Cedar House

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care. The provider was in breach of legal regulation in relation to the governance of the service.

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There was not always a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, and engagement. While there was a culture of staff and leaders working to improve the service, there was not always a demonstrable strategy or vision for achieving this. For example, we were present at an early morning information-sharing handover between staff shifts that was unnecessarily intrusive on some people in their bedrooms. Also, the service operated as one large, 12-bedded home but had the facilities such as kitchens and living rooms to support people to live in two smaller, more homely settings like others would live in. There was no strategic assessment or plan that set out why the service was managed in these ways. These issues did not align with CQC’s ‘Right support, right care, right culture’ guidance. Staff described a positive approach to supporting people and a staff member told us, “We give them our all, 100%” and “We look after them as our own.”

There were managers who understood the service and people’s care needs. The registered manager had the skills, experience and credibility to lead the service. Staff spoke positively about the registered manager and the deputy manager who they found approachable and supportive. Their comments included, “[The registered manager] will help us if we need anything.” Professionals told us they found the managers capable and well informed about people’s care and support needs.

There was a service culture where people and staff could speak up and their voices would be heard. The provider had safeguarding and whistleblowing policies and procedures in place to support and promote staff raising issues. Staff we spoke with felt they could raise concerns to senior staff. Records indicated staff were also encouraged to speak up in one to one sessions and team meetings.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them. Staff said the registered manager made adjustments in how they coordinated the service that respected people’s personal lives. A staff member said, “We always talk about equality and diversity, it is multicultural place, living and working here.”

The service did not always have clear and effective responsibilities, roles, systems of accountability and good governance in place. The governance systems in place such as regular audits had failed to ensure a consistently safe and good service was delivered. The systems had not identified and addressed the concerns we found during our assessment. For example, the issues regarding people’s safety and health concerns, the environment and some equipment, medicines management and person-centred care. The provider did not always ensure accurate and up to date records regarding the management of the service and people’s care were maintained. For example, some people’s care records did not accurately note the continence support provided to them or how staff supported people to re-position to keep them safe from the risk of pressure ulcers. This meant the provider could not be assured people always received their planned care safely. However, staff and relatives spoke positively about the management of the service. Staff said they felt supported and relatives told us, “The manager is okay, very helpful. Quiet but knows their job well.”

The service collaborated and worked in partnership with other services so as to promote effective joint working to meet people’s needs. They shared information and learning with partners and worked with them to implement changes to people’s care. We received positive feedback from professionals who worked with the service. A professional described the registered manager as “proactive and responsive.”

The service did not always focus on continuous learning, innovation and improvement of the service and people’s care experience. The provider had quality assurance and learning arrangements in place but these had not always been effective and had not encouraged creative ways of delivering equality of experiences, outcomes and quality of life for people. The provider was responsive to our findings during this assessment and acted urgently on key areas of improvement to keep people safe when we raised these to them. We saw the provider had devised new, detailed assurance and learning systems to provide the registered manager and senior leaders with more detailed oversight over this and other services across the organisation. This system was due to be implemented shortly after our visits.