Edgeview Nursing Home

Edgeview Nursing Home is a nursing home and supported living service, providing personal and nursing care to up to 24 people. The service provides support to people with learning disabilities, autistic people, and people with mental health needs and dementia. At the time of our inspection there were 21 people using the service.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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

The service understood and was adapting to meet the principals of right support, right care, right culture. Since the last inspection the service had opened a supported living service on the grounds and reduced the number of people living in the care home. The provider had plans to expand the supported living service and continue the refurbishment of the care home to enhance people’s experience.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

People received their medicine as prescribed and were supported by sufficient staff to meet their needs. Staff had access to suitable training and most staff were up to date with their required learning. Some staff needed to update their safeguarding training but were knowledgeable when we spoke to them about the safeguarding process and how to report concerns.

People had access to health professionals and advocacy services.

Right Care

People’s care plans contained person-centred information to enable staff to provide appropriate support. Risks within the service were managed with the exception of some concerns with items not being stored safely and water temperatures not being recorded.

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. However, we found reviews of people’s restrictions were required to ensure they remained valid.

Right Culture

The service had processes in place to review compliance with the regulations. We found some areas required improvement and actions needed to be shared with the team. We did find lessons were learnt when things went wrong, and the provider responded to any points identified. People found the registered manager approachable. People, relatives and professionals were encouraged to give feedback on care.

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 26 March 2020).

Why we inspected

We received concerns in relation to the management of risk for people with mental health needs. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained the same based on the findings of this inspection. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Edgeview Nursing Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Edgeview Nursing Home is a nursing home. Edgeview Nursing Home is registered to accommodate 24 people. At the time of our inspection 19 people were using the service. Edgeview Nursing Home accommodates people in three buildings. The main building, a bungalow where three people live and a converted stable building for a further three people. All areas are accessible from the main building. Some of the people living at Edgeview Nursing Home have learning disabilities or mental health needs.

The care service has not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

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

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.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support as the service was created several years before this guidance was published. The location and structure of the current building did not reflect the values of Registering the Right Support although the provider had tried to minimise the impact as far as possible by giving people choice and independence in so far as this was possible. The provider was also considering what changes they could make to develop the service so that it would meet best practice guidance through redevelopment of the building, subject to local authority planning requirements.

People were cared for by staff who were trained in recognising and understanding how to report potential abuse. Staff knew how to raise concerns about people's safety and share information so that people were safe. Accidents and incidents were monitored so any trends could be identified, and action taken to reduce any risks.

Staff were available to people and demonstrated good knowledge about people living at the home. People were supported by staff to have their medicines and records were maintained of medicines administered. Staff maintained good hygiene and used protective clothing when appropriate.

Staff told us they were well trained, and this helped them meet people’s needs. They said training updates were regular, so their knowledge was up to date. Staff understood the importance of ensuring people consented to the care and support they received, or where they lacked capacity was in their best interests. The registered manager was aware of their responsibilities regarding the action they should take if there were any restrictions needed to promote people’s safety and the person may lack capacity to consent to these.

People enjoyed a choice of meals and were supported to access professional healthcare outside of the home, for example, visits from or to their doctor and community health teams. Any changes to their care needs due to healthcare involvement were noted and followed through by staff.

We saw people were relaxed around the staff supporting them. We saw positive interactions and staff showed us that they knew the interests, likes and dislikes of people. People were supported to enjoy various activities and staff ensured that they were respectful of people's choices and decisions.

People and staff told us that the management team were approachable and if they had any concerns they would be listened to. People and staff and were positive about the overall service.

The provider ensured there were regular checks completed to monitor the quality of the care that people received, and we saw continued improvements had been made since the last inspection.

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 requires improvement (published 08 February 2019).

Why we inspected

This was a planned inspection based on the previous rating.

