Cedar Park Nursing Home is registered to provide accommodation for persons requiring personal or nursing care for up to 52 people. On the day of the inspection, there were 29 people accommodated in the service.

This comprehensive, unannounced inspection took place on 3 October 2018.

Cedar Park 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.

Accommodation is offered over three floors, offering single and double bedrooms with hand washing facilities. There are no bedrooms with en-suite facilities. The dining room, lounge and conservatory are located on the ground floor.

At our last inspection we rated the service as good overall. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

During our inspection the service did not have a registered manager in place however the manager had applied to the Care Quality Commission for registration. 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.’

At our last inspection we found that a fire door had been repeatedly propped open, keys to access medicines had been left unattended and a person who was at risk from choking had been left unattended to eat their food. At this inspection, we saw that these issues had been addressed.

Adequate numbers of suitably trained staff supported people. Staff knowledge was updated through continuous learning, supervision sessions and observations.

Interactions between staff and people were gentle and caring. Staff communicated effectively with people and respected their privacy and dignity.

People and staff spoke positively about the manager, there was an open-door policy in place and this meant that the manager was always accessible. Effective arrangements were in place to monitor the quality and safety of the service.

The service was responsive to people’s needs and provided end of life care that was personalised to people’s needs and wishes.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service supported this practice.

Further information is in the detailed findings below

The inspection took place on 29 and 30 April 2016 and was unannounced. The service was last inspected in July 2014 when there were no breaches of the legal requirements of the legislation that were in place at that time.

Cedar Park Residential and Nursing Home is registered to provide personal and nursing care for up to 52 people. The service is run from two connected buildings on the same site. On the day of the visit, there were 46 people at the home.

There was a registered manager for the service. 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.

Some staff failed to properly take into account the health and safety of people. For example, during the lunchtime staff handover meeting four people with complex needs were left alone in a lounge with no staff supervision in the same room as them. The handover took place in the conservatory, which extends out next to the lounge. However this meant people could have been at risk at this time as there was no one in immediately available in the room if there was an emergency.

People told us they felt safe there and that staff treated them well and were caring towards them. They told us that staff were kind and always respectful. When risks to people were identified suitable actions were put in place to minimise the risk of people being harmed when receiving care. The risks of abuse to people were minimised, as staff were competent in their understanding of abuse. The team were trained to know how to report concerns correctly.

People were assisted by enough staff to provide individual care and support to people and to keep them safe. Staff were deployed throughout the home in a way that meant people's needs were met.

Care plans explained what actions were needed to meet people’s range of care and nursing needs. Staff knew what was written in each person’s care records. They knew how to provide care that was flexible to each individual and met their needs.

We saw that there were positive and caring relationships between staff and people who lived in the home and this included relatives.

People told us that they were happy with the food and told us they were offered choices at each mealtime. People were provided with a varied diet that suited their needs. There were regular one to one and group activities taking place in the home. People told us they liked the entertainers who performed at the home on a regular basis.

When possible, people were included in making decisions about how they were looked after. The provider had effective systems in place that helped ensure that staff obtained consent to care and treatment in line with legislation and guidance. When people did not have capacity to consent, their care needs were assessed in line with The Mental Capacity Act 2005. Staff had completed Mental Capacity Act training. They knew about consent, people’s rights to take risks and the how to act in someone’s best interests.

People were assisted by staff who had been trained and developed in their work to improve and develop their skills and competencies. Nurses were supported to go on regular training to help them know how to provide nursing care based on current practice.

Staff spoke highly of the registered manager who they said provided strong and supportive leadership. The staff team told us they were well supported by them and they regularly worked shifts alongside them. Staff described the manager as “Very hands on” in their approach.

The manager spoke positively about the challenges of their role. Arrangements were in place to monitor the service to try and ensure people always received a caring and personalised service. Quality audits identified where improvements were nee

We used a number of different methods to help us understand the experiences of people using the service. These included observations and looking at records. This was because some people had complex needs or memory loss which meant it was difficult for some to tell us their experiences of care. We spoke with seven people and three relatives of people who lived at Cedar Park who all spoke positively about the care received and staff attitudes. One person said “the staff are very good; they look after me and are kind and very nice.” Another person told us “I have absolutely nothing bad to say, staff are good and kind and will help me with anything I need help with.”

People and relatives told us they thought the food was good and that different main meal choices were available every day. One person said “there is always a choice and there is always plenty to eat and drink. I like the food and am never hungry.” We spoke with the cook who demonstrated an understanding of nutrition. The cook showed us a list of what individual people liked and disliked to eat and preferred portion size. This ensured people were offered the food they liked, and the amount of food was appropriate for people.

We spoke with five staff who demonstrated they understood how to recognise the signs of abuse and the various forms it could take. Staff told us about the safeguarding adults’ policy, where they would find it and how to use it. Records showed carers consulted other health or social care professionals for additional advice in order to provide safe and appropriate care and safeguard people from abuse.

Staff told us they felt supported by the new manager and had regular supervision. Staff said there were opportunities to gain extra qualifications to support and develop their roles. The manager showed us records which confirmed staff had attended regular training. This meant staff were appropriately supported to provide safe and effective care for people.

Cedar Park offers a welcoming atmosphere that both people who use the service and their representatives told us made them feel at home.

We saw people being treated with dignity and respect during our visit.

Staff asked people for their consent before offering them support and there were safeguards in place where people did not have the mental capacity to make decisions.

