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.