Cedar Grange

Updated 16 March 2022

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 Care Act 2014.

As part of this inspection we looked at the Infection Prevention and Control (IPC) measures in place. This included checking the provider was meeting COVID-19 vaccination requirements. 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

One inspector carried out day one, and two inspectors carried out day two of the inspection.

Service and service type

Cedar Grange 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.

The service did not have a manager registered with CQC. This means that the provider is legally responsible for how the service is run and for the quality and safety of the care provided. A newly appointed manager was in place and was being supported by the regional manager. At the time of the inspection, they had not applied to register with CQC.

Notice of inspection

We gave a short period notice of the original IPC inspection due to the COVID-19 outbreak and measures that needed to be in place for our visit. Once the inspection was expanded to a focused inspection, we announced that we would be returning.

What we did before inspection

We contacted the local authority safeguarding and commissioning teams for feedback and looked at information sent to us since the last inspection. We used the information the provider sent us in the provider information return prior to this inspection. 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.

During the inspection

We spoke with five people who used the service and four relatives about their experience of the care provided. We spoke with six members of staff including the manager, deputy manager, regional manager, and three care workers. We also had email contact with the nominated individual who is also responsible for supervising the management of the service.

We looked around the environment to review the facilities available for people and the cleanliness of the service.

We reviewed a range of records including two people's care records, multiple medication administration records, and three staff personnel files in relation to recruitment. We also reviewed a variety of records relating to the management and governance of the service, including policies and procedures.

After the inspection

We continued to review evidence that was sent remotely as well as seeking clarification from the provider and manager to validate evidence found. We looked at audit and governance data, as well as infection prevention and control policies and procedures.

Updated 16 March 2022

About the service

Cedar Grange is a 'care home' providing accommodation across two buildings for up to 31 people who require personal care; some of whom lived with dementia. At the time of the inspection 26 people were living at the service.

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

Areas of risk were not always robustly assessed and monitored. Some areas of the service and equipment were not appropriately cleaned, which placed people at risk of infection.

Systems to monitor safety and quality of care had not identified some issues which could negatively impact on people's experiences.

We found some improvements were needed around the administration and recording of medicines. We made a recommendation about this.

People and their relatives were happy with the service. People told us they felt safe living at Cedar Grange, and staff were familiar with the safeguarding procedure.

Staff were recruited safely. There were enough staff to meet people's care needs.

Staff were supported by the management team and worked closely with healthcare professionals to meet people's needs.

The service did not have a manager who was registered with the CQC as required. A new manager had recently been recruited by the provider.

The manager had sought some feedback from people’s relatives following this inspection. Staff were updated about changes to people's needs and any changes to the service.

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

Rating at last inspection

The last rating for this service was good (published 22 March 2019).

Why we inspected

We initially carried out an announced IPC outbreak; this was to follow up on IPC arrangements. However, additional concerns were identified and it was agreed that the inspection would be expanded, as a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at IPC 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 coronavirus 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.

We found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Cedar Grange on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment and good governance of the service 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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.