There was a comprehensive care planning system in place which detailed the needs of people who used the service and how they would be met. The system was supported by a series of risk assessments and risk management plans. People who used the service and their representatives were able to contribute to their care plans, these reflected their personal preferences. There was evidence that the home worked collaboratively with other community health professionals and clinical specialists outside the home, to ensure the best care was made available to individuals. People told us that they enjoyed the food and drink provided within the home. They were able to choose what they wanted to eat and when.

Staff within the home had access to training relevant to their roles. They were also able to receive professional support and supervision within the home. On a yearly basis they had appraisals, which linked to their continuous professional development.

In November 2011 we carried out a review of Cedar Park Care Home and we identified some areas where the service needed to make improvements. Following the review, the registered providers Messrs A & M & K Desai told us about the changes they intended to make. The purpose of this review was to visit the service to check on the improvements. The areas we were concerned about were:

Consent to care and treatment, and

Care and welfare of people who use services.

We spoke to people living in the home when we carried out our previous review in June 2011, but we did not involve people during this review.

We spoke to the home manager and looked at care records to ensure that the changes that were needed had been implemented. We found that new care planning documentation had been introduced and these set out the assessed care needs of each person, and how those needs were to be met. We saw that where possible people had signed their agreement to these plans (called Enabling plans). Where people lacked capacity to make decisions about their day to day care and welfare, full mental capacity assessments had been recorded and best interest plans had been made. These measures have ensured that people receive the care and support that they need, and that where possible people were involved in making decisions about their care.

This inspection was carried out to review the actions required following the last inspection completed in June 2011

We reviewed the care records of four people, three of whom were currently living at the home and for one former service user. We found that when people became acutely ill, their care needs were not being effectively monitored and that care plans were not updated to reflect their increased needs.

Since the last inspection action had been taken to address the concerns we raised at our last review. People’s dignity was now protected. Staff were now supporting people at meal times in a way that respects their dignity and with discreet prompts and encouragement. The routine use of aprons and plastic cups had stopped. They were only used where it was in the person’s best interests.

People who we met and spoke to during our visit were very positive about the service they received and said they were included in decisions made about their care. “Before I came to live here I was asked loads of questions about how I wanted to be looked after. I am looked after very well”. “The staff are very respectful and helpful”. “I am very well looked after.”

People we met during our visit told us that they were happy with the care they received and that they were asked if they were in agreement to the care, treatment and support they were to receive. “The girls always ask me if I am ready to get up”. For people who are not always able to make their own choices and decisions, there was no system in place to carry out mental capacity assessments, so that the service could show how they made decisions in those people’s best interests.

We carried out this inspection over three days on the 12, 14 and 17 November 2014. At our last inspection in December 2013 no concerns were identified.

Cedar Park Nursing Home provides accommodation for up to 52 people who require personal and/or nursing care. At the time of our visit there were 50 people living at the home. Cedar Park is made up of two adjoining units known as the Georgian wing and the Orchard wing. The Georgian wing is able to accommodate 32 people over three floors. The Orchard wing can accommodate 20 people over two floors. Both wings have their own passenger lift, nurse’s station and communal areas including a lounge, dining room and conservatory. There are single and shared rooms in both wings and a central laundry and kitchen.

The home had recently appointed a new manager who was responsible for the day to day operation of the home. They were in the process of applying to become the registered manager of Cedar Park. 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 home manager was present during the whole of our inspection.

Risks to people’s safety were not always reported and acted on. Assessments identifying risks were not always up to date. Information showed some people were not drinking sufficient amounts but intervention to address this was not evident.

People were encouraged to make decisions about their daily lives including what to eat, what to wear and how they spent their day. However, the process for those people who did not have the capacity to make specific decisions was not being followed according to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards legislation.

People and their relatives were happy with the care provided. However, not all people were sufficiently supported to minimise their risk of pressure ulceration. Some people remained in the same position during our inspection and care charts did not demonstrate the frequency of repositioning, as detailed within care plans.

Care plans did not consistently reflect people’s individual and changing needs. Staff had written some pertinent information in the evaluation section of the plan and had not updated the main care plan. This meant there was a risk that information would be missed and not all staff would be fully aware of people’s needs.

Staff told us they felt supported and had the training they required but records did not evidence effective systems were in place. Staff were not consistently receiving supervision according to the home’s policy. Not all staff had received up to date training in mandatory subjects such as manual handling and safeguarding. Questionnaires which had been used as a training tool had not consistently been marked, which meant potential shortfalls in staff’s knowledge were not being identified.

The home had systems in place to monitor the quality of the service. These included a range of audits and the use of questionnaires and meetings to gain people’s views. However, the systems did not fully reflect the Quality Assurance policy and action plans were not always clear in terms of any issues raised. Some action plans were not specific and not re-visited to ensure any remedial work had been completed, as required.

Staff spoke and interacted with people in a polite, caring and sensitive manner. Staff regularly engaged with people and promoted conversation. Staff fully involved people in interventions such as using the hoist and gave reassurance throughout.

Staff were aware of people’s needs and were committed to their wellbeing. People had access to varied social activities based on their personal preferences. Staff were clear about promoting people’s privacy and dignity and consistently demonstrated this within their practice.

Staff managed people’s medicines in a safe manner. The home’s policies and procedures were followed. All medicines were stored securely and records demonstrated the safe receipt, administration and disposal of medicines. People’s medicines were reviewed by regular contact with GPs. Records showed that people had good access to a range of professionals, to meet their health care needs.

People were offered sufficient nutritious food, which was cooked “from scratch”. People’s health and cultural needs and individual food preferences were catered for. People chose their meal the previous day and were offered alternatives, if they did not like what was on the menu.