bedrooms, three being able to offer double occupancy, although the registered manager told us that they had all been used as single occupancy rooms for many years. 16 of the bedrooms had ensuite facilities with many having views across the English Channel. People also had access to a large communal lounge, dining room, bathrooms and toilets. There was an enclosed garden with a conservatory to the rear of the premises.

The service had a registered manager, who was present throughout the 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 and associated Regulations about how the service is run.

Staff followed correct and appropriate procedures in the storage and dispensing of medicines. People were supported in a safe environment and risks identified for people were managed in a way that enabled people to live as independent a life as possible. People were supported to maintain good health and attended appointments and check-ups. Health needs were kept under review and appropriate referrals were made when required.

A robust system to recruit new staff was in place. This was to make sure that the staff employed to support people were fit and appropriate to be working with people. There were sufficient numbers of staff on duty to make sure people were safe and received the care and support that they needed.

Staff had completed induction training when they first started to work at the service. Staff were supported during their induction, monitored and assessed to check that they had attained the right skills and knowledge to be able to care for, support and meet people’s needs. Staff continued to receive training, competence checks and support to meet the needs of people. There were staff meetings, so staff could discuss any issues and share new ideas with their colleagues, to improve people’s care and lives.

People were protected from the risk of abuse. Staff had received safeguarding training. They were aware of how to recognise and report safeguarding concerns. Staff knew about whistle blowing and were confident they could raise any concerns with the provider or outside agencies if needed.

Equipment and the premises received regular checks and servicing in order to ensure it was safe. The registered manager monitored incidents and accidents to make sure the care provided was safe. Emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do.

The care and support needs of each person were different, and each person’s care plan was individual to them. Care plans, risk assessments and guidance were in place to help staff to support people in an individual way. People's legal rights were protected as staff provided care in line with the Mental Capacity Act (2005). Correct procedures were followed when depriving people of their liberty. Staff followed the guidance of healthcare professionals where appropriate and we saw evidence of staff working alongside healthcare professionals to achieve outcomes for people.

Staff encouraged people to be involved and feel included in their environment. People were offered varied activities and participated in social activities of their choice. Staff knew people and their support needs very well. Feedback we recei

We undertook an inspection of Cedar House (Hythe) residential care home on 2nd May 2014. During the inspection we spoke with the registered manager, three staff and a volunteer worker. We also spoke with three of the people who used the service and encouraged each individual to communicate using their preferred method of communication.

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

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them, and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Staff personnel records contained most of the information required by the Health and Social Care Act 2008. We saw on two of the staff files viewed that the application form did not have a full employment history. We bought this to the attention of the registered manager so that they could take suitable action.

The provider had developed guidance on recruitment and selection to provide information to staff on the procedures for recruiting new employees. We looked at a sample of recruitment records for three staff. Examination of records and discussion with staff confirmed staff had undergone a comprehensive recruitment process prior to commencing work for the service. This meant the provider could demonstrate that the staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLs) which applies to care homes. While no DoLs applications have needed to be submitted, proper policies and procedures were in place. We saw that relevant staff had been trained to understand when a DoLs application should be made, and how to submit one. Policies and procedures had been developed by the registered provider to provide guidance for staff on how to safeguard the care and welfare of the people using the service. This included guidance on the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

We were informed that one person using the service had been assessed as lacking capacity to make decisions although no applications had needed to be submitted to deprive a person of their liberty. Training records highlighted that the majority of staff had completed Mental Capacity Act training and Deprivation of Liberty Safeguards training.

Is the service effective?

Feedback received from people using the service was positive and confirmed people were happy with the standard of care provided. Comments included: "I’m only here for respite, it’s my first experience of a care home, and I would definitely come back”. In relation to meals, one person reported: "The food is great, it’s better than a five star hotel" and another person confirmed the food was nice and tasty by replying "Yes" to the question.

