We inspected this service on the 9 March 2017. The inspection was unannounced.

At our previous inspection on 15 July 2015, we found a breach of a regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. A breach of Regulation 19, the provider had failed to ensure recruitment information was available for each person employed. At this inspection we found that improvements had been made to meet the relevant requirement.

We required the provider to make improvements in relation to the safe recruitment of staff. We found that improvements had been made and the provider was now meeting the regulations. However we have made a recommendation about this, following this inspection.

Cedardale Residential Home is a privately owned care home providing accommodation and personal care for up to 29 older people, some of whom are living with dementia, mental and physical health needs and mobility difficulties. There were 28 people living in the service when we inspected. Cedardale is a large detached property with accommodation on two floors in the main building and a spacious single storey extension. A stair lift provided access to the first floor. There is a garden to the rear of the home and off road parking at the front.

At the time of our inspection the service was undergoing refurbishment, new décor and carpets were planned for throughout.

There was a registered manager in place who was also one of the providers’ of 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. The registered manager was supported by a general manager, who managed the day to day running of the service.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. At the time of the inspection, applications had been made to deprive people of their liberty. The registered manager and the management team understood their responsibilities under the Mental Capacity Act 2005. The day to day manager had arranged for staff to receive further training to develop their knowledge. Mental capacity assessments and decisions made in people’s best interest were recorded. People were actively encouraged and supported to make decisions relating to their lives.

People using the service felt safe with the staff that supported them. Staff and the management team had received training about protecting people from abuse, and they knew what action to take if they suspected abuse. Risks to people’s safety had been assessed and measures put into place to manage any hazards identified. The premises and equipment were maintained and checked to help ensure people’s safety.

Recruitment practices were safe and checks were carried out to make sure staff were suitable to work with people who needed care and support. However, gaps in potential staffs employment history had not always been explored. We have made a recommendation about this. There were enough staff on duty with the right skills to give people the support they required. Staff were supported in their role by the registered manager and the management team.

Staff had a full understanding of people’s care and support needs and had the skills and knowledge to meet them. Staff were supported in their role and kept informed about any changes within the service by the management team. People were treated with dignity and respect by staff who also maintained people’s privacy. People were supported to develop and maintain relationships with people that mattered to them.

People’s needs had been assessed to identify the care and support they required. Care and support was planned with people and their relatives and regularly rev

We undertook this focused inspection on 15 July 2015 following concerns raised by a number of sources. The inspection was unannounced. The concerns raised were in relation to people being restricted in their beds by chairs and tables, low staffing levels and a shortage of medicines for people.

At our previous comprehensive inspection which was carried out on 2 February 2015, we identified no breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can read the report by selecting the ‘all reports’ link for ‘MGL Healthcare Limited - Cedardale Residential Home’ on our website at www.cqc.org.uk.

This report only covers what we focussed on in relation to the concerns.

Cedardale Residential Home is a care home providing accommodation and personal care for up to twenty nine older people who are living with dementia, mental and physical health needs and mobility difficulties. There were 26 people living at the service when we inspected. The service is located in Maidstone, approximately half a mile from the town centre.

Cedardale is a large detached property with accommodation on two floors in the main building and a spacious single storey extension. A stair lift provided access to the first floor. There is a garden to the rear of the home and off road parking at the front.

There was a registered manager at the home. 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.

New staff recently employed at the home were not always recruited using the procedures designed to protect people. Records relating to recruitment kept at the service did not contain the information required under schedule 3 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and records for some staff were not available in the service at the time of inspection.

Medicines were managed, stored, disposed of and administered safely. People received their medicines when they needed them and as prescribed. However, staff had not consistently followed safe practice around administering and recording medicines given to people. We have made a recommendation about this.

Safeguarding procedures were in place to keep people safe from harm. Staff had been trained in how to protect people from abuse, and discussions with them confirmed that they knew the action to take in the event of any suspicion of abuse. Staff understood the whistle blowing policy and how to use it. They were confident they could raise any concerns with the management team or outside agencies if this was needed.

Potential risks to people in their everyday lives had been identified, and had been assessed in relation to the impact the risk had on people. The premises and equipment were adequately maintained with a range of security checks in place.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the suitability of the staff employed at the service. You can see what action we told the provider to take at the back of the full version of this report.

This inspection took place on 2 February 2015 and was unannounced.

Cedardale Residential Home is a care home providing accommodation and personal care for up to twenty nine older people who were living with dementia. People had a variety of complex needs including dementia, mental and physical health needs and mobility difficulties.

The service is located in Maidstone, approximately half a mile from the town centre. Cedardale is a large detached property with accommodation on two floors in the main building and in a single storey extension. A stair lift provided access to the first floor.

There was a registered manager at 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.

