We inspected this service over two days on 6th October 2015 and 13th October 2015. It was an unannounced inspection. We last inspected the home on 12th August 2014 and no concerns were identified.
Cedar House is registered to provide accommodation with nursing and personal care, diagnostic and screening procedures and treatment of disease, disorder or injury for up to 12 people. The people living at the service predominantly have learning disabilities and require nursing care. There were seven people living at the service at the time of inspection, with one bed being used regularly for respite care.
During this inspection we met the manager who had been in post since February 2015 and was in the process of submitting their application to become the registered manager. The conditions of registration for the service state that a registered manager is required. There was not a registered manager in place at the time of inspection and the last registered manager had de-registered in March 2015. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
Relatives told us the staff were caring but at times there were not enough staff. People’s privacy and dignity was not always maintained and there were not always enough staff to provide person centred safe care to people.
The staff we spoke with understood what abuse was and how to report it if they had any concerns, not all staff had been on safeguarding training.
Care documents contained information, such as people's personal preferences and how people communicated. These documents were not always up to date and review mechanisms were not in place to ensure that people's most recent needs were recorded.
Staff recruitment procedures were in place and the provider ensured that everyone had the necessary checks to ensure they were employing appropriate people.
However, we found several issues with the recording, storage, ordering and administration of medicines which put people at risk of harm because medicines were not safely managed.
There was a complaints procedure in place and available to people and visitors but this was not being followed by the manager.
Appropriate arrangements were not in place to manage risks to people’s safety. Risks for people had not been identified or anticipated and people were at potential risk of receiving care and support that was unsafe and did not meet their needs.
We found overall that people were at risk of receiving inappropriate or unsafe care. We found breaches of six of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are taking enforcement action against the registered provider and will report further on this when it is completed.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.