The inspection took place on 21 and 22 June 2018 and was unannounced.

Cedar Lawn Nursing Home 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.

Cedar Lawn Nursing Home is a converted property and accommodates up to 30 people who require nursing care. When we inspected there were 26 people living in the home. There were three shared rooms in the property, the rest being single occupancy rooms of varying sizes. Most rooms had ensuite toilet and wash basin facilities.

There was a registered manager in post. A registered manager 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 had completed notifications as required and was in the process of completing the PIR for the service.

At our last inspection we were concerned there were not enough staff to support people. There were now sufficient staff deployed to ensure that care was safely delivered and the service was now compliant with regulations.

We had also been concerned at aspects of medicines management. This had improved and medicines were safely managed.

Risks were assessed and well-known assessment tools were used to maintain people’s health and well-being.

Equipment and systems such as the fire alarm, hoists and passenger lifts were regularly serviced and maintained.

Risks of harm from legionella was minimised with a robust risk assessment and management plan.

People were protected from being cared for by unsuitable staff by a thorough recruitment process.

Staff were knowledgeable about safeguarding and were able to identify possible signs of abuse and knew what actions to take if they suspected it had occurred.

People’s needs were assessed and care plans devised to meet their needs.

The service complied with the requirements of the Mental Capacity Act (MCA) and when necessary applied for authorisation to restrict peoples freedom under Deprivation of Liberties legislation.

Peoples nutritional needs were met and the service provided appetising meals to the requirements of individuals.

We made a recommendation that the provider reviewed staff deployment at lunchtimes.

The service was proactive in promoting people’s dignity.

Life profiles were completed for all residents which showed what people liked to do at particular times of the day.

End of life care was dealt with sensitively and people were supported to have a respectful and dignified death.

There were robust quality audits which were completed regularly and acted upon.

Policies and procedures were comprehensive, readily available and reflected good practice.

This inspection took place on 31 August and 1 September 2016 and was unannounced.

Cedar Lawn Nursing Home is an older style property which has been adapted to provide accommodation for up to 30 older people who require nursing care. The home is set over three floors with the accommodation being situated on the ground and first floors which are accessed by a lift or by stairs. Three of the rooms are for double occupancy. At the time of our inspection there were 28 people living at the home. The home does not provide specialist support for people living with dementia or those who might display behaviour which might challenge others. The service has a selection of communal sitting areas, a dining room and conservatory and a garden with outdoor seating areas. There is parking to the rear.

The manager was not currently registered with the Care Quality Commission. 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. The manager had submitted an application to register and this was currently being assessed.

Medicines were not always administered as prescribed and care plans or information within the care plans about medicines was not always complete, current or followed by staff.

Improvements were needed to ensure that there were at all times sufficient numbers of staff deployed to meet people’s needs in a responsive manner.

Recruitment practices were safe and relevant checks had been completed before staff worked unsupervised.

Staff had a good understanding of risks to people’s health and wellbeing and measures were in place to protect people from risks associated with the environment.

Staff understood the signs of abuse and neglect. They were aware of what to do if they suspected abuse was taking place.

Staff felt well supported and received an induction and on-going training which helped to perform their role effectively.

Where people lacked the mental capacity to make decisions staff had undertaken mental capacity assessments and care plans had been agreed which described the support that was to be provided in the person’s best interests.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Where people’s liberty or freedoms were at risk of being restricted, the proper authorisations had been applied for or were in place.

People received a choice of meals and were supported appropriately to eat and drink.

People were supported to access healthcare services when needed.

People told us they were cared for by kind and caring staff. Staff respected people’s choices, their privacy and dignity and encouraged them to retain their independence.

Care plans were developed that provided guidance about how each person would like to receive their care and support and about their individual needs and risks.

Staff recognised and responded to changes in people’s health care needs.

A range of activities was provided which people enjoyed.

People and their relatives were able to express their views and give feedback about the service. Their views were listened to and acted upon. .

Complaints policies and procedures were in place and displayed within the home and within the information pack given to new people when they arrived.

People, their relatives and staff spoke positively about the manager and their leadership of the home. Staff told us that the service was a good place to work and that they enjoyed their job.

Systems were in place to monitor the quality and safety of the service.

Staff worked and interacted with people and visitors in a manner that was in keeping with the organisation values, aims and objectives.

We found two breaches of the Hea

People told us they were very happy with the care and support provided at the service. One person told us "I couldn't ask for a better place - they are lovely and very patient and caring". Another told us "there are lots of activities to do but if we don't want to do them they understand". A large number of 'thank you' cards from relatives and people who had used the service previously were displayed on walls, which showed many more people also had a positive experience of the service prior to the inspection visit.

People's choices and consent to care and support were observed to be respected at all times during our visit. We observed staff supporting people with day to day activities, and the interaction was observed to be sincere, respectful and responsive to individual support needs.

We reviewed care plans for three people and they were person centred and contained essential details about people's care and support needs.

A family member told us "if I have any problems I can speak to the staff. The matron is very helpful and will support me in any way that she can. I have nothing but praise for everyone here".

Staff were seen supporting people to eat and were patient and went at their pace. During the inspection one person declined the choices that were offered for lunch. The person was asked what they would like and requested cheese on toast which was prepared by the chef. This showed that people's wishes and choices were respected and acted upon.

We spoke with four people who use the service and one person’s relative, four members of staff, the matron and a company director. People told us that staff treated them respectfully and supported them in ways that promoted their independence and met their needs. One person said that: “Care is very good” and another told us that staff: “Are so careful”. Throughout our visit we observed positive interactions between staff and people using the service. Staff we spoke with demonstrated their knowledge of care plans and people’s needs.

All of the people we spoke with told us that they felt safe in the home. They were confident that staff had the appropriate knowledge and skills to meet their needs. Staff were described as: “Marvellous” ”Friendly” “So kind” and “Very competent”. People told us that the matron listened to what they said and responded to any questions. A person’s relative told us that: “Actions are taken in response” to comments and that the matron: “Communicates well and has driven standards up in the short time she has been there”.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time of this inspection. We have advised the provider of what they need to do to remove the individual's name from our register.