The previous inspection was carried out in May 2013 when we found the service met the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Safe recruitment procedures ensured staff were suitable to work with people although not all pre-employment checks are recorded. The fire safety risk assessment for the premises was not carried out by an appropriately qualified person. We have made recommendations related to these aspects of the service.

People made complimentary comments about the service they received. People told us they felt safe and well looked after. Our own observations and the records confirmed this. Relatives were satisfied with the service.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Whilst no-one living at the home was currently subject to a DoLS, the manager understood when an application should be made and how to submit one and was aware of the Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty.

We found the home was meeting the requirements of the Deprivation of Liberty Safeguards

Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests. Staff were trained in the Mental Capacity Act 2005 (MCA) and showed they understood and promoted people’s rights through asking for people’s consent before they carried out care tasks.

People were protected from abuse. Staff had training in safeguarding adults and knew how to report abuse. Staff were able to support and care for people whose behaviour could be challenging due to their dementia. This reduced the risk of harm to themselves or others and provided effective care. Staff had the skills they needed to communicate effectively with people who were living with dementia.

There were enough staff employed in the home to provide the care and support people needed. Staff received the essential training and updates required to enable them to carry out their roles. Staff told us they received regular supervision. Appraisals were incorporated into supervision sessions to monitor the performance or staff and identify any training needs.

People had individualised care plans which were updated as people’s needs changed. Day to day information about people’s needs was passed on during handovers between shifts so that staff had all the information they needed about how to care for people.

People’s weights were monitored to make sure they were getting the right amount to eat and drink to protect them from the risk of malnutrition and dehydration. People told us they enjoyed the meals provided. Staff made sure that people’s dietary needs were catered for. People received the medicines they needed when they needed them.

People were supported to manage their health care needs. Advice from health professionals such as GPs and District nurses was followed to make sure people’s health was promoted. Prompt action was taken when people were showing signs of illness.

Staff took time to initiate conversations with people other than when they were providing the support people needed. Staff were kind, caring and patient in their approach and had a good rapport with people. People knew who to talk to if they had a complaint. Complaints were passed on to the registered manager and recorded to make sure prompt action was taken and lessons were learned which led to improvement in the service.

Each person had an individual activity programme to ensure they were provided with meaningful activities to promote their wellbeing. People were supported to maintain their relationships with people who mattered to them. Visitors were welcomed at the service at any reasonable time and people were able to spend time with family or friends in their own rooms and other areas.

The attitudes, values and behaviours of staff and the management enabled and encouraged open communication with people and their relatives. We received positive feedback from people and their relatives about the service. Whilst there were no formal processes for gaining people’s views, the management had day to day contact with people and their relatives. Relatives told us they could talk with the management at any time.

Quality assurance systems were effective in recognising shortfalls in the service and ensuring on going improvement. Records relating to people’s care and the management of the service were well organised and kept up to date.

We recommend that the provider seeks advice from a suitably qualified person to ensure any risks of fire are identified and minimised.

We recommend that the provider seeks and follows guidance on how to ensure that all pre-employment checks are recorded.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had dementia. This meant they were not always able to tell us their experiences. We observed how people interacted with the staff and management of the service. The atmosphere in the home was calm and relaxed. All the interactions we saw between staff, management and people who lived in the home were positive.

We spoke with two relatives who was visiting the home. They told us they were pleased with the way their family members were cared for. They said, “I am really pleased with it here. The staff are super”. “I like the friendliness, you always feel welcome”.

We spoke with a member of the community nursing team who was visiting the home. They told us they enjoyed visiting this home because, “People are very well looked after here, the staff really care”.

During this inspection we found that people or their representatives were asked for their consent before any care and treatment was given. People were provided with appropriate care and support that met their needs and promoted their wellbeing.

People received the medication they needed at the time they needed it.

Robust recruitment procedures ensured that people were protected through the appointment of appropriate staff.

People knew who to talk to if they had any concerns about the service and were confident they would be dealt with.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not always able to tell us their experiences. We observed how people interacted with the management of the service. We saw they felt free to express their opinions and were listened to. We saw that people were comfortable in the environment and were able to find their way around. We spoke with a relative who was visiting the home. They told us there had been significant improvements in the home.

People told us they were looked after well. They said. ”They are very good here.” “They do look after you; I don’t have to do anything.” “The food is good.” The three people we spoke with told us they felt safe in the home. They told us the home was always nice and clean.

People we spoke with expressed mixed views about the service. The majority of people who lived in the home were not able to engage with the inspection process. We spoke with three people who lived at Cedardale and three visitors. They told us: "The staff do their best”. “I don’t like it when people shout all the time." “They could do with a few more staff.” "it's alright here." Most people had nothing to do and slept during most of our visit. We spent time in one of the lounges where we saw that staff were patient and kind. During our visit we saw that staff were careful to protect people’s privacy and dignity when they were helping them with their personal care.