Edgeview is a nursing home. People in care homes receive accommodation and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Edgeview is registered to accommodate 24 people. At the time of our inspection 20 people were using the service. Edgeview accommodates people in three buildings. The main building, a bungalow where three people live and a converted stable building for a further three people. All areas are accessible from the main building. Some of the people living at Edgeview have learning disabilities or mental health needs. The care service has not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. This was as the service was created a number of years before this guidance was published. These values should include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service are not always supported or to live as ordinary a life as any citizen.

We last inspected Edgeview on 28 March 2018, when we rated the service as ‘Inadequate'. We found the provider was in breach of the regulations regarding person centred care; dignity and respect; need for consent; safe care and treatment; good governance and staffing. Following the inspection, we imposed conditions on the providers registration and placed the service in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe.

When we carried out this inspection we found the provider had made significant improvements in the areas previously identified and the regulations were now met. The service is no longer rated as inadequate overall or in any of the key questions; therefore, this service is now out of Special Measures. However, as the last two inspection reports rated the service as ‘requires improvement’ and ‘inadequate; ‘ we need to be assured that the improvements made are embedded fully into practice and will be sustained over time, therefore the overall rating of this report is ‘requires improvement.’

People were cared for by staff who were trained in recognising and understanding how to report potential abuse. Staff knew how to raise any concerns about people’s safety and shared information so that people’s safety needs were met. A revised system of recording accidents and incidents was now in place including a summary report, so any trends could be identified.

Staff were available to people and demonstrated good knowledge about people living at the home. People were supported by staff to have their medicines and records were maintained of medicines administered. Staff maintained good hygiene and used protective clothing when appropriate.

Staff told us training helped them meet the specific needs of the people living at the home and they attended regular training to ensure they kept their knowledge updated.

Staff understood the importance of ensuring people agreed to the care and support they received. The registered manager was aware of their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS) and had submitted the appropriate applications where they had assessed that people were potentially receiving care that restricted their liberty.

People enjoyed a choice of meals and were supported to access professional healthcare outside of the home, for example, visits with their GP and community health teams and any changes to their care needs were recognised and supported by staff. Most healthcare professionals gave positive feedback on the service provided and said communication with staff was good.

We saw people were relaxed around the staff supporting them. We saw positive interactions and staff showed us that they knew the interests, likes and dislikes of people. People were supported to enjoy various activities and staff ensured that they were respectful of people’s choices and decisions.

Relatives and staff told us that the management team were approachable and if they had any concerns they would be listened to.

People, staff and most healthcare professionals we spoke with were positive about the overall service. Relatives and staff complimented the improvements made since the last inspection and staff felt supported to carry out their roles and responsibilities effectively.

The management team ensured regular checks were completed to monitor the quality of the care that people received, and we saw evidence of improvements made since the last inspection, however, we found further improvement was required to ensure that all audits and checks are robust enough to identify all areas for improvement.

Edgeview is a nursing home. People in care homes receive accommodation and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Edgeview is registered to accommodate 24 people in three buildings. At the time of our inspection 24 people were using the service. Edgeview accommodates people in three buildings. The main building has three floors, two communal living rooms and a large communal dining area. There is a separate building which is an activities room. There is also a bungalow where three people live and a stable for a further three people. All areas are accessible from the main building. Some of the people living at Edgeview have learning disabilities or mental health needs. The care service has not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. This was as the service was created a number of years before this guidance was published. These values should include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service are not always supported or to live as ordinary a life as any citizen. Registering the Right Support CQC policy.

There is a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission 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.

Following the last inspection, we asked the provider to make improvements to how people’s dignity was upheld, to consider how people made choices and to ensure that action was taken to protect people from potential harm. We found the provider had not made the necessary improvements.