Relatives had written in the compliments book “My aunt was very happy here” and were also complimentary of the standard of care provided. Comments received included: "They are very caring and understanding"; “The staff are very caring”.

Is the service caring?

On the day of our visit the atmosphere in the home was calm and relaxed. The people living at the service were observed to be comfortable and relaxed in their environment and were able to follow their own plans and preferred routines. Staff were attentive to the diverse needs of the people living in the service and we saw they communicated and engaged with the people they supported in a respectful, dignified and caring manner.

We found that people living at the service had been invited to take part in their own plan of care. The registered manager and staff were observed knocking on doors and calling people by their preferred name.

Is the service responsive?

People’s needs had been assessed before they moved into the home. Records we saw confirmed people’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their wishes. People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives.

'The registered provider had developed a complaints procedure. We saw that an easy read 'service user complaints procedure and a 'complaints and comments' booklet had been produced to provide people using the service and / or their representatives with information on how to provide feedback on the service provided.

No complaints or allegations were received from people using the service during our visit and records highlighted that there had been no complaints in the last twelve months.

People told us they were asked for their feedback on the service they received and that they had also filled in a customer satisfaction survey. They confirmed they had been listened to and as a result of the survey changes to the menu had been made.

Is the service well- led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. Staff told us they were clear about their roles and responsibilities. They said the management had consulted with them before implementing changes to the management of the home and their views had been taken into consideration.

At the time of our inspection, there were 20 people living at the home.

We spoke with 8 people who used the service and 2 visiting relatives. People we spoke with told us that they were happy with the care and support they received. One person told us “I get whatever I want; they are very, very good”. A visiting relative told us that the home was “the best one I’ve ever seen”.

We looked at people’s care plans and saw that they were individualised and contained each person’s choices and preferences. There were risk assessments in place to identify and minimise risks as far as possible to people who used the service.

The home was clean and tidy and had systems and procedures in place to manage infection control and minimise cross-infection. Staff understood their responsibilities and had received appropriate training in how to keep people as safe as possible in the prevention and spread of infections.

We spoke with people who told us there were enough staff on duty and that they had a good understanding of people's needs. We spoke to staff who told us about the training they had received. One member of staff told us “the home works well; there is a structure in place”.

The home had a range of checks and audits in place to monitor the quality and safety of the service provided.

Since our last inspection in December 2011 the home had employed a new manager. People told us that they liked the new manager. People we spoke with said “Have you met the new manager, he is good, he is lovely to speak to”.

People we spoke with told us they liked living in the home and that the staff were friendly and caring. One person said “I like it here, they are very good and help you a lot”.

People told us that they felt safe and we observed that people who lived in the home were very relaxed and comfortable within the environment. They interacted well with the staff who worked with them and encouraged their independence.

Some people living at the home told us that they felt there was insufficient staff on duty. One person said “They are very short staffed particularly of a night. They struggle to answer two of you at once”. Other comments received were “, “I ring the bell twice and they think I am impatient. They have got to go off to someone else” and “When you buzz they come as quickly as they can but they have to finish other jobs before they do”. We spoke with one visitor who said ”When she wants help she needs it then. They come and go away and come back eventually”.

People told us they were happy with the care and support they received. One person said “The staff are all lovely” another person said “The staff are excellent, they could not be kinder”. Visitors we spoke with said “I think the home is very good, staff are really good with her” and “The staff are very pleasant”.

People told us the food was very good and had a choice menu. One person said “I am intolerant of wheat, cook makes me little cakes with soya flower and soya milk. Another person said “I have lost my teeth, they have gone to the dentist to be refitted and cook gave me soft food”. Another person said “I love cheese and crackers and I get it when I want it”.

People living at the home, visitors and relatives told us that they thought the home was clean and tidy. One person said “The home is too clean at times”. Other comments received were “Clean, oh gosh I don’t think I have had so many cleaners in my life” and “They come around regularly”.