Cedar Court Nursing Home (Dementia Unit)

Updated 20 July 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was conducted by 2 inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Cedar Court Nursing Home (Dementia Unit) is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. A manager had been in post for 2 years and had submitted an application to register. We are currently assessing this application.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We contacted commissioners of the service for their feedback and reviewed information we held about the service. We also asked healthwatch for feedback. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used all of this to help to plan the inspection and make our judgement.

During the inspection

We spoke with people who lived at the home, but as most were unable to give detailed feedback, we observed staff interaction with them in communal areas. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We spoke with 12 members of staff including the manager, the operations manager, deputy manager, the quality manager, 2 nurses, a member of kitchen staff, 3 care staff, laundry assistant and the maintenance worker. We reviewed a range of records. These included 8 people's care records and several medication records.

Updated 20 July 2023

About the service

Cedar Court Nursing Home (Dementia Unit) is a care home providing nursing and personal care for up to 45 people living with dementia. At the time of the inspection 37 people were living at the home. The home is in a rural location with enclosed accessible gardens. Care is divided across 2 floors and there are several communal lounges for people to spend time in.

People’s experience of using this service and what we found

Throughout the inspection we observed staff monitoring and addressing areas of risk for people. However, we found risks such a skin integrity and malnutrition were not consistently recorded in people's care records. We discussed this with the home manager and action plan was put in place to address the shortfalls promptly. We have made a recommendation about making improvements to the relevant care plans and people’s care records to ensure all documentation is accurate and up to date.

The provider's systems for monitoring the quality and safety of the service prior to our inspection were not always effective in identifying issues.

People and their relatives were mostly pleased with the care provided at the home; however, we received some concerns which we shared with the home manager following our inspection. The manager recorded the feedback and followed the home complaints policy to investigate these.

People were supported to maintain a balanced diet where this was part of their care plan, but improvements were required to make sure food and fluid intake was consistently documented. At lunch time, people were having to wait long periods of time for their meals which led to some people becoming frustrated. We spoke with the manager about our findings and they addressed it immediately by introducing staggered mealtimes.

People received their medicines as prescribed, and staff had clear information about how people liked to be supported with their medicines. Staff were knowledgeable about people's health needs and the provider had sought support from other health professionals as appropriate to support people's needs. Staffing levels were appropriate and matched the dependency tool being used to meet the needs of people at the home. Staff received training and support to enable them to effectively meet the needs of the people they supported.

The provider followed safe recruitment practices. Staff completed infection control training and followed national guidelines when supporting people to reduce the risk of the spread of infection. They were aware to report any accidents or incidents which occurred during their work.

Staff were supported in their roles through training and supervision. People had access to a range of healthcare services when needed, and staff ensured people received consistent support across different services. Staff sought consent from people when offering them assistance. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff treated people with kindness and consideration. They respected their privacy and treated them with dignity. People were supported to make decisions about the care they received and were encouraged to maintain their independence wherever possible. The provider had a complaints policy and procedure in place which people and relatives were aware of.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 1 January 2021).

Why we inspected

We received concerns in relation to risk management, documentation, quality of care and governance at the service. A decision was made for us to inspect and examine those risks. We undertook a comprehensive inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report. The provider took prompt and effective actions to mitigate the risks following our inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

Enforcement and Recommendations

We have identified breaches in relation to good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.