Risks to people were not fully considered and when incidents occurred action was not always taken. When people had behaviours that may challenge themselves and others all areas of risk had not been considered for these people. People were not safe as poor moving and handling was observed and the information in people’s care plans was not always followed. People did not receive their planned care hours and we could not always be assured there were staff available for people.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice. When people had DoLS authorisations in place the conditions of these were not being met. Staff received training however we could not be assured this enabled people to receive the support they needed. Although there were procedures in place and staff demonstrated an understanding we could not be sure all incidents were appropriately investigated or considered as safeguarding.

We found people were not always supported in a dignified way. People’s choices were not considered and they were not always encouraged to be independent. Staff did not always positively interact with people and they were unsure how to support some people. People did not always receive care that was responsive to their needs. Staff did not always have the most relevant up to date information available to offer support.

The systems the provider had in place were not always effective in identifying areas of concern. Records were not always stored securely and annual feedback had not been obtained from people and relatives. There was a lack of leadership within the home.

There was an activity room and people could access this, people were also offered the opportunity to go out. There were infection control procedures in place and these were followed. When people needed support from other health professional referrals were made. People enjoyed the food. Medicines were stored in a safe way. Staff felt listened to and knew who the registered manager was. We were notified as required about significant events within the home.

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.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Edge view Nursing Home provides accommodation and nursing care for up to 24 people with mental health and learning disability needs. Some people also have needs due to a physical disability. There were 24 people using the service.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission 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.

People were not always supported in a dignified way. The choices they made were not always considered by staff who supported them. There was an on-going safeguarding concern at the home and the provider had not taken the necessary measures as identified in their risk assessment to ensure people were protected from potential harm.

People were happy with the care they received and the staff that supported them. There were enough staff available to offer support to people. Staff received an induction and training that helped them offer support to people. The provider ensured staffs suitability to work with in the home. Staff understood their responsibility in relation to raising safeguarding concerns.

When risks to individuals had been identified action had been taken to minimise this and risk assessments were in place. Medicines were managed in a safe way. When people were unable to consent, mental capacity assessments had been completed and decisions made in peoples best interest. The provider had considered when people were being restricted and authorisations for this were in place.

People enjoyed the activities they participated in as well as the food that was offered to them. When people needed access to healthcare professionals this was provided for them. People were encouraged to maintain relationships that were important to them. People knew how to complain and when needed the provider had responded to complaints in line with their procedures.

Staff felt listened to and supported by the registered manager. People knew how to complain and complaints had been responded to in line with the provider’s procedures. Staff knew people well and they felt involved with planning their care. The provider used feedback from people and relatives to bring about changes. Quality monitoring checks were completed to make improvements to the service. The provider notified us about significant events that occurred at the home so we could ensure appropriate action was taken.

We spoke with one visiting relative, 5 members of staff the registered manager and the regional manager.

We found that care plans were person centred and individualised. People's preferences and interests were recorded. There were a wide range of suitable activities for people to join in with.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

There was an effective system in place to reduce the risk of and control the spread of infection. Cleaning audits and schedules effectively identified areas of the home that required attention.

The provider had taken suitable steps to ensure that staff were of good character and for the work required. There were effective requirements procedures in place at the service.

Quality of care provided and the monitoring of the home was effective. The service had sufficient audit and monitoring measures in place to be able to identify what further training or action could be required.

There was a new manager in post at the home. They had not submitted their registered manager application to CQC. We were told this was in the process of being completed.

During our inspection we observed staff engaging with the people living at the home in a polite and supportive manner. Plans of care for people were available. We spoke with the manager, care staff and healthcare professionals about the support provided at the home. The staff we spoke with were knowledgeable about the level of support people required.

We asked staff about their understanding and responsibilities for safeguarding (protecting vulnerable adults) people living at Edgeview Nursing Home. The staff we spoke with gave us appropriate examples of what they would report and how they would raise concerns if necessary. All staff we spoke with said they able to speak with senior staff or management about any concerns.

We spoke with the manager and staff about training available to staff at the home. Staff told us they had training provided and had one to one meetings with the manager to discuss their performance and training.

System were in place for the quality monitoring of the service provided at the home.