Archived: Edinburgh House

Edinburgh House 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.

Edinburgh House can accommodate up to 32 older people in one adapted building. The home has two floors accessed via stairs or a lift, five communal areas and a large garden where people could choose to spend their time. At the time of the inspection 26 people lived in the home.

A registered manager was 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.

Records were not always available to demonstrate people’s needs were assessed before they moved into the home, to ensure their needs could be met. In addition, the documents used did not always have a holistic focus. People told us they were always asked for their permission before personal care was provided. Staff adhered to the principles of the Mental Capacity Act, 2005 (MCA) but the records needed improvement. Risks associated with people’s needs and measures to reduce these were well known by staff but records did not provide sufficient guidance for staff who may not know the person they were supporting well.

The provider had introduced new governance systems which had identified areas for improvement. These had identified the same issues we found. The work to make these improvements had only just started at the time of our inspection and therefore needed more time for completion and to be fully embedded into practice.

There were sufficient staff to meet people’s needs. Staff were safely recruited although the registered manager’s records of this needed improvement. Staff understood their responsibility to safeguard people and had received training to do so. Medicines were managed safely. Improvements had been made to staff training and supervision although staff did not always receive training specific to people’s needs. We have made a recommendation about this. The home was clean, tidy and staff promoted good infection control management.

Staff knowledge of people was good and they provided person centred care. People were provided with appropriate mental and physical stimulation. People were treated with kindness and compassion. Observations reflected people were comfortable and relaxed in staff’s company. People were encouraged to be involved in their care and their independence was supported. People’s privacy and dignity was respected. People were supported to ensure they received adequate nutrition and hydration by staff who worked well as a team and supported access to appropriate healthcare services.

There was a process in place to deal with any complaints or concerns if they were raised. People told us they knew how to complain but had not needed to. The registered manager was accessible and operated an open-door policy. Staff were confident to raise concerns and felt listened to.

The provider was aware of the requirement to notify CQC of significant events that occurred in the home and this was happening.

At the time of our inspection, there were 21 people living at the home. There were 29 care workers, seven domestic and kitchen staff, four senior care leads, four assistant managers and a registered manager. 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. At the time of our inspection the registered manager was unavailable. However, the registered manager from another of the providers’ locations made themselves available during inspection to assist with any queries.

Following an inspection in December 2014 we asked the provider to take action to make improvements which related to person centred care and assessments to establish people’s capacity to consent to care. At this inspection, we found the necessary improvements had been made.

Not all staff members had received their mandatory training to ensure they maintained the appropriate skills and knowledge to carry out their roles effectively based on best practice. Staff were receiving regular supervision, but not all staff had received an annual appraisal.

There were audit systems in place to assess quality and safety but no real outcome from these audits had been identified. Staff morale was low, they felt communication with the manager could be improved and there had been no team meetings within the previous year. Feedback about the service was sought from people but there was no analysis of the information received.

The home had a welcoming, homely feel although the decoration was somewhat dated and tired. Generally, the home was clean and tidy. However, there was some staining on carpeting. Repairs were required within the kitchen that had not been completed.

Consent was sought by staff when providing personal care to people and there was a good understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS).

People’s medicines were administered, stored and disposed of safely and staff administering medication had all completed their annual medication update training.

There were procedures in place to ensure that risks to people were managed to keep people and staff safe. Staff demonstrated a good knowledge of how to keep people safe from abuse and avoidable harm. The home had systems in place to ensure safe recruitment practices were followed and only suitable staff were employed to work with people. There was adequate numbers of staff available to keep people safe.

We observed caring, compassionate interactions between staff and people living at the home. People were supported to eat and drink so as to maintain a healthy and balanced diet. Staff knew people well and encouraged and supported people to maintain their independence where possible whilst respecting their dignity.

Access to external health and social care professionals was readily available for people living at the home.

People’s care plans were detailed and personalised with evidence of regular review. People and their relatives were encouraged to contribute to their care plans and reviews.

There was a complaints procedure in place and any complaints that arose were dealt with effectively by the management team. People felt able to raise concerns which would be dealt with appropriately.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the end of the full version of this report.

We saw that the home was clean and well maintained. Care was provided over two floors and we saw that people had personalised their rooms with their own possessions and could access their rooms whenever they chose. Several communal areas were used by people through the day of our visit including a conservatory area.

We saw that clear care plans were in place to support people who lived at the home and to promote their independence.

Suitable maintained equipment was in place to help people maintain their independence with mobility including a lift, wheelchairs and a range of mobility aids. Staff were well trained in the use of equipment in the home.

Staff we spoke to knew people who lived in the home well. They treated people in a kind and gentle manner respecting their dignity at all times.

On the day of our inspection we saw that activities were planned for three sessions every day. These showed a wide range of activities including quizzes, reminiscing, and card games. Records showed that people in this service enjoyed the activities provided and participated in activities they chose to do.

People told us they were happy living at this home and that the staff, 'Are always very friendly.'

People using the service told us they would recommend the home. One person said 'They let you get on with the things you want to do like washing yourself'. Another said 'My favourite bit about living here is they let me be independent'. Another said they were very happy and always consulted in the delivery of their care . We found people experienced care, treatment and support that met their needs.