Updated 24 July 2023
Cedar House is a specialist hospital managed by Coveberry Limited. The hospital provides assessment and treatment in a low secure environment for people with a diagnosis of learning disability and autistic people, including those who have a forensic history, those requiring positive behaviour support, and complex mental health needs.
At the time of the inspection they had 18 people at the service.
At the time of the inspection the service had 5 operational wards, along with three purpose-built annexes. These included:
- Folkestone ward – a nine-bed ward for males and included one annexe which was non-operational at the time of our visit
- Maidstone ward – an eight-bed ward for females
- Tonbridge ward – an eight-bed ward for males
- Rochester ward – a six-bed ward for males, two of which were contained within annexes
- Poplar ward – a step down unit for five males. This ward was located outside the secure perimeter fence.
Enhanced Low Secure (ELS) ward, which provided five beds for males, remained closed at the time of the inspection and we did not visit this ward.
Cedar House is registered to provide the following regulated activities:
- Assessment or medical treatment for persons detained under the Mental Health Act 1983
- Diagnostic and screening procedures
- Treatment of disease, disorder or injury
The hospital had a registered manager in post at the time of our inspection.
The CQC last inspected the location in November 2022 when we found that the provider had made some improvements, but not fully met all the requirement notices. The provider had introduced a new comprehensive governance system but had not embedded this into the hospital’s daily practice. The provider recognised that they had actions to complete and that more work was needed to embed the improvements, to ensure they would be sustained permanently. Following the inspection in November 2022, the conditions on the registration of the hospital which prohibited the service from admitting people without prior written agreement from CQC were removed. The provider was also issued with requirement notices. We told the provider to make the following improvements:
- The provider must ensure the lighting across the hospital is suitable for the people admitted to the hospital. (Regulation 15)
- The provider must ensure that restrictive practices are reviewed and restrictions on people’s access to the community is based on individual risk. (Regulation 13).
- The provider must ensure that care plans are consistent in quality. (Regulation 9)
- The provider must ensure that people and relevant others are involved in planning their care and that this is clearly recorded. Where people refuse to engage in completing their care plans, this must be clearly documented (Regulation 9).
- The provider must ensure that staff are up to date with their training in immediate life support and medication administration and reach the compliance rate set by the hospital (Regulation 18)
- The provider must ensure that all staff received regular supervision. (Regulation 18).
- The provider must embed in practice the new clinical model which the guidance set out in Right Support, Right Care, Right Culture. (Regulation 9).
- The provider must ensure that people have regular access to necessary therapies, including psychology, occupational therapy and speech and language therapy. (Regulation 18).
- The provider must ensure that all people are able to utilise their Section 17 leave and all rationale for cancelled Section 17 leave must be documented clearly. (Regulation 17)
- The provider must ensure that all risks, including emerging and developing risks, are included on the hospital risk register. (Regulation 17).
- The provider must ensure that the model for effective governance of performance, risks, quality of care and learning from incidents is fully embedded in practice. (Regulation 17)
During this inspection we found some improvement and many of the requirement notices had been met. However, at the last inspection in November 2022 we highlighted the need for sustained improvement for governance processes to be fully embedded and this had only been partially achieved.
What people who use the service say
Overall the feedback we received from people using the service was positive, which showed an improvement since the last inspection in November 2022 when feedback from people was mixed.
Ten out of the 11 people we spoke to felt that staff were respectful, caring and compassionate. Most people told us they felt valued by staff who showed genuine interest in their well-being and quality of life. Although, 2 out of the 11 people told us that night staff were less supportive.
Most people said there were lots of activities to do and that there was enough staff to facilitate this. Although, 1 person said that community leave could sometimes be cancelled because of not enough staff who could drive the company vehicles.
Most people told us that staff were working on plans for them to move on and that they had been involved in decisions surrounding those plans.
Some people said that the food had improved and that there were lots of options. Although, most people also told us that they would prefer more healthy options.